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Biomedical subjects

P Capasso

Publications and source records attributed to P Capasso.

At least 19 recordsLinked to original sources
PubMed2005

Laparoscopic adrenalectomy for malignant neoplasm: our experience in 15 cases.

BACKGROUND: We report our experience with laparoscopic adrenalectomy (LA) for malignant pathologies that in some cases required a multiorgan resection. METHODS: In this study, we retrospectively reviewed a group of 15 patients (10 men, and five women) who underwent an operation for primitive or metastatic adrenal malignant tumors. RESULTS: The sizes of the lesions ranged from 3.5 to 8.5 cm (average 3.6). We performed 11 adrenalectomies (four right and seven left), two left adrenalectomies with distal spleno-pancreatectomy, one right adrenalectomy with nephrectomy, and one laparoscopic exploration that showed a peritoneal spreading. Six patients, with a follow-up ranging from 3 to 24 months (mean 13.6 months), are disease free; the others developed metastatic repetitions or local recurrences. CONCLUSIONS: LA could be performed always respecting the oncological principles of radical excisions. This approach in our patients has been associated with low morbidity, low intraoperative blood loss, short hospital stay, and fast functional recovery.

Adrenal Gland Neoplasms↗
PubMed2003

Laparoscopic removal of an intraperitoneal translocated intrauterine contraceptive device.

The use of an intrauterine contraceptive device (IUD) is often accompanied by various complications, the perforation of the uterus constituting the most dangerous. Here we report the case of a patient who complained of abdominal pains. She had had an IUD inserted 15 months previously. Three months later, as she could no longer see the IUD strings at the external os of the cervix, she underwent pelvic ultrasonography, which did not show the IUD in the uterine cavity. A diagnosis of expulsion of the IUD was made. A few months later, the patient accidentally became pregnant, and decided to have an abortion. From that time on, she started to complain of the above-mentioned symptoms. She had an abdominal X-ray which revealed the IUD in the abdominal cavity. She then underwent a laparoscopic removal of the translocated IUD.

Adult↗
PubMed2002

Laparoscopic repair of congenital diaphragmatic hernia with prosthesis: a case report.

We report here our experience in the treatment of a large congenital diaphragmatic hernia, an uncommon pathology, approachable by laparoscopy. The patient was a 33-year-old woman with trisomy 21 syndrome, who only complained of colicky abdominal pain and a cough for 7 months before the hospitalization. Thoracic and abdominal CT scans showed a large anteromedial diaphragmatic hernia with slippage of the colon into the mediastinum and posterior displacement of the cardiovascular structures. The patient underwent laparoscopic repair of the hernia. The colon was put back in the abdomen; the defect (8x4 cm) was repaired by a Composix mesh (PTFE-polypropylene), fixed to the diaphragm by nonabsorbable stitches and staples. The patient was discharged on the third postoperative day. The postoperative course was uneventful. Follow-up at 18 months didn't show any complications or recurrence. We believe laparoscopic repair of diaphragmatic hernia to be the elective surgical choice, because of its technical feasibility and certain intra- and postoperative advantages.

Adult↗
PubMed2002

Technical standardization of laparoscopic splenectomy: experience with 105 cases.

