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S Chiodini

Publications and source records attributed to S Chiodini.

18 recordsLinked to original sources
PubMed1998

Laparoscopic liver resections.

The authors present the rationale of the laparoscopic approach to liver surgery, showing the technique of fully endoscopic and endoscopic-assisted formal and wedge hepatic resections and the early results of their experience. From 1993 to 1997, 38 liver resections have been attempted through the laparoscopic or the laparoscopic assisted approach. Out of these 38 resections, 5 were wedge resections, 11 were segmentectomies, 10 were left formal hepatectomies, 1 was an extended left hepatectomy, 5 were bisegmentectomies, 5 were right formal hepatectomies, and 1 was an extended right hepatectomy. In two cases, one segmentectomy and one bisegmentectomy, the procedures were converted to open surgery. Wedge, segmental, and left liver resections were usually performed through a fully endoscopic approach, whereas right liver resections were accomplished by a video-assisted approach. In all but six cases, the resections were attempted for malignancy. There were no intra-operative deaths. One patient died on postoperative day-1 because of liver failure and severe coagulopathy. The early results are comparable to those of conventional surgery, with the benefits derived from minimal access surgery. Laparoscopic liver resections are technically feasible with an acceptable morbidity and mortality rate, but extensive experience in conventional liver surgery, advanced laparoscopic surgery, and the availability of all requested technology are indispensable prerequisites.

Carcinoma, Hepatocellular↗
PubMed1997

Current position of advanced laparoscopic surgery of the liver.

With the improvement of laparoscopic techniques and the development of new and dedicated technologies, endoscopic liver surgery has become feasible. While wedge liver resections are performed more and more frequently, laparoscopic anatomical liver resections are still at an early stage of development and are somewhat controversial. In 1993 we initiated formal laparoscopic liver resections in selected patients. From 1993 to December 1995 20 patients underwent endoscopic formal resections: the procedures comprised six left hepatectomies, five right hepatectomies, one of which extended to the segment IV, three mesohepatectomy, five segmentectomies and one bisegmentectomy. The operation time ranged from 120 to 270 min (average 193 min). In 17 out of 20 cases a Pringle manoeuvre was performed (mean occlusion time 45 min). No intra-operative complications occurred and there were no conversions in the whole series. Average intra-operative blood loss was 397.5 mL and 35% of patients required intro-operative blood transfusions. Post-operative mortality rate was 5% and post-operative morbidity rate was 45% (one coagulopathy with severe trombocytopaenia, six pleural effusions, one bile collection and four hematomas of the trocar sites). Such preliminary data are comparable with those of a group of 65 patients who underwent open anatomical liver resections from 1992 and 1995. Far from being a routine technique in liver surgery, the laparoscopic approach to forma liver resections may be a promising procedure in selected patients.

Aged↗
PubMed1994

Obviation of prereperfusion rinsing and decrease in preservation/reperfusion injury in liver transplantation by portal blood flushing.

Liver allografts are traditionally rinsed with cold lactated Ringer's (LR) prereperfusion to clear K(+)-rich preservation solution from the hepatic vasculature. LR has been shown, however, to be injurious to the graft. By restoring portal blood flow without rinsing and discarding the initial blood traversing the liver (PB flush), we sought to eliminate rinsing without inducing hyperkalemia. Between August 1988 and December 1992, 481 OLTx were performed in 412 pts. Four rinsing methods were used sequentially: group 1 (157 pts)--low-flow-rate cold LR rinse (500 ml, 100 ml/min via standard i.v. tubing at 100 cm H2O [LFLR]) during lower caval anastomosis; Group 2 (120 pts)--LFLR as in group 1, at reperfusion, 500 ml PB flush via IVC catheter; group 3 (66 pts)--high-flow-rate LR rinse (500 ml, 1 L/min using large-bore tubing with 100 cm H2O rinsing pressure [HFLR]), PB flush as in group 2; Group 4 (62 pts)--no LR rinse; PB flush as in groups 2 and 3. Poor early graft function (PEGF) was defined as peak ALT or AST > 2500 U or PT > 16 sec (on POD 2); PEGF causing re-OLTx or death within 14 days was called primary nonfunction (PNF). Group 1 and Group 3 had high PEGF rates. Group 4 had significantly less PEGF than Group 1, with a trend toward a significant difference from Group 3. In Group 1, 3 pts. had intraoperative hyperkalemic cardiac arrest; this did not occur when PB flush was performed. PB flush without prior rinsing optimizes graft function without risk of hyperkalemia. LR rinse, alone or followed by PB flush, is unnecessary and may be deleterious.

