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Biomedical subjects

A M Farinon

Publications and source records attributed to A M Farinon.

At least 19 recordsLinked to original sources
PubMed2001

Systemic acute-phase response after laparoscopic and open cholecystectomy.

BACKGROUND: Cytokines are the main mediators of inflammation and the response to trauma. The purpose of this study was to compare variations in cytokine levels following laparoscopic cholecystectomy (LC) and mini-laparotomy cholecystectomy (OC), since these two types of operations were considered to be a unique model for examining the role of local tissue injury in postoperative inflammatory reactions. METHODS: A total of 40 patients were studied. Eighteen of them underwent LC; the remaining 22 were operated on using the open technique. Systemic concentrations of interleukin-6 (IL-6), interleukin-1 (IL-1), tumor necrosis factor (TNF), and C-reactive protein (CRP) were measured before and after the operation. In addition, we compared pre- and postoperative white blood cell (WBC) counts, postoperative body temperature, and length of postoperative hospitalization. RESULTS: There was no difference between the two groups in IL-1 and TNF response. The rise in plasma IL-6 levels (18.86 +/- 9.61 vs 5.00 +/- 0.0 pg/ml, p < 0.0001) and CRP (8.40 +/- 5.81 vs 1.43 +/- 1.30 mg/dl, p < 0.001) were more marked after open cholecystectomy than after the laparoscopic procedure. There was no correlation between serum CRP concentrations and the other postoperative parameters. CONCLUSION: The magnitude of the acute-phase response was less pronounced following laparoscopic cholecystectomy, consistent with a reduction in tissue trauma.

Acute-Phase Reaction↗
PubMed1999

Primary malignant fibrous histiocytoma of the duodenum.

BACKGROUND/AIM: We report on a case of primary malignant fibrous histiocytoma of the duodenum. METHODS: Report of a case and review of the literature on the occurrence of this tumor in the alimentary tract. RESULTS: The neoplasm was detected incidentally at the time of diagnostic workup for upper gastrointestinal bleeding. Curative surgery using the Whipple procedure was carried out with uneventful postoperative course; no evidence of liver metastases was detected during intraoperative ultrasonography. The patient died of diffuse metastatic liver disease 2 months after surgical resection. Up-to-date review of the literature has added only 3 cases to those previously reported, including that reported by us. CONCLUSIONS: The biological behavior of malignat fibrous histiocytomas is extremely aggressive and mainly conditioned by size and histological grading. The treatment of choice, whenever possible, is based on early and complete surgical excision of the tumor.

Duodenal Neoplasms↗
PubMed1995

Ruptured aneurysm of the superficial femoral artery.

OBJECTIVE: True isolated "arteriosclerotic" aneurysms of the superficial femoral artery are rare. One case of isolated superficial femoral artery aneurysm and review of literature is reported. DESIGN: Case report and review of the literature. SETTING: Hospitalized care. PATIENT: An 80-year old man presenting with rupture of superficial femoral artery aneurysm was observed and treated with graft interposition, which resulted in limb salvage. INTERVENTION: Removal of the aneurysm and replacing of the arterial aneurysmatic segment by interposition of a polytetrafluoroethylene prosthetic graft. MEASURES: Patency of the graft with no evidence of ischemic or embolic complication assessed with a follow-up period of 6 months. RESULTS: From the review of the literature we collected 21 isolated true arteriosclerotic superficial femoral artery aneurysms in 17 patients. These aneurysms may be discovered after the onset of complications such as rupture (33%) or thrombosis and limb ischemia (19%). Other aneurysms are frequently concomitant (69%), mostly represented by abdominal aortic aneurysms (40%). CONCLUSIONS: Ruptured arteriosclerotic aneurysm of the superficial femoral artery is very uncommon and the treatment of choice is based on replacing of the aneurysmal segment with a prosthetic graft interposition or proximal and distal artery ligation and bypass. Early diagnosis and surgical reconstruction is recommended for patients with aneurysms of the superficial femoral artery that are 2.5 cm or greater in maximum diameter and for complicated aneurysms of any size.

Aged↗
PubMed1993

Multivariate analysis for predicting the presence of bacteria in bile in patients with acute cholecystitis.

OBJECTIVE: to find out whether the presence of bacteria in bile could be predicted accurately from preoperative data in patients with acute cholecystitis. DESIGN: Prospective open study. SETTING: University hospital. SUBJECTS: 42 patients undergoing cholecystectomy for acute gallstone cholecystitis. MAIN OUTCOME MEASURES: Correlations between 24 preoperative clinical and laboratory variables, and the incidence of pathogenic organism in bile. RESULTS: 4 of the 24 variables tested were of predictive significance. These were external body temperature on admission, percentage of neutrophils, preoperative white blood cell count, and total serum concentration of bilirubin. When these predictive variables were evaluated in the discriminant analysis equation they had a sensitivity of 92% and a specificity of 100% in predicting positive bile culture. CONCLUSION: Multivariate discriminant analysis permits accurate preoperative prediction of bile cultures growing pathogens in patient undergoing cholecystectomy for acute cholecystitis.

