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Biomedical subjects

M Catarci

Publications and source records attributed to M Catarci.

At least 19 recordsLinked to original sources
PubMed1999

Prospective evaluation of total parathyroidectomy and autotransplantation for the treatment of secondary hyperparathyroidism.

OBJECTIVE: To evaluate the clinical effectiveness of total parathyroidectomy with autotransplantation for the treatment of hyperparathyroidism and the recurrence rate of hyperparathyroidism after this procedure. DESIGN: A prospective study of total parathyroidectomy and autotransplantation in 19 consecutive patients with severe secondary (renal) hyperparathyroidism. SETTING: University hospital department of surgery. PATIENTS: Nineteen patients operated on for the treatment of secondary hyperparathyroidism between March 1993 and March 1996. Eighteen had been receiving longterm hemodialysis, and 1 had a functioning renal graft. INTERVENTION: Total parathyroidectomy and autotransplantation of excised parathyroid tissue into the brachioradialis muscle of the arm opposite that in which the arteriovenous fistula had been placed for dialysis. MAIN OUTCOME MEASURES: Clinical and biochemical improvement, morbidity, mortality, and recurrence rates of hyperparathyroidism after the procedure. RESULTS: The conditions of 13 (72%) of 18 patients followed up improved, and the clinical and laboratory variables indicating secondary hyperparathyroidism returned to normal. One patient died 50 days after surgery. In 2 patients (10%), mild hypoparathyroidism developed, and in 1 patient (5%), persistent hyperparathyroidism developed and required reoperation. In 2 patients (10%), recurrent hyperparathyroidism developed, and 1 (5%) required reoperation. CONCLUSIONS: Total parathyroidectomy with autotransplantation effectively relieves the symptoms of hyperparathyroidism, and the recurrence rate of hyperparathyroidism is low. Because all procedures used resulted in good control of clinical and biochemical variables, the method used for the surgical treatment of secondary hyperparathyroidism depends on the surgeon's preference.

Adult↗
PubMed1999

Routine use of open laparoscopy: 1,006 consecutive cases.

Blind insertion of the Veress needle and of the first trocar is a significant cause of laparoscopic surgery complications. Despite this risk, the closed technique is still more popular than the open one. The authors retrospectively evaluated 1006 consecutive laparoscopic operations in which Hasson's technique was routinely performed. The overall complication rate was 2.2%, but the vast majority of complications occurred during the first 50 cases (6% vs. 1.9%). They conclude that after a learning phase of about 50 cases, Hasson's technique is a quick and safe procedure.

Humans↗
PubMed1997

Causes of death and recurrence after surgery for early gastric cancer.

The postoperative course of 172 patients with early gastric cancer (EGC) was followed for a median 7 years to evaluate the causes of death, incidence and patterns of recurrence, and characteristic findings in the recurrent cases. The cumulative 10-year mortality rate (+/- SE) was 22 +/- 3.7%. Seven patients (4.1%) died of operative mortality, 11 (6.4%) died of a recurrence of the gastric cancer and 13 (7.6%) died of unrelated causes. Unrelated causes of death were metachronous primary cancer (n = 6), cardiovascular disease (n = 2), pneumonia (n = 3), sepsis (n = 1), and car accident (n = 1). Four patients died from gastric stump recurrence, three from liver metastases, two from lymph node metastases, and two from peritoneal dissemination. Using Cox multivariate analysis, histologic type had the most significant effect on recurrence. Although influenced by the tumor nature, the EGC prognosis is relatively good. Based on the results of this study, particularly in Western institutions, histologic examination of resection margins and lymphadenectomy should be improved. Moreover, patients must be carefully followed for late recurrence and metachronous cancer.

Aged↗
PubMed1997

Laparoscopic management of acute biliary pancreatitis.

BACKGROUND: The appropriate management of acute biliary pancreatitis has evolved considerably over the past decades. The advent of laparoscopic surgery made it necessary to reevaluate the traditional algorithms. METHODS: This study assesses the outcome of 40 patients laparoscopically treated for gallstone pancreatitis. The severity of pancreatitis was scored by clinical and biochemical evaluation and CT findings. Laparoscopic cholecystectomy was performed during the same admission in all cases. In no case was a preoperative endoscopic retrograde cholangiopancreatography (ERCP) performed. In 32 patients (80%) with mild acute pancreatitis interval cholecystectomy was less than 1 week (group A) and in eight patients (20%) with severe disease it was more than 7 days (group B). All patients underwent intraoperative cholangiography. RESULTS: The rate of common bile duct (CBD) stones was 5% (two cases), both occurring in the group A. There was one perioperative death (2.5%) in group B and one late CBD injury (2.5%) in group A, not requiring surgery. Complication rate was significantly higher in group B (50%) than in group A (9.4%). CONCLUSIONS: We consider that treatment of mild-to-moderate acute biliary pancreatitis can be satisfactorily accomplished by laparoscopy with routine intraoperative cholangiography and laparoscopic treatment of bile duct stones, showing no mortality and low morbidity rate. Laparoscopic treatment of patients with severe acute pancreatitis deserves further investigation.

