PubMed Health⌕ Search

Biomedical subjects

R L Rossi

Publications and source records attributed to R L Rossi.

At least 73 records · Page 4Linked to original sources
PubMed1986

Management of bile duct cysts in adults.

In 31 adult patients with bile duct cysts seen at the Lahey Clinic (Burlington, Mass) during a 20-year period, the median age at time of initial therapy at Lahey Clinic was 34 years. Abdominal pain was the most common presenting symptom, followed by jaundice and fever. The 31 patients underwent a total of 86 biliary tract procedures, of which 37 were performed at Lahey Clinic. Internal drainage was the most common operation, but it frequently resulted in recurrent symptoms requiring reoperation. Cyst excision was associated with a significantly lower incidence of recurrent cholangitis and need for reoperation and was not associated with increased operative mortality. Cystic disease was frequently associated with other hepatobiliary diseases. Biliary carcinoma occurred in five (16%) of our patients, and late deaths from biliary-related disease occurred in seven patients (22%). When technically possible, cyst excision is the treatment of choice.

Adolescent↗
PubMed1986

Segmental pancreatic autotransplantation with pancreatic ductal occlusion after near total or total pancreatic resection for chronic pancreatitis. Results at 5- to 54-month follow-up evaluation.

Reported are eight patients with idiopathic chronic pancreatitis and two patients with alcoholic pancreatitis who had near total distal pancreatectomy for disabling pain and underwent simultaneous segmental pancreatic autotransplantation of the body and tail of the gland to the femoral area in an attempt to prevent or delay the onset of diabetes. The median follow-up period was 31 months, and follow-up study in nine patients ranged from 24 to 54 months. Patency of the grafts was determined by angiography and selected percutaneous venous assays for insulin. Islet cell function was determined by oral glucose tolerance tests, intravenous (I.V.) glucose tolerance tests, and I.V. glucagon stimulation studies. Segmental autotransplantation was technically successful in eight patients, only one of whom required insulin (at 2 years after grafting). The other seven patients with technically successful grafts have remained insulin independent, including two patients who later underwent pyloric preserving pancreatoduodenectomy for completion pancreatectomy. Variable pain relief was observed in patients who underwent near total pancreatectomy, but pain was unrelieved in those patients who underwent limited distal resection. Patients with idiopathic pancreatitis appear to have better pain relief and preservation of endocrine function than alcoholic patients. Segmental pancreatic autotransplantation prevents or delays the onset of diabetes mellitus and should be considered as an alternative for those patients who require extensive pancreatic resection for chronic pancreatitis.

Adult↗
PubMed1986

Pyloric and gastric preserving pancreatic resection. Experience with 87 patients.

Eighty-seven patients with neoplasm (57 cases), pancreatitis (28 cases), or benign biliary obstruction (2 cases) were treated with pyloric preserving pancreatectomy with two postoperative deaths, neither due to abdominal complications. About 50% of patients had delay in recovery of gastrointestinal function. Six and seven patients had clinically significant biliary and pancreatic fistulas, respectively, with some patients having both. Complications required 16 reoperations. Marginal ulcer was suggested by endoscopy or barium study in five patients, three of whom were successfully managed by a medical regimen. In the other two patients, exploration failed to demonstrate an ulcer or jejunitis. In most patients, long-term gastrointestinal function was judged to be excellent based on weight gain and lack of digestive symptoms. Pyloric function and gastric motility were evaluated by abdominal scanning using indium 111 and technetium 99m. Gastric emptying of liquids and solids was normal. Estimations of enterogastric reflux showed a moderate difference between normal subjects and pancreatectomy patients. Cancer-free survival was comparable to that after the standard Whipple procedure.

Adenocarcinoma↗
PubMed1986

A five to ten year follow-up study of parietal cell vagotomy.

