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Biomedical subjects

A Tocchi

Publications and source records attributed to A Tocchi.

At least 91 records · Page 5Linked to original sources
PubMedDate not supplied

[Layered and mass sutures in the closure of median laparotomies].

A retrospective comparison of 2830 patients with midline abdominal incision closures was made. Dehiscences, infections, hernias were compared examining continuous mass closures (group A) versus interrupted mass closures (group B) and interrupted layered sutures (group C). The three groups were well matched for known risk factors for each of the above complications. Mass closures produced a significant higher number of infections (p = 0.0006) and hernias (p = 0.0001). There was no significant difference in the rate of dehiscences in the three suture groups (p = 0.07). A significant correlation was found in all three groups between the incidence of infections and that of outcoming incisional hernias. In the current study layered closure of the of the midline abdominal wounds yielded better results when compared with both running mass and interrupted mass closures. The knowledge of these findings might help when choosing the procedure to close a midline abdominal incision.

Female↗
PubMedDate not supplied

[Acquired abnormalities of the biliary tract. Preoperative diagnosis and surgical risk in the laparoscopic era].

Acquired anomalies of the biliary tract are rare. The aim of this work was to examine their frequency and to assess potential associated danger when performing a laparoscopic cholecystectomy. A retrospective analysis of clinical charts of 3.870 patients undergoing elective cholecystectomy between 1959 and 1997 was performed. Eighteen cases of choledoco-duodenal fistula, 9 of cholecysto-duodenal and 12 of cholecysto-choledochal fistulas were observed. Two cases of acquired absence of the cystic duct and one cholecysto-colic fistula were also encountered. The traditional contrastographic radiology showed to be more accurate in defining presence and nature of the acquired anomalies. Etiopathogenesis of the main anomalies and consequent risks in performing laparoscopic cholecystectomy were discussed.

Aged↗
PubMedDate not supplied

[Ambulatory closed surgery for the treatment of pilonidal sinus].

Pilonidal disease (PD) is a common chronic disorder of the sacrococcygeal region afflecting young people. Despite several methods for treating PD have been described, the management remains controversial. Recent reports have advocated different surgical approaches such as open or closed technique, but recurrence plagues all forms of therapy. We conducted this case review to evaluate the validity of an outpatient closed technique in the treatment of chronic pilonidal disease. Between January 1997 and July 1999, 65 consecutive patients with quiescent chronic PD were electively treated by surgical excision of the cyst and primary closure. There were 47 men (72%) and 18 women (28%) in this study. Patients ranged in age from 14 to 47 years, the average age being 21 years. The median healing time was 8 days and the median time to return to full work was 20 days (range 10-25). Infection and recurrence rates were 1.5% and 4.6% respectively. There was no correlation among recurrence rate, postoperative infection, or prior surgery. Cyst excision and primary closure is a safe, low cost operation with a very high long-term success rate and a negligible rate of complications. It can successfully be performed under local anaesthesia in an outpatient facility.

Adolescent↗
PubMedDate not supplied

[Use of ileostomy and colostomy as temporal derivation in colorectal surgery].

A retrospective study on 41 patients with primary stoma creation after low anterior resection of the rectum was made. Among the 41 patients 24 had a loop colostomy (Group A) and 17 had a loop ileostomy (Group B). The two groups were well matched for each of the data analysed and there was no significant difference in the rate of complications related to stomas creation and closure. In this study the Authors suggest that loop ileostomy is the best procedure to electively defunctionate colorectal anastomoses.

Adenocarcinoma↗
PubMedDate not supplied

[Carcinoma of the male breast. Prognostic factors and outcome of surgical treatment].

A retrospective study was made on 18 male patients with breast carcinoma treated at the Department of Surgery "Pietro Valdoni" of the University "La Sapienza" of Rome, Medical School. Demographics, pathology, stages, and treatment were determined from clinical reports. All patients but one underwent modified radical mastectomy. The length of follow up averaged 57.5 months. Five years actuarial survival rate was 62%. In the current study the Authors suggest that the clinical, prognostic and treatment features of breast carcinoma in men are similar to those reported in literature for post-menopausal women.

Aged↗
PubMedDate not supplied

[Cecal volvulus].

A retrospective study on 18 patients with cecal volvulus surgically treated was made. Demographics and clinical data, as well as treatment were determined from clinical reports. The operative procedures employed were cecostomy (56%), cecopexy (22%) and right colectomy (22%). The length of follow up averaged 63 months and there was one recurrence. The Authors suggest that cecostomy should be employed in patients with viable bowel, and resection should be limited to cases with gangrene.

