Splenic rupture following colonoscopy in a hemodialysis patient.
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Colonoscopy↗
Biomedical subjects
P Nobili
Publications and source records attributed to P Nobili.
[Surgical treatment of abdominal aortic aneurysm. Factors affecting mortality and morbidity].
In this report, based on a 5 year experience, 76 operation were performed electively for intact abdominal aortic aneurysm and 55 were emergency procedure for ruptured aneurysm. Factor affecting mortality and morbidity in the cases are analysed. Three patients died of cardiac causes following elective aneurysm repair, a mortality rate of 3.9%. No patients died of pulmonary causes, renal failure or required dialysis. No patient developed a graft infection, stroke or intestinal ischemia. Mortality rates for surgical repair of ruptured AAA averaged 32% and the principal cause of death is cardiac disease (50%). The second cause is renal failure. Declining of operative mortality for intact aortic aneurysm is related to earlier diagnosis using non invasive methods and correct preoperative study.
Aged↗
[A gun-shot lesion of the internal carotid. A clinical case and review of the literature].
The authors report a case with penetrating zone II neck wound and internal carotid artery injury. Optimal evaluation and management with vascular injury remains controversial. A review of retrospective studies reported in the literature has demonstrated that physical examination alone may be as accurate as arteriography in detecting significant cervical vascular injuries requiring operative repair. Not unexpectedly, the results of carotid artery repair in neurologically stable patients have been excellent, in front of the results of revascularization in patients with equivocal or less-severe neurologic deficits.
Adult↗
[Treatment of the abdominal aorta combined with a second surgical procedure].
The synchronous performance of aortic graft with a second surgical procedure should be avoided because of the risk of subsequent graft infection. The Authors reported the experience of 21 patients who underwent synchronous aortic graft with second surgical procedure. No graft infection occurred and it is concluded that such combined operation may be safer to perform than staged surgery in elderly patients.
Aortic Aneurysm, Abdominal↗
[Blunt traumatic rupture of the diaphragm].
Lesions of the diaphragm are uncommon but important complications of blunt thoraco-abdominal traumas. Their incidence is increasing over the last decades as a consequence of the increase of the road traumatology. Preoperative diagnosis is often difficult especially when the diaphragmatic lesion is associated with other skeletal or visceral injuries that may mask the clinical or radiological signs. The Authors report 12 cases of traumatic lesions of the diaphragm due to blunt trauma observed from 1980 to 1997 and that underwent surgery. In particular they discuss about the importance of an early diagnosis and a correct surgical approach to reduce morbidity and mortality. Nine patients were operated by laparotomy; thoracotomy was performed in one case and the combined approach in the last two patients.
Adult↗
[Cecum-colon invagination due to cecal adenocarcinoma. Apropos of two cases].
The Authors report in an elderly patient a ceco-colic intussusception caused by carcinoma of the cecum, and evaluate etiology and pathogenesis, the most frequently affected anatomical sites, and the various clinical manifestations of the disease. Regarding the latter, the Authors emphasize chronicity of the suboccf1p4ve status in the adult patient vs. the clinical picture of intussusception in the paediatric one. Hemicolectomy represents the most common therapeutic approach, especially when intussusception is irreducible or with the evidence of severe colonic ischemia.
Adenocarcinoma↗
[Acute occlusion of the abdominal aorta].
The Authors report on two cases of acute aortic occlusion, related to cardiac embolism and thrombosis of aortic aneurysm. The singularity of the etiology adds interest to a pathology which is already, in itself, serious and complex and which requires the intervention of the surgeon, anesthesiologist-reanimator, cardiologist, and nephrologist. The diagnosis is mainly clinical. The use of Doppler and CT scan provide to achieve the diagnosis. Surgical treatment included transfemoral embolectomy, with a Fogarty catheter, in the patient with acute aortic occlusion related to cardiac embolism, and aortobifemoral bypass, in the other patient, affected by thrombosis of aortic aneurysm.
Acute Disease↗
[Esophageal perforations. Diagnosis and treatment].
Perforation of the esophagus was retrospectively analysed in six patients. The age span was 30 years to 81 years, and the male to female ratio was 2 to 1. Each case was studied with regard to presentation, etiology, treatment and complications. The diagnosis was made at postmortem examination only in 1 patient. The perforation was iatrogenic in 1 of the patients and spontaneous in 5. Management was nonoperative in 3 cases and primary repair with drainage was performed in 2 patients. Overall mortality rate for the series was 33%. This series accumulated from a review of the literature emphasizes the importance of the influence of different methods of treatment and time lapsed between occurrence and therapy.
