Biomedical subjects

R Lotti

Publications and source records attributed to R Lotti.

24 records · Page 2Linked to original sources

PubMedDate not supplied

[An intramural hematoma of the duodenum].

Intramural hematoma of the duodenum is a rare event which is usually associated with trauma. Because of the rarity of this problem, there has been little conformity of opinions as to diagnosis and treatment of this disease. The authors report on a case of intramural hematoma of the duodenum post-traumatically occurred in a young woman. Etiopathogenesis, diagnosis and treatment of hematoma of the duodenum are thoroughly examined in the present study. Plain abdominal radiography, oral barium study, ultrasound examination, CT and RNM are diagnostic tools in this disease. It appears that most patients with intramural hematoma of the duodenum would respond well to conservative management; surgery should be reserved for those cases that remain obstructed over seven days or have evidence of peritonitis. However surgery is mandatory in cases of uncertain diagnosis. The evacuation of hematoma is considered the most effective and safest surgical treatment.

Abdominal Injuries↗

PubMedDate not supplied

[Therapeutic strategy in symptomatic diverticular disease of the colon].

Diverticular disease of the colon has been recorded with increasing frequency and approximately 25-30% of symptomatic patients require surgery for complications. Controversy still surrounds the best operative approach for the management of diverticular disease, particularly when it presents with complications. The three-stage operation has, for the most part, been abandoned because of its unacceptably high morbidity and mortality rates. Today it is generally believed that performing two-stage surgery is a wise decision, namely segmentary resection either without (Hartmann's procedure) or with anastomosis, protected by a covering colostomy. However, the ideal intervention is a one-stage surgical procedure (segmentary resection and primary anastomosis without a covering colostomy), but this can only be performed in selected patients. The aim of this study was to analyse the clinical course and the medical and surgical therapy retrospectively in 79 patients with symptomatic diverticular disease in order to identify the best therapeutic procedure; specifically, the severity of septic complications was evaluated using Hinchey's classification. The authors conclude that most patients with symptomatic diverticular disease require specific medical therapy. If surgical treatment is necessary (complicated diverticular disease), Hartmann's procedure is still a valid surgical option, particularly in the presence of diffuse faecal peritonitis. Colonic resection and primary anastomosis are certainly a satisfactory treatment, because of their low morbidity and mortality rates, but this surgical approach is only feasible in selected patients. Finally, it is a matter for the individual surgeon's experience to select the best surgical procedure in any particular situation, depending on age and general state, local findings and the extent of peritonitis.

Adult↗

PubMedDate not supplied

[Intestinal infarction. Retrospective clinical study].

Acute mesenteric ischaemia is the result of inadequate blood flow to all or part of the small intestine and the right half of the colon. Irrespective of the cause of the ischaemic insult, the end results are similar, namely, a spectrum of bowel injury ranging from completely reversible alterations of bowel function to transmural haemorrhagic necrosis of the intestinal wall. Depending on the degree of ischaemia and the length of bowel involved, a wide variety of clinical presentations are observed. Mesenteric infarction is a pathology which is encountered fairly often in elderly patients where the concomitance of other diseases make its prognosis more severe, especially since the diagnosis is usually late. The pessimism expressed more than 70 years ago concerning this disease is still shared by many physicians today. The authors report on their experience with 37 cases of mesenteric infarction. The median age of the patients was 77 years (range: 66-91). The mortality rate was 67.5% (25 deaths) which is in line with the results in the literature. The median hospital stay was 17 days (range: 10-71). The authors emphasise the difficulty of diagnosing and treating this entity, also in view of the fact that, in most centres, it is impossible to perform emergency selective angiography of the superior mesenteric artery. The need for an early specific diagnosis is stressed, because the therapeutic options may vary widely in relation to the different causes of acute intestinal ischaemia.

Aged↗

PubMedDate not supplied

[Non-palpable lesions of the breast: retrospective clinical study].

