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Biomedical subjects

A Picciocchi

Publications and source records attributed to A Picciocchi.

At least 55 records · Page 3Linked to original sources
PubMed1992

Esophageal diverticula. Physiopathological basis for surgical management.

From 1980 to 1990, 31 patients were treated surgically in our department for esophageal diverticula: 12 Zenker's diverticula (ZD); 11 mid-thoracic diverticula (MTD); 8 epiphrenic diverticula (ED). Cricopharyngeal dysfunction was detectable in 8 of 12 ZD patients (66.6%). Cricopharyngeal myotomy with diverticulectomy was performed in all cases. There were no deaths. Relief of dysphagia was obtained in all cases. No recurrences of dysphagia or diverticulum were observed at a mean follow-up of 3 years. A motility disorder was observed in 10 of 11 MTD (90.9%). An extended esophageal myotomy with diverticulectomy was performed in 3 cases, an extended myotomy alone in 3 cases, a diverticulectomy alone in 5 cases; an anti-reflux procedure was added in 6 cases. One patient died on the 7th postoperative day. All remaining patients were free of symptoms at a mean follow-up of 3.2 years. A motor dysfunction was detected in all 8 ED patients (100%). No diverticulectomy was performed. Six patients underwent Heller-Dor myotomy and 2 underwent Nissen fundoplication. There were no deaths. Relief of symptoms was obtained in all patients, at a mean follow-up of 3.1 years. Myotomy with diverticulectomy represents the treatment of choice in ZD. As regards MTD and ED, the treatment of the underlying motor disorder is the main therapeutic goal, whereas diverticulectomy is reserved to selected patients.

Adult↗
PubMed1991

Surgical treatment of hydatid disease of the liver. A 20-year experience.

The medical records of 135 consecutive patients (74 women and 61 men) who underwent surgery for hydatid liver disease were reviewed. The patients ranged in age from 4 to 81 years. Twenty-seven patients had undergone previous surgery for hydatid liver disease. Cysts were solitary in 100 patients and multiple in 35 patients. Seventeen patients had concomitant extrahepatic disease. Conservative procedures were used in 71 patients (capitonnage in 50 patients and partial pericystectomy in 21 patients). Radical procedures were used in 64 patients (total pericystectomy in 35 patients, subtotal pericystectomy in 16 patients, and wedge or major liver resection in 13 patients). Operative mortality was 2.2% and morbidity rate was 23.7%. Recurrent disease was found in 13 patients at a mean interval of 3 years from the first operation. Better short- and long-term results were obtained with the use of radical procedures.

Adolescent↗
PubMed1991

Surgical approach and sandwich radiotherapy for resectable rectal cancer: advantages and problems.

One hundred and twelve patients with locally advanced adenocarcinoma of the rectum have been treated with a protocol of adjuvant radiotherapy from 1981 to 1989. Radiotherapy was administered with a "sandwich" method at a dosage of 2700 cGy preoperatively and of 1800 cGy post-operatively. Only patients in stages B and C have been considered for results. Postoperative morbidity has been 16% and postoperative mortality 2.7%. Local failure was seen in 20% of patients without significant differences by stage, location, grading and operative technique. Distant metastases were seen in 31% of patients. Five-year actuarial survival was 49% and respectively 58% in stage B and 38% in stage C (P less than 0.01). Compared with a series of historical controls treated with surgery alone, the local recurrence rate was 20% vs. 26%, the distant metastases rate was 31% vs. 38% and the five-year actuarial survival rate was 49% vs. 36% (P greater than 0.01).

Actuarial Analysis↗
PubMed1991

[Prosthetic reconstruction of the thoracic wall after resection for cancer].

Primary tumors of lung and breast represent the most frequent cause of neoplastic involvement of the thoracic wall, being primary parietal neoplasms extremely rare; metastatic lesions of the thoracic wall are not an infrequent finding, but represent just an occasional indication for surgery. Prosthetic reconstruction after a resection that includes the bony structures of the thoracic cage is dependent upon the extension of the parietal excision. We report a personal experience with 11 cases of prosthetic reconstruction of the thoracic wall out of a total of 54 extended resections accomplished between 1979 and 1990. We did not find prosthetic reconstruction indicated for thoracic wall defects smaller than 5 cm in diameter, wherever located. As regards larger parietal defects, a reconstructive procedure appeared always necessary for anterior or lateral regions of the thorax, while we never used prosthetic implants for posterior defects, regardless of their size. In all cases we used a Silastic sheet, 1.016 mm thick, reinforced by Dacron mesh, whose margins were molded on the form of the thoracic defect and secured by 2/0 Prolene suture. Follow up ranged from 6 to 36 months. No case of rejection has been observed up to date and no interference with radiation treatment or chemotherapy has been reported.

Humans↗
PubMed1990

Radiosurgical treatment compared to surgery alone for rectal cancer.

