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Biomedical subjects

V Puchetti

Publications and source records attributed to V Puchetti.

At least 19 recordsLinked to original sources
PubMed1997

Delayed traumatic hernia of the diaphragm presenting with hypertensive pneumothorax. Case report and review of the literature.

The diagnosis of traumatic hernia of the diaphragm can be obtained at the time of injury or months-years after the trauma. The Authors report a case of traumatic hernia of the diaphragm, diagnosed 3 years after a blunt thoracic trauma in a 47-year-old man. The patient was admitted to the hospital for a pneumothorax caused by perforation of the herniated colon. He underwent colonic resection and reduction of the herniated viscera but unfortunately he died of septic shock on the 40th postoperative day. Pneumothorax is a very rare complication of traumatic diaphragmatic hernia and few cases are reported in literature. The diagnosis in the delayed phase is not easy since the correlation with the trauma is not always clear.

Hernia, Diaphragmatic, Traumatic↗
PubMed1994

Dextromethorphan test for evaluation of congenital predisposition to lung cancer.

We report the results of an investigation conducted in 992 healthy control subjects (854 adults and 138 adolescents) and in 116 subjects with lung cancer (LC) for the purpose of detecting those individuals with a possible genetic predisposition to lung cancer. The test consists of the oral administration of 64 mumol of dextromethorphan (DMP) with collection of urine samples over the following 8-h period and urine assay of the drug (DMP) and its main metabolite, dextrorphan (DOP). The ratio of the urinary concentrations of DMP to those of DOP is called the metabolic ratio (DMP/DOP) and is inversely proportional to the DMP demethylation rate. The pattern of the metabolic ratio (Log10 DMP/DOP) allowed, using a maximum likelihood approach, the identification of three subpopulations in the 854 control subjects (adults): (1) probable homozygous extensive metabolizers with Log10 DMP/DOP < -1.74 (73.1 percent); (2) probable heterozygous intermediate metabolizers with Log10 DMP/DOP in the -1.74 to -0.40 range (22.3 percent); and (3) probable homozygous poor metabolizers with Log10 DMP/DOP > -0.4 (4.6 percent). Most of the patients with LC (89 percent) were probable homozygous extensive metabolizers. As the latter have a cancer risk that is 2.54-fold greater than that of intermediate metabolizers (95 percent confidence interval [CI]: 1.37 to 4.73) and 7.43-fold greater than that of poor metabolizers (95 percent CI: 1.01 to 54.5), their identification by means of the DMP test may be particularly useful for subjects exposed to environmental and occupational carcinogens. The phenotype test used is similar to that of the debrisoquin test, but presents the advantage that DMP is a widely used, harmless drug with a faster and simpler urinary assay procedure.

Adolescent↗
PubMed1994

[Pulmonary carcinoid tumors].

27 patients suffering from carcinoid of the lung (18 females and 9 males, middle age 52 years, range 26-68) underwent surgery in our department. The neoplasms were located at the pulmonary hilum in 21 cases. The diagnosis was occasional in 6 cases, cough (51.8%) and recurrent bronchitis (37%) were the most frequent symptoms. No instances of carcinoid syndrome were detected. Preoperative staging ruled out pathologic mediastinal lymph nodes or hematogenous metastases. 26 patients underwent complete excision of the neoplasm (11 lobectomies, 9 pneumonectomies, 4 bilobectomies, 1 segmental resection, 1 bronchial wedge resection). Histologically, 4 cases were categorized as atypical carcinoids. Two patients died within 1 year, one suffering from atypical carcinoid because of disease progression, and an other one (suffering from atypical carcinoid) who underwent only at exploratory thoracotomy followed by chemotherapy. A patient suffering from typical carcinoid died within 1.5 years because of gallbladder carcinoma. From our experience and from the literature review it appears that carcinoids has to be considered as malignant neoplasms and treated according to.