BACKGROUND: Some reports have suggested that laparoscopic splenectomy (LS) can be successfully performed in adults. However, several aspects of this procedure remain as yet undefined; therefore, several attempts have been made to modify the standard technique to try to optimize the procedure. Herein we analyze our experience with 105 laparoscopic splenectomies. METHODS: From 1993 to 2000, 105 patients underwent LS at our hospital. Twelve of these patients also underwent a concomitant cholecystectomy. There were 66 women and 39 men whose ages ranged between 4 and 78 years (median, 27.7). All patients underwent an elective laparoscopic splenectomy. Seventy five patients had thrombocytopenia (ITP), 14 had hereditary spherocytosis, eight were affected by b-thalassemia, two had splenic cysts, two had lymphoma, (two had myeloid chronic leukemia, one patient presented with a splenic abscess and one had incurred an iatrogenic spleen lesion during adrenalectomy. The first patients in this series were positioned in dorsal decubitus; however, as the team's experience increased, the right lateral decubitus became the position of choice because it provides better exposure of the splenic hilum. This procedure requires the use of only four trocars. RESULTS: Mean operating time was 95 min (range, 35-320). Hospital stay ranged from 2 to 21 days (median, 4.5). There was only one conversion to open surgery. One patient died in the postoperative period due to the evolution of a preexisting malignant disease. We recorded nine complications-four subphrenic abscesses, two cases of pleuritis, two episodes of postoperative bleeding, and one intestinal infarction 16 days after surgery. Only two patients needed redo surgery. CONCLUSIONS: We believe that the laparoscopic approach is a valid alternative to open splenectomy, but mastery of some of the technical details of this procedure could greatly help avoid its complications. On the basis of our experience, it seems that the lateral approach should be considered the position of choice because it provides exposure and easier dissection of the splenic hilar structures. We also found that a 30 degrees scope and an ultrasonic dissector allowed for perfect vision and optimal hemostasis during the procedure. At the end of procedure, the spleen should be fragmented and then extracted using an extraction bag.

Adolescent↗
PubMed2001

Inguinal endometriosis or irreducible hernia? A difficult preoperative diagnosis.

Two cases of endometriosis infiltrating the round ligament and associated with an inguinal hernia are presented. The initial diagnosis was irreducible hernia, since this rare association often causes unusual preoperative symptoms and diagnostic problems. Diagnosis is frequently made by histologic examination. Surgery is the treatment of choice both for hernia and for endometriosis, and is locally curative. However, in a fertile woman with a painful mass in the inguinal region the possibility of endometriosis should be considered, and if suspected at inguinal exploration a laparoscopy should be made to rule out the presence of intraperitoneal endometriosis.

Adult↗
PubMed2001

Endovascular treatment of aortic rupture by blunt chest trauma.

BACKGROUND: The usual treatment of blunt aortic injury (BAI) is prompt surgery. Frequently severe injuries to the brain or lungs exclude further surgical treatment. The purpose of this study is to assess the feasibility of placing endovascular stent-grafts. METHODS: From 1992 through 1999, in our primary and referral trauma center, 26 acute BAI, 21 males and 5 females, mean age 40.2+/-16.3 yrs were diagnosed. The last 4 patients underwent prospectively endovascular repair with Talent endograft. Endoprosthesis parameters were measured on three-dimensional spiral CT reconstruction. While waiting for devices, blood pressure was aggressively lowered and aortic lesions were monitored by transesophageal echography. RESULTS: Stent-graft deployment was successful in all 4 patients. There were no complications of endoleak, stent migration, paraplegia or death. Angiographic exclusion was complete in all 4 patients. CT scans at a mean follow-up of 11+/-5 months showed complete healing of the aortic wall in all patients. CONCLUSIONS: For stable acute BAI, endovascular stent-graft repair is feasible and safe, and is an effective therapeutic alternative to open surgery. Because of the normal proximal and distal wall in aortic injuries, endoluminal treatment might be the therapy of choice in the near future.

Adult↗
PubMed2001

[Video-assisted appendectomy].

BACKGROUND: The acceptability of the classic laparoscopic technique in the treatment of acute appendicitis is slow, probably due to the higher costs of this method compared to the cheaper, efficacious, safe and rapid discharge associated with traditional surgery. METHODS: In order to combine the advantages of the laparoscopic technique with those of traditional surgery, we performed a retrospective study of the safety, efficacy, rapid discharge with return to normal working activities, and the costs in 70 patients referred to our attention with a diagnosis of acute appendicitis and who underwent one trocar appendectomy. This technique consists of positioning a single trocar in an umbilical site and using a 10 mm telecamera with a 5 mm operating canal. Having visualised the appendix and freed it from any synechiae, the distal end is grasped and it is removed through the umbilical trocar. Appendectomy is performed outside using a technique that is similar to traditional surgery. The diagnosis of acute appendicitis was made on the basis of clinical data (pain, leucocytosis, fever, possible resistance in the right iliac fossa).

