Biomedical subjects

Giuseppe Pisano

Publications and source records attributed to Giuseppe Pisano.

11 recordsLinked to original sources

PubMedDate not supplied

[Endometriosis of umbilical cicatrix: a case report and review of the literature].

The present report refers to a case of "primitive" endometriosis of the umbilical scar in a 50-years-old woman who complained of the appearance at the umbilicus of two nodules measuring 7 and 2 mm in diameter. These nodules, which were brownish in colour, were responsible for prickly pain and itching unrelated to the menstrual cycle. Both nodules were excised after a preoperative non-specific diagnosis of granuloma. Pathology findings revealed "cutaneous endometriosis". The authors believe that the appearance of a nodular swelling at the umbilicus of a woman of child-bearing age should lead to a suspicion of endometriosis among the possible diagnoses.

Cicatrix↗

PubMedDate not supplied

[Adenomyomatosis of the gallbladder. Personal experience and analysis of the literature].

Gallbladder adenomyomatosis is a pathological condition due to parietal thickening and intramural diverticulosis. Though it has always been considered a hyperplastic benign disease, the possibility of malignant transformation is currently admitted. Through an analysis of their personal experience and of the relevant literature, the authors draw attention to anatomical and clinical features, diagnostic interpretations and up-to-date trends in the therapy of this condition. Over the period from 1990 to 2001, 13 patients with adenomyomatosis of the gallbladder were observed, amounting to 4% of all cholecystectomies performed over the same period. According to the extent of the disease three forms have been identified: diffuse (26%), segmental (26%) and localized (48%). The clinical presentation appears to be mainly conditioned by the frequent association with gallstones (84%), and for this reason ultrasonographic features were commonly interpreted as being signs of chronic inflammation or suspected neoplasia, though retrospective ultrasound evaluation revealed pathognomonic signs of gallbladder adenomyomatosis. Indications to surgery were therefore mainly based upon the presence of stones and chronic inflammation. Cholecystectomy is currently also indicated in symptomatic cases of non-lithiasic gallbladder adenomyomatosis, whereas there appears to be no such clear-cut rule for the treatment of asymptomatic cases. Nevertheless, prophylactic laparoscopic cholecystectomy may be justified considering the evolution, the uncertain nature of the disease and the difficult differential diagnosis versus malignant lesions.

Adenomyoma↗

PubMedDate not supplied

[Cervico-mediastinal hematoma secondary to extracapsular hemorrhage of parathyroid carcinoma. Clinical case and review of the literature].

Extracapsular parathyroid haemorrhage is a rare but ominous occurrence, which may cause cervico-mediastinal haematoma and a severe calcaemia imbalance. We identified only 23 cases reported in the literature and these were always secondary to adenoma, hyperplasia or cysts, and never to carcinoma. We describe a case of a 56-year-old man who was admitted to our Institute because of the sudden development of an anterior neck swelling, together with dysphagia, dyspnoea and hoarseness. Physical examination revealed a large ecchymosis extending from the anterior neck to the upper chest, while the early symptoms had disappeared. Laboratory studies, ultrasonography and 99mtTC-Sestamibi scintiscan demonstrated the presence of primary parathyroidism due to a right inferior parathyroid neoplasm. At operation, the parathyroid was excised en bloc with the right thyroid lobe because they were joined together by an extensive fibrous reaction. Histological examination showed a well-differentiated parathyroid carcinoma with evidence of recent haemorrhage. To the best of our knowledge this is the first case of extracapsular haemorrhage due to a parathyroid carcinoma. In summary, although parathyroid haemorrhage is a rare condition, it should always be suspected when a painful mass or diffuse swelling suddenly occurs in the anterior neck, with or without ecchymosis, especially when serum calcium and phosphorus are abnormal.

Carcinoma, Papillary↗

PubMedDate not supplied

[Treatment of inguinal hernia with the Prolene Hernia System (P.H.S.)].

Among the several techniques available for the treatment of inguinal hernia, the Prolene Hernia System (P.H.S.) has gained widespread acceptance over the past few years. This is an original prosthetic device that combines, in a single step, what other techniques offer separately, namely an underlay patch (preperitoneal placement), an onlay patch (subfascial placement) and a connector that joins them together and works as a plug. The aims of this study were to specify the indications and the technique of this method and to evaluate its efficacy in our experience. From January 1999 to July 2003 we performed 156 inguinal herniorraphies with the P.H.S. in 152 patients (143 male, 9 female; mean age 62.4 years). One hundred and thirty-six cases were primary hermias (mainly types III, IV and VI according to the Rutkow and Robbins classification) and 18 were recurrences (mainly type R3 according to the Campanelli classification). In 56.5% of cases the operations were performed in the day surgery setting, 37.5% as ordinary admissions and 6% as emergency procedures. Locoregional (62.5%) or local (34.2%) anaesthesia were mainly given. Early postoperative complications (7%) were 7 haematomas and 4 seromas. In 125 patients with a follow-up of at least 6 months, the late postoperative complications included 4 cases of persistent inguinocrural pain among the primary hernias (3.7%) and a new recurrence among the recurring hernias. The Authors believe that hernia repair with the P.H.S. is a valid choice comparable to the other common techniques but they suggest its use particularly in primary hernias with major relaxation of the posterior inguinal wall of the inguinal canal or of the entire myopectineal orifice.

