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N Bedin

Publications and source records attributed to N Bedin.

11 recordsLinked to original sources
PubMed2005

Primary pulmonary nodular amyloidosis.

Primary nodular amyloidosis of the lung is an uncommon manifestation. The disease runs a benign course, but offers diagnostic problems due to non-specific radiological features entering the big field of the solitary nodule. We describe the case of a 60 year old man with multiple nodules on the left lung operated on diagnostic and therapeutic video-assisted thoracoscopy and discuss the possibilities, if any, of suspecting such a disease through radiologic characteristics along with findings from the patient's history, physical examination and laboratory tests.

Amyloidosis↗
PubMed2004

Direct trocar insertion vs Veress needle in nonobese patients undergoing laparoscopic procedures: a randomized prospective single-center study.

BACKGROUND: Nonobese patients undergoing laparoscopic procedures present a dilemma as to the correct mode of entry into the abdominal cavity because the Veress needle (VN) technique seems to be associated with a high risk of vascular and visceral injuries. Direct trocar insertion (DTI) has been reported as an alternative to the VN for creation of the pneumoperitoneum. METHODS: An open comparative randomized prospective study was conducted on the feasibility and safety of DTI vs the VN technique in nonobese patients of any age category referred for urgent or scheduled laparoscopic procedures. Exclusion criteria were obesity (defined as a body mass index [BMI] > 27 kg/m(2)), major abdominal distension, and two or more previous abdominal operations. The study endpoints were the feasibility and safety of the DTI and VN techniques. Results were evaluated on an intention-to-treat basis. Statistical analysis was carried out with the t-test for independent samples, the chi-square tests, and the Fisher's exact tests, as appropriate. The level of significance was 0.01. RESULTS: Since January 2002, a total of 598 nonobese patients have been entered into the current trial; 46% (mean BMI 21.6 A+/- 4.4 kg/m(2)) were randomly allocated to DTI, whereas 54% (BMI 21.1 A+/- 5.3 kg/m(2)) were allocated to the VN techniques. Demographic features and type of procedures were similar for the two groups. DTI was feasible in 100% of patients vs 98.7% in the VN group (p = NS). Minor complications were nil in the DTI group and 5.9% in the VN group (p < 0.01). The latter group consisted of 11 cases (3.4%) of subcutaneous emphysema and eight cases (2.5%) of extraperitoneal insufflation. Major complications were nil in the DTI group and 1.3% among VN patients (p = NS). These latter cases consisted of two (0.3%) hepatic lesions managed laparoscopically; one (0.3%) misdiagnosed ileal perforation requiring reintervention, and one (0.3%) mesenteric laceration treated conservatively. CONCLUSION: In thin and very thin patients of any age category with no more than one previous abdominal operation, DTI is a safe alternative to the VN technique and is associated with fewer minor complications. In terms of major complications, there is no difference between the two techniques. Either technique of access is acceptable Thin and very thin patients undergoing laparoscopy, on condition that the basic principles of laparoscopic surgery are complied with.

Adult↗
PubMed2002

Gallstone ileus as a complication of acute cholecystitis. Laparoscopic diagnosis and treatment.

Gallstone ileus accounts for 1-4% of all cases of intestinal obstruction, with its incidence rising with age of patients. There is often a long delay between onset of symptoms (usually abdominal pain, vomiting, and bowel distension) and proper treatment, with a simple enterolithotomy as the one of choice. We report a case of an atypical gallstone ileus presented as a complication of acute cholecystitis, treated with a laparoscopic guided enterolithotomy. A 67-year-old woman on the 5th p.o. day after a laparoscopic procedure for an empyematous cholecystitis (no sign of fistula or duodenal perforation and a "negative" intraoperative cholangiography) presented continuous vomiting as the only symptoms of a subileus (radiographic diagnostic images negative for intestinal obstruction or intraluminal gallstone or duodenal fistula). A laparoscopic diagnostic approach revealed a gallstone in the distal jejunum. Through a 5 cm midline incision the intestine, including the gallstone, was brought out extracorporally and the stone was removed by a simple enterolithotomy. The postoperative course was uneventful and the patient had no complaint at a 1-year follow-up. We consider the laparoscopic approach, in patients with "abdominal emergencies," feasible and safe in experienced hands. It provides diagnostic accuracy as well as therapeutic capabilities, as in the case of gallstone ileus we have reported.

Acute Disease↗
PubMed2000

Gallbladder melanoma mimicking acute acalculous cholecystitis.

