Biomedical subjects

P Covarelli

Publications and source records attributed to P Covarelli.

At least 19 recordsLinked to original sources

PubMed1999

[Splenic pseudoaneurysms following acute pancreatitis].

Splenic artery pseudoaneurysms are the most common of visceral artery pseudoaneurysms. Splenic pseudoaneurysms appear to have developed as a consequence of inflammatory processes adjacent to the splenic artery, particularly acute pancreatitis and chronic pancreatitis with associated pseudocysts. They are often asymptomatic and picked up on abdominal examination for ultrasound or CT scanning for other conditions. Complications include rupture with retroperitoneal hemorrhage or intraperitoneal hemorrhage. Two cases of splenic pseudoaneurysms, following acute pancreatitis, are reported between the years 1987 and 1996.

Adult↗

PubMed1999

[Treatment of parastomal colostomy hernia].

BACKGROUND: Parastomal hernias are the most common cause of in patients surgically with stomy reoperation treated. METHODS: Treatment of parastomal hernias has been faced through two kind of technics: the first one consisted in the translocation of colostomy, the second one was placing around the colostomic hole a marlex mesh which was inserted at muscular structure level. From January 1993 to May 1997 we treated 8 patients affected by paracolostomic hernia associated to laparocele. The laparocele was treated according Rives' technique with the prosthesis positioned in the properitoneal site. The parastomal hernia was treated with translocation of the colostomy in 3 cases; in the other patients a plastic surgery of the colostomic orifice was made using polypropylene little bandages in properitoneal site. RESULTS: In the postoperative period the complications concerned a single case of skin parcellar necrosis, that healed spontaneously with medications and a case of prolonged serous secretion the mean follow-up was 2 years from the wound. CONCLUSIONS: In our experience the use of marlex mesh may be effective in treatment of parastomal hernia only a patient treated with translocation of the stoma showed a recurrence of parastomal hernia. The positioning of the prosthesis at properitoneal level is subject to a lower incidence of recurrent parastomal hernia.

Aged↗

PubMed1997

[Upper digestive hemorrhage as a rare manifestation of ectopic pancreas with gastric localization].

The Authors report two cases of ectopic gastric pancreas, one of them causing a massive upper gastrointestinal hemorrhage, representing an infrequent complication of the disease. A literature review on the subject was then performed, and the importance of a differential diagnosis of the ectopy versus gastric malignancies, with relevant prognostical and management implications was assessed.

Adult↗

PubMed1996

Ploidy as a prognostic feature in colonic adenocarcinoma.

OBJECTIVE: To determine whether DNA content and cell-cycle kinetic characteristics in Dukes stage B colonic adenocarcinomas provide additional prognostic information in the context of clinicopathologic variables of known significance. DESIGN: Archival, paraffin-embedded tissue blocks from 210 Dukes B colonic adenocarcinomas were retrieved. After confirming stage, tumor cell nuclei were extracted, suspended, and stained. Cell nuclei from adjacent normal colon mucosa were used as controls. SETTING: University-based, tertiary cancer referral center. INTERVENTIONS: Samples obtained from tumors resected at our institution between 1965 and 1984 were analyzed by flow cytometry for DNA index (DI) and percentages of cells in synthesis (S) phase (%S) and in G2 and mitosis (M) phases (%G2M). The data were correlated with 5-year survival. Follow-up was complete in all patients to at least 5 years. RESULTS: Univariate analysis showed that the highest survival rates were associated with DI values near 1 and 2 (diploid and tetraploid tumors, P = .02) and the lowest %G2M values (tumors with fewer mitoses; P = .01). Five-year survival rates also differed significantly between patients with diploid (DI < 1.1) and those with aneuploid (1.1 < DI < 2) tumors (80% vs 64%, respectively; P = .02). Multivariate analysis revealed that race (P < .01), lymphatic or capillary microinvasion (P < .03), and ploidy (P < .05) were significantly associated with outcome. The influence of ploidy, race, and microinvasion on 5-year survival was estimated with logistic regression, and 8 subgroups of patients emerged with 5-year survival probabilities ranging from 39% for black patients with aneuploid tumors and microinvasion to 88% for white patients with diploid tumors and no microinvasion. CONCLUSIONS: Tumor DNA content provides additional independent information that allows further refinement of our prognostic ability in patients with Dukes B colonic adenocarcinoma. This may aid in the identification of a cohort of patients who may potentially benefit from aggressive adjuvant therapy.

Adenocarcinoma↗

PubMed1996

Ultrasonography in the management of acute appendicitis.