Adult↗
PubMed1994

[Iatrogenic rupture of the esophagus: presentation of several cases].

Four cases of iatrogenic rupture of the oesophagus are presented. The site of the lesion was in the cervical tract in 1 case and in the thoracic tract in the other 3 cases. Their etiology was pneumatic endoscopic dilatation for achalasia in 2 cases, endoscopic insertion of a Celestin tube for carcinoma of the thoracic tract of the oesophagus in 1 case, and diagnostic endoscopy in the last one. Instrumental findings were relevant in all cases. All patients underwent surgery. In the patients suffering from achalasia, the rupture was repaired by a patch of the gastric fundus. The patient suffering from carcinoma underwent an oesophageal resection, the one with cervical perforation underwent a mediastinal drainage. There were no deaths or considerable post operating complications. In a patient suffering from achalasia gastro-oesophageal reflux was demonstrated after some months following the operation.

Aged↗
PubMed1994

[Primary germinal tumors of the mediastinum: our experience in 9 cases].

9 patients (8 males 1 female, middle age 24.3 years, range 20-41) affected by primary mediastinal germ cell tumor were surgically treated in our department. They were 4 seminomas, 2 embryonal carcinomas, 1 malignant teratoma and 2 benign teratomas. Three patients were asymptomatic; cough, dyspnea and chest pain were the most frequently observed symptoms. The staging work-up did not show signs of metastatic disease in the malignant types. Benign teratomas underwent complete excision. In one patient suffering from seminoma radiotherapy and chemotherapy caused complete remission of the disease. In the others cases remission of the neoplasm was obtained by resection and adjuvant therapy in 3 cases, by neoadjuvant treatment and excision of the residual mass in 3 cases. Among the patients suffering from seminoma, 2 are dead at 60 months since initial treatment and 2 are alive at 132 and 120 months respectively. Among the patients with malignant nonseminomatous tumours, 2 are alive at 60 and 36 months and 1 patient is dead at 13 months. Two patients with benign teratoma are alive at 189 and 168 months respectively. At present a multimodality treatment including surgery, radiotherapy and cisplatin-based combination chemotherapy, give the most satisfactory results in the treatment of malignant mediastinal germ cell tumours.

Adolescent↗
PubMed1994

[Thoracoplasty today. Review of a technique of the past].

Thoracoplastic operations had ruled the field in the past as treatment of choice in the surgical antituberculous collapse therapy; they have had a notable revival during the last years as an efficient therapeutic modality in the treatment of chronic empyemas of the most various etiologies. They are thoracoplasties done with particular modalities, imposing, setting out case by case to suppress the infected pleural space. It is usually joined with a thoracotomy and it permits also the execution of other surgical intrathoracic manoeuvres such as decortications, treatment of fistulas, myoplasties. Situations such as chronic empyemas, without any solution before, have found a brilliant solution by the use of this operation.

Chronic Disease↗
PubMed1990

Mediastinal chondrosarcoma. Case report.

A 34-year-old man and a 71-year-old woman underwent radical removal of mediastinally sited chondrosarcoma, presumably originating in the periosteum of the vertebral body. The man (with mesenchymal chondrosarcoma) died of remote metastasis 6 years postoperatively. The woman (poorly differentiated chondrosarcoma, grade 2-3) is still alive 2 years after the operation.

Adult↗
PubMed1989

Emergency surgical management of retrosternal goiter causing tracheal compression.

Acute tracheal compression caused by mediastinal masses is a rare event. Dyspnea is the most frequent symptom and the treatment of choice is intubation followed by surgical operation. Four cases of acute tracheal compression due to retrosternal goiter are described. All of them underwent emergency surgical treatment. Clinical findings and problems of surgical technique are discussed.

Aged↗
PubMed1988

Pharmacokinetics and human tissue penetration of flurithromycin.