Records of 51 consecutive patients who underwent parietal cell vagotomy at the Lahey Clinic Medical Center and who had follow-up studies of five to ten years were reviewed. Operation was performed for intractability in 25 patients, intractability and obstruction in 19 patients and bleeding in seven patients. Patients with pyloroduodenal stenosis underwent digital dilation. No operative deaths occurred. Ulcer recurred in two of 25 patients (8 per cent) treated for intractability, in three of 19 patients with obstruction and in two of seven patients operated upon for bleeding. Ulcers recurring in patients operated upon for obstruction developed in the first two years after operation and were frequently gastric. Recurrences in patients treated for intractability were seen throughout the ten years of follow-up study. Of the seven patients who had a recurrence of an ulceration, five were treated successfully with medical therapy and two required truncal vagotomy with antrectomy. Functional results graded according to the Visick criteria revealed excellent to good results in 27 of 32 (84 per cent) of patients without obstruction and in 11 of 19 patients (58 per cent) with obstruction before operation (p less than 0.05). Fair to poor results were attributed to recurrent ulcers in the group of patients without obstruction and to symptoms of delayed gastric emptying in the group of patients with obstruction. We consider parietal cell vagotomy the procedure of choice to use for patients with intractable duodenal ulcer, but we have abandoned use of pyloroduodenal dilation in the patient with appreciable obstruction from fibrosis.

Adolescent↗
PubMed1985

Management of cancer of the bile duct.

Tumors of the bile duct are uncommon. Most patients will present with a syndrome of obstructive jaundice, but in a few patients the tumor can mimic benign disease of the biliary tract. Cholangiography continues to be the basis of diagnosis and gives important information for a decision on therapy. Histologic diagnosis is helpful when available, although frequently difficult to obtain and not always possible. The overall prognosis for these patients remains poor. Currently, a multidisciplinary approach is required to select for each patient the best therapy with the lowest morbidity and mortality. It should include a surgeon, gastrointestinal endoscopist, interventional radiologist, and radiotherapist. The prognosis for a patient appears to be related to the tumor's location, resectability, and, in our experience, differentiation. Therapy should be tailored to each patient based on location of the tumor, extent of the disease, condition of the patient, expertise available in each institution, and morbidity and mortality associated with each procedure. At the Lahey Clinic, the resectability rate for bile duct tumor is currently 25 per cent. Resection is more frequently possible for tumor of the distal bile duct and can result in a five-year survival rate of up to 30 per cent. For patients with unresectable distal tumor at the time of operation, a proximal hepaticojejunostomy is the palliative procedure of choice. If nonresectability of a distal tumor is determined before operation, the decision to proceed with an endoscopic placement of a stent versus surgical hepaticojejunostomy or placement of a T tube needs to be an individual one. Although five-year survival for tumor of the proximal bile duct is anecdotal, those patients who undergo resection have the longest survival and may have better palliation than those who undergo strictly palliative, nonresective procedures. To warrant exploration for resection of tumor of the proximal bile duct, careful patient selection is required, and the morbidity and mortality of operation must be minimized. An increasing role of percutaneous transhepatic techniques of decompression of the biliary tract is expected as they improve and gain wider acceptance. They are the procedures of choice in very high-risk surgical patients or in patients determined before operation to have unresectable disease. Improvement in the survival of patients with cancer of the bile duct probably depends on development of better adjuvant therapy, such as new techniques of radiation therapy and new modalities of chemotherapy, in association with surgery or with a percutaneous or endoscopic intubation technique.

Bile Duct Neoplasms↗
PubMed1985

Surgical management of chronic pancreatitis.