BACKGROUND: Ultrasonography (US) shows promise in the diagnosis of acute appendicitis. METHODS: The authors present their own experience in ultrasonography (US) employed in the diagnosis of appendicitis, based on 40 patients admitted to the Department of Surgery of the University of Perugia. RESULTS: US was found to be easily obtainable and reliable; it had good specificity and sensitivity, was not very time consuming, and had a good cost/benefit ratio. CONCLUSIONS: The authors believe US is an important diagnostic tool that can reduce useless laparotomies for false acute appendicitis, particularly in cases presenting with unclear clinical findings.

Acute Disease↗

PubMed1996

[Intestinal lymphangiectasis in adults].

Although rarely, several conditions may cause malabsorption through lymphatic obstruction. Primary lymphangiectasia, a genetically determined disease characterized by diarrhoea, steatorrhoea and protein-losing enteropathy, is one of these conditions. The Authors report their experience in three cases of small bowel lymphangiectasia occurring in adults and discuss diagnostic and therapeutic problems of the disease.

Adult↗

PubMed1996

Acute appendicitis. How many uncorrect diagnosis? A clinical and histological evaluation of 124 cases treated with emergency procedure.

Acute appendicitis is a very common disease in western countries, affecting the entire population with higher prevalence in younger people. The diagnosis of the disease is still basically performed through the clinical evaluation of the patient, while peripheral White Cell Count or imaging techniques such as ultrasonography are poorly helpful. Therefore, a great number of patients is operated without finding a severe involvement of the appendix at intraoperative observation. To evaluate the rate of false acute appendicitis and to correlate the histological involvement with the clinical behavior of the disease the Authors carried a prospective study during a period of 28 months on 124 patients with a diagnosis of acute appendicitis treated on emergency basis.

Acute Disease↗

PubMed1995

[Thoracic trauma].

From January 1989 to December 1992, in the Institute of Clinical Surgery of the University of Perugia, 102 patients were admitted for thoracic trauma. Two patients with an open thoracic trauma, both presenting multiple shot-wounds, underwent an explorative thoracotomy. One of them died on the operating-table from hemorrhage, while the other was saved by a wedge-resection. A 3rd explorative thoracotomy was successfully performed on a patient with internal thoracic trauma and severe hemothorax. Among the 100 patients with an internal thoracic trauma, mortality was 6%, but only one of the 6 deceased, had no lesions other than a fail chest. As a matter of fact 38 patients presented lesions in other parts of the body. Simple and complicated multiple costal fractures, found in 84 cases, were the most frequent lesions observed. Seventeen of the 38 patients with pneumothorax and/or pleural effusion had a chest tube applied. Three patients were operated for a diaphragmatic hernia with a positive outcome. Only 75 patients received medical treatment without surgery. Six of the patients with multiple costal fractures presented flail chest. One of them (mentioned above) died almost immediately after his admission and therefore received no more than the initial medical treatment. Four others, aged over 65, successfully underwent a costal osteosyntesis, while the 6th patient received medical therapy with a positive outcome. In the case of a critical flail chest with severe patho-physiological consequences, if the fractures are in technically favourable sites, the Authors believe it is better to immediately stabilize the thorax, since the operating trauma is minimum and in many cases the patient is already intubated and curarized.

Adult↗

PubMed1994

[Diagnostic and therapeutic problems of "second look" in acute intestinal ischemia].

The authors present their diagnostic approach to acute intestinal ischemia. They underline the need for early specific diagnosis because the therapeutic options vary widely in relation to different types of acute intestinal ischemia. Selective arteriography preceded by an aortogram is considered the diagnostic "gold standard". Although at present mesenteric ischemia is a serious, and often lethal, disease, an aggressive therapeutic approach can improve the outcome of this group of patients.

Acute Disease↗

PubMed1994

[Intestinal obstructions caused by colorectal carcinoma in the aged].

Colorectal cancer is the second most common malignancy of the adult population in the United States. It is exceeded only by lung cancer among males and breast cancer among females. Malignancies of the colon and rectum are responsible for approximately 12 per cent of all adult cancer deaths. These tumors appear as surgical urgency by intestinal obstruction for 15-20 per cent and by perforation for 3-8 per cent of all cases. It often occurs in elderly patients; in fact, urgent surgical operations are especially performed in patients older than seventy. The mortality rate for urgent surgical operation in elderly patients is about 32-54 per cent. This high mortality is even due to concurrent pathologies and particular locoregional and/or general alterations induced by tumor. The authors studied all patients older than 75 years affected by colorectal cancer and treated by choice or by urgency at Dept. of Surgery of the University of Perugia from January 1987 to February 1993 to individualize some clinical, anatomo-pathological and therapeutical significant characteristics about colorectal cancer in geriatric age.

