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M Simi

Publications and source records attributed to M Simi.

At least 37 records · Page 2Linked to original sources
PubMed1996

[Acute biliary pancreatitis: mini-invasive treatment].

Acute biliary pancreatitis (ABP) still retains high morbidity (15-50%) and mortality (20-35%). Therefore it appears to be crucial clearly assessing the aetiological factors (50% of idiopathic are in fact biliary pancreatitis) and establishing the severity in order to plan the appropriate treatment. Forty-nine ABP patients were diagnosed by ultrasound (75.5%) or by laboratory findings (22.5%). Following Ranson and APACHE II scoring, 15 cases (30.6%) were classified as severe, 34 (69.3%) as mild. All patients with severe ABP had emergency ERCP + ES (within 24-48 hours) followed by LC (< or = 10 days). Patients with mild ABP had LC within 10 days; in these cases IOC was always done. In severe cases operative endoscopy cured pancreatic inflammation in 11 cases. Subsequent LC never showed serious morbidity, but subcutaneous emphysema in one case. In 4 cases laparotomy was required since pancreatic necrosis was present, with 75% mortality. In patients with mild pancreatitis LC was successfully performed in all cases, with 8.8% morbidity. IOC showed choledochal stones in 32.5% of cases, while in severe cases stones in the biliary tree were showed in 80% of cases. In conclusion ABP treatment is always surgical, and almost always with minimally-invasive procedures in severe cases (ERCP + ES with LC < or = 10 days) if surgery is performed within 24-48 hours as well as in mild cases (LC + IOC) when surgery is done within 10 days.

APACHE↗
PubMed1996

[Acute cholecystitis: video-laparoscopic or laparotomic treatment? Role of the immune system].

Recent clinical studies suggest that laparoscopic cholecystectomy (LC) causes less depression of cell-mediated immunity than open cholecystectomy. LC is a so called "mini invasive" surgical presidia, and on the basis of this consideration we have investigated if and how the immune response is modified in patients with acute cholecystitis after laparoscopic cholecystectomy compare to patients undergone open cholecystectomy. Immune-activity (neutrophils, total lymphocytes count, lymphocytes subpopulations, HLA-DR, 6-Interleukin, skin multitests) was evaluated in 28 patients 24-36 hours before surgery and p.o. after 1, 3 and 6 days: 16 patients underwent "open" cholecystectomy and 12 LC. One day after surgery patients with open cholecystectomy showed significant increase (p < or = 0.05) of plasma neutrophils and 6-Interleukin, while these parameters were almost unchanged in patients with LC. Moreover, skin tests showed ipo or anergic response in the majority (81.8%) of patients with "open" surgery compare to patients with LC (10.5%): (p < or = 0.05). Finally monocyte antigen HLA-DR was also reduced in patients with "open" cholecystectomy: in this group we also recorded 2 cases (12.5%) of respiratory tract infection. In conclusion, LC for acute cholecystitis, avoids p.o. immunosuppression with better p.o. morbidity compare to open surgery.

Acute Disease↗
PubMed1996

[Chronic abdominal pain: role of video-laparoscopic adhesiolysis].

Adhesions have been suggested as a possible cause of chronic abdominal pain, but the reports of their etiological role conflict. Lysis of adhesions has been proposed as the therapeutic modality of choice, although the reports of success are controversial. The aim our prospective study was to determine whether laparoscopic adhesiolysis ameliorates chronic abdominal pain in patients with abdominal adhesions. Forty-one patients with chronic abdominal pain lasting for more than 6 months, but with no abnormal findings other than adhesions found at laparoscopy, underwent laparoscopic adhesiolysis. 37 patients (90.2%) were available for follow-up after a median time interval of 18 months (range: 12-41 months). Twenty-two patients (59.4%) were free from abdominal pain and 9 (24.3%) patients reported significant amelioration of their pain. Six (16.2%) patients had no amelioration. In conclusion the laparoscopy is an effective tool for the evaluation of patients with chronic abdominal pain, and laparoscopic adhesiolysis cures of ameliorates chronic abdominal pain in more than 80% of patients.

