Biomedical subjects

G Torzilli

Publications and source records attributed to G Torzilli.

45 records · Page 3Linked to original sources

PubMed1989

[Segmental splenectomy. Usefulness of linear surgical staplers].

As the high risk of sepsis after splenectomy is well recognized, reliable conservative surgical techniques in splenic surgery are widely advocated. Among these, segmental splenectomy carries specific and increasing indications. The use of linear staplers makes this operation quicker and safer. On the basis of a personal observation, Authors examine the anatomical features on which this operation is based, the surgical technique and the technical details to be followed using these devices. The advantages offered by staplers in this surgery allow to widen the indications to partial splenectomy, so as to yield a true primary prophylaxis of the post-splenectomy sepsis.

Adolescent↗

PubMedDate not supplied

Intralesional ethanol in the treatment of unresectable liver cancer.

Percutaneous ethanol injection (PEI) under ultrasonography guidance has been widely tried in not advanced hepatocellular carcinoma (HCC). Ten years after the introduction of PEI, some conclusions of its indications can be drawn. In our series, 210 cirrhotic patients were treated; 141 with multisession PEI in an outpatient clinic, 57 with "single session" PEI under general anesthesia, and 12 with both. The 1-, 3-, and 5-year survival rates (by Kaplan-Meier method) were 953%, 65%, and 41% for Child class A patients with single HCC < or = 5 cm, and 88%, 47%, and 33% for patients with multiple HCC up to five lesions < or = 5 cm. In these patients the local recurrence rate was 15% and the new lesion rate at the 5-year follow-up was 74%. One death due to hemorrhage from esophageal varices in a Child class C patient treated by single session PEI occurred. The large number of cirrhotic patients demand for effective, safe, repeatable, low-cost treatment that can be offered at many centers. PEI meets all these requirements. PEI is proposed as the treatment of choice for the mentioned patients, excluding candidates for liver transplantation and surgical resection according to the predictive adverse factors currently in use. "Single session" technique widened the indications of traditional PEI to larger lesions.

Aged↗

PubMedDate not supplied

US guided biliary drainage during hepatopancreatico-jejunostomy for diffuse bile duct carcinoma.

Liver failure is one of the principal causes of post-operative morbidity and mortality after major hepatectomy for diffuse bile duct cancer. To prevent this complication, biliary decompression must be guaranteed before and during the operation. If a nasobiliary catheter is positioned pre-operatively, biliary drainage can be maintained during hepatopancreato-duodenectomy by introducing a transhepatic drain under sonographic guidance. This original technique is described herein.

Bile Duct Neoplasms↗

PubMedDate not supplied

[Interstitial percutaneous therapies in primary and secondary liver tumors].

Multiple percutaneous interstitial systems to induce intrahepatic tumor necrosis are classifiable in two major groups: those using chemical agents (ethanol and acetic acid) and those adopting thermal effects (hot saline, radiofrequency, laser and microwave). Indication, technique and results of percutaneous ethanol injection (PEI) are considered. In the case of single hepatocellular carcinoma (HCC), < 5 cm and associated with cirrhosis Child class A long-term results of PEI are comparable with those of best surgical series with 5-years survival which range from 47 to 51%. No mortality and recurrence rates similar to those of surgical cases make PEI as an alternative to surgical resection although the difficulties in comparing retrospectively the different experiences do not enable definitive conclusions. In the case of liver metastases from colorectal cancer or endocrine tumors, which seem more sensitive to locoregional therapies, complete response rates are not adequate yet being 86%, 26%, 11% and 0% respectively in the case of < 2 cm, 2-3 cm, 3-4 cm and > 4 cm lesions and moreover no definitive data are available about long-term prognosis. Waiting for further validation about the encouraging data obtained with the other interstitial methods and in particular with radiofrequency (RF) and laser interstitial photocoagulation (FLI), PEI is a valid alternative to surgery for selected HCC patients and is a good palliation in cases with not resectable liver metastases which are anyway suitable for locoregional treatments.

Acetic Acid↗

PubMedDate not supplied

Ultrasonographic detection of portal branches and hepatic vein gas associated with mesenteric artery occlusion: a new finding correlated with patient prognosis?

