Biomedical subjects

Paolo Soliani

Publications and source records attributed to Paolo Soliani.

24 records · Page 2Linked to original sources

PubMedDate not supplied

Value and limits of emergency colonoscopy in cases of severe lower gastrointestinal haemorrhage.

Acute bleeding of the lower gastrointestinal tract causes complex diagnostic problems. Colonoscopy is subject to discussion as the first method of diagnosing lower digestive tract bleeding. From June 1998 to September 2001 we observed 80 patients with acute bleeding (45 males and 35 females; mean age: 65.5 years). All patients underwent an emergency colonoscopy. In 15 cases we carried out an angiography and in 9 a scintigraphy (always after colonoscopy). Colonoscopy detected the cause of the bleeding in 69 patients (86.2%) during the first examination. Angiography and scintigraphy revealed the haemorrhage in 8 (53%) and 7 (77.7%) cases, respectively. Ten cases were treated during colonoscopy; 31 underwent surgery. We consider an emergency colonoscopy as the first method for diagnosing the causes of bleeding. If this examination fails we consider arteriography and scintigraphy as second-line approaches for obtaining a diagnosis.

Adult↗

PubMedDate not supplied

[Pancreatic pseudocysts: endoscopic treatment. Personal experience].

Pseudocyst is a complication of acute and chronic pancreatitis. Today endoscopic drainage is reported as being the treatment of choice for these complications. Endoscopic drainage was performed in 15 patients with a pseudocyst bulging into stomach or duodenal lumen as detected by CT and endoscopic examination. All 15 cases treated from January 1991 to December 2001 (11 men, 4 women; median age: 55.7 years [range: 33-81] were successfully drained. The mean hospital stay was 4.8 days. No mortality or major complications were observed and the compliance was very good. The procedure is safe and we believe that endoscopic drainage should be the procedure of choice for pseudocysts which bulge into the gastrointestinal lumen.

Adult↗

PubMedDate not supplied

[Therapy of post-necrotic pancreatic pseudocysts: invasive treatments and their results].

Pancreatic pseudocysts are the most common lesions of the pancreas. Endoscopic and US-endoscopic techniques are today the best minimally invasive diagnostic and therapeutic procedures available for this pathology. From January 1980 to December 2001 we observed a total of 74 patients with pancreatic pseudocysts secondary to acute pancreatitis. Twelve patients were treated by medical therapy, 37 with a surgical approach, 15 by endoscopic drainage and 10 by CT-guided drainage. The mean size of the pseudocysts was 12.9 cm (range: 3.4 to 24 cm) and 69.4% were larger than 10 cm. CT-guided drainage had a 50% complication rate (P = 0.00814), a 20% mortality rate (P = 0.00463) and a 10% relapse rate. The surgical approach was associated with a complication rate of 18.9% and a 5.4% relapse rate. The endoscopic approach presented a 13% morbidity rate and a 6.6% relapse rate. CT-guided drainage is the therapeutic approach we use in emergency cases, but endoscopic therapeutic technique is the best procedure and is a valid alternative to surgical and CT-guided drainage. The shortest mean hospital stay (4.8 days) was observed with the endoscopic approach.

Adult↗

PubMedDate not supplied

Use of the transcystic guidewire in single-intervention treatment for cholecysto-choledocholithiasis. A case report and technical notes.

Videolaparoendoscopic treatment of choledocholithiasis in a single stage is an important option for this disease. We currently adopt this approach to choledocholithiasis in our department. We report here the case of a woman with stones in the biliary tract and gallbladder. After videolaparoscopic cholecystectomy we performed a transcystic cholangiography. A guidewire was used to show Vater's papilla during endoscopic papillosphinterotomy, because this was in a duodenal diverticulum that made it impossible to cannulate the papilla. We propose this method in all those cases in which, for anatomical reasons, the papilla cannot be easily cannulated.

Aged↗

PubMedDate not supplied

[Rupture of the spleen in angiosarcoma: a case report and review of the literature].

Splenic angiosarcoma is a rare neoplasm originating from endothelial cells of the blood vessels. Its incidence is about 0.14-0.25 per million. We report the case of a patient admitted in a state of hypovolaemic shock with haemoperitoneum due to rupture of the spleen. Splenectomy was performed with evacuation of the haemorrhagic effusion. The blood was aspirated and in part instilled during the operation through intraoperative blood salvage due to the large haemoperitoneum. Histological examination revealed a splenic angiosarcoma. Splenic angiosarcoma should be suspected in cases of splenomegaly with unknown anaemia and no lymphoma, leukaemia or myelofibrosis, because of its neoplastic aggressiveness and its invariably fatal outcome. It is important to perform a splenectomy before splenic rupture owing to its negative impact on long-term survival.

Aged↗

PubMedDate not supplied

[The changes in the emergency surgical treatment of diverticulitis in the last thirty-years].

BACKGROUND: The surgical management of diverticulitis in emergency is controversial: The primary reconstructive surgery or Hartmann's procedure? METHODS: The Authors have analyzed our experience on 409 cases of diverticulitis from January 1975 to December 2004; 101/409 were treated in emergency and divided in two groups before and after December 1994. The patients were divided on Hinchey's classification, type of surgical procedure, ASA status and complications. The Authors have analyzed all cases by t-Student and chi2 analysis. RESULTS: No difference between two groups on age, sex, concomitant diseases are observed. The hospital stay in patients treated in emergency was 10.2 days to 7.1 days in patients operated after 24 hours (p<0.05). The incidence of primary anastomosis in the second group is higher (p<0.03). The incidence of leaks in two groups was respectively 27.2% and 10.3% (p<0.005). The deaths were 12/101 (11.8%); 9 of these in III-IV stages of Hinchey's classification. DISCUSSION: In the lasts ten years the surgical approach to diverticulitis in emergency is changed. The individual risks factors, the Hinchey's stage, play an important role in decision making. The Authors have registered a major indications to primary anastomosis in emergency.

Colonic Diseases↗