Abdominal Pain↗
PubMed1995

Bowel stricture due to ischemic colitis: report of three cases requiring surgery.

The diagnosis of ischemic colitis is challenging and still based upon a high index of suspicion. We report here, three patients affected by ischemic colitis causing stenosis and intestinal obstruction that required surgical treatment. Results of surgery in the three cases were not fair reflecting the high mortality and morbidity rate of ischemic colitis. However, the three cases showed peculiar features allowing us to make a few speculative considerations. Better results in the treatment of ischemic colitis might be achieved by means of a prompt recognition of the initial picture and through a better control of the many associated diseases, that represent the main risk factor for the development of ischemic colitis itself and for the bad prognosis of surgical treatment.

Aged↗
PubMed1995

["Occult" carcinoma of the thyroid: clinical, morphological, and biologic characteristics for a correct therapeutic regime].

The "occult" carcinoma of the thyroid is still a highly controversial topic. The controversies not only regard its diagnosis, treatment, natural history and, therefore, its biological potential, but also aspects of a nosological nature in that there is still no unequivocal acceptance of its originality, thus leading to discussions focused on its precise definition. On the basis of our experience and other published data, we have reached the following conclusions: a) the term "occult" carcinoma of the thyroid must be used to describe a neoplasia which does not exceed 1.5 cm in diameter, irrespective of the presence or otherwise of laterocervical adenopathy, and leaving aside the fact that it can be identified using clinical and instrumental tests; b) high-resolution echography and echo-guided FNA are fundamental instruments for a correct and early preoperative diagnosis; c) the clinical, morphological and, above all, biological (a very slowly evolving neoplasia) characteristics make the occult carcinoma of the thyroid seem to be a tumour with its own nosological identity; d) on the strength of the latter, and in particular in view of its natural history, conservative surgery (lobectomy with isthmectomy), in the differentiated forms, might play a primary role in the treatment of occult carcinoma of the thyroid in the very near future. However, at present complete thyroidectomy represents the treatment of choice even in differentiated forms, whereas lobectomy is only reserved for incidental cases of occult carcinoma discovered during the final histological test; e) lymphadenectomy is indicated in the event of lymph node involvement, not to achieve a longer survival rate but to reduce the incidence of recidivation in the form of lymph node metastases. In these cases, even the mere removal of macroscopically damaged lymph nodes is sufficient to ensure the virtual absence of recidivation on which, it is worth noting, metabolic radio-iodotherapy is efficacious in the large majority of cases.

Adult↗
PubMed1995

[Intestinal obstruction caused by ischemic colitis: description of 3 surgically treated cases].

The diagnosis of ischemic colitis is challenging and still based upon a high index of suspicion. We report here, three patients affected by ischemic colitis causing stenosis and intestinal obstruction who required surgical treatment. Results of surgery in the three cases were not fair reflecting the high mortality and morbidity rate of ischemic colitis. However, the three cases showed peculiar features allowing us to make a few speculative considerations. Better results in the treatment of ischemic colitis might be achieved by means of a prompt recognition of the initial picture and through a better control of the many associated diseases, that represent the main risk factor for the development of ischemic colitis itself and for the bad prognosis of surgical treatment.

Aged↗
PubMed1995

[Cholelithiasis in the patient with cirrhosis of the liver: surgical aspects].

