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A Uccheddu

Publications and source records attributed to A Uccheddu.

At least 19 recordsLinked to original sources
PubMed2006

Role of SPECT/CT in the preoperative assessment of hyperparathyroid patients.

PURPOSE: Our purpose was to assess the clinical value and additional benefit of fusion single-photon computed tomography (SPECT) and computed tomography (CT) images in locating the parathyroids in a selected group of patients affected by primary (PHP) and secondary hyperparathyroidism (SHP). MATERIALS AND METHODS: Sixteen patients (11 women and five men; age range 35-80 years) with severe hyperparathyroidism (HP) (ten PHP, six SHP) were studied by ultrasound (US), and, after i.v. injection of 370 MBq of 99mTc-sestamibi, by planar parathyroid scintigraphy, SPECT and SPECT/CT using a dual-detector scintillation camera GE Infinia Hawkeye. All patients underwent parathyroidectomy. RESULTS: US findings were inconclusive in 12/16 patients affected by multinodular goitre, and two probable eutopic parathyroid glands were identified. "Double phase" parathyroid scintigraphy identified 14 probable parathyroid glands, SPECT 23 (14 ectopic and nine eutopic) and SPECT/CT confirmed all 23 probable parathyroid lesions, offering more precise localisation and an evident improvement in diagnostic accuracy. Sixteen of these foci of increased uptake were hyperplastic parathyroid glands, six were adenomas, one was a parathyroid carcinoma and one was a thyroid follicular carcinoma. Surgical detection of the 23 sestamibi-positive lesions was correctly matched with 100% of SPECT/CT images and 61% of SPECT data alone. Hybrid imaging thus provided additional data in 39% of lesions, and in three patients with retrotracheal glands, it modified the surgical approach. CONCLUSIONS: We believe 99mTc-sestamibi SPECT/CT to be a more reliable presurgical method to study a patient subgroup affected by PHP or SHP in whom conventional US and other scintigraphic methods have failed for intrinsic reasons due to the concomitant presence of multinodular goitre or ectopic parathyroid gland. The additional practical benefit derived from this methodology was evident. In fact, anatomical information provided by CT enables precise localisation of the functional abnormalities highlighted by SPECT, and both are essential to a correct surgical approach.

Adult↗
PubMed2005

Hypocalcemia following total thyroidectomy: early factors predicting long-term outcome.

Hypocalcemia following total thyroidectomy (TT) must be considered permanent in patients requiring calcium replacement after one year. The aim of this study was to identify early risk factors predicting long-term outcome of postoperative hypocalcemia. Among 453 patients who underwent TT from January 1998 to May 2003, a cross-sectional study between 44 patients with transient hypocalcemia (9.7%) and 3 patients with permanent hypocalcemia (0.7%) was carried out. Both low serum calcium level (< 8 mg/dl) and high serum phosphorus level (> 4.5 mg/dl), measured on postoperative day 7, were predictive for outcome. Central neck lymph node dissection, performed for thyroid carcinoma, also correlated with outcome. Serum phosphorus level > 4.5 mg/dl on postoperative day 7 resulted the only independent factor predicting permanent hypoparathyroidism. Therefore indication for central dissection would be very strict. When serum phosphorus level is unfavorable a correct replacement therapy is mandatory to prevent the consequences of permanent hypocalcemia.

Adult↗
PubMed2003

The usefulness of 99mTc-SestaMIBI scan in the diagnostic evaluation of thyroid nodules with oncocytic cytology.