Acute Disease↗
PubMed1992

Wound infection after cholecystectomy. Correlation between bacteria in bile and wound infection after operation on the gallbladder for acute and chronic gallstone disease.

OBJECTIVE: To see if there was a difference in the wound infection rates after operation for acute and chronic cholecystitis, and to see if the presence of bacteria in the bile had any influence on those rates. DESIGN: Prospective open study. SETTING: University hospital. SUBJECTS: 213 Patients undergoing cholecystectomy for acute or chronic gallstone disease. MAIN OUTCOME MEASURES: Incidence of postoperative wound infection, and of bile cultures growing pathogenic organism. RESULTS: There was no difference in wound infection rates between patients operated on for acute and those operated on for chronic cholecystitis. The presence of bacteria in the bile did not seem to influence the wound infection rate in either group. CONCLUSIONS: Early cholecystectomy and appropriate antibiotic prophylaxis result in an acceptably low wound infection rate, and the growth of bacteria from bile is not predictive of the development of wound infection.

Acute Disease↗
PubMed1991

Estrogen and progesterone receptors in the gallbladders from patients with gallstones.

Cytosolic receptors for estrogen and progesterone were assayed in 50 gallbladders from 29 women and 21 men who had cholecystectomies because of cholelithiasis. High-affinity (equilibrium dissociation constant, KD = 0.46 +/- 0.23 nmol/L of 24 cases) estrogen receptors were detected in 20 of 29 gallbladders from women (range = 1.6 to 32 fmol/mg protein; mean +/- S.D. = 10.9 +/- 8.1), whereas in men only 4 of 21 specimens contained detectable estrogen receptors. High-affinity (KD = 0.45 +/- 0.17 nmol/L; mean +/- S.D. of 41 cases) progesterone receptors were found in 25 of 29 gallbladders of women (range = 2 to 62 fmol/mg protein; mean +/- S.D. = 19.2 +/- 14.4) and in 16 of 21 gallbladders of men (range = 4 to 36 fmol/mg protein; mean +/- S.D. = 12.5 +/- 8.5). There is a statistically significant difference between men and women in the proportion of estrogen receptor-positive gallbladders, 19% and 69% for men and women, respectively. Progesterone receptors are present in similar proportion in the gallbladders of men (72.2%) and women (86.2%). In women a positive correlation between estrogen and progesterone receptors was found. Even in the absence of estrogen receptors, the gallbladders of men express progesterone receptors at levels similar to those observed in women. At least in cholelithiasic gallbladders, this suggests that a sex difference exists in the coexpression of estrogen and progesterone receptors. Such a difference could be related with the higher gallstone incidence in women than in men.

Cholelithiasis↗
PubMed1991

"Adenomatous polyps of the gallbladder" adenomas of the gallbladder.

The finding of adenomatous polyps of the gallbladder is a rare occurrence and an unusual clinical problem. Among 2,145 patients who underwent cholecystectomy for gallbladder disease only 9 (0.4 per cent) presented with adenomatous polyps. There were 6 women and 3 men, aged 17 to 70 years. Preoperative ultrasonographic diagnosis was made in only 1 of 7 patients with gallstones, in contrast polypoid lesions within a gallbladder without stones were easily confirmed by both ultrasonography and oral cholecystography in the remaining 2 patients. All polyps were 1.0 cm or less in size and without histologic evidence of malignant change. The clinical significance of this rare condition is discussed, with particular reference to a possible role in development of gallbladder carcinoma. Surgical treatment should be advocated regardless of clinical manifestation when the polyp exceeds 1.0 cm in diameter or rapid growth of the lesion is seen on ultrasonographic follow-up examinations.

Adenoma↗
PubMed1989

Urinary sodium levels related to jaundice duration in the assessment of postoperative risk of hepatorenal syndrome in elderly patients undergoing surgery for biliary obstruction.

The early diagnosis of hepatorenal syndrome (HRS) is based chiefly on biochemical alterations and in particular, the relationship between urinary sodium levels and duration of jaundice seems to offer the most reliable prognostic index. Urinary sodium levels were determined in 32 elderly patients, who underwent surgery for benign or malignant biliary obstruction, without, major organ resection; in this group 4 patients died of HRS (12.5 per cent). The diagnostic accuracy of the method reached 97 per cent.

Aged↗
PubMed1988

Dysplasia-carcinoma sequence in diminutive polyps of the large bowel.

The personal endoscopic experience regarding diminutive polyps (5 mm or less in diameter) of the colon and rectum is reported in order to evaluate the increased cancer risk related to these lesions. A total of 462 colo-rectal diminutive polyps, endoscopically removed by diathermy, have been considered in this study. The histopathologic examination of these lesions evidenced a high incidence of adenomatous polyps (69.9%), with dominance of the tubular histologic type. While mild dysplastic alterations were prevalent, moderate and severe dysplasia were observed to a lesser extent (18.9 and 1.9%) and only one case with focal carcinomatous area (1/323 = 0.3%) was recognized. In conclusion, for these lesions, even if minute in size, a dysplasia-carcinoma sequence should be considered whenever the adenomatous histologic type is evidenced and their increased risk of developing into cancer should be carefully evaluated for a correct diagnostic and therapeutic approach.

