Biomedical subjects

T Facella

Publications and source records attributed to T Facella.

13 recordsLinked to original sources

PubMedDate not supplied

[Paraesophageal hiatal hernia. Clinical considerations and report of a case].

OBJECTIVE: The authors report their experience about the treatment about a case of paraesophageal hernia and they redefine nosography. DESIGN: Report of 1 case; evaluation of effectiveness of surgical treatment. 1-year follow up. Review of its clinical presentation. SETTING: Operative Unit of General and Thoracic Surgery. Department of General Surgery, Emergency and Transplantation. Polyclinc, University of Palermo. INTERVENTION: The patient was submitted to surgery with radical and curative intention. RESULTS: Complete resolution of the pathology. Follow-up (1 year) negative. CONCLUSION: Management of patients affected by paraesophageal hernia is difficult, because the physiopathology, anatomic basis and clinical presentation are not yet clear. The aim of surgical treatment is to reduce the hernia, to repair the hiatal gap and to make a correct antireflux procedure. According to us, the open surgical approach is very safe and useful because allows more safe surgical dissection, even if there is a big scar on the abdomen, the postoperative staying in hospital is longer. Finally, we emphasise the role of follow-up in these patients: it's the only way to prevent complications.

Adult↗

PubMedDate not supplied

[Gastric antral vascular ectasia (GAVE) or watermelon stomach syndrome: report of 3 cases and clinical and therapeutic indications].

OBJECTIVE: The authors report their experience in diagnosis, treatment and ambulatorial follow up of 3 cases of obscure upper gastrointestinal bleeding by gastric antral vascular ectasia (GAVE). EXPERIMENTAL DESIGN: Complete clinical report of 3 cases. Clinical and endoscopic indication, evaluation of effectiveness of endoscopic treatment with bipolar electrocoagulation and follow-up. SETTING: Operative Unit of General and Thoracic Surgery. University "Paolo Giaccone" of Palermo. INTERVENTION: Endoscopic treatment by multiple session with bipolar electrocoagulation. No complications were registered. RESULTS: Complete recovery with "restitutio ad integrum". No relapse were recorded at follow up. CONCLUSIONS: The objective of the treatment is to recognize the site of obscure bleeding and then stop it. The choice between pharmacological, endoscopic and surgical treatment is individual for each patient. According to us, the endoscopic treatment is the first step in a gradual clinical approach, to detect the site of the lesion, to treat with bipolar electrocoagulation or with Argon Plasma Coagulator (lower wall penetration and minimal risk of perforation).

Aged↗

PubMedDate not supplied

[Regression of primary low-grade gastric mucosa-associated lymphoma by eradication of Helicobacter pylori infection: case report].

OBJECTIVE: The Authors report their experience in diagnosis and treatment of one case of primary low-grade gastric lymphoma of mucosa associated lymphoid tissue (MALT); recent international literature review. EXPERIMENTAL DESIGN: Complete clinical report. Diagnostic, clinical and prognostic indication, evaluation of effectiveness of eradication therapy and short follow-up. SETTING: Operative Unit of General and Thoracic Surgery. University "Paolo Giaccone" of Palermo. INTERVENTION: Treatment of H. Pylori infection (lansoprazole, amoxicillin and metronidazole twice a day for 14 days; after that, lansoprazole for another 4 weeks), according to international guide-lines. RESULTS: H. Pylori was completed eradicated. Disappearance and total regression of the lymphomatous tissue was observed. No relapse were recorded at short follow-up. CONCLUSIONS: Our reports confirm the recent anecdotal reports on regression of gastric MALT lymphoma after eradication of H. Pylori and indicates that the growth of these extranodal lymphomas may depend on H. Pylori.

2-Pyridinylmethylsulfinylbenzimidazoles↗

PubMedDate not supplied

[Intestinal endometriosis: an obscure cause of cyclic rectal bleeding].

