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R Ruggiero

Publications and source records attributed to R Ruggiero.

64 records · Page 4Linked to original sources
PubMedDate not supplied

[Intraoperative cholangiography in videolaparoscopic cholecystectomy: indications, advantages, and limitations].

Consensus doesn't exist about the intraoperative cholangiography specially if is need in every one laparoscopic cholecystectomy either exclusively in case of anatomical doubts or suspect of injures or stones of the common duct. We have considered 450 patient subjected to laparoscopic cholecystectomy during 1992-2000. Patients suspicious to be affected by common duct lithiasis (28 cases) are subjected to ERCP with cleaning of the biliary tree. In 18 patients (4%) it has been necessary the laparotomic conversion; 176 patients (39%) have been subjected to intraoperative cholangiography, selected on anatomical regional disposition or anamnesis and biochemical and instrumental results (history of jaundice or gallstones pancreatitis, abnormal serum level of the biliary stasis biochemistry, common bile duct major of 8 mm, michrolitiasis of the gallbladder). In 7 cases (4%) we have discovered common bile duct stones. We don't attempt intraoperative cholangiography in every one laparoscopic cholecystectomy, but only in cases where we suspect presence of common bile duct stones either iatrogenic injuries or when we retain it necessary to clarify the regional anatomy. Unlikely just in patients where would be more useful, causes major risk of intra- and post-operative complications, it is very difficult, often impossible, to attempt the intraoperative cholangiography. Routinary employing of the intraoperative cholangiography could be useful just for a little number of patients, while selective employing reduce 60% the X-ray. Collaboration with the radiologist is able to reduce the mistaken on the interpretation of the radiograms.

Cholangiography↗
PubMedDate not supplied

[Modulation of the axillary lymph node dissection in breast cancer].

UNLABELLED: Several studies showed the reliability of the sentinel lymph node (SN) technique in the evaluation of the N parameter in breast cancer so much to induce surgeons to limit the axillary dissection to the biopsy of the SN alone (SNB) in case this is negative to the extemporaneous examination. After a period of focusing on the identification technique, biopsy and histological examination of the SN (October 97-January 98) always followed by a complete dissection of the three axillary node levels (ALND), we started a study to evaluate the reliability of a limited dissection of the 1st level of the axilla (FLND) in women with T < 3 cm, N0-1a, M0, that did not undergo any neoadjuvant treatment and in which the SN resulted free from metastases. We started this phase of the study in February 1998 till May 2001. In the present paper we show the results related to this period. MATERIALS AND METHODS: We enrolled 256 women with T < 3 cm, N0-1a, M0. In 49 cases we used vital dye, in 23 dye + radioguided surgery (RGS) and in 184 RGS only. The extemporaneous histological examination of the SN has been performed with thin sections, dyed with EE. When SN was negative to the intraoperative examination, we limited the dissection to the 1st level of the axilla, except that in 3 patients, with SN located to the 2nd level, in which we did an ALND. The FLND has been performed in 17 cases with a minimally invasive technique. The definitive histological examination of the SN always included the immunohistochemistry. If the SN was positive, usually underestimated to the intraoperative examination, the patients had an adjuvant chemotherapy. RESULTS: In 203/207 patients (98.1%) SN was found to the pre-operative lymphoscintigraphy. During surgery the SN was identified in 46/49 (94%) using the vital dye, in 22/23 (96%) using the vital dye + RGS and in 176/179 (98.3%) using RGS. To the extemporaneous histological examination SN was negative in 140, metastatic in 101; to the histological definitive results of the SN we noticed 6 false negative, since others lymph nodes than SN were positive (4 cases) or for evidence of micrometastases at the immunohistochemistry which were not detected at the extemporaneous examination (2 cases). On 107 cases of N+ the SN was the only metastatic lymph node in 42 (39.3%). The false negative percentage was 5.6% and the diagnostic accuracy of the SNB was 97.5%. In the group treated with FLND we only noticed two cases of light lymphedema (1.4%). CONCLUSIONS: Our results are in concordance with the international literature and they induced us, from June 2001, to begin a new phase of the study in which we limit the dissection of the axilla to the SN only, if not metastatic, in women with T1 breast carcinoma.

Adult↗
PubMedDate not supplied

Skeletal muscle ventricles in circulation long-term: one hundred ninety-one to eight hundred thirty-six days.

It has been shown previously that skeletal muscle ventricles fashioned from canine latissimus dorsi muscle can function as effective blood pumps. We describe four dogs that have been reported on before but have now had skeletal muscle ventricles functioning as effective aortic diastolic counterpulsators for 191 to 836 days. One dog remains well with a skeletal muscle ventricle that has been pumping in circulation for 194 days; there has been no evidence of thrombus in the skeletal muscle ventricle cavity or thromboembolism. None of the three dogs that died had evidence of peripheral embolization, although two of those dogs had thrombus within the cavity of the skeletal muscle ventricle. This study proves that skeletal muscle ventricles can function long-term in the circulation and maintain diastolic pressure augmentation beyond 2 years. To the best of our knowledge, the dog whose skeletal muscle ventricle pumped in circulation for 836 days represents the longest living laboratory animal or human with a functioning heart assist device.