The management of chronic pancreatitis continues to achieve only limited success. A lack of understanding of the basic pathogenic mechanism of this disease limits our therapy to treatment of symptoms, sequelae, and complications. The diagnosis of chronic pancreatitis usually is based on a history of classic pain plus some objective findings of pancreatic disease. Imaging techniques, such as ultrasonography or CT, are helpful in defining the size of the gland and the presence of masses and collections of fluid. Endoscopic pancreatography, however, remains the most helpful tool for diagnosis. The information that it provides about the pancreatic ductal system can help in selecting a procedure that achieves the best result with the lowest morbidity and mortality. The principle to follow in the surgical management of this condition is to tailor the procedure in each patient to preoperative clinical information, information provided by pancreatography, operative findings, exocrine and endocrine status of the patient, presence or absence of drug addiction and alcoholism, and the personality of the patient as well as his or her ability to manage the possible metabolic complications of surgery. Although management of pain is the main goal, the morbidity and late mortality that can result from different procedures must be a major consideration in selecting therapy. Pancreaticojejunostomy is the procedure of choice at this time for patients with a dilated pancreatic duct sphincterotomy or sphincteroplasty for the occasional patient with proved ampullary obstruction of the pancreatic duct, and internal drainage for pseudocyst. Different degrees of pancreatic resection are indicated for patients with severe disease and small pancreatic ducts, in patients in whom decompressive operations have failed, in patients with lateralized disease to the head or tail of the gland, in some instances of pseudocyst or pancreatic fistulas, and for some patients when cancer cannot be ruled out. Attempts are being made to improve the limited results of our current therapy. Endoscopic occlusion of the pancreatic duct, pancreatic segmental autotransplantation, islet cell autoimplantation, use of the pyloric-preserving operation, and use of continuous subcutaneous insulin infusion are being tried. Further experience with these techniques is required to determine their value in the management of patients with chronic pancreatitis.

Ampulla of Vater↗
PubMed1985

Liver transplantation.

Liver replacement has become a viable treatment option for select patients with severe acute or chronic hepatic failure. Evaluation of potential candidates is discussed along with current techniques for donor organ retrieval, recipient implantation, and postoperative immunosuppression.

Adult↗
PubMed1985

Malignancies of the thyroid gland. The Lahey Clinic experience.

The management of patients with thyroid carcinoma remains controversial. Review of the Lahey Clinic's experience with 964 patients treated for thyroid malignancy and followed up for a period of 15 to 40 years assisted in the formulation of our current guidelines for management of this disease.

Adenocarcinoma↗
PubMed1985

Management of complications of portal hypertension.

The management of portal hypertension focuses on control of its complications, the most important of which is bleeding esophageal varices. Other complications, such as ascites, bleeding intestinal stomas, and hypersplenism, rarely require surgical intervention. Other than medical management, the three basic procedures now available for the treatment of bleeding esophageal varices include decompression of varices with a portosystemic shunt, nonshunting operations that attack directly the esophageal variceal-bearing area, and liver transplantation as the procedure of choice in selected patients. Patients who present with episodes of acute bleeding are usually treated initially with medical therapy including acute sclerotherapy or balloon tamponade techniques when necessary. If the patient fails to respond or if episodes of bleeding recur, further therapy is required. Although selection of therapy remains controversial, it is based on multiple factors. These include the basic pathogenic mechanism of portal hypertension in the individual patient, status of the patient as defined by Child's classification, elective or urgent nature of the operation, hemodynamic stability of the patient at the time of the procedure, site of the block in the portal system, and caliber and anatomic relationship of the vessels available for anastomosis in the portal system. Additional factors include the presence and severity of ascites or encephalopathy, age of the patient, site of bleeding (esophageal or gastric), severity of associated hypersplenism, and techniques and expertise available at a given institution. Shunting procedures achieve the best long-term control of bleeding, but they can precipitate the development of encephalopathy. Nonshunting procedures do not induce encephalopathy, but they are usually associated with a high rate of rebleeding. Also, with the possible exception of sclerotherapy, they are still associated with a high operative mortality rate in alcoholic patients classified as Child's C. Although sclerotherapy controls acute variceal bleeding more successfully than conventional methods, it is not readily applicable in patients with bleeding gastric varices. Also, it has not yet clearly been proved to be an effective method of permanent control of gastroesophageal bleeding and has not been demonstrated to increase survival. The new methods of extensive esophagogastric devascularization (for example, porta-azygos disconnection using the Sugiura procedure) are attractive because of the low late recurrence rate for bleeding without the induction of encephalopathy.(ABSTRACT TRUNCATED AT 400 WORDS)

Collateral Circulation↗
PubMed1985

Pyloric preservation with the Whipple procedure.

