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Biomedical subjects

S Ciletti

Publications and source records attributed to S Ciletti.

11 recordsLinked to original sources
PubMed2002

Endoscopic palliation of unresectable malignant oesophageal strictures with self-expanding metal stents: comparing Ultraflex and Esophacoil stents.

BACKGROUND: Two types of self-expanding metal stents to palliate dysphagia in patients with unresectable malignant oesophageal strictures have been compared. METHODS: From February 1996 to October 2000, 50 metal stents (23 covered Ultraflex and 27 Esophacoil) were placed in 50 patients (40 males, mean age: 67+/-12 years, range: 33-100, mean dysphagia score: 3.18+/-0.66) with unresectable malignant oesophageal strictures. Patients were followed until death. A retrospective review has been made of a prospectively collected database. RESULTS: The two groups were comparable as far as concerns degree of dysphagia, location and stricture length. Stent placement was successful in all cases. Covered Ultraflex stent was placed in 2 patients with oesophagobronchial fistula. No procedure-related deaths were seen. Early severe complications occurred in 2 patients (perforation in 1 and tumour bleeding in 1, in the Esophacoil group). Nine patients and 1 patient complained of pain following Esophacoil and Ultraflex stent placement, respectively. Late complications were asymptomatic rupture of distal Esophacoil rings in 2 patients, symptomatic Ultraflex stent migration in 2 and tumour overgrowth in 3 (Esophacoil 1, Ultraflex 2). Mean dysphagia score at 4 weeks after stent placement was 1.9+/-0.77. Mean survival was 177+/-109 days (range: 35-603 days). There were no significant differences in technical success, dysphagia palliation, complications (except chest pain) and survival using the two types of stent. CONCLUSIONS: Self-expanding metal stents are safe with high technical success and achieve satisfactory long-term palliation for dysphagia. The covered Ultraflex and Esophacoil stents are equally effective.

Aged↗
PubMed2001

Selective use of endoscopic retrograde cholangiopancreatography to facilitate laparoscopic cholecystectomy without cholangiography. A review of 1139 consecutive cases.

BACKGROUND: The aim of this study was to show that laparoscopic cholecystectomy can be performed safely without routine intraoperative cholangiography. METHODS: We performed a retrospective analysis of 1139 consecutive patients (376 men and 763 women with an average age of 51.4 years) who underwent laparoscopic cholecystectomy between 1991 and 1999. In all, 227 patients (20%) were selected to undergo preoperative endoscopic retrograde cholangiopancreatography (ERCP) on the basis of four criteria for risk of stones. RESULTS: ERCP allowed us to make a diagnosis of biliary stones in 53.3% of the selected patients. Extraction of the stones was successful in 97% of the cases. In 14% of cases, ERCP was normal; in 32.7%, some useful diagnostic information was obtained. There were three complications (pancreatitis) following endoscopy (complication rate, 1.3%). Laparoscopic cholecystectomy was successful in 92% of patients. The postoperative morbidity rate was 3.2% (major complications, 0.5%). There were no deaths. During a follow-up period ranging from 3 to 97 months, six patients (0.6%) were found to have residual biliary stones. CONCLUSION: This study confirms the hypothesis that laparoscopic cholecystectomy can be performed safely without routine intraoperative cholangiography.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed2001

Periampullary tumors. Analysis of 319 consecutive cases submitted to preoperative endoscopic biliary drainage.

BACKGROUND: During the last 2 decades, endoscopic retrograde cholangiopancreatography (ERCP) has been widely used for the diagnosis of periampullary tumors and the preoperative or definitive treatment of jaundice. METHODS: We performed a retrospective analysis of 319 consecutive patients (184 men and 135 women with an average age of 66.5 years) who underwent ERCP for periampullary tumors between 1987 and 1999. RESULTS: Endoscopic internal biliary drainage was successful in 293 patients (92%), with some differences due to the origin of the tumor. There were five complications (1.5%), including four bleeds and one retroduodenal perforation. There were no deaths related to the endoscopic drainage. Eighty-four patients underwent pancreaticoduodenectomy. The postoperative morbidity rate was 23%, and the overall mortality rate was 4.8%. CONCLUSION: ERCP is a valid technique for the detailed preoperative assessment of periampullary tumors. It is also a safe method for internal biliary drainage.

Adult↗
PubMed2000

Use of a self-expanding stent in the palliation of rectal cancer recurrences. A report of three cases.

BACKGROUND: Patients with nonresectable rectal cancer recurrences and elderly high risk patients are currently given a colostomy as a palliative therapy. To improve the quality of life in these patients, we inserted a self-expanding metal stent to relieve the symptoms of obstruction caused by a rectal cancer recurrence. METHODS: Three patients (two male, one female; ages 61, 69, and 59), all suffering from a rectal cancer pelvic recurrence and diffuse metastases, had a stent inserted. Using fluoroscopic and endoscopic control, a metal guidewire was passed through the obstruction. A mild dilatation of the stenosis was carried out before positioning of the expandable metal stent. RESULTS: The procedure was successful at the first attempt in all the patients, and stool evacuation was immediate. Patients complained of rectal tenesmus during the first 48 h, which was treated with nonsteroid anti-inflammatory drugs. However, there were no serious complications related to the procedure. Regular endoscopic and clinical follow-up were carried out. No patient had any evidence of recurrent obstruction. CONCLUSION: In cases of inoperable rectal cancer recurrence, the placement of self-expanding metal stents is technically feasible and safe, and it avoids a permanent colostomy.

Aged↗
PubMed1998

Major liver resection for non-Hodgkin's lymphoma in an HIV-positive patient: report of a case.