OBJECTIVE: To assess the relevance of (99m)Tc-SestaMIBI (MIBI) scan in the diagnostic evaluation of thyroid nodules with oncocytic cytology. SUBJECTS AND METHODS: Twenty-four patients with a single (or prevalent) 'cold' solid nodule with Hurthle cells (HC) at fine needle aspiration cytology (FNAC) were studied. Cytological diagnosis of oncocytic metaplasia (OM) or HC tumor (HCT) was made when HC on the smear were comprised 10-75%, or >75%. Nodules concentrating MIBI at early and late (2 h after washout) stages were considered MIBI-positive. In all cases histological findings were obtained after total thyroidectomy. RESULTS: FNAC was malignant or suspect for malignancy in 16 cases (six HCT and 10 OM) and not suspect in eight (two HCT and six OM). Histological examination revealed 14 malignant tumors (11 HCT and three OM), and 10 benign thyroid lesions (three HCT and seven OM). Sensitivity of FNAC for malignancy was 92.8% and specificity was 70.0%; HCT were identified by FNAC in only 35.7% and OM in 70.0% of cases. No significant difference in MIBI positivity was found between malignant and benign thyroid nodules. The highest percentage of MIBI positivity was found in HCT (78.5%), but MIBI-positive nodules were also observed in thyroid lesions with HC metaplasia (40.0%). CONCLUSIONS: MIBI scintiscan has no value in differentiating malignant from benign HC thyroid neoplasias. Most HCT are MIBI-positive, but this scan is not sufficiently specific to differentiate true HC neoplasias from other thyroid lesions showing HC at FNAC, although an MIBI-negative scan strongly supports the absence of true HCT.

Adenoma, Oxyphilic↗
PubMed2003

Bile leak from the accessory biliary duct following laparascopic cholecystectomy.

Anatomists and surgeons have described the presence of accessory biliary ducts between the liver and gallbladder. Bile leakage from accessory duct following laparoscopic cholecystectomy (LC) is an unusual post-operative complication. Aim of the study was to assess its incidence, the intraoperative methods helpful for notice the anatomical anomaly and the impact of endoscopic procedure as a suitable treatment. From January 1997 to September 2002, 185 patients underwent LC for symptomatic cholelithiasis in our surgical department. Post-operative bile leakage from accessory biliary duct occurred in two patients (1%): one case from the liver bed of gallbladder (duct of Luschka) and one case from an aberrant cholecystohepatic duct entering Hartmann's pouch. One patient underwent open celiotomy because of unavailability of endoscopic retrograde cholangiopancreatography. The other patient was successfully treated by endoscopic sphincterotomy and nasobiliary tube placement. By careful dissection, accessory ducts were noticed and clipped in three other patients with overall incidence of 2.7%. Meticulous laparoscopic technique aimed to careful recognize all structures during LC is the main policy to contain biliary injury within its nadir incidence. Depending of availability, endoscopic sphincterotomy and nasobiliary drainage allow diagnosis and treatment of bile leakage, preserving the effectiveness of laparoscopic procedure.

Bile↗
PubMed2001

[Carotid body tumour. Case report and literature review].

The tumour of the carotid body is rare. About 1000 cases had been reported in the literature. It may occur sporadically in 90% of cases and it affects both sexes in the same proportion and in the middle age. This tumour may be misdiagnosed if it is not suspected. Ultrasono-graphy and color-Doppler scan show a hypervascular tumour between the internal and external carotid arteries. CT-scan defines the tumour s extent on the surrounding structures. Angiography is the gold standard for diagnosis, showing a hypervascular mass displacing the bifurcation of the carotid arteries. Sometimes radiotherapy and embolization are indicated but the surgical excision of carotid body tumours is the therapy of choice. The surgical approach through incision like carotid artery operation is performed. If the subadventitial plane between tumour and arterial wall is not identified, resection of carotid artery and insertion of a shunt is required. Although the diagnosis and the surgical technique advances, the incidence of postoperative nerve injury is high in the different series. The clinical suspect and the early diagnosis are very important because low morbidity rate occurs with resection of a small chemodectoma. The surgical excision can be followed by postoperative respiratory depression or dyspnea both with regional and general anesthesia. The authors report a case of a medium size tumour operated on and developing a mild transient weakness of cranial nerve VII. Recent trends in evaluation and therapy are analysed and the literature is reviewed.

Aged↗
PubMed2001

[Urgent cholecystectomy in acute cholecystitis: laparoscopy or laparotomy?].