Adult↗
[Gallstone ileus. Our experience].
Five patients were operated on for gallstone ileus over a 10-year period. Plain abdominal radiograms performed at admission were diagnostic in only 2 patients while other procedures such as ultrasonography and gastroduodenoscopy were required in 2 patients. Obstructing stones were located in the terminal ileum in three patients and in the duodenum in two. A one-stage procedure consisting in the removal of the impacted stone, fistula repair, and cholecystectomy was performed in three patients, two of whom died. Removal of impacted stones was the only surgical treatment in the remaining two patients, with no mortality. The Authors conclude that enterolithotomy alone should be the standard procedure for gallstone ileus. The repair of cholecysto-enteric fistula should be scheduled on elective basis and only if there are continuing or recurrent symptoms.
Aged↗
[Aneurysms of the popliteal artery. A clinical case and revision of the literature].
The authors report their experience about one case of popliteal artery aneurysm. The patient was treated with aneurysm resection and dacron by-pass graft. The good surgical results and high risk of natural complications of popliteal aneurysms suggest that operation in the asymptomatic stage should always be attempted.
Aged↗
[Non-parasitic splenic cyst].
The Authors report a case of epithelial cyst of the spleen. The pathogenetic hypothesis as well as the clinical patterns of this rare disease, which is usually found in children and young adults, are considered.
Adolescent↗
[Intestinal obstruction due to phytobezoars].
The authors report nine cases of small bowel obstruction due to phytobezoars, observed from January 1982 to October 1991. The main factors in the pathogenesis of phytobezoars, particularly alimentary habits and previous gastric surgery, are considered. In five patients the operation, always performed in emergency, consisted in a longitudinal enterotomy. In two cases the plasticity of the phytobezoar allowed for a manual progression beyond the ileocecal valve. In two patients an intestinal resection was necessary. The authors prefer the finger fracture technique with manual progression of the phytobezoar beyond the ileocecal valve when the ileal loop is well conserved and the phytobezoar itself has enough plasticity.
Adult↗
[Percutaneous drainage of liver abscesses].
Three patients with hepatic abscess were treated by percutaneous drainage ultrasonographically or tomographically guided. The treatment was effective in two out of three patients. The low morbidity and the high success rate obtained suggest that this therapeutic modality should be used before considering any surgical approach.
Adult↗
[Lithiasis of the common bile duct and transduodenal papillosphincterotomy. Analysis of our cases].
The results obtained from 1978 to 1987 with the use of transduodenal papillosphincterotomy in bile duct lithiasis are reported. The operation was performed on 126 patients and produced 4.7% immediate mortality. The indications and the most frequent post-operative complications were studied. Routine intra-operative cholangiography had been carried out. The long-term results were very good in 86% of the cases, average in 13% and poor in 1%. Provided one limits its indications to cases when it is really necessary, papillosphincterotomy does not involve a higher risk than other biliary operations.
Adult↗
[Cancer of the gallbladder].
The Authors report their experience about 20 patients operated on since 1975 for primary carcinoma of the gallbladder. They remark their disappointment because of the poor percentage of preoperative and early diagnosis, that only allows a radical surgical therapy. More attention, therefore, should be payed to this not so rare pathology in the hope the survival of the patients radically operated will increase.
Aged↗
[Primary retroperitoneal tumors].
The Authors report 7 cases of primary retroperitoneal tumors observed in a five-year period. On the basis of the literature data, they examine the diagnostic, therapeutic and prognostic features, emphasizing the need for a surgical treatment supported, only when useful, by radio- and chemotherapy. The importance of an early diagnosis, thanks to modern technologic progress, is also stressed, echography in particular.
Adult↗
[Liver abscess: clinical cases and review of the literature].
Personal experience with liver abscess is presented. After a review of the epidemiologic and aetiologic factors most commonly influencing hepatic abscesses formation, the Authors discuss their clinical and diagnostic aspects. Furthermore various surgical options are examined for the proper treatment of these conditions.
Adult↗
[Neoplasms of Vater's papilla. Diagnosis and surgical treatment].
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Adenocarcinoma↗