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1.
Acta Chir Belg ; 113(5): 322-4, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24294795

RESUMO

INTRODUCTION: Anal fissure is a common disease. Usually chronic anal fissures are managed medically. When conservative management fails, surgical treatment should be considered. Lateral internal sphincterotomy has been advocated as the first choice invasive treatment but it has a reported rate of major fecal incontinence of 5%. In order to reduce the onset of major fecal incontinence after anal fissure surgery, it has been proposed to use the anal stretching plus fissurectomy. METHODS: From 2008 to 2011, 457 patients have been operated for chronic anal fissure. RESULTS: Twenty-seven patients underwent lateral internal sphincterotomy, two patients underwent posterior sphincterotomy and 428 patients underwent anal stretch plus fissurectomy. Satisfactory results have been reported in 95% of the cases. Transient incontinence rates have been of 3% after anal stretch and of 14.8% after lateral internal sphincterotomy (p < 0.05). Major and persistent incontinence rates have been reported in a case after later internal sphincterotomy (3%) but never after anal stretching (p = 0.059). Recurrence occurred in 2% of the patients after anal stretch and in 3% of the cases after lateral internal sphincterotomy (p = ns). CONCLUSION: Lateral internal sphincterotomy and anal stretch have nearly a reported 95% of good results but the first have 3-5% rates of major incontinence.


Assuntos
Canal Anal/cirurgia , Fissura Anal/terapia , Adulto , Doença Crônica , Terapia Combinada , Incontinência Fecal/etiologia , Incontinência Fecal/cirurgia , Fissura Anal/complicações , Fissura Anal/cirurgia , Humanos
4.
Transplant Proc ; 48(2): 370-6, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27109958

RESUMO

BACKGROUND: The aim of this study was to report 2 cases of liver transplantation (LT) for iatrogenic bile-vascular injury (BVI) sustained during cholecystectomy and to review the literature for LT after cholecystectomy. METHODS: Between March 2001 and July 2013, within our institution, 12 patients were treated after cholecystectomy, 3 of 12 received LT, 1 for acute de-compensation in a cirrhotic patient and 2 after iatrogenic lesions. RESULTS: The majority of iatrogenic injury occurred during video-laparocholecystectomy (63,6%; 7/11). Three patients of 12 (25%) received LT: the first patient developed acute de-compensation in chronic and after liver failure. The second patient developed recurrent cholangitis and secondary biliary cirrhosis. The third patient had undergone emergency hepatectomy because of bleeding and subsequent total hepatectomy with porto-caval shunt. Five of 12 (42%) patients were treated with bilio-digestive anastomosis: 1 patient with direct repair on T-tube; 2 patients (17%) with arterial vascular lesion requiring surgical treatment; and 1 patient treated with medical therapy. No deaths occurred. The post-operative morbidity included 1 re-intervention, 3 recurrent cholangitis, 1 anastomotic biliary stricture, 1 anastomotic bile leak, and cholestasis in 3 patients. The overall hospital stays were higher after LT. Median follow-up was 8.25 years (range, 2-14). CONCLUSIONS: The management of iatrogenic injury during cholecystectomy depends on the time of recognition, extent of injury, experience of the surgeon, and the patient's general condition. If safe repair is possible, BVI should be treated promptly, otherwise all patients should be treated in an experienced center.


Assuntos
Ductos Biliares/lesões , Colecistectomia Laparoscópica/efeitos adversos , Colestase/cirurgia , Complicações Intraoperatórias/etiologia , Falência Hepática/cirurgia , Transplante de Fígado , Adulto , Idoso , Feminino , Hepatectomia/efeitos adversos , Humanos , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/cirurgia , Falência Hepática/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
5.
Tumori ; 80(5): 339-43, 1994 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-7839462

