PubMed Health⌕ Search

Biomedical subjects

Isidoro Di Carlo

Publications and source records attributed to Isidoro Di Carlo.

11 recordsLinked to original sources
PubMed2005

External jugular vein cutdown approach, as a useful alternative, supports the choice of the cephalic vein for totally implantable access device placement.

BACKGROUND: Cephalic vein (CV) cut down for totally implantable venous access device (TIVAD) placement has been accepted as an alternative to the percutaneous subclavian vein approach. The aim of this retrospective study was to validate the external jugular vein (EJV) cut-down approach when the CV is not feasible. METHODS: Patients receiving a TIVAD from January 1995 to December 2003 were included in this study. Age, sex, surgical technique, disease, device used, length of the procedure, and morbidity were considered. RESULTS: A total of 427 TIVADs were placed in 425 patients: 253 men (59.5%) and 172 women (40.5%) aged 31 to 79 years. Of 425 patients, 5 were excluded; 420 underwent a CV cut down on the first attempt, and 391 (93.1%) procedures were successful. Among the final 29 patients, 20 (68.96%) underwent a TIVAD placement through the ipsilateral EJV cut-down approach. In the remaining nine patients (31.04%), TIVAD placement was performed through the ipsilateral internal jugular vein in four cases, via the ipsilateral axillary vein in three cases, and through the ipsilateral coracobrachial vein in the other cases. No immediate postoperative complications were detected in any of the patients. CONCLUSIONS: TIVAD placement by the CV cut-down approach is safe and fast, and its success rate is very high. By avoiding the immediate complications associated with the percutaneous approach, the EJV cut down has to be considered a valid, safe, and suitable alternative when the CV is not feasible.

Adult↗
PubMed2003

Liver metastases from lung cancer: is surgical resection justified?

Resection of the liver for metastatic lesions has largely been done for secondary colorectal or neuroendocrine tumors, and there is little information of its value for other lesions. Recent improvements in hepatic surgery have made resection of metastases a safe procedure and it should certainly be considered whenever there is an isolated lesion. We report the case of a successful resection of an isolated secondary hepatic lesion from a lung primary tumor, which was resected approximately 4 years beforehand. A review of the literature demonstrates that although early reports of similar procedures were not favorable, more recent reports reinforce the value of an aggressive approach in favorable cases.

Adenocarcinoma↗
PubMed2003

Simultaneous occurrence of adenoma, focal nodular hyperplasia, and hemangioma of the liver: are they derived from a common origin?

The association between hepatic hemangioma (HH) and focal nodular hyperplasia (FNH) or the association between FNH and hepatic adenoma (HA) has been reported. The authors report a case in which FNH, HH, and HA simultaneously appear in the liver. A 25-year-old woman was admitted to the Department of Surgery of the University of Catania (Italy), after presenting pain in the right hypocondrium. No therapy with oral contraceptives, no pregnancy and no abnormalities of the laboratory tests were found. Ultrasonography and computed tomography scans revealed four masses with the characteristics of HH, HA, FNH, and a hydatid cyst located, respectively, in segments II, IV, IV, and V of the liver. The surgical procedures performed were hemangioma and adenoma enucleation and en bloc resection of the FNH, hydatid cyst and gallbladder. No complications were recorded in the postoperative period and the patient was discharged from the hospital after 1 week. A pathological examination confirmed the preoperative diagnosis. To the best of our knowledge, the association of HH, FNH, and HA has never been reported. A common pathogenesis has clearly been demonstrated for hepatocytes and other cell types. The simultaneous presence of these three different kinds of tumor suggest that HH, FNH and HA could be the different expression of the same malformative anomaly.

Adenoma, Liver Cell↗
PubMed2002

Isolated agenesis of the gallbladder: report of a case.

We report the rare case of an isolated gallbladder with cystic duct agenesis that was misdiagnosed as acute alithiasic cholecystitis. We underline the inaccuracy of currently used diagnostic tests and the importance of making a correct preoperative diagnosis to avoid a needless surgical procedure. Based on the rare and incidental nature of this congenital anomaly, we discourage an extensive routine diagnostic workup, but rather, suggest a careful clinical and diagnostic evaluation of the patient who has symptoms suggestive of biliary tract disease. We conclude that in patients with gallbladder and cystic duct agenesis surgery might be useless and risky when performed by the laparoscopic approach. On the other hand, the awareness of the laparoscopic surgeon of the problems posed by this anomaly and a careful review of currently available diagnostic tests can prevent unnecessary laparotomy and minimize the risk of complications.

Cholecystectomy, Laparoscopic↗
PubMedDate not supplied

Hepatic resections using a water-cooled, high-density, monopolar device: a new technology for safer surgery.

Several techniques and devices have recently been developed in an effort to allow safer liver resections and avoid intraoperative blood loss. The aim of this study was to analyze our initial experience with hepatic resections using a new water-cooled, high-density, monopolar device--the Tissuelink Monopolar Floating Ball (Tissuelink Medical, Inc., Dover, NH)--in order to avoid bleeding during hepatic surgery. We analyzed patients who underwent hepatic surgery between January and June 2003. Sex, age, type of disease, and type of surgical procedure, in association with the duration of the surgical procedure, blood loss, use of vascular clamping of the liver, length of hospital stay, morbidity, and mortality were analyzed. Seven minor liver resections, two major liver resections, and one total cystopericystectomy were performed with the use of this new device. Average blood loss was 150 ml (range 50 to 300 ml). No vascular clamping was used with the exception of one patient. No deaths were recorded. Morbidity included ascites in one case and pleural effusion in another. In conclusion, the Tissuelink Monopolar Floating Ball permitted excellent coagulation of the cut liver surface, thus avoiding bleeding and vascular clamping. As a result, postoperative morbidity and mortality were low.

