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P Forti

Publications and source records attributed to P Forti.

41 records · Page 3Linked to original sources
PubMedDate not supplied

Radioguided surgery for gastrinoma: a case report.

AIMS AND BACKGROUND: Gastrinomas are the most common neuroendocrine tumors of the duodenopancreatic region. Surgical resection is the primary type of radical treatment. METHODS AND STUDY DESIGN: At the Institute of General, Gastrointestinal and Breast Surgery we treated a patient with a duodenal gastrinoma that was diagnosed and localized by means of selective celiac-mesenteric angiography and labelled octreotide scintigraphy. Surgery was performed using a radioguided technique; in this way we easily detected the small tumor and discovered another tracer-uptaking lesion that turned out to be a metastatic lymph node. RESULTS: Surgical resection is the ideal treatment for sporadic gastrinoma: it improves quality of life, prolongs survival, and reduces the incidence of metastases, with a modest percentage of complications and practically zero mortality. Meanwhile, medical treatment is being reevaluated, particularly in the case of metastatic disease or polyendocrine MEN1 syndrome. A fundamental aspect in the management of gastrinomas is tumor localization. Endoscopic ultrasonography and labeled octreotide scintigraphy (Ostreoscan) proved to be more effective than the usual imaging modalities. Intraoperative ultrasonography gastroscopy for duodenal transillumination and repeated measurement of blood gastrin levels should be performed intraoperatively in the surgical treatment of gastrinomas. CONCLUSIONS: The clinical application of radioguided surgery for tracer-uptaking endocrine tumors is still controversial. In our case the decision to use this method was influenced by the fear that the patient's obesity and the effects of previous surgery could hamper the identification of the small tumor.

Aged↗
PubMedDate not supplied

[Clinical and functional results after restorative proctocolectomy with ileal J reservoir in the treatment of ulcerative colitis].

PURPOSE: Restorative proctocolectomy is the procedure of choice in the treatment of ulcerative colitis. The operation is successful in removing all diseased mucosa while preserving a normal bowel function and a good quality of life for the patient. In this article are presented the clinical and functional results obtained in 28 patients, 19 males (68%) and 9 females (32%) after stapled restorative proctocolectomy with ileal J pouch-anal anastomosis. RESULTS: There were no perioperative deaths. The overall morbidity rate was 31%. Six patients (21%) presented pelvic abscess; 2 (7%) pelvic hematoma, 4 patients (14%) ileo-anal anastomotic stricture, 1 patient (3.6%) pouch-vagina fistula, three patients (11%) intestinal obstruction and 7 (25%) pouchitis. All patients were able to evacuate their pouches spontaneously. The mean bowel movements were 6-9/24 hours at the first postoperative month and 3-5/24 hours at the sixth month. Infrequent nocturnal seepage occurred in 6 patients (21%). Stool consistency returned to normal within 3-6 months. The mean pouch capacity was 210 cc. The mean resting pressure was diminished in 11 patients (39%), the men and maximal squeeze pressures were improved in 9 (32%); the ileo-rectal-anal inhibitory reflex was normal in 5 patients (18%), not defined in 12 (43%). Impotence or impaired bladder function was not present. CONCLUSION: The use of staplers in the surgical technique of restorative proctocolectomy with J shaped ileo-anal pouch is associated with low morbidity and better long-term results. The procedure requires a good selection of patients, a correct surgical timing, a very carefully technique and a low pre and postoperative treatment with steroids.

Adult↗
PubMedDate not supplied

Hormonal changes in male subjects over-ninety.

The physiology of aging in very old people is still poorly understood. A wide variety of age-related factors confuse the interpretation of existing data, especially as regards the modifications of the endocrine system. The effect of age on the gonad-hypophyseal function was studied in 26 over ninety-year-old males and compared with a control aged between 27 and 88, subdivided into age groups. The serum levels of total testosterone were stable up to the ninth decade while they were lower in the over ninety-year-olds; free testosterone and its peripheral metabolites (estrogens and dehydrotestosterone) were also lower in the over ninety-year-olds with respect to the others, although the decrease had started more gradually at about the fourth decade. Sex-hormone-binding-globulin, the main serum carrier of testosterone, increased gradually with age. The levels of hypophyseal gonadotropins were constant up to the ninth decade where a significant and abrupt increase was observed. The data suggest the presence of marked alterations of the testicular-hypophyseal axis in the later decades of life, with important repercussions on the pattern of circulating sex steroids.

Adult↗