A non-palpable breast lesion (NPBL) is a disease of the mammary gland that cannot be detected during clinical examination but that can be visualized by mammography and/or ultrasonography, either during screening programs or sometimes in asymptomatic women. These small lesions require an adequate diagnostic-therapeutic approach to ensure correct treatment. The aim of the present study was to analyse a series of NPBLs retrospectively in order to define them nosologically and establish an adequate diagnostic-therapeutic work-up for such cases. Ninety-three patients with a total of 99 NPBLs were observed from January 1989 to December 1999. The 99 NPBLs were submitted to ultrasonography and 31 (31.3%) were also submitted to US-guided fine needle aspiration biopsy (FNAB). Later on the diagnostic-therapeutic procedure involved surgical biopsy after radiological centering and, in the case of malignant neoplastic lesions, surgical intervention and adjuvant therapy. Ultrasonography confirmed the presence of NPBL in 45 cases of the 99 detected at mammography (45.4%). Cytological examination of the 31 FNABs yielded the following results: unreliable 19.3%, suspected malignancy 42%, negative for neoplastic cytology 6.5%, positive for carcinoma 32.3%. The histological diagnosis was one of mammary carcinoma in 41 patients (43%). Among the 41 carcinomas there were 8 (19.5%) carcinomas in situ, 24 (58.5%) invasive ductal carcinomas, 8 (19.5%) invasive lobular carcinomas, and 1 (2.5%) medullary carcinoma. In the 32 (80%) patients submitted to lymphadenectomy for 33 invasive carcinomas, 6 patients (18.7%) presented positive lymph nodes (N1). The Authors conclude that NPBLs are an important clinical entity because they may be the expression of a malignant lesion; most NPBLs are diagnosed during screening programs or sometimes in asymptomatic women by means of mammography, which is the only standardised method for their identification. The poor diagnostic capability of non-invasive methods and the potential malignancy of NPBL justify the indication for surgical excisional biopsies; in cases of histological findings of malignancy it is often possible to perform conservative surgery with similar results to radical surgery in terms of survival. When NPBLs turn out to be invasive carcinomas, a concomitant lymphadenectomy is mandatory.

Adult↗

PubMedDate not supplied

[Laparoscopic cholecystectomy in day-surgery analysis of feasibility in 166 consecutive patients].

BACKGROUND: Day-Surgery (DS) is a widely spreading reality, both for clinical advantages to patients and organizational and economic profit to hospitals. In the last years, DS has been proposed for the treatment of a large number of diseases as inguinal and crural hernias, varicose vein, benign anorectal and thyroid pathologies. Recently, also laparoscopic cholecystectomy (LC) has been realised as DS procedure, and the initial results are promising. OBJECTIVES: To determine both the clinical feasibility of LC in DS and the factors that can predict an extension of hospital stay. MATERIALS AND METHODS: The present study is a retrospective analysis of 166 patients who underwent surgery because of symptomatic cholelithiasis in a three-year period; all patients underwent elective LC in ordinary hospital-stay. In order to identifying the patients potentially eligible for LC in DS, we carried on a selection by means of 3 consecutive stages: stage A, selection on the basis of preoperative data, stage B, selection on the basis of intraoperative factors and stage C, selection on the basis of postoperative parameters. RESULTS: Out of 166 patients, only 33 (19,8%) would have been successfully treated in DS. CONCLUSIONS: This study showed that LC in DS can be realised in strictly selected patients, on the basis of rigorous clinical and organizational criteria; furthermore, a continuous training of surgeons and nursing staff, the implementation of tele-medical facilities and the improvement of anesthesiological techniques will allow to the best results.

Adult↗

PubMedDate not supplied

Argon laser trabeculoplasty: long-term results.

We analyzed the long-term success of argon laser trabeculoplasty (ALT) performed in 237 eyes of 175 patients diagnosed with primary open-angle glaucoma and followed for up to 11 years (maximum, 132 months) after treatment. The cumulative proportion of success, defined as the avoidance of glaucoma surgery or an intraocular pressure never exceeding 22 mm Hg, was calculated throughout follow up using the Kaplan-Meier life-table analysis. The success rates were: 78% at 1 year (n = 205), 71% at 3 years (n = 139), 61% at 5 years (n = 73), and 40% at 10.5 years (n = 19). Our data confirm previous reports of the high initial success rate of ALT, followed by a time-dependent decrease in its efficacy.

Aged↗