A very unusual clinical presentation of non-Hodgkin's lymphoma (NHL) of the liver is reported herein. The patient was a 35-year-old male who had been HIV-positive since 1987. Following an episode of acute pain in the right upper abdominal quadrant, ultrasonography (US) and computed tomography (CT) were performed, revealing a nodular lesion, 2.5 cm in diameter, localized in the eighth segment of the liver. Despite the fact that the lesion became significantly enlarged over a 6-month period, three repeated percutaneous biopsies proved negative. Finally, his increasing pain and the lack of a definitive diagnosis prompted us to perform a right hepatectomy. The patient had an uneventful postoperative course and is well 1 year after his operation. Establishing a diagnosis of extranodal lymphoma can be difficult, especially in HIV-positive or AIDS patients. Thus, performing a laparotomy is justified to confirm a diagnosis and decide upon the most appropriate treatment. However, in about 10% of these patients, only surgical resection allows for the diagnosis. In accordance with other reports, our experience confirms that, in contrast with AIDS patients, HIV-positive patients have a similar prognosis as non-HIV patients, and are suitable candidates for even major surgical procedures.

Adult↗
PubMed1997

Analysis of complications of endoscopic sphincterotomy for biliary stones in a consecutive series of 546 patients.

BACKGROUND: Endoscopic sphincterotomy (ES) plays an important role in treatment of biliary stones; however, there remain some controversies concerning complications of ES, which in most cases seem not to be predictable. METHODS: The aim of this study was a retrospective analysis of complications in 546 consecutive patients (267 males, 279 females, average age 63.7 years) who underwent endoscopic retrograde cholangiography (ERCP) for biliary stones from 1988 to 1995. RESULTS: ES was performed in 535 patients (98%), and extraction of stones was successful in 493 (92%). In all, 29 complications (5.4%) were observed, including bleeding 13, cholangitis seven, cholecystitis four, pancreatitis three, retroduodenal perforation two; of these, four (14%) required an operation. Overall mortality was 0.3%. CONCLUSION: While a significant decrease of the incidence of complications was observed in the course of the study, due to constantly improving experience, no correlation between risk factors and complications was identified.

Adolescent↗
PubMed1997

Laparoscopic approach for nonpalpable abdominal testis.

The approach to nonpalpable testis is probably the most important indication for laparoscopy in pediatric surgery. In abdominal testis, spermatic vessels can be too short to allow for standard orchidopexy. The division of the spermatic vessels proposed by Fowler and Stephens may result, in some cases, in testicular hypotrophy or atrophy from intraoperative devascularization. In this study, we report our experience of two-stage laparoscopic orchidopexy, first proposed by Bloom. Five patients (ages 2-10 years) were treated with this technique. Laparoscopic inspection and division of spermatic vessels were successful in all patients, with no complications. Orchidopexy was performed at an average of 6 months from the first operation. During a follow-up period of from 6 to 18 months, no patient developed atrophy or hypotrophy of the testis.

Abdomen↗
PubMed1996

ERCP in the era of laparoscopic biliary surgery. Experience with 407 patients.

BACKGROUND: The combined endoscopic and laparoscopic treatment of biliary stones is now highly debated, especially as regards possible complications compared to one-step laparoscopic treatment. METHODS: This study analyzes 407 cases (116 males, 291 females, average age 49 years, range 2-87) observed in the period from May 1991 to July 1994. All patients were evaluated preoperatively for the presence of biliary stones. Considering clinical presentation, blood analysis, ultrasonography, and medical history, 99 patients (24%) were selected for preoperative endoscopic retrograde cholangiopancreatography (ERCP). One patient refused preoperative ERCP. RESULTS: Thirty-nine patients (40%) were found to have biliary stones and were submitted to therapeutic endoscopic sphincterotomy (ES). Endoscopic clearance of the bile ducts was achieved in all patients, with one complication (pancreatitis). In performing laparoscopic cholecystectomy, no technical difficulties could be attributed to ERCP, nor were there any conversions in patients who had had preoperative ERCP. Average postoperative hospital stay was 2.5 days. During a follow-up period of from 2 to 39 months, we diagnosed three patients (0.7%) with symptomatic residual stones. They were submitted to successful ERCP and extraction of the stones. CONCLUSIONS: We conclude that ERCP offers an accurate preoperative selection of patients, allows for effective planning of treatment, and simplifies laparoscopic surgery.

Adolescent↗
PubMed1993

DNA flow cytometric analysis in patients with operable non-small cell lung carcinoma.

Fresh surgical specimens of tumors from 60 patients with previously untreated non-small cell lung carcinoma (NSCLC) who underwent radical surgery between January 1991 and October 1992 were investigated by means of flow-cytometry. The nuclear DNA measurement was carried out using a Facscan (Becton, Dickinson, USA). Analysis of the DNA content was performed in all 60 patients whilst cell cycle analysis was possible in 41 cases (68.3%). Forty-two of the 60 cases (70%) were aneuploid and 18 (30%) were diploid. The overall mean value of DNA index was 1.5. Diploid NSCLC were compared with aneuploid tumors: no significant differences in age distribution, sex ratio, histology and staging were found between the two groups (P > 0.05). An S-phase proportion of more than 10% was found in 30 out of 41 patients (73.2%). Early cancer deaths were reported in four patients (6.6%): the aneuploidy rate was very close in these patients (75%) and in the remaining surviving patients (69.6%). An S-phase proportion of more than 10% was found in 100% of early cancer deaths and in 70.2% of the remaining cases; such a difference seems of some importance although it was not statistically significant (P = 0.071). In conclusion, flow-cytometry studies seem to be a useful tool in the understanding of the biological behavior of patients with NSCLC. In the present prospective report there were no significant correlations between DNA measurements and clinical outcome, however, these results suggest that a high S-phase proportion should be seen as a possible prognostic indicator.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