Cecal Diseases↗
PubMedDate not supplied

[Non-palpable lesions of the breast: identification, localization, significance].

The authors report the diagnostic protocol used in the Breast Disease Unit of the 1st Surgical Department - University of Rome "La Sapienza" - (1987-1990) as well as the techniques for identifying and localizing nonpalpable lesions of the breast. Mammographic screening in women over 40 years, ultrasonography in women under 40 years, X-ray and ultrasound-guided fine needle aspiration and stereotactic guide wire placement with excisional biopsy, resulted to be diagnostic in 79 cases of carcinoma of the breast (2.0%) of which 13 (16.4%) were nonpalpable lesions. Moreover, the importance of nonpalpable lesions is discussed, pointing out how "very early" diagnosis of carcinoma of the breast plays a fundamental role with respect to both prognosis and treatment. The very early diagnosis of a "minimal" carcinoma ensures a significant increase in survival as well as more conservative surgical procedures that offer a better quality of life being less psychologically traumatic.

Adult↗
PubMedDate not supplied

The influence of tumor lymphocytic infiltration on long term survival of surgically treated colorectal cancer patients.

Prognostic significance of host-immune response, as gathered by the degree of tumour lymphocytic infiltration (TLI), and its relationship to other prognostic variables were investigated in 361 colorectal cancer patients admitted to our Institution for curative resection from January 1960 to December 1978. The presence of a local immune reactivity was significantly related to a less advanced stage of disease and a better differentiated tumour. A poorer prognosis was detected in patients with minor or no lymphocytic infiltration. TLI was the single most important prognostic parameter, according to the Cox model and to logistic regression analysis. These findings suggest that also TLI should be considered in the current Staging System of colorectal cancer.

Adult↗
PubMedDate not supplied

[Primary adenocarcinoma of the ureter. Case report].

Primary ureteral adenocarcinoma is an infrequent histological type of urinary neoplasm. Many authors consider intestinal metaplasia the pivotal event of the pathogenetic process, whether it occurs on a pre-existing urothelial carcinoma or on a normal urothelium. Diagnosis is essentially based on case history and clinical findings (hematuria and pain) and on diagnostic imaging. Treatment is surgical and the ideal procedure is nephroureterectomy with excision of a bladder margin adjacent to the ureteral opening and ispilateral para-aortoiliac lymphadenectomy. A 76-year-old man with primary adenocarcinoma of the ureter case is reported.

Adenocarcinoma↗
PubMedDate not supplied

[Pancreatic pseudocysts: the surgical timing].

Forty-three cases of pancreatic pseudocysts (PPC) are reviewed. Various emergency and elective surgical therapeutical options have been employed: while external drainage has confirmed to represent the best procedure in emergency occurrences, cystojejunostomy has proved to be the treatment that better provides both optimal functional results and minimal mortality/morbidity in elective situations. Our study also confirms that the thickness of the pseudocystic wall is the only feature apt to determine whether or not a PPC is susceptible of internal surgical derivation, and that abdominal ultrasound scanning is the most sensitive and reliable diagnostic method to ascertain this prerequisite, thus providing a well-timed strategy for elective derivative operations.

Adult↗
PubMedDate not supplied

[Tracheobronchial carcinoids: current therapeutic trends].

Tracheobronchial carcinoids are relatively uncommon neoplasms potentially curable with surgery. However, the extent of excision which results in the best long term local and distant tumour control is still controversial. A series of 522 patients who underwent surgical treatment for tracheobronchial carcinoids reported by the literature which included 52 cases of tracheobronchial neuroendocrine tumours observed between 1960 and december 1983 at the Institute of I Clinica Chirurgica of Università "La Sapienza" Rome was reviewed. Local recurrence rate range between 1% and 1.8% after major surgery and between 11.8% and 16.7%, after bronchial wall resection and endoscopic treatment respectively. Local recurrences were detected after a mean period of 110.2 month (median = 9 years). 15 years survival rate was above 70%. Long term prognosis was related to the degree of malignancy (typical or atypical forms) and locoregional (N) and distant metastases (M). Factors related to the possibility to obtain free margins by the surgical procedure (pneumonectomy/lobectomy or sleeve resections vs simple bronchial wall resection or endoscopic resection), the degree of bronchial wall involvement (endobronchial, iceberg, peripheral), the biology of primary tumour (atypical vs typical) and the presence of regional and/or distant metastases are of prognostic importance for both local and distant tumour control. The Authors describe their strategy for managing this disease: endoscopic treatment or simple bronchial wall resection are available for endobronchial typical carcinoid tumours. Atypical carcinoid neoplasms or tumours involving bronchial wall or peripheral lung parenchyma need more extended resection and lymphadenectomy.