Adolescent↗
PubMed1993

Prolonged preservation in University of Wisconsin solution associated with hepatic artery thrombosis after orthotopic liver transplantation.

Hepatic artery thrombosis (HAT) after liver transplantation (LTx) usually mandates retransplantation. Prolonged preservation with Eurocollins solution has been associated with HAT. We reviewed our experience with 359 LTx patients to identify risk factors for HAT. All grafts were preserved in University of Wisconsin solution. HAT developed in 12 patients (3%) within 50 days. Seven patients were asymptomatic; four presented with biliary sepsis and 1 with poor graft function. Two patients had suffered acute rejection; another 2 had severe preservation injury. Technical problems accounted for 4 cases; in the remaining 8, no etiology was found. Diagnosis was at a mean 14.7 days after LTx. One patient maintains normal graft function 3 years after LTx without intervention. Eight underwent re-LTx, 3 of whom died. Routine surveillance via duplex enabled early diagnosis and revascularization in 3 patients; in all 3, no biliary complications occurred between 6 and 20 months. Overall graft and patient survival after HAT were 33.3% and 75%, respectively. Cold ischemic time (CIT) averaged 813 min in patients with HAT and 669 min in those without HAT (P < .05). HAT occurred in 7/165 patients with CIT > 12 hr, and in 3/234 patients with CIT < 12 hr (P = 0.0699). By avoiding CIT > 12 hr, we have recently avoided HAT in 78 consecutive patients. We conclude that CIT > 12 hr may increase the risk of HAT. When HAT is diagnosed before biliary sepsis develops, flow can often be restored and retransplantation averted.

Adenosine↗
PubMed1992

Adequacy of paracardial dissection in subtotal versus total gastrectomy.

Right and left paracardial dissection represents an obligatory step in gastrectomy for gastric cancer of the lower half of the stomach because a second-level lymphadenectomy is part of the radical surgery for malignancy at this site. Whereas right and left paracardial dissection is easily accomplished during total gastrectomy, there is doubt as to whether subtotal gastrectomy achieves the same radical clearance of these groups of lymph nodes. This study therefore compared the number of lymph nodes dissected and the frequency of metastases in these compartments in 14 patients undergoing total gastrectomy and 22 submitted to subtotal gastrectomy. The mean number of lymph nodes dissected in the right paracardial compartment was 7.1 per patient undergoing total gastrectomy and 6.7 per patient in subtotal gastrectomy (P = 0.7). The mean numbers of left paracardial lymph nodes dissected in total and subtotal gastrectomy were 3.4 and 4.1 per patient respectively (P = 0.3). These data show that the same degree of radical clearance can be achieved in these nodal compartments, irrespective of the extent of gastric resection.

Adult↗
PubMed1990

Cutaneous metastases from carcinoma of the cervix.

Skin metastases from internal malignancies are rare, particularly those originating from carcinoma of the cervix: only 11 cases have been reported in the medical literature since 1940. We describe the case of a cutaneous metastases from a squamous-cell carcinoma of the cervix that was solitary, unusual for its location, and with the longest survival reported so far.

Aged↗
PubMed1988

Computer-assisted analysis of clinical and laboratory data in acute pancreatitis: early formulation of a predictive score.

