Biomedical subjects
M Rusca
Publications and source records attributed to M Rusca.
[Proposal of a surgical technique to avoid deformities after conservative treatment of T1 tumors of centroinferior quadrants of the breast].
An important aim of breast surgery is to perform a conservative treatment in which both oncological and cosmetic purposes are fulfilled. This is achieved for the T1 tumors of the upper quadrants by means of the elliptical radial quadrantectomy. In the central or inferior quadrants the cosmetic results performing the same technique are poor. We have recently published a new technique called Centroinferior Hemimastectomy for the treatment of T1 breast cancer with which both the aims are respected. We report the data obtained from thirty-three consecutive Centroinferior Hemimastectomies performed from January 1989 until June 1993. The tumors were removed as described and for those centrally located also the nipple areola complex was removed. The reconstruction was carried out by immediate reimplantation of the nipple (10 cases) or later by tattooing (16 cases). For the tumors located in the inferior quadrants, the nipple-areola complex was made to emerge through the circular skin incision and sutured separately (7 cases). The oncological follow-up (range 3-42 months, mean 16 months) did not show local or systemic relapses. The cosmetic evaluation of the patients was subjectively and objectively very good. Thus the technique can be considered a research progress offering a better quality and quantity of life.
[Analysis of type II pneumocyte protection by pneumoplegic solutions. An experimental in vitro study of lung preservation for transplantation].
With the aim of studying the physiopathological mechanism of lung preservation, we have valued the Pneumocytes Type II viability after six hours of incubation at 4 degrees C in extracellular (Ringer Lactate) and intracellular (Collins, Euro-Collins and Belzer) solutions. The cells have been cut off from adult rat's lung using the modified Dobbs' method. Alveolar Type II viability have been valued using two methods: the total protein content in each culture and the metabolic function of the cells using the rate of protein synthesis by means of 35 S methionine uptake assay. The results have demonstrated a significant difference (p < 0.05) using extracellular solution instead of intracellular. Besides, we have observed a better Pneumocytes Type II survival during Belzer's solution incubation comparing with Collins and Euro-Collins (p < 0.05). Pneumocytes type II require for a better preservation a specific solution that must be similar to extracellular fluid and added with substances able to minimize noxious events during preservation.
Contralateral spontaneous pneumothorax after single lung transplantation for fibrosis.
The authors report the treatment of a case of contralateral spontaneous pneumothorax during single lung transplantation. This is a unusual complication that must be treated to avoid life-threatening problems. There is no consensus of opinion on therapeutic procedures. This work underline the success obtained with a simple thoracostomic drainage.
[Evaluation of the clinical efficacy of misoprostol for gastric cytoprotection in patients under treatment with NSAID after proctologic intervention].
To perform ambulatorial surgery with local anaesthetics, it is important to carry out a correct postsurgical NSAID therapy avoiding the risks induced by these drugs. Two groups of patients submitted to ambulatorial hemorrhoidectomy were enrolled in a randomized study to evaluate the safety of NSAID therapy with or without the coadministration of misoprostol, a PGE1 analogue with gastroprotective action. Aim of this study was to evaluate if misoprostol in coadministration with NSAID could permit a correct domiciliary postsurgical NSAID therapy without gastric symptoms related to the NSAID therapy. From January 1990 to December 1991, 95 patients underwent hemorrhoidectomy and were discharged with analgesic therapy: the first group (n = 45) without gastroprotective therapy, the second group (n = 50) with the coadministration of misoprostol 200 mcg bid. After 7 and 14 days of treatment patients showed the following symptoms: in the first group 13.3% of the cases showed mild epigastric pain, 8.8% moderate epigastric pain and 4.4% severe epigastric pain with heartburn; in the second group (NSAID + misoprostol) only 4% of the cases showed moderate epigastric pain. The incidence of epigastric pain was statistically higher (p < 0.05) in patients treated with NSAID alone in comparison with the group treated with NSAID + misoprostol. The results, according to international literature, show that correct gastro-protective therapy with synthetic prostaglandins (misoprostol) is necessary for patients in treatment with NSAIDs.
[Videothoracoscopic treatment of spontaneous pneumothorax].
In the period between May and October 1992 we have admitted in our department 14 patients (M/F: 11/3) with recurrent spontaneous pneumothorax, being the entity more than 40% in 8 of them. All the patients were treated with video-assisted thoracoscopic pleurectomy, beginning from the 2nd to the 6th rib, completing by abrasing the further ribs below. Whenever the causative bullae or blebs were found, those were resect using and endoGIA. At the end of the procedure a pleural drain (no. 24) was positioned and maintained on suction until a complete lung reexpansion was ensured for at least a couple of days. Neither postoperative nor delayed complications and no recurrences have been observed. Our results of such an approach, once indicated the pleurodesis for the treatment of spontaneous pneumothorax, are undoubtedly encouraging both for the technical simplicity and the reduction in hospitalization time.
