Post-traumatic intrasplenic pseudoaneurysm successfully managed by embolization.
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Accidents, Traffic↗
Biomedical subjects
M Pucciarelli
Publications and source records attributed to M Pucciarelli.
Outcome of surgical treatment for extrapancreatic gastrinomas.
Since the availability of the H2-receptor antagonists (1978), seven patients admitted to the Department of Emergency Surgery, University of Pisa, with Zollinger-Ellison syndrome (ZES) sustained by extrapancreatic gastrinomas underwent elective surgical treatment. There were four women and three men, with a mean age of 37.3 years (16 to 67 years of age). Preoperative localization studies included endoscopy of the upper part of the gastrointestinal tract, computed axial tomography, ultrasound, selective angiography and transhepatic portal vein sampling for gastrin and were effective in four patients. In the other three patients, the localization of the gastrinoma was made at laparotomy. Four patients had gastrinomas of the duodenal and jejunal wall. Three underwent excisional operations, whereas the remnant was treated with pancreatoduodenectomy. In three of the patients, the location of the gastrinoma was extrapancreatic and extraintestinal, and surgical treatment consisted of nodal excision (two patients) and hepatectomy. None of the patients had undergone a gastric operation in addition to tumorectomy procedures. Soon after excisional operation, ZES recurred in one patient and a second laparotomy with nodal excision resulted in a cure. On long term follow-up evaluation, ranging from 15 to 136 months (mean of 85.1 divided by 37.3 months), no patients showed a recurrence of ZES. The possibility of extrapancreatic gastrinoma should be suspected in patients with sporadic ZES. The need for emergency surgical treatment in these patients is minimized by the medical control of the gastric secretion that consents diagnostic studies for the preoperative localization of the gastrinoma. Even if only suspected, the site of the extrapancreatic gastrinoma has an increased chance to be identified at operation. This consents to remove gastrinomas mostly by a minimal excisional procedure resulting in the normalization of gastric secretion and the prevention of malignant evolution of these tumors.
Adolescent↗
Subcutaneous seeding after percutaneous ethanol injection of liver metastasis.
A 72-year-old cirrhotic woman underwent percutaneous ethanol injection treatment of a liver metastasis of unknown origin. A subcutaneous metastasis developed at the site of the punctures. Needle track seeding is a rare complication of fine-needle biopsy but has never--to the authors' knowledge--been reported after percutaneous ethanol injection. The possible causes of this complication are discussed.
Adenocarcinoma↗
Percutaneous ethanol injection treatment of autonomously functioning single thyroid nodules: optimization of treatment and short term outcome.
Twenty-five patients with solitary autonomous thyroid nodules (15 nontoxic, 10 toxic) received percutaneous ethanol injection treatment (PEIT) under sonographic guidance in 4-7 sessions (1-2 weekly). To test different doses, smaller nodules (volume less than 15 mL) were given 0.75-2.8 mL ethanol/mL nodular tissue while larger nodules received 0.5-1 mL/mL. Except for 1 patient who developed hyperpyrexia, no relevant adverse effects were observed. A slight, asymptomatic increase in serum thyroid hormone levels was observed in both groups during the treatment. Three months after treatment, a biochemical and clinical remission of hyperthyroidism was observed in 8 of 10 patients with toxic nodules. A significant increase of TSH level was seen in both groups (p less than 0.01). Significant shrinkage of volume (p less than 0.001) as well as structural alterations of nodules were consistently recorded at sonography. A linear relationship (r = 0.98; p less than 0.0001) between pretreatment volume and volume reduction was found both for large and small nodules, thus suggesting that even limited ethanol doses may be therapeutically effective. A recovery of extranodular parenchyma activity at scintiscan occurred in 16 (64%) of 25 patients. These data confirm that PEIT is effective in obtaining functional ablation and in inducing remission of hyperthyroidism. Adverse effects are infrequent. In spite of the small patient sample, a 0.5-1 mL ethanol dose per each mL of tissue appears as effective as larger doses and seems appropriate for treatment.
Drug Evaluation↗
[Echography in the surgical emergency].
Abdominal sonography represents the diagnostic method of choice in case of acute abdomen. On the bases of their experience on more than 1200 consecutive examinations performed in case of acute abdomen the author evaluate the fields of application of sonography in acute patients. A decisional algorithm in trauma patients based on sonographic results is presented. The actual indications of sonography abdominal non traumatic pathology are presented: paying particular attention to acute gastro-intestinal diseases. The therapeutic role of interventional sonography in the acute abdomen is also discussed.
Abdomen↗