Adult↗
PubMedDate not supplied

Liver damage after transarterial chemoembolization without embolizing agent in unresectable hepatocellular carcinoma.

AIM AND BACKGROUND: Transarterial chemoembolization represents a therapy for hepatocellular carcinoma, but in cirrhotic patients affected by large or multifocal HCC with poor hepatic functional reserve, the procedure can damage normal parenchyma. We analyzed the effects on hepatic function of a modified chemoembolization consisting of ethiodized oil (Lipiodol Ultra Fluid) and epirubicin without gelatine sponge (C-LIP). METHODS: Of 90 patients with hepatocellular carcinoma observed from January 1995 to December 1999, 16 with a diagnosis of advanced (large or multifocal) disease underwent 19 C-LIP. The 30th post-C-LIP day was considered as a checkpoint of the biochemical parameters for a possible hepatic failure. The value of alpha-fetoprotein and the clinical finding of ascites were also considered after 30 days. RESULTS: Postoperative values of serum aspartate aminotrasferases, as well as alanine aminotransferase, were significantly higher than preoperative values (P = 0.002 and P = 0.019, respectively) (Table 1). In all patients, there was a significant increase in postoperative total serum bilirubin (P = 0.003). Statistical analysis showed a significant finding of postoperative ascites (P = 0.035) and the effectiveness of C-LIP on neoplastic tissue by a decrease of alpha-fetoprotein values at 30 days (P = 0.067). CONCLUSIONS: Transcatether arterial chemoembolization could represent an effective therapy against multifocal or advanced hepatocellular carcinoma, and its effectiveness is probably not decreased by using a modified procedure without embolizing agent (C-LIP). However, even when performing such a safe procedure, the hepatic functional reserve of the individual patient needs to be accurately evaluated in order to avoid liver failure.

Adenocarcinoma↗
PubMedDate not supplied

Totally implantable arterial device (TIAD): a questionable complication.

The authors report a complication of a totally implantable arterial device in a patient in which the device was inserted to prevent recurrence of hepatic metastasis. After intrahepatic chemotherapy, during the nursing of the totally implantable arterial device, the patient developed a mass close to the duodenal loop that disappeared seven months later. The spontaneous decrease of this mass suggests the hypothesis of a hematoma due to a rupture of a pseudoaneurysm of a small collateral artery.

Antimetabolites, Antineoplastic↗
PubMedDate not supplied

Primary adrenocortical carcinoma and delayed liver metastasis: is the surgery alone the right treatment? Case report.

Adrenocortical carcinoma is a very rare tumor which can develop at any age in either sex, with an estimated incidence of 0.5-2 new cases per million per year. Only few cases of adrenocortical carcinoma are reported in the literature, probably because the differential diagnosis between malignant and benign mass is not easy. Surgery represents the treatment of choice for adrenocortical carcinoma and for its possible recidivisms. We report the case of a 36-year-old female patient affected by adrenocortical carcinoma, operated on in 1999 and re-operated on in 2002 for a liver metastasis of the same tumor, without any other treatment. This case may be interesting for its rarity as well as for the several difficulties of the diagnosis and the choice of treatment. In conclusion, the follow-up of these patients is mandatory due to the difficulties of diagnosis and curative surgery represents the best choice of treatment.

Adrenal Cortex Neoplasms↗
PubMedDate not supplied

Biliary squamous cell carcinoma.

Squamous cell carcinoma of the liver, bile ducts and gallbladder is extremely rare. We report a case of squamous cell carcinoma of the common bile duct manifesting atypically without jaundice, despite its large size and proximal bile duct dilation. A review of the literature concerning all other squamous carcinoma of the biliary tract is presented including 3 other bile duct cancers, 17 intrahepatic and 30 gallbladder cancers. Compared to the more common adenocarcinoma these rare biliary cancers seem to present particular clinical features and prognostic differences which may be important for planning treatment.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

Does the psychological request of the patient justify the surgery for hepatic hemangioma?

BACKGROUND/AIMS: The incidental finding of hemangiomas has increased, but the problem of the correct surgical indications of this tumor has yet to be solved. The aim of this work is to establish whether the psychological request of surgery from patients known to have a benign tumor of the liver must be avoided or not. METHODOLOGY: Age, sex, symptoms, estroprogestinic oral therapy, methods of diagnosis, surgical procedures, morbidity, mortality, postoperative hospital stay and follow-up of the patients affected by hepatic hemangioma, observed from 1992 to 2002 in our institution, have been considered. RESULTS: Seventeen patients, with a mean age of 44 years (range 26-72), were hospitalized for hepatic hemangioma, 8 (47%) of them were operated on and 9 (53%) were managed by observation. The operated patients presented various symptoms. One patient was operated on for traumatic rupture of the hemangioma. Non-operated patients were asymptomatic or with slight dyspeptic symptoms not related with the tumor. The first diagnostic radiological examination was ultrasonography (US) in all cases. All lesions were larger than 4cm. The types of surgical procedures were 5 enucleations, and 3 hepatic resections. All operated patients resolved their clinical symptomatology, except two patients that had requested surgery for psychological implications. These patients presented their symptoms again after 2and 3 years of follow-up respectively. CONCLUSIONS: Our results suggest that liver hemangiomas should be operated for symptoms well related to the tumor or for bleeding. Psychological requests from the patients should be avoided every time.

Adult↗