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Biomedical subjects

S Leardi

Publications and source records attributed to S Leardi.

At least 19 recordsLinked to original sources
PubMed2002

Perianal acquired tufted angioma associated with pregnancy: case report.

Tufted angiomas are rare lesions described as slowly growing/spreading erythematous macules especially located in the upper trunk and neck. Herein we report the case of perianal location of a tufted angioma in a young pregnant woman. She came to our observation complaining of perianal pain accompanied by bleeding at defecation. A lesion resembling a perianal fissure was observed. Mild hypertonia of the internal sphincter was confirmed at manometry. After one week of ineffective medical treatment, surgery was planed at the end of the sixteenth week under local anaesthesia. The lesion was excised and a minimal sphincterotomy was performed; histopathology report described features of a tufted angioma. The pregnancy proceeded regularly, without anal symptoms, followed by normal vaginal delivery at the thirty-eighth week. This case showed three peculiar features: the association of tufted angioma and pregnancy, the perianal location, and the clinical appearance suggestive of an anal fissure. The clinical manifestation of a perianal tufted angioma, mimicking an anal fissure, is of utmost importance to the differential diagnosis and treatment plan, especially in a pregnant woman.

Adult↗
PubMed2001

[Acute cholecystitis in patients over 70 years old].

BACKGROUND: Gallstone disease is the most common surgical indication in the elderly. Post-operative prognosis is severe in elderly with acute cholecystitis. Aim of this paper is to investigate the factors responsible for the severe prognosis and to detect how it could be improved. METHODS: One hundred fifty-seven patients, aged between 70 and 85 years (average 82 years), undergoing cholecystectomy between the years 1990 and 2000 have been studied; 65 patients (group A) had acute cholecystitis; 92 (group B) had uncomplicated gallbladder stones. RESULTS: Acute cholecystitis was the first symptom of gallstone disease in 69.2%. Laparocholecystectomy was performed in 31 cases (47.6%) of group A and in 58 cases (63.7%) of group B. In those cases with acute cholecystitis the postoperative morbidity (18.4%) was higher than in group B (1.0%), (A vs B: chi(2)=15.3; p<0.001). Similarly, postoperative mortality was higher (6.1% vs 1.0%; chi(2)=3.2; p<0.05) The severe postoperative prognosis was correlated significantly to index ASA (ASA II vs IV: chi(2)=7.0; p<0.001) but not to the technique adopted for cholecystectomy (VLC vs open: (chi)2=0.01; p=n.s.). The results obtained seem to confirm that the high incidence of postoperative complications in acute cholecystitis is due to the presence of associated diseases in elderly patients accompanied by the septic state. CONCLUSIONS: Early colecystectomy, in those cases with symptomatic, uncomplicated gallstone disease, might avoid severe postoperative prognosis in the elderly.

Acute Disease↗
PubMed2000

[The role of melatonin in the immediate postoperative period in elderly patients].

BACKGROUND: Melatonin induces sleep and modulates immune system. Aim of the paper is to show a possible relation between impaired rhythm of melatonin secretion and the onset of postoperative septic complications and insomnia in old patients undergoing surgery. METHODS: Fifty old patients, aged from 60 to 94 years, have been studied; 39.5% of the patients had neoplastic disease. Melatonin serum levels have been evaluated by ELISA technique at 12 p.m., 3 a.m. 8 a.m. immediately before operation. Postoperative clinical findings of insomnia and septic complications have been recorded. RESULTS: The melatonin serum mean values of all the patients were 16.3 pg/ml at 12 p.m., 22.4 pg/ml at 3 a.m. and 7.1 pg/ml at 8 a.m. Neoplastic patients showed the higher values of melatonin (26.696 pg/ml, 33.143 pg/ml, 9.185 pg/ml), long-lived patients (> 90 years) the lower. The melatonin secretion curve of the old patients with postoperative insomnia (19.961 pg/ml, 20.297 pg/ml, 9.378 pg/ml) or postoperative septic complications (20.695 pg/ml, 16.183 pg/ml, 6.036 pg/ml) was significantly different compared with that of other patients. The peak was advanced, lower and decreased slowly in the midnight. CONCLUSIONS: The study seems to show a possible correlation between impaired rhythm of melatonin secretion and postoperative insomnia and postoperative sepsis in old patients undergoing surgery.

