Biomedical subjects
Publications and source records attributed to R Vecchio.
The authors describe a rare case of congenital splenic cyst, observed in a 22 year old female. Pathological and clinical aspects are discussed and the up-to-date diagnostic and therapeutic approach is presented.
One case of primary adenocarcinoma of the vermiform appendix is presented. The patient, a 55-year-old man, showed non specific symptoms and the diagnosis was made after surgery. Surgical treatment was right hemicolectomy. The patient is still alive and disease-free 12 months after the operation. The Authors review the literature and discuss some clinical aspects of this rare tumor.
The papilla of Vater and its sphincter of Oddi, lying at the confluence of the bile and pancreatic ducts in man, have long been suspected as a source of upper abdominal pain. Enlarging the opening of the transpapillary segment of the bile and major pancreatic ducts by using a transduodenal sphincteroplasty with transampullary septectomy resulted in death in a patient with a peripapillary diverticulum and pancreas divisum. Eight-six patients followed for 1 to 10 years experienced a 75% success rate. Thirty-six patients had a marked stenosis of their duct of Wirsung, suggesting that their pain was primarily from the pancreas. The remainder had either a generalized narrowing (40 patients) or a normal (7 patients) papilla. Pain was not satisfactorily resolved in patients with an associated pancreas divisum, chronic pancreatitis, and recurrent episodes of acute pancreatitis with alcoholism.
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"Stenosing papillitis" is a descriptive term for an anatomic deformity of the papilla of Vater that is characterized by narrowing of the lower end of the bile duct and the proximal end of the duct of Wirsung. The defect is secondary to inflammation and fibrosis from the chronic passage of gallstones, episodes of acute pancreatitis, chronic pancreatitis, sclerosing cholangitis, peptic ulcer disease, and cholesterolosis. Patients with papillary stenosis from gallstones may present with episodes of severe upper-abdominal pain several years after cholecystectomy. The pain is often incapacitating, and patients are often addicted to narcotic analgesics. The work-up includes abdominal ultrasonography and CT scanning and endoscopic retrograde cholangiopancreatography even though the findings usually are normal. Liver and pancreatic enzymes are not frequently elevated with the painful episodes. Transendoscopic manometry may reveal elevated pressures within the papillary portion of the distal bile duct. Some patients are relieved of their pain by transduodenal sphincteroplasty and transampullary septectomy, thereby ablating the sphincter of Oddi around the bile and pancreatic ducts and enlarging their openings.
The Authors report their experience on ileal-anal anastomosis with a J-pouch. A videotape illustrates the surgical technique. At last functional results are shown.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Colorectal cancer is one of the most common solid tumors affecting people around the world. A significant proportion of patients with colorectal cancer will develop or will present with liver metastases. In some of these patients, the liver is the only site of metastatic disease. Thus, surgical treatment approaches are an appropriate and important treatment option in patients with liver-only colorectal cancer metastases. Resection of colorectal cancer liver metastases can produce long-term survival in selected patients, but the efficacy of liver resection as a solitary treatment is limited by two factors. First, a minority of patients with liver metastases have resectable disease. Second, the majority of patients who undergo successful liver resection for colorectal cancer metastases develop recurrent disease in the liver, extrahepatic sites, or both. In this paper, in addition to the results of liver resection for colorectal cancer metastases, we will review the results of cryoablation, heat ablation, and hepatic arterial chemotherapy using a surgically implanted pump. Each of these surgical treatment modalities can produce long-term survival in a subset of patients with liver-only colorectal cancer metastases, whereas systemic chemotherapy used alone rarely results in long-term survival in these patients. While surgical treatments provide the best chance for long-term survival or, in some cases, the best palliation in patients with colorectal cancer liver metastases, it is clear that further improvements in patient outcome will require multimodality therapy regimens.
The Authors report their experience on 76 patients managed for oesophageal achalasia from 1973-1997. 65 patients have been surgically treated with Heller miotomy (19 cases) or miotomy with antireflux procedures (46 cases); 11 patients underwent an endoscopic pneumatic dilation. 54 patients, 43 surgically and 11 endoscopically treated, have been followed for a mean length of time of 6 years and 6 months. Complete cure or significant improvement of symptoms have been noted in 86% and 72.7% of patients treated respectively with surgery or pneumatic dilatation. The results have been evaluated according to the recent data from the literature and diagnostic and therapeutic aspects of primitive achalasia are discussed.
Local anesthesia is the most common technique used in the surgical treatment of inguinal hernia. The introduction of synthetic prosthesis, which are resistant to infection, has to the development of surgical techniques used in local anesthesia, in a day hospital setting. These techniques permit a lowering of hospital costs and a reduction of the incidence of complications and recurrences. Over the last few years the authors have been performing a modified Lichtenstein repair or the Rives technique in local anesthesia. In this study they present their data on 52 patients surgically treated in the period 1997-1998, and discuss the advantages of their technique.