Adolescent↗
PubMed2000

[Percutaneous nephrostomy in treatment of urinary tract obstructions and malformations in the child].

Percutaneous nephrostomy (NP) is a routinely applied procedure in adults, but sparsely reported in the pediatric population. We report the treatment of acute obstructive renal diseases in 15 children aged one day to 6 years. The causes of obstruction included pelvi-ureteral junction stenosis (10 cases) by calculus or complicated by pyonephrosis, vesico-ureteral junction stenosis (2 cases), urethral valves and stenosis (2 cases) and one complex urogenital malformation. Catheter placement was performed under ultrasonographic guidance without immediate complication. NP should be considered as a primary preoperative modality for urinary tract obstruction in the pediatric population.

Adult↗
PubMed2000

Imaging of blunt chest trauma.

In western European countries most blunt chest traumas are associated with motor vehicle and sport-related accidents. In Switzerland, 39 of 10,000 inhabitants were involved and severely injured in road accidents in 1998. Fifty two percent of them suffered from blunt chest trauma. According to the Swiss Federal Office of Statistics, traumas represented in men the fourth major cause of death (4%) after cardiovascular disease (38%), cancer (28%), and respiratory disease (7%) in 1998. The outcome of chest trauma patients is determined mainly by the severity of the lesions, the prompt appropriate treatment delivered on the scene of the accident, the time needed to transport the patient to a trauma center, and the immediate recognition of the lesions by a trained emergency team. Other determining factors include age as well as coexisting cardiac, pulmonary, and renal diseases. Our purpose was to review the wide spectrum of pathologies related to blunt chest trauma involving the chest wall, pleura, lungs, trachea and bronchi, aorta, aortic arch vessels, and diaphragm. A particular focus on the diagnostic impact of CT is demonstrated.

Diagnosis, Differential↗
PubMed2000

[Endovascular treatment of varicoceles and utero-ovarian varices].

Pelvic varices of the gonadal veins affect both males and females presenting as varicoceles in the former and utero-ovarian varices in the latter. These varices are frequently encountered in the general population and can be directly associated with a significant morbidity. The affected venous axes can be easily catheterized in a selective, retrograde manner and can then be occluded through this minimally invasive route, thus avoiding the major surgical complications while giving results comparable or superior to those of the various surgical techniques. These pathologic processes and their endovascular treatment will be discussed.

Catheterization, Peripheral↗
PubMed1999

Turf battles in radiology: how to avoid/how to fight/how to win.

Turf battles have always existed in radiology although recently, we have observed an increase in their numbers and sometimes in their virulence. The main reasons for this increase include the relative plethora of physicians especially in industrialized areas, and the rapid progress and development of medical technology and minimally invasive techniques. These turf battles risk interfering with the over-all medical costs of local health care systems as they will inevitably lead to an increase in the concentration of complex medical devices controlled by different specialties which, in turn, will lead to an increase in number of invasive and noninvasive, diagnostic and therapeutic examinations. The only way that radiologists can hope to maintain control of today's techniques will be if they are willing to offer qualitative expertise in their procedures with full clinical, academic and technological backing similar, or superior to that presented by our respective clinical and surgical colleagues. Furthermore, they should be fully involved in the decisional process and actual purchase of the technological equipment of their entire institution.

Economic Competition↗
PubMed1999

High-resolution ultrasound evaluation of internal jugular venous valves.