Gallbladder (GB) melanoma is a rare entity with a dismal prognosis. Its primary or secondary status is difficult to establish in the absence of an overt cutaneous localization. We report herein the case of a misdiagnosed GB melanoma mimicking acute acalculous cholecystitis that was treated by means of laparoscopic cholecystectomy (LC). A 54-year-old man was referred to our institution for acute cholecystitis. Apart from the ablation of some nevocytic nevi 7 years before admission, the patient's medical history was unremarkable. The ultrasound (US) examination showed a slightly enlarged acalculous gallbladder with thickened walls and a well-circumscribed polypoid mass in the fundus. The patient was treated medically and referred to LC. At surgery, some satellite nodules were visualized in the GB hepatic bed. The GB was removed, and two hepatic nodules were excised. Histology showed a pT3 melanoma. The patient underwent an open hepatic wedge resection 3 weeks after laparoscopy. No recurrence was observed at 6-month follow-up. To date, only one case of melanoma of the gallbladder treated with LC has been reported. GB melanoma is a diagnostic challenge when there is no evidence of a primary lesion. However, the occurrence of acalculous cholecystitis and a GB polyp in patients with a positive history of mole ablation should alert surgeons to the possibility of a melanoma.

Acute Disease↗
PubMed2000

Laparoscopic management of colonoscopic perforations.

Colonic perforation is a dangerous complication of colonoscopy, both diagnostic and therapeutic, and its management has become controversial. The question of conservative vs operative treatment is still under debate. Despite the recent expansion and wide acceptance of laparoscopy by surgeons, the feasibility of this technique as a means of treating abdominal emergencies has also been questioned. Of 575 patients admitted to our institution for abdominal emergencies between 1993 and 1998, 365 were treated via a laparoscopic approach. Two of these patients were treated for colonoscopic perforations, one after a diagnostic procedure and one after an operative procedure. Our technique employs an open umbilical approach with two other trocars introduced in the right iliac fossa and left flank. In the first case, a diverticular perforation of the subperitoneal rectum was suspected. The abdomen was copiously irrigated with saline solution and a drain was left in the pelvis. In the second patient, localized peritonitis was found in the left iliac fossa due to a microperforation of the sigmoid colon. It was repaired with a single absorbable suture. The postoperative course was unremarkable in both cases. In patients with an emergency abdomen due to a postcolonoscopy perforation, we consider the laparoscopic approach feasible and safe in experienced hands. It allowed us to avoid an unnecessary laparotomy and other time-consuming and expensive diagnostic investigations. This approach represents an excellent means of managing this type of emergency abdominal situation.

Abdomen, Acute↗
PubMed2000

Emergency laparoscopy: a community hospital experience.

BACKGROUND: By now, laparoscopic surgery has achieved widespread acceptance among surgeons and, generally speaking, by the public. Therefore, we set out to evaluate whether this technique is a feasible method of treating patients with abdominal emergencies, traumatic or not. To assess the routine use of emergency laparoscopy in a community hospital setting, we undertook a retrospective analysis of an unrandomized experience (presence or absence of a surgeon with laparoscopic experience). METHODS: Between January 1993 and October 1998, 575 emergency abdominal surgical procedures were done in our department. In all, 365 (63.4%) were diagnostic and operative laparoscopy procedures (acute small bowel obstruction: 23 cases; hernia disease: one case; gastroduodenal ulcer disease: 15 cases; biliary system disease: 89 cases; pelvic disease: 237 cases). These cases represent almost 56% of all laparoscopic procedures done during the same period at our institution. Laparoscopy was not performed in patients with a history of a previous abdominal approach to malignant disease, a history of more than two major abdominal surgeries, or massive bowel distension; nor was it used in patients whose general conditions contraindicate this approach. RESULTS: The conversion rate was 6.8%. The morbidity and mortality rates were, respectively, 4.1% and 0.8%. A definitive diagnosis was provided in 95.3% of cases, with the possibility to treat 88.2% of them by laparoscopy. CONCLUSIONS: We consider the laparoscopic approach in patients with abdominal emergencies to be feasible and safe in experienced hands. It provides diagnostic accuracy as well as therapeutic capabilities. Sparing patients laparotomy reduces postoperative pain, improves recovery of GI function, reduces hospitalization, cuts health care costs, and improves cosmetic results. This approach promises to play a significant role in emergency abdominal situations and will certainly become increasingly important in today's health care environment.

Adult↗
PubMed2000

Small bowel obstruction. Laparoscopic approach.

BACKGROUND: This is a retrospective review of our experience using a laparoscopic approach in the treatment of acute and chronic small bowel obstruction (SBO). MATERIALS AND METHODS: Of 136 patients hospitalized in our institutions for acute (94 cases: 69.1%) and chronic (42 cases: 30.8%) SBO, from January 1994 to March 1998, 63 (46.3%) were approached laparoscopically. The etiology was accurately diagnosed in 58 cases (92%), and it was possible to treat it laparoscopically in 82.5% (52 of 63 cases). In the remaining 11 cases (17.4%), a formal laparotomy was needed for bowel resection, due to an ischemic small bowel or for malignant disease. RESULTS: Overall, 82.5% of our cases were successfully treated laparoscopically. CONCLUSIONS: We conclude that, in experienced hands, laparoscopy is an excellent diagnostic and, in the majority of cases, a therapeutic surgical approach in selected patients with acute or chronic SBO.

