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Biomedical subjects

S Contini

Publications and source records attributed to S Contini.

70 records · Page 4Linked to original sources
PubMed1976

[Revascularization of the aorto-femoral axis by means of a by-pass. Remote results].

The Authors report their experience in 73 patients wit aorto-iliaco-femoral chronic obliteration, subjected to revascularisation. In 49 cases a bilateral by-pass was performed, in 22 a monolateral by-pass, and in two a thromboendarterioectomy. The results obtained were classified as successes or failures according to the perviousness or otherwise of the substituted or disobliterated arterial segments, and as immediate or longterm according to whether they were evaluated at the time of the patient's discharge or during a period lying betwee six months and seven years from the operation. Immediate successes were obtained in 95.9% of cases with bilateral by-pass, and in 90.9% of the monolateral by-passes. Aggregate mortality was 2.7%. In the long-term chick-ups, the previousness of the bilateral by-passes was 82.9%, that of the monolateral by-passes 72.2%. On the basis of the results obtained the Authors therfore reiterate their preference for by-passes, and for bilateral by-passes in particular (70% of cases). Monolateral bridging were in fact performed only in those cases where the contralateral vascular district was unharmed, in patients with serious ganrenous lesions and those with a high operative risk.

Adult↗
PubMedDate not supplied

Difficult diagnosis of infliximab-related miliary tuberculosis.

The use of Infliximab in the treatment of patients with rheumatoid diseases unresponsive to conventional therapies has been reported to be complicated by opportunistic infections. We report the case of a 56-yr old female rheumatoid arthritis patient complaining of fever and respiratory symptoms 9 months after commencing Infliximab, who received no ethiologic diagnosis for the six months before admission. Tuberculosis was suspected upon chest radiographic pictures and empirical treatment for miliary tuberculosis instated in the wake of microbiological confirmation. The case typifies the difficulties of diagnosing miliary tuberculosis in the immunocompromised as well as in the immunocompetent patient.

Antibodies, Monoclonal↗
PubMedDate not supplied

[Videolaparoscopy and carcinoma of the gallbladder].

There have been several reports claiming that there is a risk that laparoscopic cholecystectomy might worsen the prognosis of unexpected gallbladder cancer. The objective of this study was to evaluate which factors influence the prognosis of such cancers. A clinicopathological study was conducted in 25 patients with unexpected gallbladder cancer. The results of 10 patients undergoing laparoscopic cholecystectomy were compared with those of 15 patients undergoing open cholecystectomy. Correlations were evaluated between cumulative survival rates and seven prognostic factors, namely, age, sex, histopathological grade, pathological stage, occurrence of bile spillage, type of cholecystectomy (laparoscopic or open) and additional surgical treatments. Seven patients after laparoscopic cholecystectomy (70%) and 9 patients after open cholecystectomy (64%) had cancer recurrence: the difference was not statistically significant. There was a statistically significant correlation between survival rate and tumour stage (P < 0.01) and occurrence of bile spillage (P < 0.05). There was no difference in survival depending on whether cholecystectomy was carried out using laparoscopic or traditional techniques. Laparoscopic cholecystectomy does not adversely affect the prognosis of unexpected gallbladder cancer. Once the histological findings have been examined, the surgeon will decide whether it is necessary to extend surgery, regardless of whether laparoscopic or open cholecystectomy is carried out.

Adult↗
PubMedDate not supplied

[Laparoscopic fundoplication in gastroesophageal reflux disease: reflexions on a personal caseload].

Ninety-two patients with severe, proton-pump-inhibitor-dependent gastro-oesophageal reflux disease were submitted to surgery and operated on by the same surgeon (SC) over the past 7 years (mean age: 42; range: 23-74 years). Partial fundoplication was performed in 14 patients with impaired oesophageal motility, while 78 total fundoplications were done in the others, 51 without, and 27 with division of the short gastric vessels. The mean follow-up was 29.5 months (range: 1-85 months). Conversion to open surgery was necessary in 6 patients (all in the first 40 cases). Perforation of the gastric fundus and early migration of the stomach into the mediastinum were the two most important complications observed. The mortality was nil. 39% of the patients complained of postoperative dysphagia but only five required endoscopic (4) or surgical (1) treatment. The percentages of dysphagia after partial fundoplication and total fundoplication with or without division of the short gastric vessels were 28%, 37% and 47%, respectively. In 83.7% the patients were satisfied with the clinical results and in 84% of cases medical treatment was avoided after surgery. On the basis of these data, laparoscopic surgery appears to be a good option for gastro-oeophageal reflux disease in selected patients with a poor response to, or dependent on medical treatment. However, the results of surgery may be subject to the limitations of a learning curve, as in all complex laparoscopic procedures.