Age Factors↗

PubMed1991

[Complications after total thyroidectomy in thyroid carcinoma].

Authors report the postoperative complication rate in 52 patients who had undergone total thyroidectomy for cancer between 1984 to 1989. Total thyroidectomy has been performed in 9.8% of patients surgically treated for nodular thyroid pathology. Patients age average 49 years in a range 16-75; they were 49 women and 3 men. In 50% of cases we found papillary cancer, follicular in 40%, medullary 4% and anaplastic 6%. We shared postoperative complications in two mean groups: 1) aspecific complications as cardiocirculatory failure, respiratory failure, wound infections or collections, granulomas, keloids; 2) surgery related complications such as hypocalcemia, dysphagia, recurrent++ paralyses. The first group, we noticed just one case of respiratory mechanical failure due to severe tracheomalacia that required a temporary tracheostomy performed at the end of surgical procedure; we did not notice any death due to cardio-circulatory or respiratory failure, nor did we notice any postoperative hemorrhage; one patient presented a wound seroma, two patients presented granulomas due to subcutaneous stitches, and three developed papulous drug-induced erythema. The second group, eight patients developed a transient hypocalcemia beginning on the second postoperative day, without relevant tetanic crisis, well treated by calcium administration; only two of these patients developed permanent hypoparathyroidism. In 3 cases we had to perform exeresis of a laryngeal inferior nerve involved by the cancer, while in 5 more cases we noticed a transient monolateral paralysis that disappeared in 2 or 3 months. Three patients presented dysphagia before intervention and healed post-surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗

PubMed1990

[Prognostic factors in neoplasms of the upper 2/3 of the stomach compared to the lower 1/3. Our experience].

The choice of the type of surgical treatment used in gastric cancer, in cases where it is possible to operate in relation to the extent of cancer, raises the question of whether the surgeon should perform a total exeresis of the organ, even in cases where the tumour is located in the 3rd distal of the stomach. A retrospective study was carried out on patients admitted to the Surgical Department of the University of Perugia between January 1963 and December 1988. Having rejected 123 cases because of incomplete data or insufficient follow-up, 1.140 cases were selected from a total of 1.263 patients. The sites of neoplasia were as follows: terminal esophagus: 1.76% of cases; cardia: 6.67%; fornix of the stomach: 9.37%; the body of the stomach and lesser curvature: 23.65%; body of the stomach (other portions): 10.07%; angulus: 3.63%; gastric antrum: 37.82%, pylorus: 4.45%; the remaining 2.58% showed a diffuse form involving two or more the above parts. The subdivision of the cases into stages, using the TNM classification, revealed the following groupings: 7.04% of patients were first observed at stage I, 20.70% at stage II, 42.04% at stage III and 30.20% at stage IV. From the above figures it is evident that radical surgical was indicated only in some of the patients observed. The prognostic factors examined in the comparative study of different tumour sites were: age, sex, macroscopic and histological tumour type, size, infiltration of neoplasia through gastric wall coat, lymph node and/or systemic diffusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗

PubMed1990

[Our experience with early gastric cancer].

Gastric cancer has always required surgical therapy since in the majority of cases at the moment of treatment symptoms are already at an advances stage. Over the past years many advances have been made in the early diagnosis of many forms of neoplasia, but the rate of progress has been much slower with regard to gastric cancer. Only the preventive and regular use of gastroscopy will allow the disease to be diagnosed at a non-advanced stage. The term early gastric cancer is used to describe a carcinoma which only infiltrates the mucosa, or the mucosa and submucosa, irrespective of lymph node or other metastases. The present study was based on a retrospective analysis of cases of stomach cancer observed in the Surgical Department of the University of Perugia from January 1963 to December 1988. A total of 1,263 patients were affected by cancer of the stomach during the above period. One hundred and twenty-three cases were not included because of incomplete data or insufficient follow-up. A total of 1,140 patients were therefore included in the study; of these only 99 cases were affected by early gastric cancer. Age, sex, earlier gastric diseases, life styles, familial occurrence of disease, and symptomatology were among the different parameters evaluated. In addition, the site of disease, diagnostic methods, pre- and post-operative staging, intramural diffusion of the disease and surgical treatment were taken into account. In older cases the 5-year survival rate was calculated, whereas in more recent cases statistical methods, based on accumulated data, were used to estimate survival rates.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1989

[Aneurysm of the innominate artery: pathology simulating pulmonary neoplasm].

