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M Nacchiero

Publications and source records attributed to M Nacchiero.

At least 19 recordsLinked to original sources
PubMed2003

Second harmonic imaging improves trans-abdominal ultrasound detection of biliary sludge in 'idiopathic' pancreatitis.

BACKGROUND: Recently, biliary sludge has been strongly correlated with 'idiopathic pancreatitis'. It is often diagnosed by trans-abdominal ultrasonography, despite the low sensitivity of this investigation. New scanners, using second harmonic imaging, may improve the quality of the echographic picture. AIM: To verify the impact of this methodology on the detection of biliary sludge in patients with 'idiopathic' pancreatitis. METHODS: Fifty patients with 'idiopathic' pancreatitis observed over a 18-month period entered the study. Exclusion criteria were gall-bladder stones, polyps, clinical conditions related to biliary sludge development and haemolytic disorders. Patients were assessed blind by two operators using either conventional ultrasonography or second harmonic imaging. The parameters of diagnostic quality of both examinations were evaluated using, as the gold standard, microscopic examination of the gall-bladder content collected at endoscopy after cholecystokinin infusion. RESULTS: An improvement in sensitivity, specificity, efficiency and negative predictive value was obtained by second harmonic imaging compared with conventional ultrasonography. CONCLUSIONS: Second harmonic imaging, in our experience, is a reliable non-invasive tool for the diagnosis and follow-up of biliary sludge in the course of 'idiopathic' pancreatitis.

Acute Disease↗
PubMed2002

Typhlitis complicating induction therapy in adult acute myeloid leukemia.

In a retrospective analysis of 161 consecutive adult patients with de novo acute myeloid leukemia undergoing induction therapy, including cytarabine, etoposide and anthracyclines, seven patients (4.3%) developed typhlitis. All presented severe neutropenia, fever, abdominal pain and tenderness within 16 days from starting chemotherapy (median 11 days; range 5-16). Three patients underwent surgery and survived, four were treated only with supportive therapy: two recovered and two died. In our experience early recognition of typhlitis and rapid recovery of the neutrophils are the most important determinants of the results of surgical and/or medical approaches. The management of typhlitis, a life-threatening condition, is controversial and depends on many factors characterizing each patient, which must be evaluated in collaboration between the surgeon and the hematologist.

Adolescent↗
PubMed2002

One-day vs standard thyroidectomy. A perspective study of feasibility.

BACKGROUND: The aim of this randomized controlled trial is to evaluate the feasibility of one-day thyroidectomy, comparing the results of this method vs standard thyroidectomy. METHODS: From June 2000 to June 2001, 110 patients underwent total thyroidectomy under general anesthesia for thyroid disease. The patients were randomized into 2 groups: in group A (40 patients) we used the one-day thyroidectomy; in group B (70 patients) we employed standard thyroidectomy. In both groups postoperative mobilization was immediate and the mean postoperative hospitalization stay was 21 hours (range: 18-24) in group A and 60 hours (range: 21-120) in group B. The mean follow-up was 10 months (range: 6-18 months). RESULTS: The patients of group A showed hypoparathyroidism with temporary hypocalcaemia in 3 cases (7.5%) vs 5 (7.1%) of group B; this finding was not statistically significant. No cases of definitive hypoparathyroidism, nor lesions of RLN, of the external branches of the superior laryngeal nerve, nor postoperative hemorrhage were observed in either group. CONCLUSIONS: The one-day thyroidectomy was found to be a safe, feasible and cost effective procedure, it is convenient for both the patient and the surgeon, and offers the same immediate and long-term results as the standard thyroidectomy in selected patients.

Adult↗
PubMed2001

Management of narrower anastomotic colonic strictures. Case report and proposal technique.

Management of narrower (<5-mm) colonic anastomotic stricture mainly is performed endoscopically by repeated balloon dilation often ineffectively. The use of metal self-expanding stents in the malignant and benign stricture of the large bowel has been suggested only recently, and is still being debated. In this report we propose a single-stage procedure that we developed to manage narrower anastomotic colonic stricture. A 60-year-old man 2 years previously had undergone surgery for perforated sigmoid diverticulitis by means of Hartmann's procedure. He was submitted to two mechanical recanalization attempts, both of which failed with dehiscence of anastomoses. He reached us with a significant stricture of the colorectal anastomoses (smaller than 5 mm in diameter) and a diversion ileostomy. After two endoscopic balloon dilations, we observed the relapse of the anastomotic stricture, so we decided to draw up another strategy. We performed a dilation with a TTS balloon, leaving a metallic self-expanding covered stent in situ for 3 months. The aim was to achieve the definitive healing of the anastomotic scar tissue at the desired diameter. We removed the stent during the ileostomy closure. At the time of this writing, 18 months of follow-up evaluation, the patient defecates without any problem

Anastomosis, Surgical↗
PubMed2001

Ultrasound duplex as a sole exam for surgical purposes in lower limb arterial obstructive disease.