Bronchial Neoplasms↗
PubMedDate not supplied

[Age as a prognostic factor following excisional surgery for colorectal cancer].

On a series of 369 patients with colorectal cancer who underwent curative resections at the I Instituto di Clinica Chirurgica della Università "La Sapienza" of Rome between 1960 and 1980, age was related to survival. All patients were followed for a minimum of ten years; 79 of them were aged over 65 years and 290 under at the time of the operation. The survival was correlated to the age and to other prognostic parameters: post surgical stage (TNM UICC classification) degree of differentiation of the tumour (NG--Black classification), degree of lymphocytic infiltration of neoplasm (LI Black classification) as expression of immunological immune-response of the host. Patients less than 65 years old had a better survival than patients greater than = 65 years old (median survival 72 months and 44 months respectively) (p = 0.006). These differences where true in subgroups with stage 2 of disease (p TNM UICC) and a favourable immunological reactivity (LI greater than = 2). These results suggest a possible independent role of age in defining the outcome of patients with colorectal cancer.

Age Factors↗
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Synthetic prostheses in repair of chest wall defects after exeresis of malignancies.

Five cases of chest wall repair with synthetic prostheses following thoracectomy for malignant tumours are reported. Two patients were submitted to partial sternal resection (manubrium); in the first case Marlex mesh alone and in the second a composite graft with Methyl-methacrylate were used. The remaining cases underwent extended thoracectomy and reconstructive procedure based upon Marlex prosthetic replacement and myoplasty. No postoperative complications were observed and satisfactory stabilization of the chest wall with good cosmetic results were obtained.

Bone Neoplasms↗
PubMedDate not supplied

[Acute cholecystitis: elements for diagnosis and therapy].

The Authors report their experience in the surgical management of 439 patients with acute cholecystitis. Symptoms and laboratory findings at onset, preoperative diagnostic tools, associated disorders, surgical procedures as well as age-related postoperative morbidity and mortality and length of postoperative stay were analyzed. The most valuable investigation in the diagnosis of acute cholecystitis was ultrasound carried within the first 48 hrs, with positive results in 81% of cases. Tc-99m-HIDA biliary tract imaging proved to be a rapid, highly sensitive and specific, non invasive method of diagnosing acute cholecystitis in doubt cases. Morbidity (4.8%) and mortality (0%) rates in younger patients were inferior than those (22% vs 1.5%) observed in the elderly. Early and late results indicate that early cholecystectomy is the treatment of choice in acute cholecystitis.

Acute Disease↗
PubMedDate not supplied

[False positive results in breast diagnosis after treatment].

The authors referring to a case with a false positive diagnosis which recently came to their observation, describe the clinical, mammographic and echographic patterns to be considered in order to reach a differential diagnosis between benign and malignant lesions of the breast, which occur on surgical scars following quadrantectomy and subsequent radiotherapy. In particular, after an attentive research of the data reported in literature and after careful evaluation based on their personal experience, they conclude that the traditional clinical evaluation occupies a very prominent role in the follow-up of patients who underwent breast cancer surgery. They also believe that the diagnostic techniques, undoubtedly useful and necessary, must always be subjected to a critical evaluation in order to avoid, to the maximum, the possibility of diagnostic errors.

Breast Neoplasms↗
PubMedDate not supplied

[The umbilical pilonidal cyst: a case report. Comments on its etiopathogenesis and treatment].

A rare case of umbilical pilonidal sinus is reported. Epidemiology and symptoms of this disease are analyzed and possible mechanisms of formation are discussed. Clinical as well as pathological patterns observed seem to support the hypothesis of a congenital etiopathogenesis. Total omphalectomy is proposed as definitive treatment in order to avoid recurrences.

Adult↗
PubMedDate not supplied

Surgical treatment of duodenal diverticula.

Fourteen patients with duodenal diverticula are reviewed. The various aetiopathogenic assumptions and the different indications and surgical options are examined.

Adult↗