Early cholecystectomy is the best policy in the case of acute cholecystitis. The aim of this retrospective study is to evaluate the current treatment of choice of acute calculous cholecystitis, as seen in our experience and in the literature data. Between January 1997 and July 2000, 150 patients were operated on for cholecystectomy. In the group of 30 patients (20%) with acute cholecystitis, 15 patients (50%) were managed with laparoscopic approach while 15 patients (50%) with traditional operation. At the beginning the Authors chose the open via for understand the pathologic findings of acute cholecystitis, then they always preferred the laparoscopic approach. Comparison between two groups concerned the interval between onset of symptoms and operation, postoperative mortality and morbidity rates, postoperative hospital stay and follow up. Statistical analysis was performed by the Student's t-test and the chi-square test. Both groups were homogeneous with regard to sex, age and onset of symptoms. There were no deaths and morbidity rate in the laparoscopic group was 20% versus 40% (p = ns). The average postoperative hospital stay in the laparoscopic group was 5.6 days versus 10.5 days (p = 0.046). The conversion rate into laparotomy was 6.6% (1 case). There has been one case of incisional hernia in the open group at a mean follow up of 20 month. Early laparoscopic cholecystectomy is the treatment of choice of acute cholecystitis because of a lower postoperative morbidity rate and a significant shorter hospital stay.

Acute Disease↗
PubMed1999

[Transmission and scanning microscopy of elastofibroma ultrastructure].

Elastofibroma is a rare benign tumor of soft tissues that has the elective localization in peri- or interscapular region. It is characterized by the proliferation of fibroblast-like cells which appear enveloped by abundant elastic and collagen fibers. Here we present a case of elastofibroma, observed in a 63 year old woman in the interscapular region. The neoformation has been studied by transmission electron microscopy (TEM) and scanning electron microscopy (SEM). Our hypothesis is the possibility that elastofibroma is the consequence of active neoformation of fibers elastic normal in the quality that subsequently is meet to progressive degenerative phenomenons.

Female↗
PubMed1994

[Colorectal cancer in old age. Our experience].

Two hundred and thirty-three patients treated for colorectal cancer during the period 1976-1991 were divided into three groups (A: < 65 yr; B: 65-74 yr; C: > 74 yr) in order to perceive possible statistically significant differences in patients older than 75 years. Epidemiological features are similar among the three groups, while a greater diagnostic delay (p = 0.013), a higher incidence of emergency procedures (p = 0.006) and a more advanced AP stage were found in group C. The high anesthesiological risk determined a conservative surgical approach only in 4.1% of patients, while a curative resection was performed on 51% of group C vs 72.7% of group A (p = 0.016). Postoperative complications and mortality for curative resections were 28% and 12% in group C vs 24.6% and 2.9% in group A (p = n.s.); the overall 5 years survival rate was 62.9%, 51.7% and 42.2% in groups A, B, and C. It is concluded that age alone should not be considered as a contraindication to curative surgery for colorectal cancer, for life expectancy and quality are considerably worse in the elderly undergoing derivative surgery.

Aged↗
PubMed1994

[Surgery of the obstructive complication of carcinoma of the left colon. The clinical problems and the authors' personal experience with 56 surgical cases].

A retrospective analysis was carried out on 56 pts., (37 M, 19 F), mean age 64 yrs., operated for moderate to severe obstruction due to left colon carcinoma. Clinical and pathological features, treatment and results were compared with those of 108 pts. with left colon cancer who underwent elective surgery. Mean duration of obstructive symptoms was 5.3 days and mean delay between admission and operation was 1.15 days. Site and nature of the obstruction were assessed pre-operatively in 80.3% of the pts. Distribution of tumor localization was similar in the two groups. ASA risk was statistically higher in pts. with obstruction. Staging according to the Astler-Coller (mod. 1978) classification, showed a greater incidence of more advanced stages in the obstructing tumors. In the group with obstruction a three stage surgery was carried out in 18 pts. (32.1%), a two stage in 6 (10.7%), a primary resection in 6 (10.7%) and a decompressive colostomy in 26 (46.5%). Radicality and resectability rates were 50% and 53.6% vs 69.4% and 82.4% in elective surgery. Mean post-operative stay was 42 and 21 days respectively in the two groups. Overall post-operative death rate was 19.6% vs 9.2%, and 3.3% vs 7.8% after resective surgery. Post-operative complications accounted for 21.4% vs 21.3%. 5-year survival rate after curative surgery was 47.8% vs 76.8%. On the basis of their results and on Literature reports the Authors suggest a reevaluation of a staged surgical treatment for obstructing left colon cancer based on primary decompression following an E.L. when needed. Consequent resection and intestinal reconstruction should be performed after 2-3 weeks.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Acute complications of pulmonary hydatidosis. Apropos 44 cases].