RESUMO

AIMS AND BACKGROUND: In patients undergoing potentially curative surgery for colorectal adenocarcinoma, the presence of occult disease is thought to be responsible for distant metastases, particularly of the liver. During the 1980's preoperative intra-arterial chemotherapy was used in patients with adenocarcinoma of the sigmoid colon since it was thought that the biological effects induced by radiation in rectal lesions could be induced by cytotoxic agents in sigmoid cancer which was found to be less sensitive to radiation. The aim of the present paper is to report long-term results of an early pilot study on 20 patients with sigmoid colon adenocarcinoma treated with a 6 preoperative intra-arterial infusion of mitomycin-C followed by curative surgery. METHODS: From January 1980 to December 1986, 20 patients with adenocarcinoma of the sigmoid colon were treated with a 6 hours preoperative intra-arterial infusion of mitomycin-C followed by potentially curative surgery (Group A). Eighteen hours prior to surgery the patients underwent selective arteriography of the inferior mesenteric artery through puncture of the femoral artery at the inguinal fold. The Seldinger technique was applied and Cook BP6 catheter was used. At the end of the examination, the catheter was positioned in the inferior mesenteric artery and mitomycin-C, 10 mg/m2, was infused in 500 ml of normal saline over a 6 hours period after which the catheter was definitively removed. Within 18 hours following intra-arterial mitomycin-C infusion all 20 patients underwent potentially curative surgery of their sigmoid adenocarcinoma. During the same period, 48 comparable sigmoid colon cancer patients underwent potentially curative resection alone (Group B). RESULTS: At 5 years overall recurrence rate was 30% and 39.6% in Group A and B patients, respectively (P = n.s.). In patients with Stage C disease, recurrence was less frequently observed in Group A (44.4%) than in Group B (77.7%) (P = n.s.). Overall survival at 5 years was comparable in the two groups of patients (70% and 64% for Group A and B, respectively) and median survival was > 60 months in both groups. In patients with Stage C lesions, there was a trend for improved survival at 5 years in Group A patients (55%; median > 60 months) compared to Group B (22%; median 27 months) patients (P = n.s.). CONCLUSIONS: Although the difference indicating decreased recurrences and improved survival for Stage C patients treated with preoperative intra-arterial mitomycin-C were not statistically significant, the long term results of this small pilot study are encouraging.


Assuntos
Adenocarcinoma/tratamento farmacológico , Mitomicina/uso terapêutico , Neoplasias do Colo Sigmoide/tratamento farmacológico , Adenocarcinoma/secundário , Adenocarcinoma/cirurgia , Adulto , Idoso , Quimioterapia Adjuvante , Feminino , Humanos , Incidência , Infusões Intra-Arteriais , Masculino , Pessoa de Meia-Idade , Mitomicina/administração & dosagem , Projetos Piloto , Recidiva , Neoplasias do Colo Sigmoide/patologia , Neoplasias do Colo Sigmoide/cirurgia , Análise de Sobrevida , Fatores de Tempo , Resultado do Tratamento
6.
Lymphology ; 29(2): 83-6, 1996 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-8823731

RESUMO

From our experience in 16 patients with persistent chylothorax from fistulas of the thoracic duct or its tributaries, we conclude that no standard treatment is uniformly successful and multimodality therapy should be considered. In selected patients, an anastomosis between ectatic lymphatics or hyperplastic lymph nodes and an adjacent vein may be attempted. Chylothorax from "leakage" of the thoracic duct or its tributaries is rare. Rupture of the thoracic duct superior to the sixth thoracic vertebrae generally results in a left-sided chylothorax; below that level, injury usually results in a right-sided chylothorax. The etiology is heterogeneous and includes blunt trauma, penetrating wounds (1), iatrogenic operative injury and lymphatic obstructions due to congenital abnormalities, inflammatory processes or neoplasms. Based on our experience in 16 patients with persistent chylothorax from thoracic duct complex lesions, we review the available treatment options.


Assuntos
Quilotórax/terapia , Adolescente , Adulto , Anastomose Cirúrgica , Tubos Torácicos , Terapia Combinada , Drenagem/métodos , Feminino , Humanos , Masculino , Nutrição Parenteral Total , Pleurodese , Ducto Torácico/cirurgia , Toracostomia
7.
Minerva Chir ; 49(11): 1111-5, 1994 Nov.
Artigo em Italiano | MEDLINE | ID: mdl-7708233

RESUMO

In this review the authors after an introduction on the risk factors, the symptoms and diagnostic aspects of rectal carcinoma, show the different surgical techniques, used second the literature and personal experience on 37 cases for the upper, middle and lower neoplastic lesions of the rectum.