Open cholecystectomy in cyrrotic patients with good liver functions has operative mortality similar to normal subject (0.5-1%), while in patients with severe hepatic cyrrosis mortality varies between 7 and 83%. In this study we have evaluated the post operative results in cyrrotic patients undergone to open cholecistectomy in order to evaluate indications, controindications and risk factors related to surgery. In the last 7 years 34 patients with liver cyrrosis have been operated for biliary calculi, one of them had laparoscopic cholecystectomy. Morbidity was 29.4% (10 cases) mortality 8.8% (3 cases). Jaundice was the main indication for emergency (66.6%) in the two cases it was related to uncompensated liver functions. Endoscopic Retrograde Cholangio-Pancreatography (ERCP) can demonstrate today the causes of jaundice avoiding unecessary operations. Post operative evaluations of our series confirm that operative risk is strictly related to epatic disease and to an appropriate surgical option. Moreover patients with compensated liver cyrrosis, (Child A), do not represent anymore a controindication to laparoscopic cholecystectomy that has less septic post operative complications when compared to open surgery.

Aged↗
PubMed1993

Neuroendocrine epithelial cells of the main pancreatic ducts and ampulla.

In this study we investigated by immunocytochemistry (peroxidase-conjugated extravidin-biotin system) the existence of neuroendocrine cells in the main ducts draining the exocrine pancreas and in the ampulla of Vater of six human specimens obtained at surgery (duodenocephalopancreasectomy). Using a panel of primary antibodies for Chromogranin A, gastrin, CCK, somatostatin and serotonin (5HT), we visualized scattered neuroendocrine cells in the epithelium of Wirsung duct and in the ampulla. All were positive for Chromogranin A and the majority were also positive for serotonin (5HT), while gastrin cells were seldom observed. Interestingly, their number was far lower than in the adjacent duodenal mucosa. We believe that these neuroendocrine epithelial cells may have specific physiological roles such as epithelial trophism and differentiation.

Aged↗
PubMed1991

Incidence and indications for cholecystectomy in a public health district of a small town in central Italy.

There are major differences in cholecystectomy rates between different countries. We prospectively recorded all gallbladder operations in L'Aquila, Italy (a small town in central Italy with a population of about 98,700 inhabitants) from June 15, 1987 to June 14, 1988. During that year 210 cholecystectomies were performed (women and girls = 71.4%), for a calculated yearly incidence rate of 0.212%. Cholecystectomy was elective in 85.2%, urgent in 8.6%, and was performed in the course of other abdominal operations (mainly colon cancer) in the remaining 6.2%. Half (44.3%) of the patients were operated on because of at least one episode of biliary colic, and 9.0% because of an acute complication. Respectively 16.2% and 30.5% were operated on because of dyspeptic symptoms or to prevent symptoms or complications. Gallstones were not found in six, while exploration of the common bile duct revealed gallstones in seven patients. The chemical analysis showed that 84.7% were cholesterol stones (mixed or pure). We presume that most observed differences in cholecystectomy rates between different Western countries are more likely owing to differences in indications for surgery rather than to differences in prevalence of gallstones.

Cholecystectomy↗
PubMed1990

Enteroglucagon and peptide Y-Y response after construction of a pelvic reservoir in humans.

The results of an investigation of plasma levels of gastrointestinal hormones in patients after the construction of a pelvic reservoir are reported. Enteroglucagon (EG) and peptide tyrosine-tyrosine (PYY), two hormones believed to play a relevant role in the adaptive response to bowel resection, were investigated using a specific radioimmunoassay in basal conditions and after a standard meal. Pouch patients showed a statistically significant increase in basal levels of both enteroglucagon and PYY compared with control subjects (P less than 0.02 and P less than 0.001, respectively). The response of enteroglucagon to food ingestion, evaluated by means of the total integrated response, was similar in patients and controls. Conversely, the response of PYY was significantly increased in pouch patients compared with control cases (P less than 0.02). Results of this investigation suggest that gut hormones may be involved in mediating the adaptive response of the intestine to pouch construction. Changes of gut peptides may explain, at least in part, the functional results observed after pouch construction.

Adult↗
PubMed1990

Immunocytochemical study of endocrine cells in pelvic ileal reservoirs.