BACKGROUND: The aim of the research is to value the efficacy of ultrasound duplex as a sole preoperative exam in peripheral Arterial Obstructive Disease (PAOD). Angiography is undoubtedly known as the gold standard, though its risks and complications. In the last decades duplex scanning and its variant, has proven to be an irreplaceable tool in the diagnosis of these disease. METHODS: We evaluated five previous studies that compare angiography to duplex scanning. RESULTS: Out of 273 cases, 207 (73.8%) had a good correspondence between the two methods; besides if we consider each arterial tract duplex reliability is better in distal diseases (159 cases out of 200, 79.5%) than in proximal (48 out of 73.65%) contrasting with an other meta-analytic evaluation made by Koelemay et al. Moreover we wanted to verify our personal experience, by the intention to treat method, if the surgical operation selected for our patients would have been the same based only on pre-operative echo-duplex scanning. After the analysis of about 20 files the research was interrupted because there was a perfect correspondence between the two exam only in three cases, all of them re-operation for graft branches obstruction. The lacks of duplex has been: 1) non identification of important lesions on the aorto-iliac tract; 2) insufficient location of distal disease. CONCLUSIONS: The angiography results the fundamental choice in the treatment of PAOD particularly in the distal tracts. Debatable is the role of echography in aorto-iliac portion, where a number of lesions may be effectively treated by endovascular procedures.

Arterial Occlusive Diseases↗
PubMed2000

Surgery of abdominal aorta in octogenarians. Can indications be extended?

BACKGROUND: This paper describes the authors' experience with the management of the abdominal aorta in patients aged over 80 years. METHODS: Ten urgent procedures were performed on patients older than 80 years during a 2 year period. In 4 cases surgery was performed because of a ruptured aneurysm of the subrenal abdominal aorta, in 2 cases for active symptomatic aneurysms, in 3 cases for severe lower limb ischemia (occlusion of the iliac and femoral arteries) and in 1 case for a secondary aortoenteric fistula. RESULTS: The operative mortality rate was 20% (2 cases with a ruptured aneurysm). Five patients are still alive in good health conditions (one of them had been operated twice for two different diseases). Even if our findings refer to a small number of patients, although similar series on emergency operations found in the literature are not substantially larger, the results do not advise against operative treatment of the abdominal aorta in cases requiring a direct approach, even in patients over 80 years of age. CONCLUSIONS: If this treatment strategy is obviously adopted in emergency conditions, as with the patients we are reporting on, since the alternative to operation is usually death, it should also be carefully considered in elective circumstances, where alternative treatments such as endovascular stents did not to date obtain better results. In the elective scenario all the necessary biological and physical parameters as well as the patient's age should be taken into proper account in deciding whether to operate. This is specially true now that the average life spans of an individual is longer so that patients, who may incur serious problems if left untreated, may be offered a better quality of life.

Age Factors↗
PubMed1998

Insulin-like growth factor-1 and insulin-like growth factor receptor in thyroid tissues of patients with Graves' disease.

Growth factors are frequently involved in the regulation of mitosis and differentiation of several cell types and insulin-like growth factor-1 (IGF-1) is actively involved in the thyroid stimulating hormone-mediated proliferation of thyrocytes. In view of the pivotal role of IGF-1 in thyrocyte proliferation and of the still unsettled role of this growth factor in the pathogenesis of hyperplastic thyroid lesions, we investigated the expression of IGF-1 and of its corresponding receptor, by means of immunohistochemistry, in the surgical specimens obtained from six patients with Graves' disease. Moreover, IGF-1 mRNA expression was analysed in one such case by means of Northern hybridisation. All samples showed consistent intracytoplasmic immunoreactivity for both IGF-1 and IGF-1 receptor; the vast majority of hyperplastic thyrocytes were strongly decorated by the two antibodies used in this study whereas stromal cells displayed IGF-1 immunoreactivity only. IGF-1 mRNA was markedly overexpressed in Graves' disease in comparison with normal thyroid tissues. The results of this study suggest that IGF-1 and IGF-1 receptor may be actively involved in the pathogenesis of Graves' disease; furthermore, IGF-1 and IGF-1 receptor apparently act by different mechanisms (paracrine vs. autocrine) as suggested by their differential expression in epithelial and stromal cells.

Graves Disease↗
PubMed1998

An unusual complication resulting from surgical treatment of periampullary tumours.