OBJECTIVE: Authors report their experience about a case of intestinal endometriosis that lead cyclic and recurrent rectal bleeding in a fertile-age woman. DESIGN: Report of 1 case with multidisciplinary approach and surgical treatment. Surgical effectiveness evaluation and 2 years follow-up. Brief review on the recent literature and the diagnostic and therapeutic implications. SETTING: Section of General and Thoracic Surgery, Department of General Surgery, Emergency and Organ Transplantation, Policlinico "Paolo Giaccone", Palermo. INTERVENTION: After correct and sure diagnosis, the patient was submitted to sigmoid segmental resection with radical and curative intention. RESULTS: Complete recovery. Follow-up (24 months) negative. CONCLUSIONS: Diagnosis of endometriosis should be considered in women with recurrent monthly abdominal pain and bowel symptoms, especially if accompanied by gynaecologic complaints, even because the significant symptoms overlap with the irritable bowel syndrome (IBS) and makes the differentiation extremely difficult. Treatment of GI endometriosis is best approached in collaboration between gynaecologist experienced and intestinal surgeon. The high accuracy and low complications suggested that EUS-FNA was effective for the correct histologic diagnosis of intestinal endometriosis.

Anastomosis, Surgical↗

PubMedDate not supplied

[Gastric foreign body: bezoars. Apropos of two cases].

OBJECTIVE: The authors report their experience about the treatment of two cases of gastric bezoar, treated in curative mode, the first endoscopically and the second with surgical intervention. SETTING: Operative Unit of General and Thoracic Surgery, Department of General and Emergency Surgery, Organ Transplantation, Policlinico, University of Palermo. INTERVENTION: The patients were submitted to curative treatment, one with endoscopic treatment (mechanical fragmentation of phytobezoar and fragments extraction via-overtube), the second with surgical gastrotomy (stamp trichobezoar). There were no procedure-related complications. RESULTS: The two patients were curative and radically treated. Negative 2 years follow-up. CONCLUSIONS: There is no standardized method for the treatment of gastric bezoars. Endoscopic removal of gastric bezoars after fragmentation and using overtube is effective and safe. Surgical intervention, equally safe, is reserved to huge, stamp, impacted or complicated bezoars.

Adult↗

PubMedDate not supplied

[Aberrant pancreas: a rare cause of epigastralgia].

OBJECTIVE: The Authors report their experience about a case of aberrant pancreas that lead epigastralgia. DESIGN: Report of 1 case and endoscopic treatment (upper endoscopy + EUS + endoscopic polypectomy + endoscopic biopsy of the base. Surgical effectiveness evaluation. SETTING: Section of General and Thoracic Surgery, Department of General Surgery, Emergency and Organ Transplantation, Policlinico "Paolo Giaccone", Palermo. INTERVENTION: After correct and sure diagnosis, the patient was submitted to endoscopic polypectomy with radical and curative intention. RESULTS: Complete recovery. Hematochemical and endoscopic follow-up (1 months) negative. CONCLUSIONS: Diagnosis of aberrant pancreas is very hard and always post-resection. Symptoms are poor and makes the clinical diagnosis extremely difficult, except when the mass attains big dimension (>5 cm). The best treatment of aberrant pancreas is based on correct diagnosis (upper endoscopy + EUS + FNAB) and on a radical treatment that, if the lesion is mucosal, is totally endoscopic (endoscopic polipectomy), without specific risk.

Abdominal Pain↗

PubMedDate not supplied

Treatment of complications of hepatic hydatid disease by ERCP: our experience.

BACKGROUND: The aim of this study was to evaluate the effectiveness of endoscopic sphincterotomy and positioning of naso-biliary drain or biliary endoprosthesis for preoperative and postoperative complications of hepatic hydatid disease (fistuias, compressioni cholestasis, rupture in biliary tree). METHODS: During the period 1994-2003, 22 patients (12 male and 10 female, mean age 55.4 years, range 16-65 yrs) underwent endoscopic treatment for complications of hepatic hydatid disease. Indications for ERCP in 5 patients treated before surgery (Group A) were obstructive jaundice in ali, associated with acute cholangitis in 4 (80%) and acute pancreatitis in 1 (20%). In 17 patients treated after surgery (Group B), the indication was acute cholangitis in 6 (36%), obstructive jaundice 3 (17%), and persistent external drainage in 8 patients (47%). OBSERVATIONS: In group A, ERCP detected hydatid vesicies within the bile duct in all patients. Ali patients underwent endoscopic sphincterotomy and clearance of the duct with no complications. The 8 patients in Group B with persistent external drainage had biliary fistulas that resolved after endoscopic treatment within 10 to 25 days (in 4 patients with low-flow fistula was positioned nasobiliary drain to repeat cholangiogram) or in 4-6 weeks (in 4 patients with high-flow fistula was positioned biliary endoprosthesis). In 2 of 8 patients (25%) with postoperative external biliary fistulas was observed choledocholitiasis (resolution with ERCP). Ali the 9 patients with postoperative obstructive jaundice or acute cholangitis, had cyst remnants obstructing the bile duct. Surgical reintervention was avoided in all patients in group B: all underwent endoscopic sphincterotomy and clearance of the bile duct without complications. After treatment, all patients remained asymptomatic. CONCLUSION: Endoscopic sphincterotomy with positioning of naso-biliary drain or biliary endoprosthesis is a safe and effective treatment for preoperative and postoperative biliary complications of hepatic hydatid disease.

