Biomedical subjects

M T Paganelli

Publications and source records attributed to M T Paganelli.

6 recordsLinked to original sources

PubMed1999

Benign biliary stricture. Personal experience and technical notes.

BACKGROUND: Benign biliary strictures are a binding situation for clinicians when choosing the best treatment. This is a benign disease and needs safe, effective and lasting therapy. Up to day non surgical treatment have been suggested as the first therapeutical option but surgery seems to support the best late results. METHODS: The authors report their experience in 206 patients, 64 males and 142 females, aged from 27 to 77 years, affected by postoperative (160 patients) or inflammatory (46 patients) biliary strictures. All the patients but three had been treated by surgical procedures. RESULTS: Postoperative morbidity and mortality were 18.4% and 3.4% respectively. Follow-up ranged from 2 to 16 years. Late stricture of bilio-enteric anastomosis has been observed in 8.2% of patients and peptic ulcer or cholangitis in 4.9% of cases. Restenosis appeared after a mean time of 2.5 years (range 20 months-6 years), supporting the need for a long term follow-up. Effective late results have been reported in 91.5% of patients. No late complications of ineffective results have been observed after transduodenal sphincterotomy. CONCLUSIONS: The authors propose some guidelines for choice charce of treatment, analysing the limits of non surgical therapy and underlying the best surgical tactics. Bilio-enteric anastomosis is a safe, effective and lasting therapy for biliary strictures; Hepp-Couinaud hepatico-jejunostomy is the best choice for high-medium stricture; transduodenal sphincterotomy preserves its important role in low biliary stenosis.

Adult↗

PubMed1998

[Mannhein index in the prognosis and treatment of acute peritonitis].

BACKGROUND: Early prognostic evaluation of patients affected by acute peritonitis is really desirable to program a correct therapeutic plan, selecting high-risk patients for more aggressive therapeutic procedures. The Mannheim peritonitis index is reliable and easy to apply, so its use is possible without the need of intensive care units. METHODS: Between 1991 and 1995 a total of 235 patients were operated on for acute peritonitis. A retrospective study on this group of patients was performed in order to estimate prognostic reliability of Mannheim peritonitis index. RESULTS: The overall mortality was 8.1%; for patients with a score less than 26 the mean mortality rate was 2% and for score greater than 26, 40.5%. This score is the threshold over which the therapeutic approach have to be more aggressive; planned multiple laparotomies or the open abdomen technique could be the best options to explore and clean up the peritoneal cavity from septic debris. In personal experience, all patients who died had residual sepsis in peritoneal cavity.

Adolescent↗

PubMedDate not supplied

[Intralobular pulmonary sequestration: apropos a case].

The authors report their experience with a patient suffering from an intralobar bronchopulmonary sequestration (IBS). The lesion was misdiagnosed as metapneumonic lung abscess. IBS is a rare, diagnostically binding lung congenital malformation. So far, TC and MR angiography achieve pathognomonic findings with low invasivity. The best treatment of IBS could be surgical resection.

Adult↗

PubMedDate not supplied

[Isolated rupture of aneurysm of the internal iliac artery].

Isolated aneurysms of the internal iliac artery are rare and often asymptomatic. They are frequently diagnosed as a result of complications such as rupture. The authors describe in detail two cases of ruptured aneurysms of the internal iliac artery treated by emergency surgery with no perioperative mortality or morbidity.

Aged↗

PubMedDate not supplied

[Endoscopic percutaneous gastrostomy with gastropexy: a safe technical choice].

Percutaneous endoscopic gastrostomy is an interesting method of providing enteral nutrition or gastric decompression in patients who are candidates for operative gastrostomy or nasoenteric tube feeding. We report our experience with percutaneous endoscopic gastrostomy with gastropexy (Introducer T-Fastener) in 41 patients. This method uses a technique in which the anterior gastric wall is non-surgically sutured to the anterior abdominal wall before catheter insertion. This technique was successful in all patients, including one subject with a Billroth II hemigastrectomy. Enteral nutrition was started in all cases within 24 hours of the end of the procedure. The medium enteral nutrition period to date is 482.5 days. There were no deaths related to the procedure and no patients had major specific abdominal complications requiring urgent surgical repair. Eight patients complained of minor specific complications which were successfully resolved in all cases with simple conservative procedures and/or therapies. These results indicate that the Introducer T-Fastener method for performing percutaneous endoscopic gastrostomy is rapid, safe, and inexpensive.

Adult↗

PubMedDate not supplied

Intraoperative ultrasonography for pancreatic insulinomas.

BACKGROUND/AIMS: Islet cell adenomas of the pancreas are both single and benign tumors in more than 90% of the cases. Even with the use of increasingly innovative diagnostic techniques, a percentage of tumors are not located in the preoperative or, sometimes, even intraoperative phase. This study compares the results of various diagnostic techniques and provides a brief review of the literature. MATERIALS AND METHODS: Between January 1978 and December 1994, 15 patients (11 females and 4 males) averaging 49 years of age (range 27-70) affected by pancreatic insulinoma underwent surgery at the Department of General Surgery of the "R. Silvestrini" Hospital. RESULTS: In 8 cases the tumor intrapancreatic position was indicated in the preoperative stage. On the contrary, intraoperative ultrasonography allowed the correct location in all the cases, but one. Surgery allows for the complete cure from the diseases when the removal of adenoma is complete. All of our patients underwent surgery which involved enucleation or resection of the distal portion of the pancreas. CONCLUSION: The choice of the type of operation to perform, as well as the consequential morbidity and mortality, seems to depend essentially on the size and position of the insulinoma. All of the patients, except for one who died because of a pancreatic fistula, are alive and normoglycaemic.

Adult↗