A Palmieri — Page 6 | Search PubMed

UNLABELLED: The aim of this work is to remark the scientific worth of the laparoscopic approach in patients with varicocele. PATIENTS AND METHODS: From March 1993 to December of the same year 15 patients suffering from varicocele have been treated with a laparoscopic procedure. The technique is widely described in the next pages. RESULTS: Twelve patients have completed the 3 months follow-up whereas five among them have reached the 6 months control. The results are really interesting specially under a functional point of view. DISCUSSION: The noninvasive advantages provided by laparoscopy are always important, but is the worth of the results we have obtained under a functional point of view and the success in inducing pregnancy in some patients that lead us to remark the utility of this procedure comparing it, with the therapeutic proposals nowadays performed. They are: traditional surgery according to Ivanissevich or Palomo procedures percutaneous transvenous embolization under radiological guide varicocele vein ligation under local anesthesia. CONCLUSIONS: Laparoscopic varicocelectomy represents according to us and some other authors a proposal with a better response if compared to traditional surgery, specially under a functional aspect. Under a costs-benefits evaluation it may be considered more convenient than the radiological approach.

Adolescent↗

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Pre-operative evaluation of cervical adenopathies in tumours of the upper aerodigestive tract.

BACKGROUND: Carcinomas of the upper aerodigestive tract are characterized by a high incidence of local metastasis in the neck. The presence of lymph node metastasis represents the most unfavorable prognostic factor for these tumors. A diagnostic routine is needed in order to identify the highest number of neck metastasis, thereby optimizing the selection of patients eligible for surgical neck treatment and reduce costs and length of hospital stay. MATERIALS AND METHODS: Our study analyzes the sensibility, specificity, and diagnostic accuracy of clinical examination, echography (US), computed tomography (CT) in cervical metastasis detection by comparing them with the histopathological examination of the neck dissection specimens (pN) in 53 patients suffering from carcinoma of the upper aerodigestive tract. RESULTS: Clinical examination: sensibility 82.1%; specificity 80%; diagnostic accuracy 81.1%; US with a cut off point for minimal adenopathy diameter of 0.5 cm 92.8% sensibility, 60% specificity, 77.3% diagnostic accuracy; US with cut off point 1 cm 82.1% sensibility, 80% specificity, 81.1% diagnostic accuracy; US with cut off point 1 cm, also considering round shape or multiplicity of the adenopathy: 82.1 sensibility, 80% specificity, 81.1% diagnostic accuracy; CT with cut off point 0.5 cm: 92.8% sensibility, 32% specificity, 64.1% diagnostic accuracy; CT with cut off point 1 cm: 85.7% sensibility, 64% specificity, 75.4% diagnostic accuracy; CT with cut off point 1 cm, also considering central necrosis, extracapsular spread, multiplicity of the adenopathy 89.2 sensibility, 60% specificity, 75.5% diagnostic accuracy. CONCLUSIONS: By relating the results obtained from preoperative methods to the anatomopathological analysis of the surgical specimens we can draw the following conclusions: a) a neck positive to palpation in a subject with carcinoma of the upper aero digestive tract must be submitted to neck dissection. Such patients have an 81.1% likelihood of having a metastasis. In these patients the use of radiologic studies of the neck must be restricted to cases with uncertain involvement of retropharingeal, mediastinic, paratracheal lymph nodes or in the follow-up after treatment; b) a neck negative to palpation in a subject with carcinoma of the upper aero digestive tract, must be further investigated. The US and the CT must use a cut-off point of 1 cm to consider a neck positive. Radiologic criteria for malignancy, i.e., multiplicity, roundish shape, central necrosis and capsular invasion do not significantly increase the diagnostic accuracy of the radiographic methods; c) the combined use of US and CT does not offer significant advantages in the detection of metastasis, in any case CT is preferable when primary tumor has to be evaluated; d) the assessment of patients that are negative to palpation and to US and to CT must consider the parameters linked with primary tumor, such as site and size, Broder's grading, Invasive Cell Grading, and thickness.

Head and Neck Neoplasms↗