Biomedical subjects

A Tocchi

Publications and source records attributed to A Tocchi.

98 records · Page 6Linked to original sources

PubMedDate not supplied

[Biliary calculi in liver cirrhosis. Clinical, epidemiologic & therapeutic aspects].

BACKGROUND: Incidence of cholelithiasis in cirrhotic patients is twice of threefold that in non cirrhotic one. Cholelithiasis is often asintomatic, however, when complications occur, emergency surgery is burden by high rates of morbidity and mortality. Purpose of the current study is to state the clinical features and to assess the outcome of elective surgery in these patients. METHODS: Sixtyseven consecutive patients with liver cirrhosis (Group A) who underwent elective surgery for biliary stones were retrospectively reviewed. Preoperative clinical features, surgical procedure, postoperative morbidity and morality were recorded and compared with those of the 3291 non cirrhotic patients (Group B) observed in the same period and submitted to elective surgery for biliary stones. RESULTS: Stone involvement of the biliary tract (A vs B:31.3% vs 20.5%), cholangitis (A vs B:23.8% vs 13.0%) and acute biliary pancreatitis (A vs B:4.4% vs 0.7%) were found to be more frequent among cirrhotic patients. In Group A postoperative morbidity and mortality in Child-Pugh A and B were found to be not statistically different from those of Group B patients. CONCLUSION: Authors conclude that definitive biliary surgery may be considered as a successful and safe indication in the treatment of cirrhotic patients in Child-Pugh A and B grade. Conservative approaches are considered as more suitable in Child-Pugh C patients, and definitive elective procedures should be considered for these patients only when an improvement of their liver function can be achieved.

Adult↗

PubMedDate not supplied

[Non-resectable neoplasms of the biliary duct: palliative surgery vs non-surgical management].

A retrospective analysis comparing the results of biliary enteric anastomoses and non-operative management in unresectable bile duct carcinomas was carried out. Twenty-four patients underwent surgical drainage (Group A), and 29 were managed with transhepatic or endoscopic stent (Group B). Concomitant medical diseases were more frequent in group B patients (16.6% vs 48.2%, p < 0.03). Group A and group B were comparable in morbidity (29.1% vs 41.3%), mortality (12.5% vs 13.7%) and 1-year survival rate (21% vs 17%). Median survival was 4.2 months in group A and 2.6 in group B. Jaundice relief was achieved in 70.8% of group A patients and in 68.9% of group B. Group B patients experienced more cholangitis (p = 0.001) and required more hospital readmission (p = 0.0015). Quality of life was better in group A patients, however difference did not reach statistical significance. Therefore, low risk patients with unresectable hilar bile duct tumor and yet good life expectancy may benefit from surgical palliation.

Aged↗

PubMedDate not supplied

[Carcinoma of the splenic flexure. Nosological and therapeutic contribution].

Twenty-one patients undergoing colectomy for carcinoma of the splenic flexure from November 1996 throughout October 1993 were studied retrospectively. Clinical and prognostic features were compared with those of other colon cancers treated in the same period at the same Institution. No differences in symptoms at onset and stage distribution were found in the two groups. The complex removal of the cancer tissue was achieved with the resection of the major part of the transverse colon, splenic flexure, descending colon and its mesocolon. The splenic flexure cancer did not show a worse prognosis than other colon cancers.

Adenocarcinoma↗

PubMedDate not supplied

[Recurrent high anal fistula: treatment with the use of seton].

The functional impact of treating patients with high recurrent fistula in ano by a cutting seton fistulotomy was assessed in 28 cases. Functional outcome following treatment with this technique was evaluated with regard to fistula eradication and effect on fetal continence. All patients had a history of previous fistula surgery. The fistula was cured in 27 patients with no reports of altered continence at follow up. Reported data suggest that cutting seton is effective in treating complex, recurrent, high fistula in ano. Exact identification of internal and external orefices and avoidance of internal sphincterotomy are stressed as the technical landmarks responsible for such a result.

Adult↗

PubMedDate not supplied

[Inflammatory fibroid polyp of the stomach. Report of a case].

Inflammatory fibroid polyp (IFP) is a rare lesion of the gastroenteric tract more frequently occurring at the level of the stomach. The etiopathogenesis of IFP as well as the nature of the cells constituting these lesions remain unknown. Abdominal pain and anaemia due to chronic blood loss are the most common presenting features but neither radiology and CT scanning nor endoscopy are capable to achieve any conclusive diagnostic information. Histologic examination of the specimen obtained by endoscopic or surgical excision is considered to be the only way for the definitive exclusion of a neoplastic nature. A case of IFP treated by means of total gastrectomy is presented.

Biopsy↗

PubMedDate not supplied

[Increased blood amylase levels in the postoperative period after liver resection].

Preoperative and postoperative values of amylase were assessed in patients submitted to hepatic resections for primary or secondary liver tumours. Among these 40 had underlying liver cirrhosis and 18 normal liver. Preoperative serum amylase levels were increased in patients with cirrhosis. Postoperative amylase levels were found to be overlapping to preoperative one both in patients with normal and cirrhotic liver when no Pringle's manoeuvre was used in the course of surgery. A significant postoperative increase in serum amylase levels was detected in the group of patients where liver resection was carried out under Pringle's manoeuvre. Two patients of the cirrhotic group developed mild pancreatitis. It is suggested that portal congestion relates morphological changes of pancreas and hyperamylasemia and that Pringle's manoeuvre, if prolonged, carries a potential risk of pancreatitis especially in patients with underlying liver cirrhosis.

Adult↗

PubMedDate not supplied

[Treatment of cecal diverticulitis].

Twenty-three cases of acute solitary diverticulitis of the cecum are reviewed. Cecal diverticulitis continued to be almost indistinguishable from acute appendicitis although longer duration of symptoms and lesser incidence of nausea and vomit are reported. A correct preoperative diagnosis is then seldom performed. On the basis of this experience appendectomy is recommended when diverticulitis is diagnosed in order to avoid further clinical complications. If a carcinoma cannot be completely ruled out or an abscess or rupture is present, then a right colectomy should be performed.

Abscess↗

PubMedDate not supplied

[Preoperative bowel cleansing: outpatient versus inpatient preparation].

This study investigated the safety and efficacy of preoperative outpatient bowel preparation (OBP) and compared it with inpatient bowel preparation (IBP). Records of patients who underwent OBP and IBP for elective colorectal surgery from January 1995 to December 1997 were compared. All patients were instructed to take during the three days before surgery metronidazole (1.5 g pro die) while an oral polyethylene glycol solution was used for the oral lavage during the 12 hours before operation. The two groups, 65 patients, were uniform for age, sex, diagnosis and operations performed. The OBP group had a shorter length of hospital stay (median 9 vs 10 days; p = ns) whereas the complication rate was similar including infectious complications. Data on operating time, perioperative fluid and blood requirements, perioperative diuresis were not significantly different in the two groups. Outpatient bowel preparation for elective colorectal surgery is safe and effective while offering short hospital stay and therefore reduction in medical care cost.

Aged↗