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Biomedical subjects

P Ronconi

Publications and source records attributed to P Ronconi.

At least 19 recordsLinked to original sources
PubMed2006

Lateral popliteal sciatic nerve block: a single injection targeting the tibial branch of the sciatic nerve is as effective as a double-injection technique.

BACKGROUND: Evidence indicating that single- and double-injection techniques for inducing a sciatic nerve block via a posterior subgluteal approach yield a similar success rate prompted us to investigate whether the two anesthetic techniques yield a similar success rate via a lateral approach. We also hypothesized that, owing to the peculiar anatomic features of the sciatic nerve at the popliteal level, a single injection via the lateral approach might induce effective anesthesia by targeting the tibial nerve only. METHODS: Ninety-six patients undergoing popliteal sciatic nerve block via a lateral popliteal approach for foot surgery were randomized to receive a single 30-ml injection of ropivacaine 7.5 mg/ml to block the tibial nerve (TN group, n= 32) or the common peroneal nerve (CPN group, n= 32), or two separate 15-ml injections (TN + CPN group, n= 32), after stimulation to evoke motor responses from the target nerves. RESULTS: The mean time to obtain a complete sensory blockade (surgical anesthesia) was shorter in the TN group than in the CPN and TN + CPN groups (14 +/- 7 min vs. 23 +/- 17 and 21 +/- 14 min, respectively; P < 0.05). The success rate was similar in the TN and TN + CPN groups (94%) and, 25 min after the initial injection, was already better in these groups than in the CPN group (94% vs. 75%; P < 0.05). CONCLUSIONS: A lateral popliteal sciatic nerve block obtained with a single 30-ml injection of ropivacaine 7.5 mg/ml after electrostimulation to locate the tibial nerve is as effective as multiple TN + CPN stimulation and injection, and local anesthesia has a significantly shorter onset time.

Amides↗
PubMed2001

Ambulatory anesthesia for foot surgery.

Ambulatory surgery has developed extensively over the past few years in most Western countries. The absence of specific legislation in Italy creates a lack of trust in patients and interferes with the development of this discipline. The authors describe their experience in the organisation of an outpatient foot surgery centre over the past thirteen years, which is in constant expansion and currently performs about 300 operations every year. They report the criteria used to select patients, the organisation of the operating theatre, pre- and postoperative treatment and the anesthetic techniques used. Among the latter, they describe a new approach used to block the popliteal sciatic nerve. The results obtained show a high approval rate from the majority of patients treated. The authors attribute this success to a series of factors, including patient selection and surgical procedures, the maintenance of constant standards of quality similar to those in hospitals and the experience of outpatient anesthesia.

Ambulatory Surgical Procedures↗
PubMed1997

Selection of locally advanced gastric carcinoma by preoperative staging laparoscopy.

BACKGROUND: The present study is a prospective evaluation of immediate preoperative laparoscopy compared to ultrasound/computed tomography (US/CT) staging for gastric cancer in a series of 100 patients observed at two major Italian hospitals from April 1995 through September 1996. METHODS: After a complete preoperative work-up all c-M0 patients underwent laparoscopy immediately prior to an eventual surgical exploration. pTNM was considered as the gold standard for the evaluation of the results. RESULTS: Laparoscopy detected 21 unsuspected M+ cases out of 100. As regards locally advanced tumors, laparoscopy showed a sensibility of 69.7% for T3 and 89.6% for T4, significantly higher than US/CT staging (23.2% and 48.3%, respectively; p < 0.02). In this series laparoscopic staging altered clinical staging in 58% of cases. CONCLUSIONS: This procedure plays two crucial roles in the preoperative evaluation of advanced gastric cancer: It makes it possible to avoid unnecessary surgical exploration in M+ cases and, to date, it represents the most reliable and economic tool for the selection of locally advanced tumors in the light of neoadjuvant treatment.

Adenocarcinoma↗
PubMed1996

Immediately preoperative laparoscopic staging for gastric cancer.