The distribution and morphology of intestinal endocrine cells was investigated in the mucosa of pelvic ileal reservoirs using immunocytochemical methods. Endoscopic biopsies were obtained from 15 patients after the construction of a modified J-pouch. The mucosa of the reservoir showed a variable degree of colonic metaplasia in all cases. No relevant quantitative variations of gut endocrine cells were detected, as revealed by immunostaining for the general marker, chromogranin, compared with normal ileal mucosa. Immunostaining for different peptide-containing cells resulted in normal number and morphology of serotonin, enteroglucagon, peptide tyrosine-tyrosine, and somatostatin-containing cells. Neurotensin cells were less numerous than in normal mucosa. The role played by gastrointestinal hormones in the adaptive response of the intestine to pouch construction is, presently, unclear. Further studies involving measurements of fasting and meal-stimulated levels of gut hormones in pouch patients might clarify this aspect.

Adult↗
PubMed1990

Early complications after surgery for Crohn's disease.

A group of 212 patients operated upon for Crohn's disease were studied and the early postoperative complications with related problems were assessed. The morbidity was 28.3 per cent, 60 patients had at least one complication, mainly of septic nature. The mortality was 3.3 per cent (7 patients), sepsis and deep vein thrombosis with pulmonary embolism were the most common causes of death. Postoperative complications were significantly higher (39.7%) (p less than 0.001) in patients with a pre-operative nutritional deficit and in those who had urgent surgery (44.4%) (p less than 0.001). Among patients with pre-operative sepsis, the morbidity was also higher (34.6%), but was not significant. Peri-anastomotic complications (dehiscence, abscess, fistula, bleeding) were apparently more frequent (45.4%) in patients with histological residual Crohn's disease at macroscopically free resection margins although this contrasts with previous series. A proper pre-operative diagnostic approach, adequate peri-operative protein-caloric repletion, antibiotic therapy, prevention of thromboembolism and elective surgery, are still the primary tools in reducing the morbidity and mortality after surgery for Crohn's disease.

Adolescent↗
PubMed1990

[An animal model for the study of liver regeneration by magnetic resonance imaging].

Liver regeneration after partial hepatectomy was studied in rats by means of magnetic resonance (MR) imaging and T1 relaxation time. Fourteen hepatectomized rats were compared to sham operated ones and to controls which had not undergone any surgical treatment. The animals were imaged at 0.5 T, and inversion recovery (IR) technique was employed at the T-null of liver before surgery. T1 was determined in vitro with spectroscopy. Regenerating rat liver exhibited a significantly high increase in MR signal intensity and T1 values (p less than 0.05) 24 hours after surgery, returning to baseline values at 2 weeks. Sham operated animals and controls did not exhibit significant changes in signal intensity from baseline values (p greater than 0.05). These findings suggest that MR imaging is able to detect the pathophysiological changes occurring in liver parenchyma during the regenerating process and to monitor different stages of the hyperplastic process.

Animals↗
PubMed1989

Heterotopic gastric mucosa of the rectum--characterization of endocrine and mucin-producing cells by immunocytochemistry and lectin histochemistry. Report of a case.

Heterotopic gastric mucosa in the rectum is particularly uncommon; only 23 cases have been reported to date. Moreover, no studies have been done on the neuroendocrine apparatus and glycoprotein production of the heterotopic mucosa. This study reports on a 13-year-old boy, admitted with rectal bleeding and persistent tenesmus. An ulcerative lesion was found on colonoscopy; biopsies revealed a fundic-type gastric tissue. Medical therapy (H2-blockers) promptly healed the rectal ulcer; surgical excision of the heterotopia was performed with complete and permanent relief of symptoms (3-year follow-up). Immunocytochemistry (PAP) revealed 5-Ht and somatostatin cells in the gastric-type mucosa, as in the normal human stomach. These cells also were present in the surrounding rectal epithelium where PYY-enteroglucagon cells were detected, which were absent in the heterotopic tissue. Mucin histochemistry showed PAS-positive cells also strongly stained by LA lectin in the heterotopic tissue, differentiating the rectal epithelium that remained unstained. Therefore, the morphofunctional status (endocrine cells and mucins) of the gastric heterotopia was almost identical to its orthotopic counterpart, confirming the hypothesis that endocrine cells and mucin-producing cells differentiate their metabolic products according to the anatomic and functional activity of the epithelium where they grow.