Adult↗

PubMedDate not supplied

[Basedow's disease associated with benign and malignant nodular disease of the thyroid: diagnosis and treatment].

Nowadays the prevalence of thyroid nodules in Graves' disease (GD) is estimated as ranging from 15 to 33% and several studies support a high risk of thyroid cancer in this condition. The present study presents a retrospective analysis of 41 cases of GD submitted to total thyroidectomy from 1995 to 2003, aimed at discovering the most useful elements for an optimal diagnostic and therapeutic strategy. We identified 23 patients with coexisting nodular goitre (nodular variants of GD) and among these we carried out a comparative study of 12 cases with only benign nodules and 7 with thyroid carcinoma detected prior to the operation. Four cases were not considered because of incidental microcarcinomas. We found no significant differences in the number, average size and radionuclide imaging of nodules in the two groups. In contrast, analysis of ultrasonographic findings showed that hypoechogenicity correlated closely with malignancy, particularly if associated with ill-defined margins, microcalcifications and intranodular vascular patterns, whereas hyperechogenicity was a typical appearance of benign lesions. Our study suggests that routine thyroid US scans should be considered for complete evaluation of GD, since this pathology frequently implies the development of thyroid nodules which are not always detectable at clinical or radionuclide examination. Surgery is mandatory when nodules with suspicious ultrasonographic features are found and if malignancy cannot be excluded at fine needle aspiration cytology.

Adult↗

PubMedDate not supplied

The treatment of Spigelian hernia with the Prolene Hernia System: notes on techniques.

Spigelian hernia repair techniques use prostheses both in the traditional and the videolaparoscopic approach; only in selected cases direct suturing of the parietal defect is performed. The aim of this study is to describe a technique that uses a device proposed specifically for inguinal hernias, but which has not yet been described in the literature, namely the Prolene Hernia System (P.H.S.). Our personal experience consists of 7 cases (5 females and 2 males; mean age: 58 years) operated on from January 2002 to May 2003. Four patients were operated on in the ordinary hospitalisation regime with selective spinal anaesthesia and three patients were treated in the day surgery setting with local anaesthesia. With this technique, the underlay patch is positioned in an adequately prepared preperitoneal space and the onlay patch above the internal oblique muscle, while the connector acts as a plug positioned in the parietal defect. The method has proved simple, safe, and fast. It causes minimal discomfort to the patient in terms of postoperative pain and allows rapid rehabilitation. Moreover, it can also be performed in the day surgery setting. The authors conclude that the P.H.S. Spigelian hernia repair technique is a valid alternative to any of the other methods used to date.

Adult↗

PubMedDate not supplied

Femoral hernia repair with Bard Mesh Dart Plug.

Several tension-free femoral hernia repair techniques are currently available with different approaches and prosthetic devices, all of which, however, largely yielding excellent results. The aim of this report was to describe the technical aspects of femoral hernia repair via an infrainguinal approach using the Bard Mesh Dart Plug, and to evaluate the short- and medium-term results in our experience. From May 2000 to December 2003, 25 patients (F/M ratio 2.1:1; mean age 66.4 years) underwent femoral hernia repair with the Bard Mesh Dart Plug. Fourteen patients (56%) were operated on as emergency cases for irreducible hernias and in 3 cases a bowel resection under general anaesthesia was necessary. The other 11 patients underwent surgery on an outpatient day surgery basis under local or spinal anaesthesia. Topical antibiotic prophylaxis was administered in all cases, while short-term prophylaxis with ceftazidime was limited to emergency patients. The main phases of the operation are described. The mean operative time was 40 minutes and the patients were mostly discharged within 2 hours of surgical treatment. No general or local intraoperative complications were registered. Postoperative mortality occurred in a single case (a 98-year-old woman, ASA IV, affected by strangulated hernia). Postoperative morbidity included 4 seromas and 1 haematoma. No recurrences were observed over a mean follow-up period of 24 months (range: 5-46 months). The femoral hernia repair with the Bard Mesh Dart Plug is a simple, safe, fast and effective procedure which can often be carried out in the day surgery setting. It can therefore be regarded as a valid alternative to other tension-free techniques.

