Biomedical subjects

Giuseppe Modica

Publications and source records attributed to Giuseppe Modica.

18 recordsLinked to original sources

PubMed2006

Trocar-related abdominal wall bleeding in 200 patients after laparoscopic cholecistectomy: Personal experience.

AIM: To determine the complications and incidence of the first and second access-related vascular injuries induced by videolaparoscopic cholecistectomy. METHODS: We retrospectively reviewed vascular injuries in 200 consecutive patients who underwent videolaparoscopic cholecistectomy from 2003 to 2005. One hundred and one patients with placement of radial expanding trocars were assigned into group A and 99 patients with placement of pyramidal tipped trocars into group B. All the patients were submitted to open access according to Hasson for the first trocar. RESULTS: Bleeding did not occur at the intraoperative cannula-site in group A. However, it occurred at the intraoperative cannula-site of 7 patients (7.1%) in group B, with a statistically significant difference (P < 0.01). No mortality was registered. More vascular lesions were found in group B. CONCLUSION: The advantage of Hasson technique is that peritoneal cavity access is gained under direct vision, preventing most severe injuries. The open technique with radial expanding trocars is recommended for secure access to the abdominal cavity in videolaparoscopy. Great care should be taken to avoid major complications and understanding the abdominal wall anatomy is important for reducing bleeding during or after s placement of trocars.

Abdominal Wall↗

PubMed2006

Presence of white bile in malignant biliary obstruction is associated with poor prognosis: personal preliminary observations.

OBJECTIVE: The chemical composition and clinical significance of white bile in patients with malignant obstructive jaundice were evaluated in a prospective study. MATERIALS AND METHODS: 115 consecutive patients with inoperable malignant biliary obstruction underwent endoscopic placement of 10 Fr straight, plastic biliary stents, Amsterdam-type. Bile was aspirated during the endoscopic procedure and a blood sample was taken. Patients were divided into two groups: those with white bile and those with yellow bile. The groups were compared for decremental fall in bilirubin, cholangitis after stent insertion, and survival. RESULTS: Thirty-five patients (15 men, 20 women; mean age 54 years) underwent endoscopic drainage for malignant obstruction (29 hilar, 6 distal bile duct). Eighteen patients had white bile. Refractory jaundice (p > -0.025) was seen in nine (50%) patients with white bile compared with three (17.6%) patients with yellow bile; mean difference -42.2 (95% CI [-62.4, -22.0]) and -45.7 (95% CI [-72.0, -19.4]), respectively. The bilirubin (0.49 mg/L) and bile acid (14.6 mmol/L) concentrations in white bile were significantly less than bilirubin (41.9 mg/L) and bile acid (62.2 mmol/L) concentrations in yellow/black bile. Cholangitis developed in 66.6% of patients with white bile compared with 35% of those with yellow/black bile (OR 3.67: 95% CI [0.74, 19.25]). Kaplan-Meier curves showed that median survival was shorter in patients with white bile (36 [23-60] vs 75 [35-220] days) (p = 0.004, log rank test), which was significant even after adjusting for potential confounders with Cox proportional hazards regression. CONCLUSION: White bile is largely devoid of bilirubin and bile acids. The presence of white bile was associated with significantly worse survival in patients with malignant biliary obstruction.

Aged↗

PubMed2004

Ultrasound (US) guided central venous catheterization of internal jugular vein on over 65-year-old patients versus blind technique.

BACKGROUND AND OBJECTIVES: Performing a central venous catheterization (CVC) on older patients for long-term central intravenous therapy could be a very important procedure. It could be associated with a high incidence of related complications, especially on over 65-year-old, high risk, selected patients. METHODS: The authors analyzed the results of 72 central venous CVC of internal jugular vein performed on over 65-year-old patients with ultrasound (US) guide from January 1998 to April 2003. RESULTS: The average performing time was 4 min, with 98.7% of success, 0% of major complications, and 4.1% of minor complications (one mild vagal hypotension and two catheter dislocation). CONCLUSIONS: The US guided technique is a safer procedure especially in older patients; it affords an easier and more rapid cannulation of a central vein, drastically reducing major and minor complications.

Aged↗

PubMed2004

Comparison of central venous catheterization with and without ultrasound guide.