Between February 1981 and September 1989, 144 patients with rectal cancer were treated according to a radiosurgical sandwich protocol (27Gy + surgery + 18Gy) or postoperative radiotherapy (45Gy) at the University Hospital 'A. Gemelli' in Rome. This group is compared with a group of 133 patients operated on between January 1968 and January 1981, by the same team of surgeons but who received no radiotherapy. The historical group is comparable to the radiosurgical group in terms of stage, histology, and surgical procedures. The median follow-up period of the radiosurgical group is 38 months and 68% of cases have been observed longer than 2 years. At 2 years local recurrence in the historical control group was 22% versus 17% in the prospective group (p = 0.8). For Stage C disease, local recurrence dropped from 54% to 35% with adjuvant radiotherapy (p = 0.3). Metastases were observed in 22% of the control group versus 13% of the radiosurgical group (p = 0.2). For Stage C disease the incidence of distant metastases dropped from 59% to 26% at 2 years with the use of the prospective radiosurgical protocol (p = 0.05). The Kaplan-Meier survival rate at 5 years was 46% for the historical group and 72% for the radiosurgical group (p = 0.003) (Stage A 71% & 94%, Stage B 48% & 77%, and Stage C 16% & 38%, respectively). Neither serious nor late toxicity has been detected in the radiotherapy group, nor were surgical complications observed in the pre-operative radiotherapy group. The data strongly suggest a survival advantage for patients treated with the radiosurgical combination (p = 0.003).

Adenocarcinoma↗
PubMed1990

[Stapling techniques in exeresis surgery of bronchogenic carcinoma].

From January 1983 to October 1989, 221 bronchogenic carcinomas were surgically treated at our Department. Different stapling techniques were employed in 153 cases: 138 stapled sutures of main and lobar bronchi, 33 stapled parenchymal sutures and 21 stapled sutures of the pulmonary artery. Stapling-related complications were observed in 3 patients: 1 bronchopleural post-pneumonectomy fistula (0.72%); 2 persisting air leakages following stapled parenchymal suture (6%). The use of vascular staplers, though, has never been associated with complications. The advantages related to the use of stapling devices are represented by lower air leakage and bleeding rates, with a reduced operative trauma; on the other hand, disadvantages seem to be more theoretical than realistic. At our Department stapling devices nowadays represent the choice in thoracic surgery either for main and lobar bronchi or parenchymal sutures.

Anastomosis, Surgical↗
PubMed1989

Value of ERCP in the diagnosis and management of pre- and postoperative biliary complications in hydatid disease of the liver.

Twenty-nine patients with symptomatic hydatid disease of the liver were evaluated preoperatively by endoscopic retrograde cholangiopancreatography (ERCP) in the years 1982-1987. In the same period, 6 patients who previously underwent surgery for the parasitic disease also underwent ERCP because of postoperative symptoms of biliary obstruction. Findings at ERCP excluded biliary tract involvement in 11 cases. Positive findings were shown in 24 patients, including compression of the bile ducts in 4, small cysto-biliary communications in 5, intrabiliary rupture in 9, residual hydatid material in the common bile duct, and sclerosing cholangitis in 3. Endoscopic removal of migrated hydatid debris was achieved in 8 patients, avoiding reoperation in 4.

Adult↗
PubMed1987

[Simultaneous bilateral renal cell adenocarcinoma. One-stage surgical treatment].

Review of a very well documented case with a very complete iconography, and of the literature led to the following conclusions. First, it is preferable to treat these patients by a one-stage operation involving nephrectomy on one side and, if possible, conservative treatment to other kidney. Second, that the prognosis in synchronous bilateral renal cancer is much better than that of metachronous bilateral cancers (5-year survival 69% and 37.5% respectively), probably because the former are usually of low grade and early stage. This justifies the most audacious surgical tentatives and, in this respect, this paper is of very high interest.

Adenocarcinoma↗
PubMed1986

Venous involvement by follicular carcinoma of the thyroid gland.

Involvement of the great veins by thyroid neoplasms is a rare event: to date 9 cases have been reported and only 2 of them have been surgically treated. The authors describe a case of follicular thyroid carcinoma involving the proximal tract of the left innominate vein at its confluence with the superior vena cava: a neoplastic bud was protruding into the lumen, but the endothelial lining appeared to be perfectly preserved. Full radicality was obtained by a major vascular procedure.

Adenocarcinoma↗
PubMed1985

[Leiomyosarcoma of the inferior vena cava].

Leiomyosarcoma is a rare tumor of soft tissues. The inferior vena cava is affected infrequently, a literature review showing only 66 cases reported previously, 29 of these patients undergoing radical surgery. The case described was diagnosed during operation for gallstones, and the lesion was excised radically using an original technique. Experience of this case and opinions of various authors who have treated similar cases suggest that the factors determining choice of therapy are: the caval segment involved, an effective collateral circulation, longitudinal or circumferential extension of the affected vascular wall, the presence or absence of neoplastic or hepatic thromboses.

Adult↗
PubMed1984

[Cavoauricular thrombectomy under extracorporeal circulation and right superior lobectomy for paraneoplastic thrombosis in a case of lung cancer].

A patient with superior vena cava thrombosis from cancer of the right lung is described. The particular interest of this case resides in: The numerical scantiness of cases reported in the literature: 12 cases reviewed; The exceptional nature of the etiopathogenic mechanism: paraneoplastic thrombosis; and the more precise problems relating to the indication, technique and tactics with respect to surgery.

Adenocarcinoma↗