BACKGROUND AND METHODS: The authors describe the rising of four postoperative pancreatic pseudocysts in a series of 20 patients treated for periampullary tumours by pancreaticoduodenectomy (PDT), with the closure of pancreatic stump, between 1989-1996. The operation was always performed by the pylorus-preserving technique according to Traverso-Longmire. RESULTS: In four patients (20%) 3, 4, 4, and 8 months after PDT with closure of the pancreatic stump, the authors observed the development of pseudocysts (PPC) in the pancreatic remnant. All these patients previously had a pancreatic fistula. Three symptomatic patients underwent surgical drainage of the pseudocyst in a jejunal loop (2) or in the stomach (1); in the asymptomatic patient, the clinical feature and the size of the cyst allowed for conservative treatment. In 2 cases PPC was the consequence of a pancreatic fistula evolved in acute pancreatitis of the stump. The PPC drained by cystogastrostomy appeared 4 months after the closure of the pancreatic fistula: the pancreatic stump was completely substituted by a cyst presenting a communication with the pancreatic duct. CONCLUSIONS: The authors conclude that PPC is a rare complication of the pancreatic resection that results from acute or chronic pancreatitis; sometimes pathogenesis is due to a cyst resulting from the pancreatic duct occlusion by phlogistic tissue as a consequence of the surgical suture.

Aged↗
PubMed1982

Surgical treatment of chronic pancreatitis. Report of 134 cases treated by resection or drainage.

One hundred thirty-four patients (123 men and 11 women) were operated on for chronic pancreatitis (69 pancreaticojejunostomies, 20 cytopancreaticojejunostomies, 22 left pancreatectomies, and 23 Whipple operations). Half of these patients were followed up for 5 years or more. Four patients died from cancer of the pancreas. The operative mortality rate was 4.2 percent after anastomosis, 13.5 percent after pancreatectomy, and 8.7 percent after a Whipple operation. Relief of pain was the main aim of operation. The rate of good results after pancreaticojejunostomy (85 percent) was higher than after resection (71 percent after right pancreatectomy or Whipple operation and 66.6 percent after left pancreatectomy). The mortality rate after 5 years 26 percent after anastomosis, 30 percent after Whipple operation, and 45 percent after left pancreatectomy. Alcoholic intake did not appear to influence the operative result but improved the quality of life of the patient. Postoperative complications are more common and more serious after resection than after anastomosis. If dilated, the common bile duct must be drained as well as the pancreatic duct after anastomosis. Whenever the pancreatic duct is dilated more than 8 mm it must be drained rather than resected.

Adult↗
PubMed1981

Action of gastrointestinal hormones on the myoelectric activity of the sphincter of Oddi in living rabbit.

The aim of this work was to compare the action of gastrointestinal (GI) hormones on the myoelectrical activity of the sphincter of Oddi. Using an experimental design previously described, we studied the electrical activity of the sphincter of Oddi and compared the percentage variation in the number of spikes before and after injection of hormones. Increasing doses of the following hormones were injected i.v. at random: CCK, OP-CCK, caerulein, bombesin, gastrin, secretin and glucagon. CCK and caerulein (as previously found), and also bombesin, OP-CCK and gastrin increased the spikes activity of the sphincter of Oddi. Secretin had no effect and glucagon decreased this activity. There was no tachyphylaxis, but a good dose-effect relationship for each hormone. Compared on a molar basis caerulein is 8 times more effective than CCK and OP-CCK which in turn are more potent than bombesin. Gastrin acts only at pharmacological doses.

Ampulla of Vater↗
PubMed1980

An interesting case of pancreaticoduodenal trauma.

A case of severe duodenal trauma is described in which duodenal rupture occurred but relative integrity of the pancreas was maintained. Conservative surgical management with construction of a new papilla of Vater and with anastomotic protection by a gastrojejunostomy proved successful and obviated the need for pancreaticoduodenectomy.

Abdominal Injuries↗
PubMed1978

The parotid and the pancreas. V. Effects of a synthetic prostaglandin analog on parotid gland secretion.

Effects of a synthetic prostaglandin analog--16,16-dimethyl prostaglandin E2 methyl ester (16-diMe-PGE2)--on parotid secretion were evaluated in eight dogs under anesthesia. Graded doses of 16-diMe-PGE2 (0.3, 0.5, 1.0 and 2.5 microgram./kg.) were administered intravenously with the parotid in the resting state or in response to urecholine (intravenous infusion or subcutaneous injections). Profound and prolonged inhibition of volume occurred. Amylase concentration was increased but output was unchanged. Bicarbonate concentration was increased but output was decreased. Nonsteroid inhibitors of endogenous prostaglandin synthesis did not alter these effects. Although these studies do not establish a physiologic role for prostaglandins in the regulation of salivary secretion, they do demonstrate a wide-ranging effect of prostaglandins on the gastrointestinal tract.

Amylases↗