Biomedical subjects
Publications and source records attributed to R Guglielmi.
A case of epidermoid cyst of the spleen in a young man is reported. The importance of the echotomography and CT for diagnosis of this unusual pathology is pointed out. The role of splenectomy as first choice in the treatment of splenic cysts is emphasized.
Authors emphasize the surgical risk in elderly. Mortality and morbidity are pointed out in male and female patients. They report on 30 aged patients operated for various pathologies also discussing the results.
A case of enterorrhagia sustained by arteriovenous malformation of the caecum in a young patient is reported. The importance of an early diagnosis to avert a serious anemia is underlined. Preminent role of colonscopy and selective visceral angiography in the diagnosis of such disease is discussed. At first a conservative urgently treatment of caecum bleeding is advised. Subsequently, when the patients is in more favourable conditions, an elective surgical operation is considered as essential.
The authors present different kinds of laser used in the treatment of several surgical affections in out patients. A review of the international literature and main uses of this technique are shown.
A case of cystic mesothelioma of the peritoneum, presenting as acute appendicitis is reported. The authors stress the difficulty of a correct preoperative diagnosis of this rare tumor, which however, may be considered benign, with a good long-term prognosis.
Thymic carcinoid is a rare lesion. Two cases are reported and diagnostic as well as therapeutic problems are discussed.
Authors' experience in detecting neoplasms by a computerized telethermographic system in animal models is reported. The new technique seems to have a great potential as a photo-diagnostic method particularly when followed by the surgical treatment or the photodynamic therapy (PDT) of the neoplastic lesions. Literature reports on the PDT of tumors are reviewed.
Currently, bronchopleural fistulas present a decreasing complication rate in thoracic surgery, especially since surgical management of tubercular infections is no longer needed. The introduction of non-reacting suture materials and the technological advances have also lowered the incidence of such complication. Although fistulas tend to be chronic, their treatment is possible. Today, in fact, the use of human fibrin glue gives positive results which depend on the extent of the fistula as well as the adherence of the glue to the bronchial wall. The authors report their experience in two cases treated with human fibrin glue.
A case of ganglioneurofibroma of the lung surgically managed is reported. Symptoms were those of an enlarging mass in the thorax. The essential clinical features of the condition are briefly discussed.
The authors report two cases of hernia of Morgagni, respectively observed in a 42-year-old man and in a 16-year-old boy. In the first case the diagnosis was previous (20 yrs.) to surgical treatment. On the contrary, in the second case the diagnosis was not possible before surgery because of the patient's young age and mild symptoms. Surgical treatment, through thoracotomy in the first case and laparotomy in the second one, was able to repair the diaphragmatic gap.
Intra-abdominal liposarcomas (IALS) represent a rare localization compared to other liposarcomatous (LS) sites such as the lower extremities and the retroperitoneum. The authors report their experience in a case of giant liposarcoma (weight: Kg 8.2) presenting a massive intra-abdominal extension. Diagnostic and therapeutic problems related to this type of neoplasm as well as a literature review are reported.
Authors report four cases of mediastinal tumors. X-rays, CT scan, bronchial endoscopy, angiography and mediastinal endoscopy can be useful to diagnose this kind of neoplasms. Surgical treatment and, further, radio or chemotherapy are used in case of mediastinal neoplastic lesions. Unfortunately, lifetime longer than five years is observed just in 50% of the patients.
One hundred nineteen patients operated upon for acute ischemia of the lower limbs have been retrospectively reviewed, in order to evaluate the influence of the condition on outcome, and the patterns of treatment. Fifty six per cent of the patients were males and 42% females, 68.4% had an history of aorto-iliac obstructive disease; 51.2% of the ischemias were due to arterial thrombosis and 48.8% to embolism, in 12.5% of the cases etiology was unknown. Thrombosis were more frequent in younger patients' population (mean age 59.8 years) compared to embolism (mean age 69 years), even if the mean age of patients bearing an ischemia of embolic type has risen, in the last 10 years: 62.1% were due to atrial fibrillation and 50% occurred on pathologic arteries, patients with arterial obstructive disease presented a higher incidence of arrest of embolic material at the common femoral artery bifurcation. Women's mean age was significantly higher then that of men (70.9 vs. 59 yrs.). Embolism was more frequent in women than in men (64 vs 42.2), whereas thrombosis was more frequent in men than women (57.8 vs 36%). There were more deaths in women than men (30.8 vs 20.8%), but more amputations in men than women (37.3 vs 17.3%). Embolism of arterial origin include 15.2% of all acute ischemias and 31% of all embolisms, and their site of origin is often unknown, particularly when it is located in the thoracic aorta, which mandate a complete arteriography and eventually a CT-Scan of the thorax and the abdomen. A lower limb phlebitis, associated with an acute ischemia mandates the search of a patent foramen ovale, and an heparin induced thrombocytopenia. Surgical treatment is directed towards obstruction removal (embolectomy, by-pass) and towards the treatment of the causative agent (aortic endarterectomy, caval filter, anticoagulants). Post-operative thrombolysis may be beneficial in case of distal residual thrombus after embolectomy. An higher mortality rate has been observed in acute ischemias due to embolism rather than thrombosis (31 vs 19.6%) and more major amputations in thrombosis than in embolism (37.7 vs 17.2%). Overall mortality rate has been of 25%, with an amputation rate of 28%. Present results have been compared with those of the literature, both agree on some changes over the last 20 years, concerning the incidence of different mechanisms of acute ischemias and their prognosis.