Biomedical subjects
P Ferraina
Publications and source records attributed to P Ferraina.
Primary segmental infarction of the greater omentum: a rare cause of RLQ syndrome: laparoscopic resection.
The authors report a rare case of a patient with a primary segmental infarction of the greater omentum who reported acute abdominal pain. Despite preoperative clinical studies and imaging evaluation, an etiologic diagnosis could not be determined. The diagnosis of this uncommon disease was determined after initial laparoscopic exploration. A laparoscopic resection was performed. The patient had an uneventful recovery and was discharged within 12 hours. The differential diagnosis of the right lower quadrant syndrome includes several disorders, of which the primary segmental infarction of the greater omentum is not frequent. The authors emphasize the usefulness of routine laparoscopic exploration in patients with RLQ syndrome because it adds the possibility of mini-invasive treatment to the initial diagnosis.
[Application of a preoperative evaluation model in patients undergoing elective abdominal surgery].
We used a preoperative evaluation model based on the clinical history in order to determine the clinical characteristics of the patients. We also estimated the prevalence of asymptomatic disease in ASA1 patients and described the frequency of diagnosis that motivated suspension of the surgery during the preoperative time. Another purpose was to establish the perioperative complications according to the risk index and to detect the medical reasons for suspension of surgery during hospitalization. A total of 777 patients having an indication of surgery were evaluated in this program. Only 507 completed the preoperative evaluation. Of these, 57.79%, had at least one known disease or were diagnosed by their clinical history. Preoperative tests were indicated according to age in ASA1 patients. Complementary studies were indicated in relationship to the history and physical examination in ASA2 and ASA3 patients. After the evaluation, 27 surgeries were suspended: 21 were considered high risk, 2 suffered unknown active infections, and 4 ASA1 patients had severe asymptomatic anemia. A total of 328 patients were admitted for surgery. In 5 of these patients the anesthesiologist stopped the procedure in the operating room. The causes were acute decompensations of known pathologies. There were no complications or deaths related to unknown diseases and no patients died from cardiopulmonary or metabolic complications. In ASA1 patients, there were no complications related to this evaluation. This study allowed us to determine the clinical status of the patients and in consequence high-risk surgeries were canceled. In admitted patients a few surgeries were canceled for clinical reasons. This program probably decreased patient morbimortality, unnecessary hospitalization and costs.
Relation between postoperative infections and gallbladder bile leakage during laparoscopic cholecystectomies.
BACKGROUND: In 1,577 laparoscopic cholecystectomies, 111 due to acute and 1,466 due to chronic cholecystitis, the incidence of intraoperative gallbladder rupture and its relationship with abdominal wound infections were evaluated. METHODS: A sampling test for binomial proportions and a binomial approximation test for discrete data were employed for statistical analysis. Gallbladder accidental opening took place in 250 (19%) out of the 1,466 chronic and in 44 (40%) out of the 111 acute cholecystitis, disclosing a statistically significant difference (p < 0.01). Postoperatively, there were 32 (2%) surgical wound infections, 17 (1.3%) in the absence of gallbladder injury and 15 (5%) when gallbladder injury was observed, likewise showing a statistically significant difference (p < 0.05). RESULTS: It should be pointed out that all 32 wound infections involved the umbilical incision, of which 3 with chronic suppuration required reintervention where remnants of stones were found in the parietal route. The seven with symptomatic abdominal fluid resolved without specific treatment. As regards the seven intraabdominal infections, two remitted with antibiotics and five required percutaneous drainage. There was no significant correlation between the presence of cavity fluid abdominal collections or infections and bile spillage. CONCLUSION: Gallbladder injury proved more frequent in laparoscopic cholecystectomies performed due to acute cholecystitis, while bile spillage increased the incidence of umbilical wound infection, particularly in the presence of remnants of stones, but there was no correlative increase in the incidence of intraabdominal collections or infections.
Pancreatic serous cystadenomas. Report of 8 cases with a mean follow up of 7 years.