The relationship between concentrations in serum and levels in tissue of flurithromycin, a new fluorinated macrolide, was determined in patients undergoing maxillofacial surgery and thoracotomy. All patients received 500 mg of flurithromycin orally every 8 h. Drug levels in serum, bone, soft tissue, lung, and pericardial fluid were determined microbiologically. The total amount of antibiotic per gram of tissue was calculated on the basis of the concentration in the supernatant of the homogenate. From the parallel course between free concentrations in serum and calculated contents in interstitial fluid tissue, it was concluded that the tissues examined were easily accessible by flurithromycin; penetration values measured by the ratio of areas under the curve were 8.3 for lung, 3.6 for bone, and 0.8 for soft tissue. The results of the pharmacokinetic study suggest that accumulation of the drug during repetitive multiple doses is predictable. Mean residence times were 10.2 and 8.3 h in groups 1 and 2, respectively. For bacteriostatic drugs such as macrolides, not only very high but also prolonged concentrations in tissue lead to favorable therapeutic result.

Adult↗
PubMed1988

[Spontaneous rupture of the esophagus (presentation of a case)].

The authors describe the case of a 67-year-old patient with spontaneous rupture of the middle third of the oesophagus, occurring apparently without any involvement of intraluminal hypertension. The surgical treatment consisted in the execution of an aspiration drainage of the left pleural cavity, followed by a right thoracotomy with exploration of the mediastinum. A gastrostomy according to Witzel was also performed. Total parenteral nutrition was instituted in the post-operative period. Healing of the oesophageal lesion was confirmed radiologically 2 months after admission to our department.

Aged↗
PubMed1988

Bronchopulmonary carcinoids: report of nine surgically treated cases.

Nine cases of bronchial carcinoids treated by surgery are reported. Six of them were females and three males. Their ages ranged from 37 to 68 years (median 52.8 years). Lobectomy was carried out in four instances (bilobectomy in one) and pneumonectomy in three. Based on preoperative histology two conservative operations were performed: one patient underwent segmental resection of the right upper lobe for a peripheral carcinoid and the other sleeve resection of the bronchus. The operations were complicated only in one case in which a broncho-pleural fistula appeared postoperatively and was successfully treated by thorachoplasty. There was no postoperative death. The only patient with an atypical carcinoid died one year after pneumonectomy. The other eight patients, with typical carcinoids are alive and without recurrent disease at 6 months to 8 years from surgery. Lymph node and parenchymal infiltration, observed in 3 patients, were not fatal. It is concluded that carcinoids should now be considered malignancies; typical carcinoids carry a more favorable prognosis than atypical ones and can be managed by conservative operations without affecting the survival rate. The spreading of the tumor to lymph nodes and surrounding tissues was not associated with an increased mortality in the reported cases.

Adult↗
PubMed1987

Imipenem kinetics in serum, lung tissue and pericardial fluid in patients undergoing thoracotomy.

Imipenem serum pharmacokinetics, lung tissue and pericardial fluid concentrations were measured in 10 patients undergoing thoracotomy, following a 1 g intravenous infusion of imipenem-cilastatin. The serum concentrations of imipenem 0.5 h and 4 h after the end of the 40 min infusion were 53.3 (+/- 16.7) and 2.0 (+/- 0.3) mg/l, respectively. The concentration of imipenem in lung tissue at 1 h was lower than in pericardial fluid and at 2.25 h the mean concentration of imipenem in pericardial fluid was 10.5 mg/l, vs. 0.28 mg/kg of lung tissue. Imipenem concentrations in pericardial fluid remained above 5 mg/l, well above the MIC for most pathogens, for 1 h whereas in pericardial fluid the concentration was 10.5 mg/l at 2.25 h.

Body Fluids↗
PubMed1987

[Esophagogastroplasty in the treatment of squamous carcinoma of the esophagus (our experience)].