PURPOSE: To compare the effectiveness, safety and time needed to perform central venous catheterization (CVC) in the presence or absence of an ultrasound (US) guide. METHODS: Between January 1999 and February 2002 we performed CVCs in 196 patients: 105 patients received US guided CVC (group I) and 91 patients had CVC without US guide (group II). RESULTS: The average time to perform CVC was shorter with US guide (4 vs 7 min). The utilization of the US guide was also associated with improved success (98.09% vs 91.2%, p<0.025) and lack of major complications (0% vs 9.8%, p<0.001). CONCLUSIONS: US-guided CVC affords an easier, safer and more rapid cannulation of a central vein. It is especially helpful in those patients with anatomical variation or difficult veins (small or not visible, non-palpable landmarks) and in those with coagulative disorders.

Catheterization↗

PubMed2002

Altered androgen metabolism eventually leads hepatocellular carcinoma to an impaired hormone responsiveness.

Sex steroid hormones are thought, among several other risk factors, to play a role in liver malignancies. For example, from epidemiological studies in hepatocellular carcinoma (HCC), a clear disadvantage for male sex is evident. In addition, elevated levels of serum testosterone (T) and increased T to Estradiol (E(2)) ratio have been reported to predict an increased risk of HCC for male cirrhotic patients. On the other hand, palliative treatment of liver cancer patients with anti-hormones has been widely used in the past. However, the molecular mechanism(s) underlying sex steroid action on either normal or transformed liver cells, have not yet been fully clarified, nor endocrine discriminants have been satisfactorily assessed for an adequate characterization of liver cancer tissues. In this paper, we report studies on hormonal status of human liver tissues and cells, especially focusing on androgens, to better define endocrine end-points of interest for HCC. A consistent evidence from ex vivo or in vitro systems strongly suggests that high affinity binding sites of androgens are expressed at sufficient concentrations to induce a biological response in either normal or phenotipically transformed hepatocytes; in the latter, however, high heterogeneity and/or more scattering concentrations were encountered. Further, experimental data seem to suggest that lack of response to androgens may be due to a rapid metabolic conversion of steroids by neoplastic tissues and cells. Cancer hepatocytes privilege in fact 5beta more than 5alpha metabolic pathway of androgens. This may eventually lead biologically active androgens to be transformed into less active derivatives, as it occurs for T which is massively converted (>90% at 6 h) thus hindering the whole mechanism of action of androgens.

Androgens↗

PubMedDate not supplied

[Prevention of clogging of biliary stents by administration of levofloxacin and ursodeoxycholic acid].

One of the main advances in biliopancreatic endoscopic therapy has been the ability to palliate patients with biliary obstruction by placement of a stent during ERCP, but this is often complicated by clogging of the stent with subsequent jaundice and/or cholangitis. Stent clogging may be caused by microbiological adhesion and biliary stasis. Therefore, the use of antibiotics and choleretic agents such as levofloxacin and ursodeoxycholic acid has been investigated to see whether they prolong stent patency. Ninety patients with strictures of the biliary tract and untreatable macrolithiasis with endoscopically inserted stents were randomized into two groups: 49 subjects in group 1 (levofloxacin + ursodeoxycholic acid) and 41 in group 2 (ursodeoxycholic acid alone). In the patients in group 1 "stent patency in situ" was 50% longer than in group 2, with a lower incidence of cholangitis and hospital admittance. No adverse pharmacological effects were registered. Treatment with ursodeoxycholic acid and levofloxacin to prevent clogging of biliary stents is recommended as routine practice on the basis of our brief experience. Further trials are needed with rigorous methodology and adequate statistical power, because the perfect biliary stent (inexpensive, easy to insert, and with prolonged patency) does not exist. Prophylactic stent replacement is probably the most prudent strategy to avoid cholangitis, but the optimal time interval is unknown.

Administration, Oral↗

PubMedDate not supplied

[Surgical treatment of liver hydatidosis: our experience with diagnostic and therapeutic consideration].