The diagnosis of bowel infarction is still a challenge. In some cases, portal venous gas is an associated feature and in these patients, the prognosis is very poor. We report on our experience with two consecutive cases in which ultrasonography showed gas in the portal venous branches, and also in the hepatic veins in one of them. At laparotomy, advanced bowel necrosis was found, and both patients died within 24 hours. Other cases of portal venous gas associated with bowel infarction have been reported, but this is the first report of gas also being found in the hepatic veins. There may be a relationship between the amount of gas in the intrahepatic veins and the stage of bowel ischemia. Confirmation of this might improve the selection of patients and eliminate unnecessary procedures.

Aged↗

PubMedDate not supplied

Inflammatory pseudotumors of the liver: prevalence and clinical impact in surgical patients.

BACKGROUND/AIMS: Progress in diagnostic imaging has increased the number of focal liver lesions detected and reports of an occasional finding of inflammatory pseudotumors of the liver are becoming numerous. To estimate their prevalence and clinical impact in surgical series we evaluate retrospectively our experience. METHODOLOGY: Four hundred and three patients carriers of a total of 717 focal liver lesions underwent liver resection consecutively in our Department from October 1995 to August 1999. All these patients underwent surgery. RESULTS: After surgical resection, 3 patients each proved to be carrying an IPT nodule accounting for 0.7% of all patients and 0.4% of all focal liver lesions. One inflammatory pseudotumor was only disclosed intraoperatively in a patient with an hepatocellular carcinoma. The other 2 accounted for 20% of the patients whose preoperative diagnoses were wrong. The operative procedures for the inflammatory pseudotumor nodules were: wedge resection, because the inflammatory pseudotumor was considered a new malignancy, a limited resection and a left extended hepatectomy with bilioenteric anastomosis, distal gastrectomy and lymphoadenectomy in one patient each. Inflammatory pseudotumors accounted for 33% of wrong indication for surgery. CONCLUSIONS: Our experience shows that, despite the low prevalence of hepatic inflammatory pseudotumors, their impact in the appropriate management of patients with focal liver lesions is not irrelevant.

Carcinoma, Hepatocellular↗

PubMedDate not supplied

[Percutaneous alcoholization of the small hepatocarcinoma].

Percutaneous ethanol injection (PEI) under ultrasound guidance is a new therapeutic possibility for patients with small hepatocellular carcinoma (HCC). In our series, 51 patients with a total of 72 lesions were treated (tumor size 0.8-5.0 cm). No significant complications occurred after 745 treatments. Forty patients presented complete remission, as no evidence of residual HCC was revealed during the follow-up (mean 18 months). Ten patients with lesions larger than 3.5 cm and one with lesion less than 3 cm presented partial remission (80-90% of necrosis). The cumulative survival rates at 1, 2 and 3 years (Kaplan-Meier method) were 100%, 89% and 58%. The survival rates for patients carrier of single lesion were 100%, 94% and 71% respectively. In comparison with the survival curves of untreated and surgically treated patients, PEI seems to be the better treatment for operable HCC smaller than 3 cm, and for lesions smaller than 5 cm in patients with surgical risk.

Adult↗

PubMedDate not supplied

The usefulness of ultrasonography in the diagnosis of the Spigelian hernia.

Normally acquired, the Spigelian hernia is rare. Due to low incidence and frequent atypical presentations diagnosis is often difficult. Controversies exist about the diagnostic approach. We report our experience in two cases in which ultrasonography permitted a correct diagnosis of surgically confirmed Spigelian hernias. One of the two cases proved to be a carrier of bilateral Spigelian hernia at ultrasonography and at surgery. In our opinion ultrasonography represents the gold standard in the diagnosis of Spigelian hernias and we recommend its use as the first step in all cases of abdominal wall mass.

Adult↗

PubMedDate not supplied

Reconstruction of the inferior vena cava using a hepatic venous patch obtained from resected liver.

A 59-year-old woman with a 3 cm liver metastasis from rectal cancer underwent an extended right hepatic lobectomy with partial resection of the wall of the inferior vena cava. The metastasis was located behind the roots of the right and middle hepatic veins and involved the inferior vena cava. For reconstruction of the inferior vena cava, the intrahepatic middle hepatic vein, 2.5 cm in length, which was distant from the metastatic lesion, was removed from the resected liver. Then divided longitudinally to prepare a venous patch of 2.5 by 2.0 cm in size and applied to the defect. This technique facilitates reconstruction of the inferior vena cava without sacrificing other veins.

Female↗