Biomedical subjects

Pietro Conti

Publications and source records attributed to Pietro Conti.

5 recordsLinked to original sources

PubMed2005

Bisegmentectomy 7-8 as alternative to more extensive liver resections.

BACKGROUND: Preservation of hepatic parenchyma should be attempted whenever possible in order to reduce the risk of liver failure and increase the chance to re-resect the recurrence. STUDY DESIGN: The presence of a lesion in segments 7-8 infiltrating the right hepatic vein is usually an indication for right hepatectomy. If a thick inferior right hepatic vein is seen, a bisegmentectomy 7-8 can be performed. We review our experience with this uncommon liver resection. RESULTS: In 11 of 332 patients with colorectal liver metastases, a lesion was localized in segments 7-8 infiltrating the right hepatic vein. Six underwent resection of segments 7-8. The mean estimated rate of remnant liver volume (segments 2-4 plus caudate lobe) was 23.7%; 4 patients had neoadjuvant chemotherapy. Intraoperative mean blood loss was 200 mL without transfusions; no patients developed postoperative liver failure, and there was no in-hospital mortality. Surgical margin was negative in all patients. Median survival was 25 months, with 3 patients alive and disease-free. One patient with an intrahepatic recurrence underwent re-resection. CONCLUSIONS: Bisegmentectomy 7-8 is an uncommon but safe procedure that allows curative resections without unnecessary sacrifice of functional parenchyma.

Aged↗

PubMedDate not supplied

[Design and implementation of an integrated HIS-RIS-PACS system: our experience].

PURPOSE: To develop an integrated information system to support the administrative and healthcare work processes in a highly specialised research-oriented healthcare institution composed of one hospital and a separate outpatient centre. The project, developed within the context of an ongoing process of technological innovation, aimed to improve the efficacy and efficiency of the services provided. In particular, over the past year our efforts focused on developing and implementing a RIS-PACS system to support the management of clinical data and radiological reports and images. MATERIALS AND METHODS: The RIS-PACS system was implemented in four phases to meet the technical-functional needs of the Units of the Department of Diagnostic Imaging. The plan was developed considering the work flow between the Department, the outpatient centre and the hospital wards with the aim of creating a filmless and paperless organisational model for the Radiology Units. The four implementation phases were characterised by defining and developing protocols that would integrate the systems (HIS, RIS, PACS and modalities) to guarantee correct and complete management of the work flow. RESULTS: Phases I and II have already been completed and have led to efficient, safe and complete interaction between the hospital wards, the outpatient centre and the Radiology Units. Overall performance of the hospital has improved and the outpatient centre is now completely managed in digital mode. Phases III and IV will extend these positive results by enabling the routine distribution of radiological reports and images to all hospital wards and clinics and associated facilities. As a result, the use of film and printing and developing materials will gradually be reduced, enabling all the required clinical and diagnostic information to be immediately and securely shared. DISCUSSION AND CONCLUSIONS: This project is one of the first examples in Italy of the routine implementation of a single virtual radiology department distributed across physically remote locations. In particular, the project was successfully completed thanks to the approach used in planning and defining the clinical and functional specifications, and in the implementation phase. We conclude that setting up an information system truly capable of supporting the routine clinical activity of a Diagnostic Imaging Department requires a detailed operational project and careful planning of each implementation phase.

Diagnostic Imaging↗

PubMedDate not supplied

Biliary squamous cell carcinoma.

Squamous cell carcinoma of the liver, bile ducts and gallbladder is extremely rare. We report a case of squamous cell carcinoma of the common bile duct manifesting atypically without jaundice, despite its large size and proximal bile duct dilation. A review of the literature concerning all other squamous carcinoma of the biliary tract is presented including 3 other bile duct cancers, 17 intrahepatic and 30 gallbladder cancers. Compared to the more common adenocarcinoma these rare biliary cancers seem to present particular clinical features and prognostic differences which may be important for planning treatment.

Carcinoma, Squamous Cell↗

PubMedDate not supplied

[Blunt liver trauma: efficacy of non-operative management].

All haemodynamically stable patients with blunt abdominal trauma can be managed conservatively by non-operative management which is the treatment of choice in 80% of liver trauma. Non-operative management, when feasible, yields very good results in terms of survival, need for blood transfusions, morbidity and reduction of hospital stay. The Authors retrospectively analyse their recent experience with liver trauma. Of 53 patients with blunt liver trauma, 36 underwent surgical treatment whereas 17 haemodynamically stable patients received non-operative management. After CT scans, all patients on non-operative management underwent haemodynamic monitoring, US and blood examinations. A percentage of 47.1 % had a > or = grade III trauma. The mortality and morbidity rates were 0% and no blood transfusions were needed. The efficacy of non-operative management was 100% and none of the patients needed subsequent surgical treatment. Our clinical experience demonstrates that non-operative management is feasible and effective even for higher grade traumas, but always requires strict clinical, haemodynamic and US monitoring and careful patient selection. Current progress in the field and recent evidence reported in the literature indicate the likelihood of further developments and more widespread utilisation of non-operative management in liver trauma.

Adolescent↗

PubMedDate not supplied

[Pancreatic trauma: a case report].

Pancreatic trauma is a rare event, accounting for approximately 3% of all blunt abdominal traumas. The related mortality is quite high, around 5-30%, mostly due to the associated haemorrhagic lesions and to the delay in establishing the diagnosis, while pancreatic damage is directly responsible for death in only 5-10% of cases. We report here on a case of severe pancreatic trauma, underestimated initially and treated surgically at a later stage. The literature shows that the main difficulty in cases of pancreatic trauma is still related to failure recognizing the injury or to the frequent delay in diagnosing the condition, above all in haemodynamically unstable patients. In these cases, as in the one treated in this report, the clinical evidence and the priority accorded to the treatment of the shock are factors that tend to limit thorough examination. In haemodynamically stable patients, on the other hand, the multislice CT-scan and MR pancreatography-wirsungography are useful for the diagnosis. The treatment can be either conservative or surgical, depending on the extent of the damage, especially to the Wirsung duct. Surgical treatment with preservation of the entire pancreatic parenchyma, as performed in our case, even if technically demanding, makes it possible to maintain the function of the pancreas, thus reducing the risk of metabolic complications.

Adult↗