Adult↗
PubMedDate not supplied

[Splenectomy for hemorrhage from esophageal varices with massive thrombosis of the portal bed in the absence of cirrhosis: an intervention to be reevaluated? Reflections on a clinical case].

It has been suggested that the ideal definitive treatment of hemorrhage from esophageal varices due to extrahepatic portal hypertension should be a selective shunt, avoiding splenectomy, when possible, for its unfavorable effects. We present a case with extrahepatic portal hypertension and polycythemia vera who complained acute recurrent variceal bleeding in spite of multiple sclerotherapy sessions, with a massive thrombosis of the portal bed and radicles without any possibility to perform a shunt. The combined treatment was emergency splenectomy followed by a closed program of sclerotherapy. The result was good at two years of follow-up. The optimal treatment of patients with episodes of bleeding varices for extrahepatic portal hypertension and patency of splenic vein should be a selective shunt; poor long-term results have been reported in patients without patency of the major tributaries of the portal system and treated with other operations than shunts. Splenectomy could gave a role in producing these unhappy results. After splenectomy it has been observed an increased thrombocytosis, venous infarction of the bowel, increased susceptibility to infection and also a paradoxical higher risk of bleeding by removing low risk collaterals. From this anecdotal report it can be argued that splenectomy is not necessarily followed by bad results and can be the first therapeutic option in emergency and in some selected cases with huge, high risk varices, difficult to treat by sclerosis only, and without suitable vessel for a shunt.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMedDate not supplied

[Indications for esophagogastroduodenoscopy (EGD) in the octogenarian: a first-step investigation?].

Esophagogastroduodenoscopy (EGD) is the most reliable diagnostic method to evaluate the upper digestive tract. It is conceivable that a rising number of very aged patients with dyspeptic symptoms will come to observation as a consequence of the increasing mean age of the population; however there is not yet a complete agreement to submit patients with extremely advanced age to an EGD. The aim of this study is to evaluate the indications and the tolerance of the upper digestive endoscopy in patients more than 80 yrs old. EGD. Two hundred sixteen patients (mean age 84.5 yrs) were submitted to an EGD without any sedation and pharyngeal anesthesia in one-third of cases. Indications were specific symptoms in 52.3% and aspecific in 47.7%. Tolerance was very good with only one case requiring heavy sedation. We do not report complications. As expected, a high percentage of proliferative lesions were found, but also phlogistic and peptic lesions were very common. X-Rays were performed in 20% of cases but false negatives were observed in 11.6% and false positive in 23.2%. Moreover radiological procedures were poorly tolerated in a relatively high percentage of cases. Our experience showed that: 1) EGD is a very well tolerated and safe procedure in patients with very advanced age; 2) unsuspected lesions are found even in patients with aspecific symptoms; 3) EGD should be proposed as a first study in dyspeptic very aged patients being more tolerated and more reliable than X-Rays in these cases.

Aged↗
PubMedDate not supplied

Multiple splanchnic artery aneurysms. Report of a case.

It is reported the case of a patient with multiple visceral aneurysms (seven). These aneurysms are more common than usually appreciated but their multiplicity is rarely reported in the literature. Angiography should always follow surgery when a splanchnic aneurysm is recognized by chance only at operation and when the surgeon is already aware of the multiple aneurysms. It is indicated a contemporary treatment of all of them to avoid the subsequent risk of rupture which has been suggested to increase after laparotomy.

Aneurysm↗
PubMedDate not supplied

Abdominal aortic aneurysms: some controversial points.

A retrospective review of the surgical treatment of 51 abdominal aortic aneurysms is reported. Thirty-five (69%) patients were operated on electively, and 16 (31%) had emergency surgery. Fissurated aneurysms were included in the elective surgery group. The operative death rate was respectively 2.7% and 50%. Controversial points about diagnosis, treatment of associated diseases, surgical technique, and selection of the patients for surgery are presented and discussed.

Aged↗