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Biomedical subjects

S M Giulini

Publications and source records attributed to S M Giulini.

At least 73 records · Page 4Linked to original sources
PubMed1978

[Proposed technic of drainage tunneling in marsupialization of hydatid cysts of the hepatic cupula].

Even though the present tendency is to make use of radical operations, such as pericystectomy, hepatic resection and lobectomy, in the surgical management of hydatidosis of the liver, marsupialisation is still the method of choince in a large and clearly defined number of cases. While usually simple, this operation may prove difficult and complex when used on cysts of the cupola, since it may often be necessary to mobilise the liver to a large extent and employ damaging approach routes. A description is offered of a particular technique for tunnelling the desinage tube which considerably simplifies marsupialisation in cases of this kind.

Drainage↗
PubMed1977

[Porto-systemic anastomosis in the treatment of portal hypertension due to intrahepatic block. Advanced surgical technics].

A physiopathological interpretation is offered of the possibilities given by recent selective or portally regulated reduction of pressure in achieving a balance between reduction of pressure and diversion. Classic demonstrations, in fact, prove effective in the prevention of haemorrhage due to rupture of oesophageal varices. On the other hand, by over-diversion of the portal flow from the liver, they may cause a further deterioration in liver performance and more imposing the greater the flow of portal blood through the liver preoperatively. Procedures aimed at de-tension of the portal system, particularly the gastro-oesophageal segment, and at ensuring an intrahepatic venous flow sufficient to obviate steal syndrome damage, are described. Some of these procedures are still at the experimental stage. The techniques involved are explained, along with the underlying principles achieved by or prospected for each of them.

Drainage↗
PubMedDate not supplied

Complete in vitro prosthesis endothelialization induced by artificial extracellular matrix.

This report presents our research on the conditions necessary to substain optimal in vitro prosthetic endothelialization using human endothelium cultures. Human vein endothelial cells were seeded at a concentration of 3 x 10(5)/cm2 in a gelatinized Dacron patch graft coated with a commercial collagen film, using a solution of fibrin glue. Endothelium adhesion, proliferation, and survival were measured by [3H]thymidine incorporation, after 7 days of incubation. Finally, the morphology of prosthetic endothelialization was analyzed by scanning electron microscopy. We observed that the Dacron patch grafts coated with collagen film were able to promote endothelialization better than the prostheses coated with highly concentrated collagen solution or gelatin. We therefore concluded that the collagen film that supports endothelial cell adhesion and proliferation uniformly covers the entire synthetic endoluminal surface of the Dacron graft, thus preventing endothelial cell alterations induced by direct contact with the synthetic prosthetic surface.

Adhesives↗
PubMedDate not supplied

[Hilar localization of splenic cyst does not always exclude the possibility of resective treatment].

Non parasitic cysts of the spleen require surgical treatment because of their progressive growth and in order to prevent the potential severe complications associated with such cysts. Since it is now well known that total splenectomy, especially in young patients, has potential for short- and long-term complications, much emphasis has been placed on splenic salvage, suggesting partial splenectomy as procedure of choice for splenic cysts. However various Authors suggest that many but not all splenic cysts can be treated with partial splenectomy. In particular cystic mass arising from the anterior aspect of the hilum near to vascular peduncle contraindicate partial resection requiring splenectomy. In a case observed TC scan demonstrated a very large epidermoid cyst penetrating hilar parenchyma just above splenic vessels insertion. Preoperative imaging suggested splenectomy as the only possible procedure to remove the cyst. At operation the exposure of the splenic artery extended proximally along the pancreatic tail showed an arterial branch running with satellite vein in the splenopancreatic ligament for inferior segment of the spleen. As we found this branch it was possible to resect cyst preserving a large inferior parenchymal segment normally perfused and functioning at postoperative scintigraphic controls. In conclusion not all hilar cysts must be considered an absolute indication to splenectomy. An accurate and extensive exposure of splenic artery and vein can demonstrate vascular anatomical variations permitting resection also for large cysts located near the splenic hilum.