Aged↗
PubMed1999

[Treatment of acute biliary pancreatitis in the aged in the endolaparoscopic era].

BACKGROUND: Acute biliary pancreatitis (ABP) still retains high morbidity (15-50%) and mortality (20-35%). Therefore it appears to be crucial to clearly assess the aetiological factors (50% of idiopathic are in fact biliary pancreatitis) and to establish the severity in order to plan the appropriate treatment. METHODS: In this study we have considered 61 patients divided into 2 groups. Group 1 had 29 ABP patients aging less than 65 years, group 232 patients aging more than 65 years; the diagnosis was made by ultrasound and serological values in 78.5% of cases, while in the remaining 21.5% was only serological. Following Ranson and APACHE II scoring 18 cases (29.5%) were classified as severe [6 (20.6%) in group 1; 12 (37.5%) in group 2: p < 0.01], 43 (70.4%) as mild. All patients with severe ABP had emergency ERCP + ES (within 24-48 hrs) followed by LC (< or = 10 days). Patients with mild ABP had LC within 10 days; in these cases IOC was always done. RESULTS: In severe cases operative endoscopy cured pancreatic inflammation in 13 cases. Subsequent LC never showed serious morbidity, apart subcutaneous emphysema in one case. In 5 cases laparotomy was required since pancreatic necrosis was present, with 60% mortality. In patients with mild pancreatitis LC was successfully performed in all cases, with 6.9% morbidity. IOC showed choledochal stones in 32.5% of cases, while in severe cases stones in the biliary tree were showed in 88.8% of cases. No significant differences were detected between group 1 and 2. CONCLUSIONS: In conclusion ABP treatment is always surgical, and almost always with minimally-invasive procedures in severe cases (ERCP + ES with LC < or = 10 days) if surgery is performed within 24-48 hrs as well as in mild cases (LC + IOC) when surgery is done within 10 days, independently from the age of the patients.

APACHE↗
PubMed1998

[The use of prosthetic meshes in the surgical treatment of inguinal hernia: the costs and profits for the local health screening unit].

BACKGROUND: Inguinal hernioplasty represents one of the most frequently performed surgical operation. The recent introduction of prosthetic mesh made Bassini operation obsolete, with more space gained by the newly developed "tension-free" and "sutureless" surgical techniques. This new approach, however, results in increased initial costs for the hospital, due to the purchase of mesh materials. On the other hand a reduction of overall expenses for a single hernia repair should be expected. In this work an attempt is made to verify this, by calculating the cost-benefit ratio of different techniques for hernia repair. METHODS: The type and amount of materials used in a standard Bassini hernia repair, Lichtenstein and Trabucco have been examined. The amount of anesthetic drugs required, the average hospital stay and time away from work were recorded too. The costs of the three operations considered, not including routine expenses (operating room, bed sheet, etc.) have been estimated. RESULTS: Lichtenstein and Trabucco repair performed in local anesthesia (L. 1.354.120, L. 1.567.120) were cheaper than Bassini (L. 2.820.950). CONCLUSIONS: Since the system of diagnosis-related group offers a fixed amount of reimbursement for hernia repair (L. 3.247.000), the extensive use of tension free and sutureless methods, offers better profit for the Hospital. Last but not least, tension free hernia repair ensures short hospital stay, less postoperative pain, good compliance and better quality of life for the patient.

Cost-Benefit Analysis↗
PubMed1997

[Risk indices in geriatric surgery: ASA index versus Reiss index].