Adult↗

PubMedDate not supplied

[Abdominal wall hernia surgery: prosthetic materials].

Treatment of abdominal hernia has been revolutionised by using new prostheses. Reduction of tissue tension, elimination of wall defects and lowering of recurrences are the key aspects of the success of these devices. In Italy, prostheses are widely used. Marketing enquires show percentages of prosthesis use of over 80% for the treatment of primitive hernias and as much as 100% for recurrences. It is strongly recommended that randomised prospective studies be carried out in order to establish the advantages and disadvantages of the various techniques. Moreover, an international classification should be considered so that all surgeons can use the same language and compare their results.

Biocompatible Materials↗

PubMedDate not supplied

[Peutz-Jeghers syndrome: an account of 3 cases in the same family and a review of the literature].

Peutz-Jeghers syndrome is a rare autosomal dominant polyposis characterized by mucocutaneous pigmentation, intestinal hamartomas and an increased risk mainly for gastrointestinal and gynaecological cancer. Our interest in this syndrome is due to the observation of three cases in the same family, two of whom presented the classic Peutz-Jeghers syndrome, while the other had perioral pigmentation only. Therefore, the main clinical elements emerge in the two first cases presenting with recurrent abdominal pain and sub-occlusion. The condition was managed by a combination of radiological, endoscopic and surgical procedures which enabled us to map and remove several gastrointestinal polyps. On histopathological examination the polyps were mainly hamartomas, though some presented both hamartomatous and adenomatous features, while others, removed endoscopically during the follow-up, were identified as true adenomas with initial carcinomatous changes. Furthermore, in one case follow-up examination allowed the early diagnosis and treatment of a cervical carcinoma. In agreement with the literature, our experience suggests that simple polypectomy, via an endoscopic and/or surgical approach, is the treatment of choice in Peutz-Jeghers syndrome. However, if gangrene due to invagination or neoplastic change occurs, an intestinal resection is mandatory. Cancer surveillance must be the first aim of follow-up.

Adult↗

PubMedDate not supplied

[Small bowel obstruction caused by postoperative adhesions: personal experience and review of the literature].

Small bowel obstruction due to postoperative adhesions still remains an important matter in terms of frequency, diagnostic and therapeutic commitment and costs. The Authors report on a series observed over 14 years consisting of 63 patients (71 cumulative hospital admissions). Surgery was required in 42 cases (59.2%), 23 cases were treated in emergency and 19 cases after failure of conservative treatment. In 29 cases (69%) the surgical procedure was limited to adhesiolysis, whereas in 13 cases (31%) an intestinal resection was performed. During operation the mechanisms responsible for obstruction were: strangulation by an adhesive band (39.4%), angulation (34%), bowel loops and volvulus glued together (13.2% in each case). The operative mortality was 4.7% (2 cases). In 29 cases (40.8%), after medical treatment, the obstruction was completely resolved within a mean period of 4.15 days (range: 2-8). The results lead to the conclusion that diagnostic accuracy in cases of obstruction due to postoperative adhesions is still uncertain. The main aspects of treatment and surgical timing are left to the surgeon's personal experience. Medical treatment, however, should be the first therapeutic option and, in case of doubt, further diagnostic investigations are necessary (mainly CT) to identify those cases amenable to surgical treatment.

Abdomen↗

PubMedDate not supplied

[Sclerotherapy and hydrocelectomy for the management of hydrocele in outpatient and day-surgery setting].

The purpose of this report was to compare two different procedures in the treatment of idiopathic hydrocele, namely, hydrocelectomy and percutaneous sclerotherapy, both of which performed in the outpatient or day surgery setting. A detailed description of the technical local anaesthesia steps is reported together with the sclerotherapy method. The study was conducted in 71 patients with a total of 77 hydroceles treated from 1993 to 2004. Surgery was carried out in 53 cases and sclerotherapy in 24. The latter was more frequently opted for elderly subjects as well as in those patients who requested it. Local or locoregional anaesthesia was reserved to patients treated surgically. The two treatments were compared on the basis of the following parameters: age, operative time, length of hospital stay, success rate and complications. The efficacy of the two procedures was comparable (sclerotherapy 95.8% vs surgery 100%), but sclerotherapy proved more favourable in terms of simplicity, rapidity of execution, shortness of hospital stay and risk of complications. However, 41.7% of patients required more than one treatment to obtain a radical cure, whereas surgery was effective in all cases in just one step. Hospital stay and morbidity were almost the same when surgery was performed under local anaesthesia. Sclerotherapy is an efficient alternative to the classic hydrocelectomy. The choice between the two treatment modalities should be made, taking into account above all the patient's individual preference.

Adolescent↗