Assuntos
Neoplasias Retais/diagnóstico , Neoplasias Retais/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Métodos , Pessoa de Meia-Idade , Metástase Neoplásica , Recidiva Local de Neoplasia/cirurgia , Complicações Pós-Operatórias , Neoplasias Retais/patologia , Reto/patologia
8.
Minerva Chir ; 50(11): 959-62, 1995 Nov.
Artigo em Italiano | MEDLINE | ID: mdl-8710148

RESUMO

The treatment of colorectal obstructions is a surgical problem. The surgeon can choose between primary resection with anastomosis and the staged operations. The one stage procedures need colon decompression or intraoperative colonic lavage. In our experience between 1990 and 1993, 23 patients required an emergency intervention for colon obstruction; between them 13 patients were affected by a left colonic obstruction and were treated with a staged procedure (like Hartman operation) in 9 cases and with intraoperative colonic wash-out with primary anastomosis in 4 cases. The last group had a good postoperative course without an increased incidence of anastomotic leakage (no one in our limited experience). Compared with staged surgery, immediate resection and anastomosis had significant advantages for the patients because: 1) the quality of the life is better (absence of colonstomy); 2) the cumulative hospitalization is reduced (15 days vs 32 days); 3) there is a reduction in operative risk and in the cumulative intra- and postoperative immunodepression. The correct evaluation of the effect on the long-term survival of these factors needs larger series and of longer follow-up.


Assuntos
Doenças do Colo/terapia , Obstrução Intestinal/terapia , Irrigação Terapêutica , Doenças do Colo/cirurgia , Humanos , Obstrução Intestinal/cirurgia , Período Intraoperatório
9.
Minerva Chir ; 51(7-8): 573-6, 1996.
Artigo em Italiano | MEDLINE | ID: mdl-8975162

RESUMO

Adenocarcinoma of the anal glands is a rare slow-growing tumor with a more favorable prognosis compared with colorectal adenocarcinoma, especially if an early diagnosis is established. Clinical symptoms of this disease, often associated with a fistula in ano as in the reported case, include: perianal pain, rectal bleeding and presence of perianal mass. Also perianal Paget's disease may be a not rare association with adenocarcinoma of the anal glands. We believe, therefore, that a histological examination of the resected fistulas in ano should be performed, in searching for the presence of mucinous granules. In addition, it's very important to carry out a careful examination of those patients presenting pruritus ani or eczematous lesions of the anal region. In fact adenocarcinoma of the anal glands may be due to a chronic irritation of the epithelium over a period of years. Radiation therapy and chemotherapy have proved not to provide survival benefit in the treatment of this disease; the same result is obtained with a local excision of the lesion. The only chance for cure, therefore, is early diagnosis followed by radical operation. Miles abdominoperineal resection represents the approach of choice we have adopted for our patient. A radical groin dissection should be carried out only if there are metastases to the inguinal nodes. If necessary, abdomino-perineal resection may be folowed by adjuvant irradiation.


Assuntos
Adenocarcinoma/patologia , Neoplasias do Ânus/patologia , Idoso , Humanos , Masculino
10.
G Chir ; 14(9): 496-503, 1993 Dec.
Artigo em Italiano | MEDLINE | ID: mdl-8167084

RESUMO

After a careful review of the Literature, diagnostic and therapeutic strategies for Primary Retroperitoneal Tumours (PRT) are reported. The Author analyzes the experience of the Institute of Clinica Chirurgica "R" (Chief: Prof. E. Tosatti) as well as that of Anatomia Chirurgica (Chief: Prof. E. Cariati),--University of Genoa--in the management of PRT, stressing the importance of preoperative staging for a correct surgical approach.


Assuntos
Neoplasias Retroperitoneais/diagnóstico , Neoplasias Retroperitoneais/terapia , Adulto , Idoso , Árvores de Decisões , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
11.
G Chir ; 15(4): 175-8, 1994 Apr.
Artigo em Italiano | MEDLINE | ID: mdl-8086307

RESUMO

The Authors considering cholelithiasis as an heterogenic pathological entity report their experience of 25 surgical consecutive patients: 20 with cholesterol or combination gallstones and 5 with black pigmented gallstones. In this series the most frequent factors associated with cholesterol gallstones were LDL hypercholesterolemia and hypertriglyceridemia; while the most frequent factors associated with black pigmented gallstones were hepatopathies. The most frequent symptom was dyspepsia. Only the black pigmented and the mixed gallstones were associated with jaundice and pancreatitis. According to the Literature infection is associated to brown pigment gallstones in 95% of cases, in this series infection is rarely associated with other types of gallstones. Treatment with oral bile salts is useful only in pure cholesterol gallstones, so the distinction among different types of gallstones is useful not only for a better knowledge of their pathogenesis but also for a correct choice of the therapeutic options.