Acute Disease↗
PubMed1997

History of reconstruction after total gastrectomy.

Nearly a century has passed since Schlatter carried out the first successful total gastrectomy and antecolic end-to-side oesophagojejunostomy in 1897 in Zurich. Actually, fourteen years before, Conner attempted a total gastrectomy, but his patient died on the operating table. From the first success, a large number of different procedures have populated the worldwide literature, with a lot of papers reporting "original' techniques or data about the functional outcome.

Anastomosis, Roux-en-Y↗
PubMed1996

Laparoscopic Billroth II distal subtotal gastrectomy with gastric stump suspension for gastric malignancies.

BACKGROUND: Laparoscopy has played an ill-defined role as a diagnostic tool for the staging of gastric and other intra-abdominal malignancies for a long time. The widespread use of the laparoscopic approach for the treatment of some benign abdominal diseases, such as biliary lithiasis and gastroesophageal reflux disease, has encouraged the authors toward its use in the treatment of malignant gastric neoplasms, both for palliation and for curative surgery. METHODS: A five-puncture technique for laparoscopic distal subtotal gastrectomy, omentectomy, division of the left gastric artery at its origin, and D1 lymph node dissection has been developed by the authors, and is fully depicted and discussed. Reconstruction of digestive continuity is achieved through a posterior transmesocolic side-to-side stapled gastrojejunostomy, facilitated by an original method of suspension of the gastric stump to the anterior abdominal wall. RESULTS: In a preliminary series of 10 cases, this technique was demonstrated to be safe, showing no mortality, and having morbidity rates comparable to those of open surgery. CONCLUSION: The operation is effective, with a mean number of resected nodes comparable to that usually achieved in open surgery, and no cases of conversion to laparotomy.

Abdominal Muscles↗
PubMed1995

Arterial vasculature of the stomach and oncologic gastrectomies.

Preoperative knowledge of the gastric arterial blood-supply with special regard to anatomic anomalies is desirable for a correct surgical approach to this viscus and for the reduction of intra- and postoperative complication rates. The authors report their experience with the use of preoperative digital angiography in the evaluation of 46 consecutive patients undergoing gastric cancer surgery. Twenty of these (43.5%) presented a vascular anatomy different from the normal pattern. In 6 (13%), a double arterial anomaly was detected. Some anatomic anomalies of the celiac axis and superior mesenteric artery are described in relation to operative procedures during oncologic gastrectomies.

Aged↗
PubMed1995

Senior versus proctored young and resident surgeons' experience in laparoscopic cholecystectomy: is there any need of previous exposure to open biliary surgery?

Since its introduction in 1987 laparoscopic cholecystectomy (LC) has gained rapid acceptance as the preferred management of symptomatic cholelithiasis. In our department, during the past 3 years, the number of open cholecystectomies (OCs) has dramatically decreased. The impact of the introduction of LC as a part of the overall surgical procedures performed by residents is analyzed. To date junior-level residents have already more experience in LC than in OC. Indeed in our teaching unit junior-level residents performed only 5% of biliary surgical procedures in open surgery. Residents participated in the "surgeon's" position in 47.9% of the LCs and as either surgeon or first assistant in 100%. We analyzed both the cases where residents acted as surgeons and where they did not. It appeared that there was no difference in the complication and conversion rates. More intraoperative cholangiographies (IOCs) were performed by residents. This was probably due to the anxiety of making a mistake because of their lack of experience. This report suggests that the decrease in the number of OCs is not a drawback and that it is possible to acquire an adequate knowledge of biliary anatomy and surgery from LC training, if strict proctoring criteria are respected.

Cholangiography↗
PubMed1995

Laparoscopic management of volvulated Meckel's diverticulum.