The use of the Risk Index in surgery is aimed to plan surgical strategy in order to achieve a better postoperative prognosis. This is especially true in geriatric surgery where the ASA Index and, more recently, the Reiss Index are widely employed. Since the mentioned Risk Indices are calculated on the basis of different factors, in this study we compared the two Risk Indices with the aim of verifying which index offers better prognostic indications. 210 patients, aged over 70 years, undergoing surgical treatment, were investigated. The patients were grouped according to the ASA and Reiss Indices. The ASA Index showed good correlation only with postoperative mortality. The three classes of Reiss Index showed a significant correlation with the incidence of post-operative morbidity and mortality (p.o. morbidity: 7.1%, 21.5%, 30.3%; p.o. mortality; 1.7%, 9.2%, 24.2% -Chi 2 = 20.7; p < 0.001). Our results support the hypothesis that Reiss index offers better prognostic evaluation of postoperative outcome, suggesting its use in assessing postoperative prognosis in geriatric patients. In addition, our observation confirms the criticism reported of the ASA Index, merely considered as an indicator of health status regardless of surgical treatment. In conclusion, routine preoperative evaluation of the Reiss Index should be advised in geriatric patients with the aim to forecasting surgical risk in the first place, and them modifying operative strategy in order to improve postoperative results.

Age Factors↗
PubMed1997

[Video laparoscopic cholecystectomy in acute cholecystitis: when,how and why?].

Acute cholecystitis has been previously considered as contraindication for laparoscopic cholecystectomy (LC), but recently, several studies have demonstrated that the laparoscopic approach can also be effective in such cases, although iatrogenic lesions of the biliary tree have been increasingly reported. Aim of this study was to verify the effectiveness of LC in patients presenting with acute cholecystitis on the basis of preoperative and intraoperative findings, postoperative mortality and morbidity, in order to assess those conditions which still can be considered as contraindications for LC. From September 1992 to January 1995, 133 patients have been consecutively admitted and operated for LC. 46 cases (36.5%) had histologically proven acute cholecystitis. Moreover we have compared preoperative date (clinical history, laboratory findings, Rx and ultrasound evaluation) with intraoperative findings to assess a correlation with intraoperative difficult conditions evaluated according to De Manzini score. Our results demonstrate that clinical data significantly correlate with intraoperative difficult situations. Hepatobiliary ultrasound also has shown good correlation between the thickness of gallbladder wall and difficult operations (73.9 sensibility-70.1 specificity). Therefore, in patients with clinically severe acute cholecystitis, and thickened gallbladder demonstrated by ultrasound it is very likely that the surgeon will experience difficult in intraoperative situations. In these conditions laparoscopy may be considered mainly as a diagnostic procedure in order to evaluate the entity of inflammatory changes considering the possibility of an open conversion that must be done before any iatrogenic lesion occur. This policy has allowed us to avoid in our series postoperative complications such as lesions of the biliary tree. In conclusion we believe that LC for acute cholecystitis should be considered as a therapeutical option only for selected cases.

Acute Disease↗
PubMed1996

Is laparoscopic cholecystectomy a safe alternative to open cholecystectomy for pediatric patients with cholelithiasis?

The results with five pediatric patients (6-15 years) who underwent laparoscopic cholecystectomy for symptomatic cholecystolithiasis are reported here. One patient had associated hematological disease (sickle-cell anemia). All five children were submitted to surgery using the laparoscopic technique. Intraoperative cholangiography was performed in two cases with uncertain ductal and vascular intraoperative anatomy. None of the operations was converted to open cholecystectomy, and there were no operative complications. The mean hospital stay was 2.2 days (range 2-3 days). All five children were able to return to normal activity within a week. No long-term complications were seen in any of the patients during an average follow-up period of 10.6 months (range 8-14). We believe that laparoscopic cholecystectomy in children is safe and effective, and that it is an important alternative to open cholecystectomy. However, prospective comparative studies of the procedure are necessary.

Adolescent↗
PubMed1996

Primary gastroduodenal tuberculous infection presenting as pyloric outlet obstruction.