Animals↗
PubMedDate not supplied

[Breast-conserving surgery in breast cancer].

Breast-conserving surgery is the treatment of choice for the breast cancer T < 3 cm. The local recurrence is a problem of diagnosis and consequent treatment. We enrolled, from 1987 to 2004, 1504 breast cancer. In 803 (53.4%) tumor with T < 3 cm we performed conserving surgery. The sentinel lymph node (SN) technique induce to limit the axillary dissection in patients T1a-b to the SN only if non metastatic and located to the first level, the dissection of the 1st level of the axilla in patients T1c-T2 < 3 cm and SN negative, complete axillary dissection in patients with metastatic SN or located to the 2nd level. Our percentage of local recurrence in the follow-up was 3.5% at 5 years and 6% at 10 years.

Axilla↗
PubMedDate not supplied

[Ductal carcinoma in situ of the breast].

The Authors report their experience about 127 ductal carcinoma in situ (DCIS) of the breast. Guidelines for surgical treatment are: radiological or clinical diagnosis, tumor's extension, histological classification, grading and margin status. At the present the Authors prefer breast conserving surgery with tumor margin's study. They report their experience in the last seven years about sentinel node biopsy. Radiotherapy and endocrine therapy are indicated for selected patients; local recurrence after DCIS therapy is 8,1% on a 6,1 years follow-up.

Adult↗
PubMedDate not supplied

[The smooth muscle autograft in continent colostomies. Experimental research on rabbits].

The authors stop onto make use of the colon smooth musculature to resolve the question of medical and surgical methods used until now to improve the continence of colostomies. Owing to the experiences and co-operating with some other research centers, the authors refer about the experiment performed on the rabbit, where a small leaf of intestine serous-muscular tissue was employed to perform a continence system on colostomy. The analysis of manometric results obtained from check animals in different post-operatory periods (3-7-14-21 days) pointed out a moderate reaction of neosphincterial function, while the histological results prove a favorable histological development without to change the muscular tunica fibrous tissue. The easy application, harmless of employed methods and undoubted comfort for the patient stand for valid indications in the development to come of this method.

Animals↗
PubMedDate not supplied

[Roux-en-Y reconstruction with defunctionalized jejunal loop, after gastric resection].

Authors report their personal experience on Roux-en-Y reconstruction, after partial gastric resection. They have considered 39 patients: 24 of them had been operated for a peptic ulcer of the lesser gastric curve and 15 for a pyloric cancer for which a partial gastric resection had been adopted for various reasons (age, stage or else). The follow-up lasted on an average of 42 months (4 to 68). Controls concerned secretory activity and motility. A prolonged stasis of solids, in the gastric stump or in the isolated loop, has been observed in two of the long controlled patients, together with superficial ulcers of the digiunal mucosa. Alcaline reflux was absent or very small; inflammatory changes of the gastric mucosa were hardly evident. In conclusion the authors regard the partial gastric resection, followed by the reconstruction with a digiunal isolated loop, as a valid surgical technique, for peptic ulcers of lesser gastric curve and for gastric cancers for which total gastrectomy seems not indicate.

Anastomosis, Roux-en-Y↗
PubMedDate not supplied

[Segmental liver transplantation. Experimental studies in swine].

Authors report the results of an experimental application of one of the more recent techniques of liver transplantation, which has the preparation ex situ as a basilar step of the procedure. 18 pig were operated on, from september 1991 to march 1993; they were divided in two groups: the first (group A) underwent an auxiliary segmental autotransplantation of left lobe to heterotopic subdiaphragmatic location; in group B an orthotopic segmental autotransplantation of right lobe after ex situ preparation of the liver according the technique of Pichlmayr was performed. The results show that a bigger application of ex situ surgery may help to find a resolution to the problem of the small number of liver donation.

Animals↗
PubMedDate not supplied

[Ultra-low laparoscopic rectal resection and colo-anal anastomosis. Experimental study on swine].

Nowadays oncologic surgery is defining new criteria in the treatment of rectal cancer: preservation of sfincterial function, ultra-low resections with distal margin at only 2 cm distally to the tumor, role of mesorectum as preferential site of lymphatic diffusion, preservation of lombo-aortic and pelvic nerves. Laparoscopy is showing good results in bowel surgery so as previously got on biliary tract: less visceral manipulation, less stimulation of immunologic system, less pain, early resumption of peristalsis and food intake, better recovery, less hospital stay. We experimented on pig ultra-low laparoscopic resection of the rectum, with preservation of sfincterial function, and mechanical anastomosis at the upper edge of the sfincterial ring. The evaluation of surgical technique, post-operative supervision, and follow-up instrumental control (anal manometry, endo-rectal ultrasonography, sfincterial electtromanometry, Rx barium enema) show technical feasibility and confirm a better recovery with regular defecatory function.

Anal Canal↗