Laparoscopy in the emergency setting is a logical extension of this technique. Open laparoscopy is particularly useful in the management of the acute abdomen. In our institution, after a sequential work-out that includes physical examination, laboratory data, plain abdominal roentgenograms and ultrasonography, diagnostic laparoscopy is advocated. We present the laparoscopic treatment of an intestinal obstruction caused by a volvulus around Meckel's diverticulum. The efficacy and safety of the diagnostic and/or therapeutic laparoscopic procedures in the emergency setting are discussed.

Adolescent↗
PubMed1995

[Diagnostic accuracy of computerized tomography. Preoperative staging of gastric cancer].

"Imaging techniques" have assumed greater clinical value in the further assessment of an endoscopically or radiologically verified neoplastic lesion of the stomach through the ability to evaluate its extent of invasion, metastatic involvement of lymphnodes and/or distant organs. US, CT, and more recently NMR are non-invasive modalities that provide an accurate preoperative assessment of potential surgery decision making. Common current practice of preoperative CT in gastric cancer and relevant results documented in letterature, have inclined many clinicians in its use in staging this disease. The aim of the study is to evaluate and assign the efficacy of CT imaging in the preoperative staging of gastric cancer by comparing the results obtained with this imaging technique with the postoperative histopatologic findings of 25 patients with adenocarcinoma of the stomach. CT demonstrates the primitive lesion as a gastric wall differentiate T1 (parietal invasion extending to the lamina propria and submucosa) and T2 (invasion of the muscolaris propria and the submucosa). The performance values of CT in detecting tumor extension to the sierosa were as follows: sensitivity of 78%, specificity of 63%; and overall accuracy of 72%. The sensitivity and specificity of CT in demonstrating adjacent organ involvement were approximately 75% and 85% respectively, and overall accuracy of 84%. In the detection of metastatic involvement of lymphnodes CT demonstrated to be 70% sensitive, 62% specific with an efficacy of 68%. In terms of M-stage, CT imaging identified liver metastases in 3 patients (2 located in the VII segment and 1 in the IV) and 1 metastasis to the adrenal gland. All were confirmed by specimen histopathologic findings.

Humans↗
PubMed1994

[Long-term results of surgical treatment of early cancers of the stomach].

The postoperative course of 172 patients with early gastric cancer operated between 1974 and 1987 was reviewed with a median follow-up of 7 years. The survival probability at the end of 1989 was 0.916 (excluding operative mortality and other causes of death) or 0.876 when the operative mortality was included. Univariate analysis showed a significant survival difference according to the presence or absence of submucosal invasion (p = 0.02, Log-Rank test) and lymph node invasion (p = 0.04, age greater than or less than 50 years (p = 0.03) and according to the type of resection performed (total gastrectomy with gastric and perigastric lymph node dissection or subtotal gastrectomy with incomplete lymph node dissection (p = 0.05). Eleven patients died from cancer recurrence, one is still alive with a recurrence of the gastric stump. The other deaths were due to cancers of other organs (6), cardiovascular disease (2), pneumonia (3), septicaemia (1) and a car accident. Although the prognosis of early gastric cancer is relatively favourable in European countries, patients must be carefully followed for a long period because of recurrences and the high incidence of cancers in other organs.

Adult↗
PubMed1994

Surgical anatomy of the papilla of Vater and biliopancreatic ducts.

The present research was aimed at defining the surgical anatomy of the biliopancreatic ducts and of Oddi's sphincter. The numerous anatomic variations of the papilla, the millimetric distribution of its muscle fibres, and any morphological detail of clinical significance have been investigated. An integrated analysis of radiographic, tridimensional (casts), and histologic findings has been carried out in 49 of 64 autoptic bilio-duodenopancreatic specimens. Exact limits of the choledocus and Wirsung sphincters were defined. A consistent accumulation of circular muscle fibres could be seen, on the choledocus duct side, up to a mean distance of 13.6 mm from the papillary pore. However, more rarefied fibres were present up to 20.5 mm. Muscle fibres were seen to stop roughly on the pancreatic duct side at 7.3 mm from the papillary pore. The beginning of the sphincter was observed 2-3 mm above the papillary pore. There was no evidence suggesting the presence of upper, middle, and lower biliary sphincters. Five anatomic diversities of the Wirsung-choledocus confluence were found. The Y type was the most frequent (61.2%), followed by the U type (22.4%), V (14.3%), and II (2.1%). Santorini's duct with a normal papilla was present in 16 per cent of the cases. These data along with other interesting observations on antireflux mechanisms (Santorini's valves) and on the ductal space orientation appear to be useful guidelines for a physiopathological understanding of bilio-pancreatic diseases and for any therapeutic procedure on these structures.

Ampulla of Vater↗