Assuntos
Colelitíase/química , Idoso , Colelitíase/complicações , Colelitíase/cirurgia , Colesterol/análise , LDL-Colesterol/sangue , Feminino , Humanos , Hipercolesterolemia/complicações , Hipertrigliceridemia/complicações , Masculino , Pessoa de Meia-Idade , Pigmentos Biológicos/análise , Espectrofotometria
12.
G Chir ; 17(1-2): 15-8, 1996.
Artigo em Italiano | MEDLINE | ID: mdl-8679407

RESUMO

Esophageal cancer has a poor prognosis. The Authors in reviewing esophageal carcinogenis stress the importance of an early diagnosis to improve surgical results and compare their experience with those of other Authors.


Assuntos
Neoplasias Esofágicas/cirurgia , Neoplasias Esofágicas/mortalidade , Neoplasias Esofágicas/radioterapia , Esofagectomia , Humanos , Metástase Linfática , Metástase Neoplásica , Cuidados Pré-Operatórios , Dosagem Radioterapêutica , Fatores de Tempo
13.
G Chir ; 16(10): 442-4, 1995 Oct.
Artigo em Italiano | MEDLINE | ID: mdl-8588988

RESUMO

Medical approach to gastroduodenal ulcer has dramatically changed with the advent of anti-H2 drugs. There is still a role for surgery, but it has been confined to the treatment of the complications (perforation, stenosis and some cases of haemorrhage). In this paper the Authors collected the data of 43 patients (27 males and 16 females, mean age 45), operated between July 1988 and December 1992; 12 patients were operated for pyloric stenosis, 16 for gastrointestinal bleeding and 15 for perforation. Surgery was accomplished as an emergency procedure in 20 cases, delayed emergency procedure in 4 cases and elective procedure in 19 cases. 39 out of 43 patients were under anti-H2 treatment for a previous diagnosis of peptic ulcer. In conclusion, anti-H2 therapy, even correctly carried on, may not be effective in avoiding possible complications. This goal may be obtained in patients under omeprazole treatment.


Assuntos
Úlcera Péptica/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade
14.
G Chir ; 17(6-7): 329-31, 1996.
Artigo em Italiano | MEDLINE | ID: mdl-9272973

RESUMO

The Authors report their experience in 290 cases of thoracic outlet syndrome (TOS) and 71 cases of Paget-Schroetter syndrome, that is a condition due to thrombosis of the subclavian and/or axillary vein. They point out that diagnosis is mainly clinical-instrumental and the ulnar nerve conduction velocity (UNCV) test is of fundamental importance. The Authors emphasize how the good results obtained could be related to the complete removal of the first rib and to the axillary approach that they strongly support.


Assuntos
Síndrome do Desfiladeiro Torácico/cirurgia , Adolescente , Adulto , Veia Axilar , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Condução Nervosa , Recidiva , Reoperação , Síndrome , Síndrome do Desfiladeiro Torácico/diagnóstico , Tromboflebite/diagnóstico , Tromboflebite/etiologia , Nervo Ulnar/fisiologia
15.
G Chir ; 22(10): 353-7, 2001 Oct.
Artigo em Italiano | MEDLINE | ID: mdl-11816948

