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U Tedeschi

Publications and source records attributed to U Tedeschi.

26 records · Page 2Linked to original sources
PubMedDate not supplied

Liver transplantation. A summary of our surgical practice.

At the turn of the new century, liver transplant procedures can finally be considered an efficient treatment option. Technology has helped transplant intervention become a preferred treatment for patients with progressive and irreversible liver failure. New immuno-suppressive drugs have been introduced which reduce the patient's immunological reaction to the implanted organ, entail minimal side effects and improve practical applications of liver transplantation. As a result of these technological advanced and proper disease management, liver transplant procedures are no longer thought of as an elite therapy, reserved for selected patients with end stage liver disease. In our opinion, it is now a sound and valid surgical option with strictly defined characteristics, indications and well-understood limits. Throughout the past decade, we have studied and applied this type of intervention and have come to terms with its rapid expansion at both the theoretical and practical levels. The most significant obstacle remaining today is the discrepancy between the ever increasing demand and limited supply of organs. The future of liver transplant lies in overcoming this obstacle. Liver transplant practice began at our Institute on 23 November 1990 with the first surgical intervention to replace an organ. In the past 10 years, we have exceeded 200 liver transplant procedures.

Adolescent↗
PubMedDate not supplied

[Stomach rupture due to barotrauma (a report of the 13th case since 1969)].

The thirteenth case of rupture of the stomach after a diving accident since 1969 is reported. This rare event was caused by equipment failure and panic reaction, which induced swallowing air during diving and consequential gas expansion in gastric cavity meanwhile the rapid ascent. Peritoneal decompression by paracentesis quickly improved the patient's condition and the following surgical laparotomy revealed a gastric tear along the lesser curvature, which was closed by suturing. The patient presented a postoperative splenic abscess two months later; literature demonstrated that rupture of a filled stomach may lead to septic complications.

Abdomen, Acute↗
PubMedDate not supplied

[The use of intra-arterial lipiodol in assessing hepatocarcinomas treated by percutaneous alcoholization. The initial experience].

Eight patients with inoperable hepatocellular carcinoma were treated by means of percutaneous alcoholization of the malignancy (11 nodular lesions less than 5 cm O). Upon treatment completion they were all given intraarterial injection of lipiodol, which was followed, a week later, by a CT scan. At angiography, during the parenchymal phase, 7 of 11 nodules appeared as avascular areas, whereas in the remaining 4 cases an intense parenchymal effect was seen within the previously treated areas. Lipiodol CT scans revealed intense uptake of oily material in the 4 hypervascular lesions as well as in 1 of those with avascular appearance. In 4 lesions, pathology of bioptic specimens obtained from the areas with contrast pooling was consistent with the persistence of viable neoplastic tissue. In these patients alcoholization had therefore to be continued. Lipiodol accumulation within previously treated nodules has proved to be related to the presence of residual neoplasm. Moreover, in 2 cases, focal retention of lipiodol was very helpful for biopsy under CT guidance. According to our experience, we believe lipiodol administration followed by CT to be very useful in evaluating and staging HCCs. We nevertheless believe that the procedure should be performed only after alcoholization has been completed: this would inform us of treatment effectiveness and subsequently enable us to decide whether treatment can be discontinued.

Angiography, Digital Subtraction↗
PubMedDate not supplied

[Lithiasic, congenital, choledochal dilatation: problems of diagnosis and therapy].

We report a case of a 30-year old female with congenital lithiasic choledochal dilatation which was not diagnosed at the ultrasonographic examination. Congenital biliary dilatation abnormalities are rare and may clinically present with episodic biliary colics or more rarely with recurrent pancreatis. Ultrasound, CT-scanning and ERCP usually make these anatomic alterations evident but in some cases there may be some doubt despite the vast range of radiological techniques available (PTC, Tc99m-Isida scinti-scan). The best results from a diagnostic point of view are obtained from the ERCP that may in fact visualize an anomalous pancreatico-biliary junction, rule out carcinoma, accurately define the cyst dimensions or show the intrahepatic ductal radicals. Furthermore, the extraction of intracystic stones or the treatment of choledochocele through a papillostomy may be performed. However the ERCP may cause traumatic pancreatitis, above all in youngster as was verified in our patient. During surgical exploration, the definitive diagnosis can be achieved via intraoperative cholangiography. We emphasize that in patients with congenital choledochal dilatation, the dilated choledochus should be excised even in young children to avoid the risk of malignancy which may occur also following cyso-duodeno- or cystojejunostomy treatment. In our patient an hepatiocojejunostomy on a Roux-en-Y limb was performed. This single case has been oresented along with a review of the literature to recall such anomalies in differential diagnosis of biliary colics and to stress that the choice treatment is surgical resection.

Adult↗