OBJECTIVE: The Authors report on their experience in diagnosis and treatment of liver hydatidosis (LH). MATERIALS AND METHODS: From January 2000 to December 2003, we observed 24 patients (10 male = 42% and 14 female = 58%, male/female ratio 1:1.4, range of age 23 - 80 years, mean age 45.25 years). The most frequent initial symptom was hepigastric and hypocondriac pain (82.6%), meanwhile acute abdominal pain was only in 26.1%. In one half of cases performed radical surgery (total pericistectomy), in 35% of cases the AA subtotal pericistectomy and only in 17% the AA partial pericistectomy. Only one left hepatectomy during total pericistectomy we performed. Major complications were registered, except a post-operative bleeding treated with 3 blood transfusion. The mean time of bedridden was 68 days (range 4 - 35, mode 7 days, median 7 days). All patients are actually in clinical, instrumental and serological follow-up as outpatients (3 months - 2 years): we not encountered any relapse. CONCLUSIONS: The surgical treatment of liver hydatidosis must to be radical (as in total pericistectomy), free from severe and disabling complications and without risks and relapses. The choice of type of surgery (radical or conservative) must came from attempt examination of anatomo-clinical tools and experience and agreement of surgical team.

Abdomen, Acute↗

PubMedDate not supplied

[A rare complication of ERCP: Mallory-Weiss syndrome].

OBJECTIVE: To describe the management and outcome after endoscopic treatment of hematemesis by Mallory-Weiss Syndrome (MWS) occurred after CPRE (suspected choledocolithiasis). BACKGROUND DATA: Although cough and retching is common during EGD or CPRE, MWS resulting from endoscopy seems to be uncommon (0.0001-0.04%) and always self-limiting. CASE REPORT: The patient was submitted to CPRE with the suspicion of choledocholithiasis. Eight hours after CPRE the patient presented with hematemesis and hypotension. With emergency EGD, the AA identified a small bleeding mucosal tear (visible vessel with spurting) just proximal to the esophagogastric junction. The patient was safely treated with endoscopic hemoclipping after the failure of sclerotherapy. CONCLUSIONS: The usefulness of hemoclipping in MWS is emphasized: although always self-limiting, endoscopic hemostasis is mandatory in high risk patients. The hemoclips are effective and safe in hemostasis in the case of bleeding visible vessel (spurting or oozing), even with or after sclerotherapy. The hemoclips not obstacles the healing.

Aged↗

PubMedDate not supplied

[Bronchial carcinoid: a review of the recent literature].

OBJECTIVE: To evaluate methods of diagnosis and treatment, and the long term survival of patients treated for bronchial carcinoid tumor by the review of recent literature. METHODS: The Authors conducted a retrospective study on internet-based-evidence of patients treated for bronchial carcinoid tumor since 1993 to 2004. Symptoms, diagnosis, operative approach and survival were assessed. CONCLUSIONS: On the basis of the review of the international literature, the Authors affirm that the 5 and 10-year probability of survival are closely linked to the histological type of carcinoid, to the presence of nodal and distant metastasis. Owing to the potential malignancy of these tumours, preference should be given to radical exeresis.

Bronchial Neoplasms↗

PubMedDate not supplied

[Videolaparoscopic cholecystectomy: personal experience].

AIM: Laparoscopic cholecystecomy (LC) is now the gold standard for the treatment of gallstones. In this report were analyzed 153 LC performed by a single surgical team and, according to results, elaborated any technical recommendation. MATERIALS AND METHODS: 153 LC has been performed in Section of General and Thoracic Surgery of University of Palermo, Sicily, by a single surgical team, since 2000. Indications for LC were all forms of calculous cholecystitis (biliary colic in 73.2%, acute cholecystitis in 4.5%, gallbladder polyps in 5.8%) or colecystocoledochal lithiasis (9.8%). The mean age of patients was 49.46 years (range 18-78) and 62.7% were female. The patients were studied in our Section with hematochemical routine, plane chest roentgram, ECG, abdominal ultrasound (the day before the operation) and ASA classification (ASA I: 9.8%, ASA II: 67.3%, ASA III: 22.9%). RESULTS: All cases (153) were uneventful in terms of either serious intraoperative complications or necessity in relaparoscopy. In operatory room we adopted the French position, with mean operatory time of 65.03 minutes (range 30-180 minutes) and we also used the French technique of exposure of the cystic pedicle. The grade of difficulty of LC was analysed according 4 variables (approach to peritoneum, approach to gallbladder, pedicle dissection, cholecystectomy). There were 10 cases (6.5%) of convertions in total. Subhepatic space drainage was performed in 60.1% of cases. No postoperative biloma or subhepatic infiltration were observed. No port site infections were diagnosed, no port site hernias observed and no mortality observed. The mean postoperative bedstay was 2.21 days. CONCLUSIONS: LC is the treatment of choice for symptomatic gallstone disease. When performed by experienced surgeons, it is safe and effective.