RESUMO

UNLABELLED: In the era of video-laparoscopic surgery there are a lot of surgeons that still continue to perform open appendectomy. This choice is the consequence of the good results of open appendectomy (clinical, cosmetic, hospital stays and hospital costs). Published trials on laparoscopic appendectomy don't show that it is superior to the open approach. The aim of this study is to critically review the literature on laparoscopic and traditional appendectomies and to report a clinical experience on 86 consecutive patients that underwent open appendectomy. PATIENTS AND METHODS: From September 2000 to March 2001, in the Department of Emergency Surgery of Villa Scassi Hospital in Genoa, 86 patients underwent open appendectomy (32 men; mean age 29.8 years; range 15-54 years/54 women; mean age 22.4 years; range 13-80 years). All the patients underwent blood examinations, abdomino-pelvic ultrasonographys and the women gynecological evaluation. The Authors used, almost always, the Stropeni way of access (cutaneous Mac Burney and right para-rectal incision of the muscles). Discharge has been done as soon as possible. Removed appendices were submitted to histological examination and were classified as normal or pathologic according to the severity of the lesion. Review of articles has been done on Medline. RESULTS: Suspected appendicitis have been confirmed by histological examination that documented 1 normal appendix, 7 chronic appendicitis, 45 acute catharralis, 22 acute suppurative and 11 gangrenous or perforated appendicitis. The specificity of open appendectomy has been 97.6% (100% for men). Post-operative complications were: 2 wound infections and 1 recurrence of an abscess (2.58%). Open appendectomy did carry an hospital bill of 2,500,000 IT liras (1,200 USA dollars) for non complicated appendicitis and 2,000 USA dollars for perforated appendicitis. The early discharge allowed us to spend 119 millions IT liras less in 7 months (99,600 USA dollars in a year). DISCUSSION: The role of laparoscopic appendectomy isn't still established. After a critical review of the literature we can suggest that: 1) laparoscopic appendectomy increase operative time (63 vs 43 minutes: p < 0.0001); 2) laparoscopic approach can reduce the length of post-operative stay in hospital; 3) hospital bill is strongly reduced by open appendectomy (4,274 vs 7,923 USA dollars). On our experience the cost of the hospital for uncomplicated appendicitis is 2,500,000 IT liras (1,200 USA dollars). Otherwise it has been suggested that laparoscopic appendectomy has a better diagnostic accuracy respect to open appendectomy. Some Authors report a percentage of "negative" appendices of 16-50%. In Authors experience the percentage of "negative" appendices is 1.3% and so the diagnostic accuracy is 96% in women and 100% in men, probably because we systematically performed a preoperative abdomino-pelvic ultrasonography and, for the women, a gynecological evaluation. In conclusion, laparoscopic appendectomy should be done in case of suspected appendicitis in women. In the other cases, when there is a strong clinical suspect of appendicitis and, in particular, in case of suppurative appendicitis, the Authors recommend to perform an open appendectomy using the Stropeni approach. In case of perforated appendicitis with abdominal abscess they recommend to perform an open appendectomy using the right para-rectal approach or the median umbilical-pubis approach.


Assuntos
Apendicectomia/métodos , Laparoscopia , Doença Aguda , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Apendicectomia/economia , Apendicite/cirurgia , Custos e Análise de Custo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais
16.
G Chir ; 17(3): 91-5, 1996 Mar.
Artigo em Italiano | MEDLINE | ID: mdl-8679428

RESUMO

In this paper the Authors report their experience of Orringer operation in 12 patients with oesophageal cancer observed from 1978 to 1992, and stress the possibility to extend the indications to Akijama oesophagectomy without thoracotomy for the treatment of malignant tumors of the entire oesophagus.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Idoso , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Toracotomia
18.
G Chir ; 17(4): 155-7, 1996 Apr.
Artigo em Italiano | MEDLINE | ID: mdl-8754550

RESUMO

The authors report their series of 7 adenocarcinomas of the hepatic hilum. Five patients with a stage IV tumor underwent palliative surgery while the remaining 2 patients underwent radical surgery. One patient died and 3 reported postoperative complications. Overall survival was 2 years and 6 months: these results can be considered satisfactory taking into account the advanced stage and the bad prognosis of this type of tumor. The aim of a better quality of life may represent a reasonable indication to surgery.


Assuntos
Adenocarcinoma/cirurgia , Neoplasias Hepáticas/cirurgia , Adenocarcinoma/patologia , Adulto , Idoso , Anastomose em-Y de Roux , Neoplasias dos Ductos Biliares/patologia , Neoplasias dos Ductos Biliares/cirurgia , Feminino , Hepatectomia/métodos , Ducto Hepático Comum/patologia , Ducto Hepático Comum/cirurgia , Humanos , Jejuno/cirurgia , Tumor de Klatskin/patologia , Tumor de Klatskin/cirurgia , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade
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