Gastroduodenal tuberculosis occurs in underdeveloped areas and, although rarely, also in western countries, affecting mainly immigrants, immunodepressed, or low socioeconomic classes. We report a case of gastroduodenal tuberculosis presenting as pyloric outlet obstruction. We describe the clinical features and the diagnostic approach to the patient, emphasizing the role played by surgery in the diagnosis and treatment of the established complication. Developments are needed in the diagnostic area (video-laparoscopy, polymerase chain reaction of mycobacterial DNA) and in the mini-invasive treatment of obstructive complications (endoscopic balloon dilatation, video-laparoscopic surgery).

Adult↗
PubMed1995

Bowel stricture due to ischemic colitis: report of three cases requiring surgery.

The diagnosis of ischemic colitis is challenging and still based upon a high index of suspicion. We report here, three patients affected by ischemic colitis causing stenosis and intestinal obstruction that required surgical treatment. Results of surgery in the three cases were not fair reflecting the high mortality and morbidity rate of ischemic colitis. However, the three cases showed peculiar features allowing us to make a few speculative considerations. Better results in the treatment of ischemic colitis might be achieved by means of a prompt recognition of the initial picture and through a better control of the many associated diseases, that represent the main risk factor for the development of ischemic colitis itself and for the bad prognosis of surgical treatment.

Aged↗
PubMed1995

[Intestinal obstruction caused by ischemic colitis: description of 3 surgically treated cases].

The diagnosis of ischemic colitis is challenging and still based upon a high index of suspicion. We report here, three patients affected by ischemic colitis causing stenosis and intestinal obstruction who required surgical treatment. Results of surgery in the three cases were not fair reflecting the high mortality and morbidity rate of ischemic colitis. However, the three cases showed peculiar features allowing us to make a few speculative considerations. Better results in the treatment of ischemic colitis might be achieved by means of a prompt recognition of the initial picture and through a better control of the many associated diseases, that represent the main risk factor for the development of ischemic colitis itself and for the bad prognosis of surgical treatment.

Aged↗
PubMed1990

Enteroglucagon and peptide Y-Y response after construction of a pelvic reservoir in humans.

The results of an investigation of plasma levels of gastrointestinal hormones in patients after the construction of a pelvic reservoir are reported. Enteroglucagon (EG) and peptide tyrosine-tyrosine (PYY), two hormones believed to play a relevant role in the adaptive response to bowel resection, were investigated using a specific radioimmunoassay in basal conditions and after a standard meal. Pouch patients showed a statistically significant increase in basal levels of both enteroglucagon and PYY compared with control subjects (P less than 0.02 and P less than 0.001, respectively). The response of enteroglucagon to food ingestion, evaluated by means of the total integrated response, was similar in patients and controls. Conversely, the response of PYY was significantly increased in pouch patients compared with control cases (P less than 0.02). Results of this investigation suggest that gut hormones may be involved in mediating the adaptive response of the intestine to pouch construction. Changes of gut peptides may explain, at least in part, the functional results observed after pouch construction.

Adult↗
PubMed1990

Early complications after surgery for Crohn's disease.

A group of 212 patients operated upon for Crohn's disease were studied and the early postoperative complications with related problems were assessed. The morbidity was 28.3 per cent, 60 patients had at least one complication, mainly of septic nature. The mortality was 3.3 per cent (7 patients), sepsis and deep vein thrombosis with pulmonary embolism were the most common causes of death. Postoperative complications were significantly higher (39.7%) (p less than 0.001) in patients with a pre-operative nutritional deficit and in those who had urgent surgery (44.4%) (p less than 0.001). Among patients with pre-operative sepsis, the morbidity was also higher (34.6%), but was not significant. Peri-anastomotic complications (dehiscence, abscess, fistula, bleeding) were apparently more frequent (45.4%) in patients with histological residual Crohn's disease at macroscopically free resection margins although this contrasts with previous series. A proper pre-operative diagnostic approach, adequate peri-operative protein-caloric repletion, antibiotic therapy, prevention of thromboembolism and elective surgery, are still the primary tools in reducing the morbidity and mortality after surgery for Crohn's disease.