Adolescent↗

PubMedDate not supplied

["Rendez-vous" technique for palliation of neoplastic jaundice: personal experience].

INTRODUCTION: "Rendez-vous" technique (RV) assume contemporaneous percutaneous transhepatic choledochal drainage (PTCD) and endoscopic (ERCP) approach to make easier biliary cannulation when it fails for anatomic, neoplastic or iatrogenic causes, in subject unresectable at presentation ("not fit for surgery"). MATERIALS AND METHODS: Over a 3 years period 618 ERCP were performed in the Service of Digestive Endoscopy in Section of General and Thoracic Surgery, 59 of whom (9%) failed for non-visualization of ampulla of Vater (25%), intradiverticular ampulla (54%) or anatomic defects (21%). Were attempted 44 pre-cut: 14 failed (close biliary stricture), and we proceed to RV. RESULTS: 11/14 (79%) RV were successful (successful stent insertion was defined as passage of the stent across the stricture) and 3 failure (21%) occurred in close biliary malignant obstruction even to percutaneous transhepatic approach. Only in 28% were registered minor complications (2 post-procedure fever, 1 papillary bleeding post PTE, 1 case mild acute pancreatitis). No mortality procedure related was registered and was not necessary to recur to surgery. CONCLUSIONS: RV is very useful in case of difficult cannulation of biliary tree and after failure of pre-cut. US-guided PTC is easy to perform, with low incidence of complications. Every well experienced team who works on bilio-pancreatic pathologies may recurs to this technique: even if not much utilized, RV can solves complex cases of biliary stricture.

Aged↗

PubMedDate not supplied

[Prevention of complications in thyroid surgery recurrent laryngeal nerve injury personal experience on 313 cases].

INTRODUCTION: Thyroidectomy poses many challenges for the surgeon who undertakes endocrine surgery and iatrogenic injury of inferior laryngeal nerve (ILN) is one of the most serious (0-20%). We report our personal experience of a series of 313 thyroidectomy with intraoperative identification of ILN. METHODS: 313 patients (253 females, 60 males, whose age was between 17 and 86 years, mean 41 years) had undergone thyroidectomy in our Operative Unit from January 2000 to January 2004. Among them, 259 patients underwent total extracapsular thyroidectomy, 38 subtotal thyroidectomy, 5 isthmo-lobectomy and 11 were completions of thyroidectomy in patients who had previously undergone a first thyroid surgical intervention. RESULTS: We identified 588 ILN (in all cases), in the left or in the right side only in case of isthmo-lobectomy or completion of thyroidectomy. In two cases (0.63%) we noticed on the right side a non recurrent laryngeal nerve. Concerning the postoperative results we noticed only one case (0.38%) of ILN injury with monolateral vocal cord hypomotility and temporary dysphonia, actually on phoniatric therapy at follow-up. CONCLUSION: A strong knowledge of the anatomy and embryology of the thyroid region, a commitment to meticulous attention to detail, the awareness of the extremely varying course of the ILN and the inferior thyroid artery and their relations, and adequate experience are all required to maintain a level of expertise and avoid ILN. Thyroid carcinoma, recurrent goitre, total thyroidectomy operation, duration of the operation are factors which increase the risk of postoperative ILN injury.

Adolescent↗

PubMedDate not supplied

Heterotopic gastric mucosa in the gallbladder: case report and literature review.