Adolescent↗

PubMedDate not supplied

[Treatment of gastrointestinal stromal tumor (GIST)--review of the literature and a case report].

BACKGROUND: Gastrointestinal stromal tumors (GIST) are rare mesenchimal tumors that are characterized by constitutive overexpression of the tyrosin-kinase receptor KIT (CD117). The authors analyse the basis of the treatment of gastric GIS, starting form the study of a recent observed case. EXPERIMENTAL DESIGN: Report of one case treated with endoscopic resection. Evaluation of treatment and 2-years follow-up. RESULTS: The treatment of gastric GIST must be modulated on prognostic, genetic and molecular factors. These factors are the basis of the formation and growth of GIST. CONCLUSIONS: Complete surgical extirpation without rupture remains the only curative treatment of localized favourable prognosis. Endoscopic treatment, as in our case, reflect the modulation of therapy on prognostic factors. Selective targeted therapy of metastatic disease yields encouraging clinical responses.

Antineoplastic Agents↗

PubMedDate not supplied

[Endoscopic palliation of obstructive jaundice caused by inoperable pancreatic cancer: personal experience].

AIM OF THE STUDY: Few patients with pancreatic cancer are eligible for resection. In the remainder, estimation of prognosis is important to optimise various aspects of care, including palliation of biliary obstruction and trial of chemotherapy. The aim is to refer our personal experience about the palliation with endoscopic stenting in patients with unresectable pancreatic cancer. METHODS: The Authors reviewed retrospectively 132 patients affected by unresectable pancreatic cancer who underwent palliative interventions with endoscopic stenting from 2000 to 2004. RESULTS: Jaundice dramatically decreased in 86% of patients within 36 hours, in 12% within 48 hours and in 2% after two days. As complication were registered 3% of bleeding after endoscopic sphincterotomy, 2% mild acute post-ERCP pancreatitis and in 7% of patients transitory hyperamylasemia. The most frequent late complication was relapse of jaundice or cholangitis for stent clogging (51%) in a variable range fom 72.3 to 120.7 days, treated with stent substitution. No mortality ERCP-related was registered. CONCLUSION: Resection offers the only potentially curative approach to pancreatic cancer. The majority of patients are either too old, too ill with coexistent disease, or have a tumour that is undoubtedly inappropriate to resect. Thus for the vast majority an endoprosthesis to relieve the jaundice, is the preferred management, after a multidisciplinary approach.

Adult↗

PubMedDate not supplied

Acute pancreatitis during liver hydatidosis: treatment with ERCP and endoscopic sphincterotomy.

INTRODUCTION: The Authors report on a case of a young woman who developed acute pancreatitis when affected by liver hydatidosis, successfully treated with endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy. METHODS: An endoscopic sphincterotomy was performed, with extraction of multiple hydatid membranes. OBSERVATIONS: Laboratory values returned to normal within 36 hours of the sphincterotomy. The patient was dismissed with oral therapy (Albendazole 400 mg bis in die for 4 months) and antibodies to Echinococcus were not detectable 1 month later. One year later, at ultrasound and CT the hydatid cyst was regressed and patient was still without symptoms. CONCLUSIONS: Hydatid membranes in the biliary tract should be considered as a potential cause of pancreatitis in patients with hydatidosis, even if it is a rare complication, caused by the obstruction of the distal part of common bile duct by fragments of hydatid membranes, scolices or daughter cysts. ERCP may be beneficial, but surgery remains the treatment of choice for treatment of liver hydatid cysts.

Acute Disease↗

PubMedDate not supplied

[Substernal goitre. Personal experience].