Acute Disease↗
PubMed1999

[Emergency laparoscopic surgery: a hospital's experience].

BACKGROUND AND AIM: The wide diffusion and increasing use of laparoscopic surgery prompts the authors to broaden discussion to its validity and diagnostic-therapeutic use in emergency abdominal surgery. The aim was to evaluate the efficacy of laparoscopic surgery in the light of reports in the international literature and in relation to the situation in our hospital. METHODS: From April 1994 to May 1998, out of 1016 emergency abdominal operations performed at our hospital, 783 (77.5%) used a laparoscopic approach for diagnostic and therapeutic purposes: intestinal occlusion: 26 cases; gastrointestinal ulcer pathology: 15 cases; hepatobiliary pathology: 398 cases; "pelvic" pathology: 305 cases; colic pathology: 39 cases. These represent 24.4% of all laparoscopic procedures carried out during the same period. We preferred to use immediate laparotomic access in patients with the following characteristics: anamnesis of previous surgery for malignant pathologies; anamnesis of more than two major abdominal operations; massive intestinal distension; patients whose general conditions were a contraindication to a laparoscopic approach. RESULTS: The conversion rate was 6.2% (49 cases) with morbidity of 3.4% (25 cases) and a mortality rate of 0.2% (2 cases). A final diagnosis was made in 763 patients (97.4%) with the possibility of treating 719 of them (94.2%), again using a laparoscopic approach. CONCLUSIONS: It is right to regard the laparoscopic approach in emergency abdominal surgery as a feasible and safe model, offering a high potential for diagnosis and therapy if appropriately performed by an expert and well coordinated team. The increased experience of mini-invasive surgery and the improved range of instruments available make the laparoscopic approach a valid alternative to laparotomy, even in the event of emergency abdominal pathologies.

Acute Disease↗
PubMedDate not supplied

[The rationale of laparoscopic treatment in acute appendiceal disease].

Notwithstanding its widely perceived advantages, laparoscopic appendectomy has not yet met with universal acceptance. The aim of the present work was to illustrate retrospectively the results of a case-control study of laparoscopic vs open appendectomy carried out at our institution. From Jan. 1993 to Dec. 1999 a total of 457 patients (M:F = 210:247; mean age 25.2 +/- 15 years) underwent emergency and/or urgent appendectomy. Among them, 254 (55.5%) were operated on laparoscopically, while 203 (44.5%) were treated by conventional surgery The choice of technique depended upon the availability or otherwise of a team expert in minimally invasive surgery. The laparoscopic technique conversion rate was 3.9% and was mainly due to the presence of dense intraabdominal adhesions. The major intraoperative complication rates were 0.39% and 0% in the laparoscopic and laparotomy groups, respectively (P = ns). Major postoperative complications occurred in 2 and 1%, respectively (P = ns). The postoperative mortality rates were 0.4% and 0.5% in the laparoscopy and laparotomy groups, respectively (P = ns). The reoperation rate was 1.1% in the laparoscopic group as against 0% in the open surgery group (P = ns). Minor postoperative complications were observed in 0.8% and 7.5% of patients in the laparoscopy and open surgery groups, respectively (P = 0.001) and consisted mainly of wound infections. Resumption of bowel function was significantly more rapid and the hospital stay significantly shorter in the laparoscopically treated patients. The greater diagnostic accuracy of laparoscopy allowed concurrent diseases to be diagnosed in 9% of laparoscopically treated patients with histologically proven appendicitis as against 1.5% of those treated by conventional surgery (P = 0.001). Similarly, among those patients with no evidence of gross and/or microscopic appendicitis, concurrent diseases were detected in 58.4% of the laparoscopic cases as against only 6% of the laparotomy cases (P = 0.0001). Despite the limitations of a retrospective investigation, on the basis of our experience we believe that laparoscopic appendectomy is as safe and effective as conventional surgery, presents a higher degree of diagnostic accuracy and makes for less trauma and a more rapid postoperative recovery. Such features make its use mandatory in female patients of child-bearing age referred for urgent abdominal and/or pelvic surgery.

Acute Disease↗
PubMedDate not supplied

[Laparoscopic approach to inguinal hernia pathology].

Laparoscopic hernia repair has already become as accepted a technique as the conventional ones and is routinely used in those centres where this kind of surgery is normally performed. The two most commonly used laparoscopic techniques (transabdominal and total extraperitoneal) have been shown to produce good results in terms of post-operative course and recurrence rates, but still present the disadvantages of high cost and the need for general anaesthesia. We report here a retrospective analysis of our early experience with laparoscopic treatment of inguino-crural hernias. The positive results achieved (no cases of conversion to an open technique; no recurrences to date; 4.7% major morbidity) allow us to consider this approach a valid alternative to the traditional ones in selected, well-informed patients.

Female↗