Serous cystadenoma of the pancreas are rare tumors and have little or no malignant potential. We report our experience in the management of eight cases of these tumors in the last 22 years. All the patients were women with a mean age of 59 years. All the cysts caused symptoms. Ultrasound and CT-scan were useful in the diagnosis of the pancreatic cystic tumor out not in determining the nature of these lesions clear. FNA-biopsy was performed in 6 cases but in only case was the diagnosis confirmed. All tumors were resected. Four radical pancreatoduodenectomies, two distal pancreatectomies and two cystectomies were performed. Mean followup was 83.5 months. All patients are alive and with no signs of recurrence. Complications include an external pancreatic fistula, an acute cholangitis and a case of delayed gastric emptying. In all cases the histological diagnosis was serous cystadenoma of the pancreas. We conclude that resection of these tumors is mandatory although they are supposed to be benign, in order to avoid complications and because malignant transformations has been related to nonresective treatment.
[Papillary and cystic tumors of the pancreas. Clinico-pathological, cytopathological, immunohistochemical, and nuclear ploidy study].
Seven cases of PCNP were studied; 5 females and 2 males, ages ranging from 21 to 68 years (mean 39). All had asymptomatic masses located in the head (3), body (2), isthmus (1) and tail (1). In 4 of them fine-needle aspiration (FNA) was done and showed a diagnostic pattern with papillary clusters as well as isolated epithelial cells with monomorphic appearance, round nuclei and inconspicuous nucleoli; 5 cases had a surgical resection and only 2 a biopsy due to unresectable tumors. Histologically, they showed the typical features of PCNP with solid, papillary, trabecular and cystic patterns. IHQ studies showed positivity for cytokeratin (n = 5), alpha-1-antitrypsin (n = 4), monoclonal NSE (n = 3), chromogranin (n = 3) and estrogen receptors (n = 1). All cases were negative for insulin, glucagon, somatostatin, EMA and CEA. DNA analysis done with an image analyzer showed 4 diploid tumors, 2 diploid-tetraploid an 1 aneuploid tumor. One patient died because of postoperative complications and the remaining 6 are alive with a mean follow-up of 17 months (2-36). We emphasize the diagnostic appearance of the tumor on FNA, and the low grade malignant potential of this neoplasm supported by the predominance of diploid tumors. Our IHQ findings suggest both an exocrine and endocrine differentiation.
[Hepatic lesion caused by halogenated anesthetics].
Two patients has been presented to whom general anaesthesia consecutive with halogenated anesthetics has been administrated. In one of the observations the first anaesthesia was administrated with enfluorane and halothane was for the others. The two patients inured with jaundice and in one of them accompanied with hepatic insufficiency; both of them had favourable evolution. The histology of one of them show us a lesion compatible with injury caused by halogenated anaesthesia. In one of the patients appears evidences of hypersensitivity. It is request the possibility that the enfluorane could be acting as a sensibilisant drug of the hepatic injury produced by the halothane. This experience suggest us the danger already described of the consecutive use at short intervals of halogenated anesthetics. So long as fat patients are more sensible to the toxic action of these anesthetics it is suggested prevent in their cases.
[Correlation of the clearance of amylase and creatinine in acute pancreatitis and other pathologies].
The study of a group of 151 patients confirms the diagnostic value of elevated ACCR in pancreatitis, it was positive in 89.4% of them, of the group, 30 were normal, 19 exhibited acute pancreatitis and 102 had various other pathologies. Serious pancreatitis has shown coincide with a long-lasting rise of ACCR, and its rise in the course of the disease was a sign of a new outburst of progressive necrosis. Total unreliability when abnormal creatinine clearance is present was ascertained. The possible mechanism of increase in ACCR has been considered also in connection with the study of the results obtained on a group of patients exhibiting renal insufficiency, gastrointestinal bleeding, acute colecystitis, vesicular lithiasis and obstructive jaundice.