BACKGROUND: This ongoing study is a prospective evaluation of immediately preoperative video-laparoscopy compared to ultrasound/computed tomography (US/CT) staging for gastric cancer. An analysis of the first 70 cases is reported. METHODS: TNM staging is used to compare the US/CT findings and the laparoscopic findings with the gold standard for pathologic findings in resected specimens. RESULTS: In our series 47 out of 70 cases are locally advanced cancers (stages III and IV): In this subset the predictive value of laparoscopic staging is 86.4%. Laparoscopy shows an overall staging accuracy of 68.6%, compared to 32.8% for US/CT. The difference is statistically significant as regards the T factor (T3: 69.7% vs 12. 1%, p < 0.002; T4: 84.2% vs 42.1%, p < 0.05); as regards the M factor, laparoscopy appears the most specific method for detecting peritoneal seeding. CONCLUSIONS: This procedure plays a crucial role in determining the resectability of the tumor, thus avoiding unnecessary laparotomies. A meticulous staging becomes mandatory when applying modem treatment options (e.g., neo-adjuvant chemotherapy) to locally advanced cancers; in this context the use of staging laparoscopy will have a relevant impact on future treatment.

Adenocarcinoma↗
PubMed1990

[Antibiotic prophylaxis with sulbactam/ampicillin in colon surgery].

We evaluated the effectiveness of sulbactam/ampicillin (S/A) as a perioperative prophylaxis regimen in elective colic surgery (procedures lasting less than 4 hours). We studied 18 patients (11 males, 7 females; mean age 46 yrs, range 21-72), by an open, non-comparative trial: S/A was given soon before anesthesia (1 g + 2 g) and the same dose was repeated every 6 hours, up to 5 doses. The drug was well tolerated, and there were no side effects requiring the interruption of the prophylaxis. Infection rate was low (only one case of evident suppuration of the wound).

Adult↗
PubMed1985

The treatment of relapsing clubfoot by tibialis anterior transfer underneath the extensor retinaculum.

Nineteen patients with 22 relapsing clubfeet were treated by tibialis anterior transfer underneath the extensor retinaculum. This operation is indicated in cases of relapse in which the clubfoot is still supple. It is not indicated in cases with subtalar rigidity. The results were excellent in 19 cases, fair in 2 and poor in one. The fair and poor results were attributable to faulty technique or errors of indication.

Child↗
PubMed1982

Ogilvie's syndrome (acute colonic pseudo-obstruction): review of the literature (October 1948 to March 1980) and report of four additional cases.

Four additional cases of Ogilvie's syndrome (acute colonic pseudo-obstruction), representing the first cases described in Italy, are reported. The medical literature concerning the subject is also thoroughly reviewed. Ogilvie's syndrome is an acute massive dilatation of the large bowel without organic obstruction of the distal colon. Three hundred and fifty-one cases have been described in the literature to date. Eighty-eight per cent of the cases were associated with various extracolonic affections (metabolic and organ dysfunctions, postoperative and posttraumatic states, etc.). Twelve per cent of cases were not associated with known disorders and were defined as idiopathic. The pathophysiology of the syndrome is still unknown. Ogilvie, who first described the syndrome in 1948, suggested an imbalance between the sympathetic and parasympathetic innervation of the colon: this neurogenic hypothesis has been shared by other authors, although explanations may differ slightly. The clinical and radiologic picture closely resembles mechanical obstruction of the large bowel. The most marked dilatation usually takes place in the right colon and cecum: if the distended cecum reaches a diameter larger than 9 to 12 cm, perforation is likely to occur; if perforation occurs, the mortality rate increases from 25 to 31 per cent to about 43 to 46 per cent. If conservative management fails to control the dilatation and cecal rupture is impending or suspected emergency surgery is indicated, the surgical procedure of choice is dictated by the general conditions of the patient as well as by the intestinal findings: operation may consist of cecostomy, colostomy, or right hemicolectomy or simply emptying the bowel.

Adult↗
PubMed1978

[Late complications of latero-lateral choledocho-duodenostomy. Physiopathology, diagnosis and therapy. Apropos of 6 cases].

Laterolateral choledochoduodenostomy is commonly used in the treatment of lithiasis and both benign and malignant stenosis of the main bile duct, and is regarded on all sides as safe and free from late complications. The latter, however, were noted in 6 personal cases and consisted of pain (5/6 cases), fever (4/6 cases), and dyspepsia (3/6 cases, icterus (1/6 cases). Surgery revealed recurrent or residual lithiasis (4 cases) and stenosis (4 cases). It is felt that the reflux of duodenal material into the main bile duct after creation of the anastomosis led to ascending cholangitis, stagnation and hence stenosis of the opening. Closure of the opening and extensive papilloplasty is not followed by immediate postoperative sequelae.

Adult↗