Adult↗
PubMedDate not supplied

Early and long-term prognostic factors after liver resection for HCC.

The Authors discuss the principal early and long term predictive factors after liver resection in patients with hepatocellular carcinoma (HCC). The Authors report (131 cases) early mortality as 7.6%, entirely confined in the group, numerically prevalent and affected by cirrhosis. None of the 50 patients with chronic hepatitis (29 cases) or normal liver (21 cases) died after hepatic resection. Mortality is higher in Child B patients (20.7%) and in cases in which a massive haemotransfusion was given (p < 0.05), apart from the width of resection and from the number of hepatic resections. None of 41 cirrhotic Child A patients undergoing a limited hepatic resection (< or = 1 segment) died during the perioperative period. In the group of patients which survived to the resection, global survival at 5 years was 45%. The most important prognostic factor is local recurrence while cirrhosis and the degree of liver failure are not statistically significant. No feature can identify a subgroup of patients with a higher risk of recurrence, which is observed in 52% of patients with a follow up observation after more than 1 year. Among the 29 patients alive after more than 4 years from liver resection, only 11 didn't have local recurrence. The others were treated with iterative hepatic resections or with radiological techniques. In conclusion, the present experience suggests that, in selected cases, hepatic resection could be a low risk therapy (in cirrhotic patients as well). The long term results could improve with an aggressive attitude towards recurrence.

Adult↗
PubMedDate not supplied

[Acute pancreatitis: resultos of a diagnostic-therapeutic protocol in 80 consecutive cases].

The treatment of acute pancreatitis cannot be standardized in the absence of a prompt diagnosis and of an accurate severity and prognostic score. This study, based on 80 consecutively observed patients, compared the aetiological, clinical, diagnostic (laboratory and imaging) and prognostic data used to select the most appropriate therapy for each patient. The results confirm that the Ranson score shows a satisfactory prognostic relationship between the number of positive parameters and the severity of the disease. Ultrasound, which is useful for defining the aetiologic factors and in the follow-up of peripancreatic effusions, has proved to be limited as a means of imaging abnormalities of the pancreatic parenchyma. CT scans are confirmed as being the only method of accurately demonstrating the presence of necrosis and of evaluating its effective extent. ERCP was performed as soon as possible in the presence of biliary stasis or of suspect ultrasonographic signs. Surgical treatment proved necessary only in 7.5% of cases, on each occasion to drain infected necrotic foci. Promptness of the surgical indication plays an important role in the outcome of necrosectomy and drainage performed with the closed technique. Mortality was limited to 1.25% in our series. A correct diagnostic approach together with prompt treatment can reduce the mortality rate of this disease to a minimum.

Acute Disease↗
PubMedDate not supplied

Hemorrhagic cholecystitis as a likely cause of nontraumatic hemobilia in metachromatic leukodystrophy: report of a case.

A 17-years-old man with the juvenile form of MLD developed massive hemobilia. CT and US scans showed blood and clots filling the gallbladder and the biliary ways, with no bleeding source seen at selective angiography. Explorative laparotomy evidenced bleeding from a papillomatous gallbladder mucosa, resolved with cholecystectomy. Histologic examination with specific colorations diagnosed hemorrhagic cholecystitis from metachromatic leukodystrophy of the gallbladder. This is, to our knowing, the third case reported in Literature, and thus hemorrhagic cholecystitis may be considered a life-threatening complication of MLD to be prevented with cholecystectomy as soon as signs of gallbladder pathology (papillomatosis/polyposis, jaundice, abdominal pain) are suspected.

Adolescent↗
PubMedDate not supplied

Is there an association between Helicobacter pylori cytotoxin Cag A seropositivity and risk for gastric cancer?