Adolescent↗
PubMed1988

Diagnostic and therapeutic problems of non perianal fistulas and abscesses in Crohn's disease.

Problems related to the appearance of non perianal fistulas and abscesses are examined in a series of 204 patients operated on for Crohn's disease. Incidence of these complications was 34.3% (70 cases); one or more fistulas were present in 54 patients, associated with abscesses in 13, while abscesses alone were present in 3. The highest incidence was observed in the male sex, in patients over 50 years, and in the presence of stenosing Crohn's lesions (P less than 0.001). On the contrary, the primary site of Crohn's disease does not seem to affect significantly their appearance. The clinical suspect of fistulas or abscesses should be supported with radiographic, endoscopic, echographic and scintiscan findings, even though about 7.2% of fistulas are diagnosed only intraoperatively. Surgical treatment is the most suitable therapeutic management; however enteroenteric and mesenteric fistulas are only relative indications for surgery. TPN is suitable for postoperative enteric fistulas (5 cases). Postoperative morbidity is not different in patients with or without such complications at surgery. Long-term prognosis of non perianal fistulas and abscesses is related only to recurrences of Crohn's disease and their anatomopathologic evolution.

Abscess↗
PubMed1987

Raised plasma concentrations of platelet factor 4 (PF4) in Crohn's disease.

Plasma platelet factor 4 (PF4), secreted by the platelets, is an index of platelet aggregation and thromboembolic risk. The authors assessed PF4 in 20 patients with Crohn's disease (ileitis in 13 patients, ileocolitis in seven) and in 20 healthy volunteers. Disease activity was low (Crohn's Disease Activity Index less than 150) in 11 patients and high in nine. Radioimmunoassay of PF4 using Abbott's Kit was performed on one sample of plasma from each subject (nv less than or equal to 0.324 nmol/ml), (nv less than or equal to 10 ng/ml). A significantly higher concentration of PF4 was found in Crohn's disease patients: 4.625 +/- 1.1 nmol/ml (142.5 +/- 36 ng/ml) than in the control group: 0.189 +/- 0.07 nmol/ml (5.6 +/- 4.8 ng/ml) (Z = 5.396, p less than 0.0001). No correlation was present between PF4 levels and activity, the site of disease, or medical treatment with or without prednisone.

Adult↗
PubMed1986

Recurrence of Crohn's disease after resection. Are there any risk factors?

We report two studies on possible risk factors for postoperative recurrence of Crohn's disease and an extensive literature review. In our retrospective study, 90 patients who had undergone curative resection and anastomosis 1 to 22 years (average 9.3 years) previously were examined. The recurrence rate, calculated by actuarial methods, was 62.2% after 10 years and 86.4% after 15 years. The site of recurrence was clearly related to the initial location of disease (p less than 0.001). However, of the various clinical, pathological, and surgical factors studied, only the preoperative history correlated directly with recurrence (p less than 0.05). The prospective study evaluated the influence on recurrence of microscopic lesions at grossly free margins of ileocecal resection. Twenty-two consecutive patients, operated on for Crohn's disease of the terminal ileum from 6 to 34 months previously (average 24 months), were studied. From the histological grading previously established, recurrence was independent of involvement at both proximal and distal section lines. Therefore, we recommend conservative resection to obtain only grossly uninvolved margins.

Actuarial Analysis↗
PubMed1985

Exaggerated response of thyrotropin to thyrotropin-releasing hormone in patients resected for Crohn's ileitis.

We have studied the response of thyrotropin to exogenous thyrotropin-releasing hormone in 13 patients who had previous intestinal resection for Crohn's disease, and in 42 healthy controls. An exaggerated and prolonged response curve was found in eight of the patients and one control (P less than 0.01), while baseline hormone levels were normal in all. These results may be related to the state of iodine deficiency known to develop in inflammatory bowel disease, but the pathophysiology requires further elucidation.

Adult↗