Adenoma↗
PubMed1987

Papillitis: a critical appraisal based on intraoperative radiomanometric evaluation.

Disagreement still prevails over intraoperative diagnosis of papillitis as shown by the variability in incidence reported with a wide range of percentage. A study, concerning 2957 biliary operations for benign diseases has been carried out in order to analyse the incidence of papillary disorders. Two periods have been considered: before and after the intraoperative employment of radiomanometry. Primary benign stricture of the papilla, diagnosed in 0.1% of the cases in the first period, was not found in the second period; papillitis associated with lithiasis of the gallbladder was recognized in 2.5 and 0.3% of the cases respectively (no cases in the last four years); papillitis associated with common bile duct stones was found, according to the period considered, in 11.6 and 2.4% of cases (1.4% in the last four years). These results seem to suggest that benign papillary stenosis is a rare pathologic entity, often overdiagnosed or misjudged, and that planning of surgical treatment of common bile duct stones should be carefully considered, taking into account this remark in order to avoid unnecessary procedures.

Ampulla of Vater↗
PubMed1987

Physiopathologic role of microlithiasis in gallstone pancreatitis.

A study of 108 patients with acute or acute relapsing gallstone pancreatitis was carried out in order to evaluate the incidence of biliary lithiasis and microlithiasis. The severity of pancreatic damage associated with both clinical states and the physicochemical characteristics of the minute stones were also evaluated. The results suggest that the risk of acute pancreatitis is increased in patients with microlithiasis and that in patients with acute pancreatitis due to microlithiasis the lesions are more severe. These results warrant the conclusion that cholecystectomy should be performed upon all patients with echographically detected microlithiasis, even in the absence of symptoms. Early surgical treatment must be performed whenever pancreatitis develops.

Acute Disease↗
PubMed1986

Duodenogastric reflux and gastric damage from non-steroidal antiinflammatory drugs.

The authors describe cases urgently admitted for iatrogenic gastric lesions due to non-steroid antiinflammatory treatment during the past year. Nine patients were affected by peptic ulcer (bleeding in five cases), while in the remaining 11 an erosive acute gastritis could be observed. Among them, ten patients had been taking acetylsalicylic acid, one indomethacin and the others ketoprofen, indoprofen or similar drugs. In 11 patients, five presenting gastric ulcer and six affected by haemorrhagic gastric damage, an evident duodenogastric reflux was demonstrated. Fifteen patients were treated pharmacologically and complete healing of the lesions was obtained, while in five patients surgical treatment was necessary. The authors conclude by pointing out the high incidence (over 50%) and the pathogenetic role of duodenogastric reflux in gastric lesions appearing in patients treated with non-steroidal antiinflammatory drugs.

Adult↗
PubMed1984

Ultrasonic detection of colonic carcinoma in emergency.

The role of ultrasound scanning in the diagnosis of cancer of the colon under emergency conditions such as intestinal obstruction, perforation or, more rarely, heavy colonic bleeding, is discussed. In any case, ultrasound scanning can quickly and rationally indicate choices for further assessment when possible. Characteristic ultrasonic images are described, and possible differential diagnoses are discussed briefly. The method seems significantly sensitive, although nonspecific, as it can give analogous images in cases of inflammatory pseudo-tumors, Crohn's disease, and adult intussusception.

Adult↗
PubMed1984

Technetium-99m HIDA hepatobiliary scanning in evaluation of afferent loop syndrome.

A study of 118 patients, operated on with Billroth II gastrectomy for peptic disease and affected by postgastrectomy syndromes, was carried out. Fifty patients were investigated by means of technetium-99m HIDA hepatobiliary scanning. In 18 patients, in whom an afferent loop syndrome was clinically suspected, hepatobiliary scanning demonstrated an altered afferent loop emptying in 8 and atonic distension of the gallbladder without afferent loop motility changes in 10. Among the patients in the first group, four were treated with a biliary diversion surgical procedure and in the second group, two patients underwent cholecystectomy. Our findings indicate that biliary vomiting, right upper abdominal pain pyrosis, and biliary diarrhea in Billroth II gastrectomized patients are not always pathognomonic symptoms of afferent loop syndrome. Technetium-99m HIDA hepatobiliary scanning represents the only diagnostic means of afferent loop syndrome definition. A differential diagnosis of abnormal afferent loop emptying and gallbladder dyskinesia is necessary for the management planning of these patients, and furthermore, when a surgical treatment is required, biliary diversion with Roux-Y anastomosis or Braun's biliary diversion seems the treatment of choice for afferent loop syndrome, whereas cholecystectomy represents the best procedure for atonic distension of the gallbladder.

Adult↗