Adolescent↗
PubMed1989

Intestinal endocrine cells in radiation enteritis.

In this study, the intestinal endocrine cells were investigated in 13 surgical specimens affected by radiation enteritis. Endocrine cells were studied by means of Grimelius' silver staining and immunostaining for chromogranin, a general marker of endocrine cells. Positively stained cells were quantified by counting their number per unit length of muscularis mucosa. Results in radiation enteritis were compared with matched control specimens by using Student's t test. Chromogranin immunostaining showed a statistically significant increase of endocrine cells in radiation enteritis specimens compared with controls both in small and large intestine (ileum, 67.5 +/- 23.5 cells per unit length of muscularis mucosa in radiation enteritis versus 17.0 +/- 6.1 in controls; colon, 40.9 +/- 13.7 cells per unit length of muscularis mucosa in radiation enteritis versus 9.5 +/- 4.1 in controls--p less than 0.005 in both instances). Increase of endocrine cells was demonstrated also by Grimelius' staining; however, without reaching statistical significance. It is not clear whether or not the increase of endocrine cells in radiation enteritis reported in this study is caused by a hyperplastic response or by a sparing phenomenon. We should consider that increased endocrine cells, when abnormally secreting their products, may be involved in some of the clinical features of radiation enteropathy. In addition, as intestinal endocrine cells produce trophic substances to the intestine, their increase could be responsible for the raised risk of developing carcinoma of the intestine in long standing radiation enteritis.

APUD Cells↗
PubMed1988

Diagnostic and therapeutic problems of non perianal fistulas and abscesses in Crohn's disease.

Problems related to the appearance of non perianal fistulas and abscesses are examined in a series of 204 patients operated on for Crohn's disease. Incidence of these complications was 34.3% (70 cases); one or more fistulas were present in 54 patients, associated with abscesses in 13, while abscesses alone were present in 3. The highest incidence was observed in the male sex, in patients over 50 years, and in the presence of stenosing Crohn's lesions (P less than 0.001). On the contrary, the primary site of Crohn's disease does not seem to affect significantly their appearance. The clinical suspect of fistulas or abscesses should be supported with radiographic, endoscopic, echographic and scintiscan findings, even though about 7.2% of fistulas are diagnosed only intraoperatively. Surgical treatment is the most suitable therapeutic management; however enteroenteric and mesenteric fistulas are only relative indications for surgery. TPN is suitable for postoperative enteric fistulas (5 cases). Postoperative morbidity is not different in patients with or without such complications at surgery. Long-term prognosis of non perianal fistulas and abscesses is related only to recurrences of Crohn's disease and their anatomopathologic evolution.

Abscess↗
PubMed1987

Prediction of surgery for obstruction in Crohn's ileitis. A study of 64 patients.

The charts of 64 patients with Crohn's ileitis were reviewed to determine what characteristics at the time of first observation at a specialized center were predictive of surgery for irreversible obstruction, using Cox's proportional hazard model. Individual variables which proved significant (P less than 0.01) included age at presentation to the clinic, serum albumin, sedimentation rate, and the presence of radiologic strictures. Patients eventually requiring surgery were older than the rest because of a later date of symptom onset; furthermore, patients with strictures on initial x-rays had not been ill for a longer period of time than those who did not have strictures. These data suggest that fibrosis and stenosis are characteristic of a subgroup of Crohn's patients, rather than being inevitable phases of disease evolution. Multivariate analysis revealed that patients with low serum albumin, high sedimentation rate, and roentgenologic stenosis at first observation were ten times as likely to require surgery for obstruction at 10 years than those without any of these three unfavorable parameters.

Adult↗