INTRODUCTION: we report on a case of heterotopic gastric mucosa in the neck of the gallbladder and we also review 95 other reports of HGM in the gallbladder in the international medical literature from 1977. AIM: to evaluate the gold standard treatment in heterotopic gastric mucosa of the gallbladder by the analysis of literature, compared with our anecdotal experience. PATIENT AND METHOD: a 43-year-old man, who was recently symptomatic, visited our hospital to submit to laparoscopic cholecistectomy for cholelithiasis. Ultrasonography revealed a broad-based polypoid lesion in the gallbladder (2.5 cm in diameter in the neck of the gallbladder), with multiple gallstones. RESULTS: standard laparoscopic cholecystectomy was performed. The specimen revealed a 2.5 x 1.7 x 0.5 cm polypoid lesion with deep in the body, with many gallstones in the gallbladder. Histologically, the polypoid lesion consisted of gastric fundic glands located only in the mucosa of the gallbladder. The surrounding mucosa consisted of almost normal epithelium without any metaplastic changes. Postoperative technetium 99m-pertechnetate scintigraphy demonstrated no evidence of gastric heterotopia elsewhere in the body. Actually the patient is in long-time follow-up, asymptomatic. CONCLUSIONS: for its extreme difficult to make a conclusive diagnosis and thereby rule out the possibility of cancer, it appears that laparoscopic cholecystectomy may be unavoidable for patients affected by heterotopic gastric mucosa at the present time and care must be taken when a diagnosis is made based on intraoperative frozen sections.

Adult↗

PubMedDate not supplied

[Non recurrent laryngeal nerve. Personal experience].

PURPOSE: Damage to the recurrent laryngeal nerve (RLN) during thyroid or parathyroid surgery is the most common iatrogenic cause of vocal cord paralysis. Identification of the RLNs and meticulous surgical technique can significantly decrease the incidence of this complication. Nonrecurrent RLNs (NRRLNs) are exceedingly rare. Surgeons need to be aware of their position to avoid injuries. PATIENT AND METHODS: A retrospective review of 263 right RLN exposures (and 251 left RNL) over a 5-year period was performed. RESULTS: Two NRRLNs were encountered, for an incidence of 0.39% (0.76% only for right dissection), without anatomic anomalies on the left side. The nerve anomaly was never preoperatively diagnosed. CONCLUSION: NRRLNs are rare and is associated with a right subclavian artery arising from distal aortic arch. Awareness of their existence and correct surgical technique will prevent the surgeon from accidentally lesion of NRRLN one if it is encountered during thyroid or parathyroid surgery.

Humans↗

PubMedDate not supplied

[Endoscopic treatment of pancreatic pseudocysts].

AIM: the Authors report their experience about the endoscopic treatment of pancreatic pseudocysts (PP). PATIENTS AND METHODS: report of 10 cases; evaluation of effectiveness, morbidity and mortality of treatment. SETTING: Section of General and Thoracic Surgery, AOUP ?Paolo Giaccone?, University of Palermo. PROCEDURE: endoscopic drainage was performed in all 10 patients, with 2 cysto-gastrostomy, 5 cysto-duodenostomy and 3 trans-papillary cystic drainage. RESULTS: 100% successful; one case of bleeding post-procedure (10%), one case of sepsis (10%) and one case of stricture of fistula between PP and duodenum. CONCLUSION: endoscopic drainage of PP is a safe and simple treatment, with high rates of success and low rate of complication procedure-related, complementary to surgery.

Adult↗

PubMedDate not supplied

[Severe rectal bleeding after transrectal US-guided prostate biopsy. Case report].

CASE: The Authors report their experience about a case of severe rectal bleeding after transrectal ultrasound-guided prostate biopsy. INTERVENTION: After correct and sure diagnosis, the patient was submitted to resolutive endoscopic haemostatic treatment (failure of haemostatic mechanical manoeuvres, emergency colonscopy, haemostasis with sclerotherapy, heat bipolar probe and Argon Plasma Coagulation). RESULTS: Complete recovery (immediate stop bleeding). Follow-up (1 year) negative. CONCLUSIONS: Rectal bleeding after prostate biopsy is a important but rare complication of prostate cancer screening, potentially lethal. Best knowledge of causes and risk factors may improve the diagnosis and standardize the treatment. The prostatic biopsy is surely the best procedure for the screening of prostate cancer in the population, associated with PSA dosage.

Biopsy, Needle↗