The Authors describe the evolution of their anesthesiological techniques in the surgical repair of inguinal hernia. In this study they compare indications, complications, costs, hospital stay, length of surgery, postoperative pain and return to work after operations performed under local, spinal and general anesthesia. In their experience inguinal hernia treatment with local anesthesia and a tension-free technique is the preferred method of surgical repair.
Cholecystectomy is a common surgical procedure performed in patients with sickle cell disease (SCD). Postoperative complications, including acute painful vaso-occlusive crisis and acute chest syndrome, have been described frequently after either traditional or laparoscopic cholecystectomy (LC). It's still not clear if preoperative blood transfusion, hyperhydration, intraoperative body temperature conservation may reduce complications rate. The Authors reviewed the charts of seven patients with SCD operated on LC for symptomatic gallbladder lithiasis and describe their perioperative management. In 3 patients preoperative endoscopic removal of stones was achieved. Five patients with HB lower than 9 g/dl and/or HbS higher than 40% were transfused preoperatively and all the patients were hyperhydrated. Intraoperative monitoring was achieved for early recognition of ventilation to perfusion mismatch and acid-base balance or temperature modifications. The Authors reported only one case of postoperative lower extremities pain. This study suggests that LC is a safe procedure in SCD if appropriate monitoring and perioperative management are achieved.
A total of 26 surgical patients with chronic idiopathic thrombocytopenic purpura (ITP) were reviewed and results of splenectomy were statistically related to age and sex, length of and response to pre-operative corticosteroid therapy, pre-operative platelet count and time interval between diagnosis and surgery. Median age was 37 years (range, 17-81 years) and the male:female ratio was 1.16. Pre-operative platelet count ranged from 2-70 x 10(9)/l. The length of pre-surgical corticosteroid therapy (prednisone 1-2 mg/kg/day) varied from 2 weeks to 3 years. Steroid therapy was unsuccessful in 15 patients and only achieved temporary remission in the remaining 11 cases. The time interval between diagnosis and splenectomy ranged from 4-60 months. There were 21 responders (80.4%) and 5 non-responders (19.6%) to splenectomy. Using the chi-square test, differences in age, length and response to pre-operative steroid therapy and diagnosis-to-splenectomy interval did not achieve statistical significance when responder and non-responder groups to splenectomy were compared. Conversely, a significant difference was found comparing male to female groups, since 92.9% of males and only 66.7% of females were successfully treated by surgery (P approximately 0.01). In addition, patients with a pre-operative platelet count less than 30 x 10(9)/l responded at an higher rate (100% versus 70.6%; P approximately 0.05) to splenectomy.
The occurrence of post-operative pain, although less severe and frequent than in open surgery, may affect length of hospital stay and early return to normal activity in some patients operated on with laparoscopic surgery. Although several pathogenetic factors have been indicated in the literature, the mechanism responsible for post-operative pain after laparoscopy; still remains unclear. In this study the Authors evaluated post-operative pain in 90 patients submitted to laparoscopic cholecystectomy and correlated it to the length of operation, endoabdominal CO2 pressure maintained during surgery, and use of local anesthesia instilled din the liver bed and in the sites of introduction of trocars. Measuring post-operative pain by means of a modified Scott-Huskisson Visual Analogue Scale, no difference in the severity of the pain was noted in the two subgroups of patients with a length of operation inferior or superior to 60 minutes, respectively. Conversely, a statistical significant difference (p = 0.04 and p = 0.049 according to Fisher exact test and Pearson test, respectively) was observed evaluating the use of local anesthesia and the level of CO2 endoabdominal pressure, with less pain in patients whose pressure was maintained under 10 mmHg and in patients treated with instillation of local anesthetic drugs in the liver bed and in the sites of introduction of trocars.
The authors report 32 patients admitted to the hospital with iatrogenic bile duct stricture. Cholecystectomy with or without bile duct exploration was the most frequent (84.3%) surgical procedure responsible for the lesion, followed by BII gastric resection. Six patients had undergone one previous attempt at repair in another institution. Most patients had undergone a hepatojejunostomy, which has the procedure of choice in the last cases. Mortality and morbidity rates were 0 and 15%, respectively. The complications reported were a biliary fistula and 2 post-repair bile strictures that required one or more re-operations. During the follow-up 2 other patients developed episodes of cholangitis, treated medically. Clinical, diagnostic and therapeutic aspects of iatrogenic bile duct strictures are reviewed.