INTRODUCTION: Aim of the study is to discuss the diagnostic and therapeutic problems of substernal goiter (SG). MATERIALS AND METHODS: The Authors retrospectively analyzed 12 patients (3.1%) with substernal goiters among 379 patients undergoing surgical treatment for thyroid diseases from January 2000 to 2005, and evaluated the clinical data, preoperative diagnostic findings, surgical treatments, histopathological results, and postoperative complications. RESULTS: The most common symptoms were a cervical mass (100%) and dyspnea (16%), but 50% of the patients were asymptomatic. Chest radiography provided the first evidence of a substernal goiter in 100% of the patients. The AA performed total thyroidectomy and operated through a cervical incision in all the patients. There was operative mortality (1 case: = 8%), 2 (16%) patients suffered temporary hypoparathyroidism; no patients suffered transient vocal cord paralysis. Malignancy was diagnosed by histopathological examination in 2 patients (16%). CONCLUSIONS: The presence of a substernal goiter is considerd as a sole indication for surgery. Surgical treatment of SG requires a diagnosis that exactly defines the extent of the lesion. A correct choice of surgical access and scrupulous operating technique are likewise of paramount importance to reduce the risk of severe compressive complications. Most retrosternal goiters can be resected through an entirely cervical approach with a low complication rate. On rare occasions a median sternotomy or a sternal split will be required to permit a safe and complete thyroidectomy.

Adult↗

PubMedDate not supplied

An uncommon complication of liver biopsy: obstructive jaundice from blood clots.

INTRODUCTION: The AA. report on a case of one young woman who developed obstructive jaundice induced by hemobilia after percutaneous liver biopsy, successfully treated with endoscopic retrograde cholangiopancreatography (ERCP) METHODS: An endoscopic sphincterotomy was performed with extraction of the clots OBSERVATIONS: Four weeks after ERCP the patient was healthy and asymptomatic, valuated as outpatient CONCLUSIONS: The role of ERCP in managing biliary sequelae of hemobilia is well established: biliary decompression is required if and intrabiliary lot causes obstructive jaundice and/or biliary colic. ERCP is feasible and leads to relief of symptoms in most cases, without the need of surgery.

Adult↗

PubMedDate not supplied

[Biliary stent placement for postoperative benign bile duct stenosis: personal experience].

OBJECTIVE: To describe the management and outcome after endoscopic treatment of 23 patients with post-operative benign bile duct stricture (BBDS) managed in Authors' Department from 1991 to 2000. BACKGROUND DATA: The management of the postoperative bile duct strictures remains a challenge for even the most skilled biliary tract surgeon and endoscopist. The 1990s saw a dramatic increase in the incidence of bile duct strictures from the introduction and widespread use of laparoscopic cholecystectomy. The management of these injuries, short-term outcome and follow-up have been reported. METHODS: Data were collected retrospectively on 23 patients treated in the Service of Diagnostic and Operative Endoscopy of the Operative Unit of General and Thoracic Surgery (Policlinico Paolo Giaccone, Palermo, Italy) with BBDS between 1991 and 2000. All patients underwent ERCP (endoscopic retrograde cholangiopancreatography). Follow-up and pharmacological therapy post-ERCP were conducted by scheduled medical audit. RESULTS: Of the 23 initial patients, 20 undergoing endoscopic stenting (3 with complete transaction were invited to surgery), 16 had completed treatment with symptoms resolution (mean follow-up of 70 months). One patient died of reason unrelated to biliary tract disease before the completion of treatment. Seven had not completed treatment. Of 16 patient who had completed treatment, 13 were considered to have a successful outcome without the need of follow-up invasive, diagnostic or therapeutic interventional procedures. Overall, a successful outcome, was obtained in 65% of patients, including those requiring a secondary procedure for recurrent strictures. CONCLUSIONS: Postoperative bile duct strictures remain a considerable surgical challenge. Management with endoscopic cholangiography to delineate the postoperative anatomy and to place biliary stents, to solve the symptoms, is associated with a successful outcome in up of 65% of patients, in well experienced team. Endoscopic treatment should be the initial management of choice for postoperative bile duct stenosis, as a real alternative to surgical reconstruction: because his failure will not compromised the following surgical treatment prior endoscopic treatment does not preclude surgery), whereas endoscopic treatment is impossible one a Roux-en-Y loop has been constructed

Adult↗

PubMedDate not supplied

[Infrequent early complication of mechanical digestive anastomosis: bleeding. Personal experience].