[Videothoracoscopic wedge resections of the lung].
The recent development in thoracoscopic instrumentation has widely improved their surgical applications so to allow lung resection whether for diagnostic of therapeutic purpose. From June to December 1992, we performed 14 segmental atypical lung resections in 12 patients. The indications were: recurrent spontaneous pneumothorax due to bullae or blebs in 7 cases, solitary peripheric lung nodule in 6 cases, for diagnostic purposes in suspicious interstitial lung disease in one case. Lung resection were carried out using stapling device (EndoGIA). In the cases of solitary lung nodule, the frozen section confirmed the presence of metastases in 4 subjects and thus it was proceeded towards an exploratory mini-thoracotomy (3 cm long) so to allow a further palpatory video-assisted evaluation of the lung surface. The remaining 2 patients were diagnosed to have hamartomas. The wedge resection in the patient with interstitial lung disease allowed diagnosis of sarcoidosis. There were no postoperative complications, nor deaths. Video-thoracoscopic lung wedge resections are indicated for treating bullae and blebs while performing pleurectomy for spontaneous pneumothorax, for removing benign and metastatic peripheral lung nodules. The procedure is substantially diagnostic in case of interstitial lung diseases. It's important to underline that the therapeutic value of thoracoscopic approach for metastatic lung nodules has not proved to be less or more efficient than the thoracotomy one and for this reason further investigations are required.
[Videothoracoscopy in diagnosis and treatment of chronic pleural effusions].
Thoracoscopy is the most important method for the diagnosis, and in particular cases for the treatment, of chronic pleural effusion of unknown aetiology. The Authors report their experience of 4 cases, 2 males and 2 females, that underwent a thoracoscopy from June to December 1992. The method was done in 3 cases in general anesthesia and in one case in local anaesthesia.
[Functional study of the esophagus in progressive systemic sclerosis: utility of the manometry].
The authors report their experience about the esophageal manometry in patients with Progressive Systemic Sclerosis (PSS). From January 1987 to December 1991, 32 patients (27 females and 5 males, in the ratio of 5.4 to 1; mean age of 56.6 years, range 18-84) were send to our Department with the diagnosis of PSS. The patients were divided in two group according to the presence or absence of esophageal symptoms. The first group (A) of 12 patients without symptoms, was examined only with manometry, while the second (B) was studied with the 24-hour pH-monitoring and esophagoscopy. In the group A the manometry noticed in 9 cases (75%) various degrees of esophageal motility disorders; in B the 90% of cases had a more or less severe disorder of the peristalsis. Moreover the grade of esophagitis and the importance of the gastroesophageal reflux were proportioned to the motility disorders. The conclusion is that also the subjects with PSS, but without esophageal symptoms, have in a high percentage motility disorders of the viscera. The alterations of the peristalsis increases in the group of symptomatic patients associated with esophagitis and severe reflux. On account of the fact that the esophageal lesions involve not only the LES but also the esophageal body, it is clear that the anti-reflux surgical procedures fail and an early medical therapy is the more adequate treatment.
[Mechanical sutures in gastroesophageal surgery: usefulness and limits of our experience].
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[Endoscopic sclerotherapy of bleeding gastroduodenal ulcer. Our experience].
The Authors report their experience in the treatment of bleeding gastric and duodenal ulcers by means of endoscopic sclerotherapy. From August 1988 to December 1989, 104 patients with haematemesis and/or melena were observed at the Clinica Chirurgica Generale, Toracica e Vascolare-Università di Parma. Endoscopy, carried out in the first 24 hours, led to the diagnosis of a bleeding gastric or duodenal ulcer in 73 cases; 22 of these patients underwent emergency sclerotherapy using 1:10,000 Adrenaline in association with 1% Polydocanol. Results obtained are the following: absolute haemostasis in 20 patients (91%), and surgical intervention in the other 2 cases for renewed haemorrhage. Among patients endoscopically treated, one death (5%) was recorded. Further complications were not encountered. The Authors believe sclerotherapy is reliable and quick thus representing a considerable therapeutic advance in the treatment of gastroduodenal haemorrhage, notoriously at high death rate (8-10%).
[Preliminary experiences of the University of Parma study group on "The diagnosis and treatment of chronic constipation"].
The authors present a report of their study on a group of patients affected by serious chronic constipation undergoing multidisciplinary evaluation by a radiologist, a neurologist and, if necessary, also a psychiatrist. From June 1989 to October 1990, 40 patients were examined using anal manometry, intestinal transit time, proctogram and electromyography of the pelvic floor. The examinations carried out by the different specialists led to the following results: 10 patients were found to be affected by slowed transit due to right colon constipation; in 16 cases, spastic pelvic floor syndrome (S.P.F.S.) was diagnosed; 5 subjects showed a rectocele which in 3 was associated with S.P.F.S.; 3 patients presented with an anterior rectal prolapse; in 6 cases the diagnosis was perineal descent syndrome, associated in 3 cases with S.P.F.S.; the remaining 6 subjects manifested a diminished ampullary sensitivity. This experience reveals the complexity of the alterations that, alone or in association, cause chronic idiopathic constipation. The authors' conclusion is that a correct diagnostic approach requires close collaboration between various specialists, who, by careful examination of different aspects of the colo-recto-anal region, arrive at an accurate physiopathological diagnosis leading to the most suitable therapy.