A chance case of aneurysm of the brachiocephalic trunk suggested a review of the literature on this rare pathology. Stress is laid on the possible asymptomaticity of the lesion and on its frequent chance observation in chest X-rays; the diagnostic procedure, at times particularly complex, may not lead to decisive results but the possibility of aneurysm of the brachiocephalic trunk must be borne in mind in any case so as to avoid gross diagnostic and therapeutic errors.

Aged↗

PubMedDate not supplied

[Choledochojejunostomy using a mechanical stapler].

Authors performed the mechanical termino-lateral bilio-digestive anastomosis, adopting a circular 21 mm stapler device. The patient was affected by non neoplastic papillary stenosis producing a common biliary tract dilatation so large to allow the stapler's head introduction. A 12 month follow-up was performed using ultrasonography and MRI cholangiopancreatography, that obtained a good demonstration of both biliary tract and bilio-digestive anastomosis.

Ampulla of Vater↗

PubMedDate not supplied

Adenocarcinoma arising from a recurrent fistula-in-ano.

Anal fistulas are frequent events which often recur after an inadequate surgical treatment. Nevertheless their evolution into malignant diseases is infrequently observed. The authors report one case of mucinous adenocarcinoma arising out of a recurrent, long-lasting fistula-in-ano. As reported, abdomino-perineal resection combined with radiotherapy can be the choice treatment. The difficulty is to obtain a reliable differential diagnosis. No imaging technique nor histologic examination can establish a definitive reliable diagnosis; nevertheless, as the risk of adenocarcinoma developing from a long-lasting recurrent fistula-in-ano, although small, is real, authors believe that operative exploration and biopsy of recurrent abscesses and fistulas should be recommended.

Adenocarcinoma↗

PubMedDate not supplied

[Surgical treatment of thyroid cancer in 243 cases].

The incidence of thyroid cancer, which accounts for 1-2% of all malignancies, constantly increasing. Its management requires an integrated approach, in which the surgeon plays a pivotal role, providing the basis for further treatment. At present, the extent of exeresis, the lymph-node dissection technique and the management of upper respiratory-digestive tract infiltration are still debatable issues. The authors report on their experience with 243 surgically treated thyroid malignancies over the period from January 1986 to December 1999. The operations performed were: total thyroidectomy 226 cases, lobo-isthmectomy 3 cases, total thyroidectomy + lung metastasectomy 1 case, total thyroidectomy + SE quadrantectomy 1 case, total thyroidectomy + monolateral modified neck dissection 30 cases, total thyroidectomy + bilateral modified neck dissection 17 cases, total thyroidectomy + radical neck dissection 1 case, total thyroidectomy + tracheal sleeve resection 5 cases. In 9 cases, extensive tracheal involvement (5.5 cm), age or neoplastic histology allowed only palliative treatment (endoscopic recanalization + tracheal endoprosthesis or tracheostomy. Nd-Yag laser endoscopic recanalization was performed in 2 patients as a preliminary stage in subsegmental radical treatment, and in 5 cases for palliation. Recurrent laryngeal nerve palsy occurred in 3 cases, long-term hoarseness in 2, and hypoparathyroidism in 4. The overall mean hospital stay was 4.8 days. Of 299 patients still alive, 215 are free of disease. Surgery is the treatment of choice, with the goal of completely removing the neoplasm, together with any anatomical structures involved in infiltration (muscles, respiratory-digestive tract, lymph nodes). Satisfactory palliation can be achieved by endoprosthesis deployment or tracheostomy in all cases where surgery is ruled out due to extent of disease, patient age or histological type.

Adult↗

PubMedDate not supplied

[Neoplastic involvement of the inferior vena cava].

Inferior caval vein invasion not infrequently complicates advanced neoplastic lesions. Primitive caval neoplasms (leiomyosarcomas) or other tumors such as renal carcinomas, pheochromocytoma, as well as liver, testis, and retroperitoneal tumors most likely cause caval invasion. In the past, caval invasion was a clear index of non operability, while today, a modern multidisciplinary approach allows to treat successfully even so advanced diseases. In the present report the Authors analyze the cases treated at the Dept. of Surgery of the University of Perugia, and review the most important international reports on this subject illustrating the new possibilities offered by IVC substitution with biological or artificial grafts.

Adenocarcinoma↗