The pylorus-preserving pancreatoduodenectomy simplifies resection, allows a satisfactory postoperative weight gain, prevents postgastrectomy symptoms, is followed by a low rate of jejunal ulceration, and can be performed with an extremely low postoperative mortality rate, providing that the pancreatic and biliary anastomoses are constructed so that no leakage occurs. Preliminary data indicate a satisfactory survival rate when this procedure is used for periampullary cancer, and reasonable relief of pain is achieved when the procedure is used in chronic pancreatitis.

Chronic Disease↗
PubMed1985

Reconstruction of the biliary tract.

The history of biliary reconstruction is a record of almost 100 years of surgical advancement. A reasonable technique is now available and applies not only to reconstruction after injury in the course of cholecystectomy but also to reconstruction after resection of tumor or in the treatment of sclerosing cholangitis, choledochocyst, or biliary calculi. A successful technique requires a dissection that does not compromise blood supply to the proximal duct, the use of a single layer of interrupted sutures, the temporary placement of a stent, and the use of bowel at the hilus of the liver without tension. As in most operative procedures the actual performance of the reconstruction is relatively easy in slender, good surgical subjects, but operative decisions and the actual technique used in locating the proximal duct and in suturing deep in the right upper quadrant can make reconstruction a difficult procedure.

Anti-Bacterial Agents↗
PubMed1985

Surgical management of gastrinoma.

In eight of 10 patients with Zollinger-Ellison syndrome resection of all visible tumor tissue was combined with gastrectomy. The results in this group of patients, as in other series reported in the literature, suggest that excision of gastrinoma by partial pancreatectomy or enucleation can be combined safely with gastrectomy. Perhaps excision of tumor is preferable in the management of patients with solitary tumor who do not have the multiple endocrine neoplasia syndrome. We await further follow-up studies and experience with additional patients before judging this thesis of tumor resection with gastric preservation.

Adenoma↗
PubMed1985

Management of nonfunctioning islet cell tumors of the pancreas.

Eleven patients with nonfunctioning islet cell tumor of the pancreas were examined. Since no hypersecretory syndromes were noted, patients' complaints related to enlarging pancreatic masses. Pancreatoduodenectomy was the most commonly performed procedure, with long-term survival of 77 per cent and 62 per cent at two and five years, respectively. Immunohistochemical stains for various polypeptides were positive in two of four tumors tested. Surgical therapy remains the most effective treatment for resectable lesions, with prolonged survival possible in most patients.

Adenoma, Islet Cell↗
PubMed1985

Hyperparathyroidism.

A review of hyperparathyroidism and current controversies in diagnosis and management is presented. Accurate diagnosis by the endocrinologist and an experienced surgeon remain the standards for good surgical results. Hyperparathyroidism is a heterogeneous disease, and therapy must be individualized to each patient. Conservative surgical removal of parathyroid tissue is preferred in most patients.

Adenoma↗
PubMed1984

Common bile duct calculi. 1. Surgical therapy.

Multiple techniques are now available for management of the patient with retained or recurrent common bile duct calculi. The goal of treatment is extraction of calculi with the lowest possible incidence of morbidity and mortality, the lowest cost and least discomfort to the patient, and the best long-term results. The choice of therapy--surgical or nonsurgical--depends on several factors, including presence or absence of the gallbladder and a T tube, type of calculi, operative risk, accompanying conditions, and expertise available at a particular institution. The decision to explore the common bile duct at the time of elective cholecystectomy is based on clinical, operative, and cholangiographic information. A rigorous technique of surgical exploration that includes duodenal mobilization, choledochoscopy, and cholangiography is necessary. In selected patients, biliary enteric anastomosis decreases the incidence of retained or recurrent calculi.

Alkaline Phosphatase↗
PubMed1984

Common bile duct calculi. 2. Nonsurgical therapy.

Several nonsurgical methods of therapy are available for treatment of retained common bile duct calculi. These include percutaneous extraction, endoscopic extraction, dissolution, and endoscopic sphincterotomy. The method chosen depends on location and size of calculi, size of sinus tract, patient age, surgical risks, and other factors. In most cases, procedures can be carried out safely and successfully with few or no complications.

Aged↗