Although the presence of valves in the distal portion of the internal jugular veins has been widely described by anatomists and pathologists, their existence remains underscored in the medical literature. We set out to demonstrate their sonographic aspect and to evaluate their morphology, location and prevalence. Seventy-five cadavers were evaluated for the presence and aspect of such valves through neck dissections. Concurrent evaluation of the sonographic character of these structures was performed in another cohort of 75 adults. Valves of the distal portion of the internal jugular veins were found in 93 % of the cadaveric studies. Ultrasonography easily demonstrated the valve leaflets in 87 % of patients; all were observed in the distal portion of the internal jugular (IJ) veins. Sixty percent were bilateral with the majority of unilateral veins found on the right side. High-resolution ultrasonography easily demonstrates valves in the distal portion of the IJ veins which are present in the great majority of persons. Their evaluation may be of use in percutaneous procedures using this venous access.

Aged↗
PubMed1999

Radiation doses delivered to radiologists during contrast-enhanced helical-CT examinations.

This work monitors the radiation doses to a radiologist during supervision of automatic contrast media injections during helical-CT examinations of the chest and abdomen. Forty consecutive standard helical-CT examinations of adult's chest and/or abdomen were monitored with five dosimeters worn by the radiologist supervising the entire injection with the hand on the injection site. Mean doses per examination measured at chest, thyroid gland, and hand levels were 11, 16, and 130 microGy, respectively, during chest examinations, and 5, 7, and 55 microGy during abdominal examinations. According to the high number of CT examinations performed, wearing lead apron, special lead glove protection, and thyroid shield is highly recommended.

Adult↗
PubMed1998

Spiral CT aortography: an efficient technique for the diagnosis of traumatic aortic injury.

The objective of this study was to assess the efficiency of spiral CT (SCT) aortography for diagnosing acute aortic lesions in blunt thoracic trauma patients. Between October 1992 and June 1997, 487 SCT scans of the chest were performed on blunt thoracic trauma patients. To assess aortic injury, the following SCT criteria were considered: hemomediastinum, peri-aortic hematoma, irregular aspect of the aortic wall, aortic pseudodiverticulum, intimal flap and traumatic dissection. Aortic injury was diagnosed on 14 SCT examinations (2.9 %), five of the patients having had an additional digital aortography that confirmed the aortic trauma. Twelve subjects underwent surgical repair of the thoracic aorta, which in all but one case confirmed the aortic injury. Two patients died before surgery from severe brain lesions. The aortic blunt lesions were confirmed at autopsy. According to the follow-up of the other 473 patients, we are aware of no false-negative SCT examination. Our limited series shows a sensitivity of 100 % and specificity of 99.8 % of SCT aortography in the diagnosis of aortic injury. It is concluded that SCT aortagraphy is an accurate diagnostic method for the assessment of aortic injury in blunt thoracic trauma patients.

Accidental Falls↗
PubMed1998

[Endovascular treatment of abdominal aortic aneurysm. Preliminary experiences with the Talent endoprosthesis].

BACKGROUND: The treatment of infra-renal abdominal aortic aneurysms (AAA) with endovascular stent-graft prostheses is receiving increasing attention as an alternative to major abdominal surgery. Numerous systems are under clinical investigations. We report our preliminary clinical results with the new Talent straight and bifurcated endografts. METHOD: We treated 5 patients with 3 straight and 2 bifurcated stent-grafts implanted by surgical femoral arteriotomies and placed under fluoroscopic guidance. Control CT and angiographic examinations were performed during an average follow-up of 5.3 months. RESULTS: In the first patient the procedure had to be converted to an open surgical operation to repo sition the distal end of the prosthesis. We had no mortality, or major systemic complication. Three patients had a postimplantation syndrome. All aneurysms showed a decreased size at 3 months, in spite of 3 small persisting leaks. CONCLUSION: The Talent endograft is safe, and efficacious in the endovascular treatment of AAA. This method requires a good cooperation between the vascular surgeon and the interventional radiologist. Learning curves influence preliminary results.

Aged↗