The authors report on their experience with 42 cases of squamous carcinoma of the oesophagus subjected to oesophagectomy and oesophagogastroplasty. The patients' mean age was 55.2 years (range: 41-70) with a 13:1 male/female ratio. A positive history of cigarette smoking and of alcohol consumption was found in 87% and 80% of patients respectively. The sites of the neoplasms were as follows: 24 in the mid 3rd of the oesophagus, 9 in the lower 3rd, 6 in the upper 3rd of the thoracic oesophagus and 3 in the cervical oesophagus. In 39 patients the operation was performed in two stages according to Lewis and in 2 cases it was performed in 3 stages according to McKeown, while one patient was treated with a pull-through operation according to Akiyima. Six patients died during the first 30 days postoperatively as a result of circulatory complications or ARDS. Fistulization of the anastomosis as observed in 5 cases, though this was clinically manifest only in two. Mean survival was 5.9 months, 18.6 months and 10.5 months according to the period considered.

Adult↗
PubMed1987

[Esophageal localization of granulosa cell tumor (presentation of a clinical case)].

The authors report on a case of granular cell tumour localized in the lower third of the thoracic oesophagus. The patient, a 49-year-old male, suffering from symptoms of dysphagia over the previous few months, was treated surgically by thoracotomy enucleation of the neoplasm. Despite its slow growth, this rare benign neoplasm, which probably originates in Schwann's sheath, is a candidate for endoscopic or surgical resection.

Diagnosis, Differential↗
PubMed1987

[Preoperative evaluation of the patient candidate for surgical intervention on the chest: methods of study and risk factors].

The authors review the main methods designed to evaluate operability and surgical risk in candidates for chest surgery. They also report on their own experience with 135 cases operated on for thoraco-pulmonary diseases requiring surgery; in these cases, postoperative complications were studied in relation to various respiratory parameters evaluated differentially and as a whole prior to surgery. This study enabled the investigators to establish that patients with CV, FEV1, FEF25-75 and Tiffffeneau Index values below 60% of the respective theoretical reference values run a very substantial risk of postoperative complications, with a post-surgical morbidity rate of more than 60% in such patients. Similar risks are run by patients with VR values below 60% or above 120% of predicted values or with Emphysema Index values above 120% of predicted values. The author's experience with fractional bronchospirometry revealed that, in the high-risk patient sample, a predicted postoperative FEV1 value of only 800 ml/sec is a poorly selective limit.

Adolescent↗
PubMed1985

[The ND-Yag laser in the treatment of non-resectable esophageal neoplasms: evaluation and results].

The Authors show a set of 9 cases of patients suffering from oesophagus flaky carcinoma, judged radically non-operable, and treated with endoscopic laser-therapy by N.D. Yag Laser. They illustrate the patients' main clinical data, method followed, complications observed and results obtained. What seems to emerge from the analysis of the data is: the effectiveness of laser-therapy in the control of disphagia, simplicity of the technique and its acceptability by the patient, as well as the rareness of complications. Three are the clinical parameters used for the checking of patients before and after the laser treatment: disphagia, odynophagia and thoracic ache. The intenseness of symptoms was classed from 0 up to 3. Before the treatment, six patients out of nine showed class 3 disphagia; after the treatment, two could assume fluids (class 2), two fed also on minced foods (class 1), and two fed normally; in the two cases with initial class 2 disphagia a normal feed could be adopted; in one case no initial disphagia was present. Odynophagia was initially present in one case only at class 3, in three cases at class 1, and in all the other cases it was absent (0). After the treatment, odynophagia disappeared totally, except in one class 1 case, which remained unchanged. The presence of thoracic ache before the treatment was class 1 in four cases, class 3 in one case, and absent in four cases. After the treatment, the class 3 ache turned into class 1: in one class 1 case it was not modified; in the remaining cases the ache, if present, disappeared. Some questions remain opened, concerning the effect on survival, even in relation to other palliative methods, to the duration of the palliation obtained and to the eventual associability of lasertherapy to radiotherapy.

Aged↗