INTRODUCTION: Bleeding from mechanical digestive anastomosis is an uncommon complication (0.9-3.2%) often self-limiting but potentially lethal if not evidenced intraoperatively or in the immediate postoperative. MATERIAL AND METHODS: The Authors retrospectively report incidence of anastomotic bleeding after stapled anastomosis (11/163 = 6.7%) and analyse probable causes. In 6 of 11 patients (54%) intraoperative bleeding was stopped after manual reinforce of anastomosis (3/6) or stopped spontaneously (3/6). In 5 patients (45%), 1 with gastro-jejunal anastomosis, 2 with ileo-colonic anastomosis and 2 with colo-rectal anastomosis, they used endoscopy and endoscopic treatment in emergency. RESULTS: All 5 patients were treated with endoscopic clerotherapy (NaCl 0.9% plus epinephrine 1:10000): in 4 (80%) the Authors obtained hemostasis after the first treatment but in one of 2 cases ol ileo-colonic anastomosis (20%) the bleeding relapsed and the patient was re-operated. In 1 patient with the self-limiting lower anastomotic bleeding was associated to a Dieulafoy's gastric ulcer, perendoscopic treated successfully. In summary 2 patients were resubmitted to laparotomy, without evidence of source of bleeding. CONCLUSIONS: In accord with literature, bleeding from mechanical digestive anastomosis is a rare complication, often self-limiting (50-76%), that may be evidenced and treated early in intraoperative phase. Endoscopic examination may have diagnostic (source and type) and therapeutic valence, is effective, with low intrinsic risk and can reach endoscopic hemostasis without relaparotomy, except in case of rebleeding.

Anastomosis, Surgical↗

PubMedDate not supplied

[Complications in thyroid surgery: symptomatic post-operative hypoparathyroidism incidence, surgical technique, and treatment].

INTRODUCTION: Total thyroidectomy has a definite role in the management of malignant and benign thyroid disorders, with minimal complications and rare postoperative mortality. Even though thyroid surgery is quite safe, mechanical damage, devascularization or inadvertent removal of the parathyroid glands are possible. The aim of this study is to report report the personal surgical experience and to define some of the pathologic and clinical characteristics of unintentional parathyroidectomy and post-thyroidectomy hypocalcemia. MATERIALS AND METHODS: A retrospective-observational study was carried on 313 thyroidectomies from January 2000 to January 2004 (60 males and 253 females), mean age 41 years (range 17-86 yrs). The positions of at least 3 parathyroid glands are defined, and are left within their fat envelope. Parathyroid glands and their vascular supply are preserved by individual ligation of the branches of the inferior thyroid artery on the surface of thyroid lobe. RESULTS: Over 313 thyroidectomy, in 3 cases (0.95%) the AA. accidentally removed parathyroid glands (1 superior and 2 inferior), transplanted in sternocleidomastoideus pouch. The overall incidence of temporary hypocalcemia was 5.4% and no cases of permanent hypocalcemia were registred, regressed after medical therapy. DISCUSSION: Prevention of complications in thyroid surgery is based on knowledge of embryology and anatomy of cervical district, to visualize and respect the glands and their vascular pedicle: the patients must be appropriately and preoperatively counselled regarding potential complications and they must be well aware of the surgical risk they are undertaken. It is possible by the identifications of risk factors. CONCLUSIONS: Postoperative hypocalcemia is the most immediate surgical complication of total thyroidectomy; it is a multifactorial phenomenon, where surgical technique has a greater phisiopatologic impact. However, hypoparatyroidism does not appeared to be the main reason for hypocalcemia after thyroidectomy, and other causes (surgical stress, "hungry bone syndrome", release of calcitonin during surgical manipulation) may be important contributory factors. In conclusion, as we exposed, extent of resection, surgical technique and thyroid pathologic condition had a greater impact on the rates of postoperative hypoparathyroidism. By developing understanding of the anatomy and the ways to prevent each complication, the surgeon can minimize each patient's risk and can handle complications expediently and avoid worse consequence.

Adolescent↗