The results of a retrospective study of 111 cases of acute pancreatitis are reported. Based on diagnostic investigations and clinical outcome, patients have been divided into three groups: oedematous, limited and extensive necrotizing pancreatitis. The step-wise statistical analysis of clinical and laboratory parameters at the time of admission related to the pathological findings has allowed the formulation of a severity score to be applied to every new case of acute pancreatitis. By discriminant function coefficients a concordance percentage of actual and predicted classification has been obtained in over 90% of the cases. The presence of shock after 12 hours of intensive treatment, the hemorrhagic appearance of the peritoneal fluid and tachypnea are the variables with highest discriminating power. In view of the high concordance percentage between actual and predicted classification results, this predictive score could be applied, to every new case of acute pancreatitis at admission.

Acute Disease↗
PubMedDate not supplied

[Glypressin and emergency sclerotherapy, deferred emergency shunt (Warren, portacaval, mesocaval): new tactics in the treatment of severe hemorrhage by esophagogastric varices in cirrhotic patients].

Transplenic decompression of esophageal varices by distal splenorenal shunt according to Warren (DSRS) aims to a selective detention of the esophago-gastric varices, also assuring an adequate portal perfusion and hypertensive state of the porto-mesenteric district. The DSRS though, should and must not be performed in emergency as a high mortality rate is registered in all cases of emergency porto-systemic derivations. A mortality risk is reported even during endoscopic sclerosis if performed in emergency compared to the elective procedure. The scope of our study was to test the validity of a new approach of the hemorrhagic cirrhotic patient: the end point was to stop the bleeding with Glypressin and deferred sclerotherapy, associating a selective shunt at 40-60 days. Out of 32 patients with esophago-gastric variceal bleeding, 8 were selected also for derivative surgery. Results show Glypressin as the first and best therapeutic approach. The drug in many cases stops bleeding or at least reduces the blood loss allowing an easier endoscopic sclerosis. Further sclerosis and/or surgical therapy may assure variceal eradication.

Adult↗
PubMedDate not supplied

[Prognostic factors in operated breast carcinoma].

The traditional prognostic factors (tumour size, lymph node involvement, receptor status) have now been shown to have limits in terms of prognostic definition. These limits may be partially overcome when parameters exist to determine the extent of tumour biological aggression and the patient's degree of immune response. It is important to clarify these links because they may lead to more precise indications regarding the prognosis and choice of therapy, above all in cases of breast cancer operated with no lymph node involvement. Breast carcinoma is often surrounded by inflammatory cells showing host and tumour interaction. The aim of this study was to evaluate the prognostic value of lymphocyte infiltration in operated breast cancer. The degree of lymphocyte infiltration observed in 56 breast cancer patients was compared with other prognostic factors (tumour size, lymph node status, histological variants, necrotic areas and desmoplastic reaction). This preliminary study allowed the authors to examine the degree of peritumoral lymphocyte density as an important predictive index of overall survival in patients with breast cancer and N-.

Adult↗
PubMedDate not supplied

[Clinico-epidemiological findings in breast carcinoma in elderly patients].

Old age certainly represents one of the major risk factors for the development of neoplasia. In breast cancer the incidence rises with age and continues until the age of 84. In EEC countries approximately 140,000 new cases are reported every year and at the end of the 80s there were 10,983 deaths from breast cancer in Italy, an increase of over per 1000 women each year. Fifty par cent of new cases were diagnosed in women aged over 65. The efficiency of a screening programme is evaluated by the fall in mortality rates in the population included in the programme compared to that not included. Results from controlled studies have confirmed the efficacy of breast cancer screening in women aged between 50-70, showing a significant drop in mortality rates which range between 21 and 36%. Adequate diagnostic and therapeutic management are of primary importance and screening programmes are organised in highly efficient structures using specifically trained staff. This underlines the need to set up appropriate services and structures for the prevention and treatment of breast cancer in elderly women, given that the latter represent the most frequently affected age group. Old age should be considered a natural extension of life and all elderly women have the right to receive treatment to prevent breast cancer.