BACKGROUND: Since discovered in 1990, Cag A, a protein expressed by specific strains of Helicobacter pylori, was thought able to explain why only a few Helicobacter infected patients develop peptic diseases and gastric cancer. However, clinical trials provide discordant results. MATERIALS AND METHODS: In this study we evaluate Helicobacter pylori and Cag A seropositivity in 35 cancer affected patients, in 36 gastritis affected patients and in 40 healthy blood donors by means of two commercially available fluorescence enzyme-immunoessay (ELISA). RESULTS: Odds ratios determination strongly suggests that Cag A bearer Helicobacter strains play a pathogenetic role in gastric diseases (OR 4.23, 95% CI 3.22-5.24 for cancer versus healthy volunteers, OR 3.2, 95% CI 2.19-4.21 for gastritis versus asymptomatic patients), but is unable to demonstrate a direct carcinogenic activity (cancer-gastritis difference is not significant: OR 1.32, 95% CI 0.39-1.25). CONCLUSIONS: Cag A seropositivity can be considered a risk factor for peptic disease, and only indirectly for gastric carcinoma. The paper also discuss some sampling, laboratory and statistical bias that can explain a wide eterogenity of the results reported in the literature.

Adult↗
PubMedDate not supplied

[Distal pancreatic resection with splenic preservation for metastasis of renal carcinoma diagnosed 24 years later from the nephrectomy].

Renal cell carcinoma is a malignant tumor with a singular biological behaviour, presenting in some reported cases very late metastases. This report describes a case of solitary pancreatic metastasis from kidney carcinoma, operated on 24 years before, that appears exceptional because of the long disease-free period after nephrectomy and the unusual metastatic site. The 73-year-old woman concluded the follow-up several years before; she presented aspecific abdominal pain and ultrasonographic examination and CT-scan revealed the presence of a mass in the pancreatic istmus. The mass was excised with splenic preservation and was diagnosed to be a pancreatic metastasis from clear cell renal carcinoma. We discuss the diagnostic and therapeutic features of this tumors. It appears important to obtain the diagnosis preoperatively, because good results may be obtained with surgery, justifying an aggressive surgical approach.

Aged↗
PubMedDate not supplied

[The role of magnetic resonance in the follow-up of aortofemoral prosthetic reconstructions].

The authors report their experience with the use of Magnetic Resonance (MR) in the follow-up of patients undergone aortofemoral bypass or substitution procedures for aneurysmal and/or steno-occlusive lesions of the aortoiliofemoral vascular bed. Twenty-eight patients, at least 2 years from aorto-bifemoral revascularization were evaluated by means of coronal and parasagittal MR planes (mean follow up 78.9 months). One exam over 28 was found to be not diagnostic; whereas the technique showed great usefulness in the morphological and haemodynamic evaluation of each of the graft sites explored (proximal anastomosis, graft body and limbs, femoral anastomosis and periprosthetic tissues) in the remaining 27 cases. The use of this method, in spite of some setting up problems peculiar to the type of examination, according to the authors is very promising because of the chance to obtain morphological and functional data at once and because of the interesting current and future developments of this diagnostic device.

Anastomosis, Surgical↗
PubMedDate not supplied

Ki67 immunohistochemical evaluation in colorectal cancer and normal colonic mucosa. Possible clinical applications.

Cell proliferation was evaluated by Ki67 monoclonal antibody in 33 colorectal adenocarcinomas and in the normal colonic mucosa. Immunoreactivity was assessed independently by two observers in two subsequent evaluations with a semiquantitative method, by counting at least 2000 cells in two distinct neoplastic specimens (central and peripheric section). There was an excellent intra-inter observer agreement in Ki67 score for each specimen. The tumor score range from 7 to 70% (median 48.8), without any significant correlation with sex and age of the patient and location, size, staging and grading of the neoplasm. Tumor Ki67 score was almost identical in central (46.96%) and in peripheral section (49.24%), and always higher than in normal mucosa. There was no distinction in Ki67 score in normal mucosa at various distances from the tumor. In our experience, Ki67 provides a reliable and reproducible method for assessment of proliferative activity; its clinical applications need further studies.

Adenocarcinoma↗