[Significance of explorative thoracotomy in the diagnosis and symptomatic treatment of bronchogenic carcinoma].
Diagnostic imaging and mediastinoscopy have reduced but not eliminated the exploratory thoracotomy in the management of lung cancer patients. Considering all the limits of such diagnostic techniques, an aggressive approach to lung neoplasm imply an increase both in explorative thoracotomies and in radical or palliative intraoperative procedures. Our study includes 55 explorative thoracotomies performed on 206 surgical operations for lung cancer. The patients of E.T.'s group couldn't undergo surgical resection in 28 cases because of direct tumoral mediastinal diffusion, involving cardio-pericardial wall and/or great vessels; in 20 for extensive nodal mediastinal diffusion, in 3 patients for pleural dissemination, and 4 had unresectable chest wall involvement. Postoperative mortality rate was 3.6% vs. 5.5% recorded in resected patients; postoperative morbidity rate was 9%. During explorative operations became possible to define more exactly diagnosis and, through palliative procedures, to improve life quality: in fact we performed tumor histology correction or settlement (12/55 P.ts), pericardiotomy for pericardial effusion (5/55 P.ts), pleurodesis or pleurectomy when pleural effusion was present (16/55 p.ts), intercostal neurolysis in involved chest wall areas (4/55 p.ts).
Plasma and tissue CEA and TPA markers in operable breast cancer. Preliminary results.
CEA and TPA were studied in sera and in histologic specimens of 200 patients with benign (77) or malignant (123) breast pathology. The frequency and expression of the two markers was different in benign and in cancer tissues. Histologic positivity and high levels of circulating markers were observed more frequently in cancer patients than in patients with benign disease. Tissue positivity for the two tumor markers did not always correlate with elevated levels of circulating markers. Positive CEA and TPA incidence was higher in tissue samples than in serum samples. In the breast cancer group, among 33 patients with histologic positivity for CEA, only 5 cases had circulating CEA levels higher than 5 ng/ml; among 91 patients with histologic positivity for TPA, only 45 cases showed circulating levels for TPA higher than 95 U/l. These findings confirm that tumor size, secretory characteristics and vascular supply are factors affecting the achievement of high circulating marker levels. Combined marker measurement in serum and tissues can provide more information about the presence of a given tumor marker. A limited evaluation of the prognostic meaning of the study of combined CEA and TPA in sera and in tissues was carried out during the follow-up of 60 evaluable patients. Only 5 patients had cancer relapses in the first 12 months from surgery; in 2 of 5 patients TPA was positive initially and at the time of recurrence, in serum as well as in tissues. Circulating CEA gave negative findings in all relapsed patients; 2 of them showed weak positivity only in the histologic staining at the time of presentation.
[Carcinoma of the esophagogastric junction].
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[Perendoscopic bleomycin treatment of inoperable neoplasms of the esophagus: our first clinical experience].
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[Treatment of stenosis and prolapse of colostomy: ambulatory surgery].
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[Surgical treatment of pulmonary metastasis: diagnostic protocol and individualization of indication criteria].
Lung is the second most frequent site of cancer metastasis (29% of autopsies). At the present time, surgery is the only potentially curative treatment available to patients with no other secondary localizations. Solitary or multiple, unilateral or bilateral, and synchronous or metachronous appearing pulmonary shadows, in cancer patients, give rise to both diagnostic and therapeutic problems. Diagnostic methods are selected by sensibility and specificity. The most sensitive is the thoracic C.T. (sens. 94%; spec.: 76%) and the most specific is fine needle biopsy (sens.: 92%; spec.: 98%). These two tests alone provide diagnostic certainty in 97-100% of cases, including small (3-6 mm) subpleural and multiple lesions. Tomography, bronchoscopy or Ga-67 scanning are indicated only in selected cases. Selection of patients for surgical treatment is based on: 1) tumors almost exclusively producing pulmonary metastasis (soft tissue sarcomas, renal, head and neck cancers); 2) tumor-free time (1 year considered good long) 3) length of doubling time (+40 days). This selection criteria also applies to multiple and/or bilateral lesions. Surgical treatment consists of surgical excision with minimal parenchymal sacrifice. Long-term follow-up after metastasectomy, shows a considerable improvement in both the survival period and residual quality of life in comparison to patients not surgically treated, or treated by chemotherapy alone.