Adult↗
PubMedDate not supplied

Serum ostase in the follow-up of breast cancer patients.

The present study was carried out on 152 patients divided into three groups: A) 73 underwent radical surgery for breast carcinoma without signs of metastases; B) 31 patients with radiologic and scintigraphic evidence of bone metastases originating from malignant mammary neoplasia (14 with only one and 17 with two or more localizations); C) 48 affected by simple mammary cysts. No patients had a previous history of primary or secondary bone pathologies or renal, hepatic or endocrine ones. Besides this, no patient took drugs influencing the metabolic turnover of the bony tissue in the three months preceding the study. After surgery all patients underwent standard clinical and laboratory follow-up, the latter including, every 3 months, the evaluation of serum CA 15.3, CA 27.29 MCA, and ostase. The ostase cut-off, obtained by the statistical elaboration of the serum values of the 48 patients with benign mammary cysts and the 73 disease free patients, was 17 microg./L. The mean concentration in the three groups and two subgroups was: 13.76 microg./L (patients without metastases), 31.84 (patients with metastases), 18.4 (limited bony metastases), 40.04 (diffused bony metastases) and 5.36 (mammary cists). The diagnostic sensitivity of ostase proved superior to that of CA 15.3 (84% vs 75%) except when considering the subgroup with limited metastases (71.4% vs 72.7%), while the specificity was similar (around 78%). CA 27.29 and MCA were not useful as markers of metastasis. In a longitudinal-perspective study it was possible periodically to test these markers in 13 patients, at first, disease free and then with signs of bone progression evidence by skeletal scintigraphy. In 11 of these patients ostase and CA 15.3 showed increased values, an average 136 and 131 days respectively, before instrumental evidence of progression. None of the 13 patients, at the time of bone progression diagnosis, showed clinical, laboratory or instrumental signs of disease in other organs. The precocity of the serum increase of ostase could have a triple role: 1) accomplishment of a closer follow-up in patients at "high risk" of bone disease; 2) aid in the interpretation "in a neoplastic sense" of an "uncertain image of hypercaptation"; 3) accomplishment of a supporting or specific oncology treatment at an earlier stage which may be of some advantage as regards quality of life.

Adult↗
PubMedDate not supplied

Adjuvant treatment for breast cancer in the elderly.

Eighty one patients with breast cancer stages I, II and III (T3a) were given adjuvant treatment with tamoxifen (Nolvadex), chemotherapy, or both. Most patients had estrogen and progesterone receptors measurement. Twenty one (63.6%) patients of the tamoxifen group were node positive, all 25 (100%) of the chemotherapy plus tamoxifen group and 13 (56.5%) of the chemotherapy alone group. Tamoxifen was administered for at least 3 years. Disease free survival and overall survival were substantially similar after treatment with tamoxifen or chemotherapy plus tamoxifen. Side effects were more numerous and severe in patients given chemotherapy. In receptor positive elderly breast cancer patients tamoxifen represents an excellent adjuvant therapy independently of disease stage. Chemotherapy should be reserved for subjects at high risk of recurrence in controlled clinical trials.

Aged↗
PubMedDate not supplied

Hepatic resections through the laparoscopic approach.

Hepatic surgery has been undergoing progressive modifications in surgical approach to liver, passing through tohraco-phrenolaparotomy to bilateral subcostal incision and current Makuuchi's. Laparoscopic liver surgery should not be considered a new surgery, but simply a new surgical approach, with difficulties but advantages too. Laparoscopic hepatic resections are feasible with low morbidity and mortality; the short and medium term results are comparable to those obtained with open surgery provided that the surgeon has a significant experience in open hepatic surgery, advanced laparoscopic surgery and the availability of all and pertinent instrumentation. The aim of this paper is to show the rationales formal of hepatic resections through the laparoscopic approach, focusing on the necessary instrumentation, the surgical technique and results.

Hepatectomy↗