The authors examine a series of 44 patients with an acute complication of the hydatid disease of the lung. Clinical data, diagnostic features, surgical procedures and short and long term results are compared with those of 80 cases presenting no complications. Acute complication has in many cases a non specific clinical presentation and its evidence can only be found by means of radiology. The basic principles of surgical treatment are the same of the non complicated cysts, even though resection is more often performed (56.8%) since contextual lung and bronchial involvement is frequent. The authors report no significant difference between short- and long-term results in the two series.

Acute Disease↗
PubMed1991

[Embolism of the superior mesenteric artery. A clinical experience].

The Authors report their clinical experience in superior mesenteric artery embolism: 10 arterial embolisms (71%) collected from a series of 14 obstructions of the superior mesenteric artery. The main interval from the beginning of the symptomatology to hospital admission was 48 h. Laparotomy was performed in all ten patients; gangrenous bowel was resected in 2 and 2 had an embolectomy of the superior mesenteric artery without intestinal resection. The remaining 6 patients had laparotomy alone and died. The Authors emphasize the difficulty in recognizing the disease at an early stage and suggest to contemplate in patients at risk with a persistent abdominal pain, the possibility of a superior mesenteric artery embolism.

Aged↗
PubMed1990

[Complementary profundoplasty. Clinical experience].

The Authors report a 68% overall success rate in a three years follow-up study of 45 "complementary" profundoplasties. The key factors with a significant prognostic effect on the clinical surgical results are the early postoperative increase of the resting ankle pressure index (I.W.) and the angiographic preoperative patency of the tibial arteries. An early postoperative increase of I.W. has been always associated with good results whereas an unchanged postoperative I.W. has always been associated with poor results; an angiographic tibial run-off (one or two or three patient tibial arteries) has been associated with significant better clinical results (p less than 0.001).

Aged↗
PubMed1990

[Endarterectomy of the internal carotid. Clinical experience].

The authors report a clinical experience on 37 internal carotid endarterectomies of 33 patients classified as: group A (asymptomatic patients); 4 patients (13%), group B (RIA); 9 patients (27%), group C (stabilized neurological lesions); 19 patients (56%), group D (acute cerebral ischemia): 1 patient (3%). Sixteen thromboendarterectomies (43%) were carried on for the prophylaxis of neurological lesions, 20 (54%) to increase and balance the cerebral blood flow in patients with stable neurological lesions, 1 (3%) for acute cerebral ischemia. The overall operative mortality was 6%, the operative morbidity was 22%. The clinical follow-up concerned 26 patients: the overall mortality was 19%: in survivors the late results were excellent. The rate of postoperative stenosis was 18%: 80% of these arteries had been treated without a patch angioplasty.

Aged↗
PubMed1989

[Primary lymphoma of the rectum].

Observation of a case of primary rectal lymphoma (123 cases described) led to a discussion of certain aspects of the condition. Although the clinical picture points to a straightforward general diagnosis of cancer, it is possible to achieve correct diagnosis using deep and multiple perendoscopic biopsy, considering the submucous origin of the lymphomas. The therapeutic approach should allow for correct staging which is only obtained by means of diagnostic studies aimed at excluding multicentric localisations. Surgery must be considered elective in stage I and II or in cases of need. Sensitivity to radiotherapy has led some authors to propose it as a primary treatment. Chemotherapy is indicated alone or in association with radiotherapy or surgery. It is also pointed out that treatment modalities are still debated because data are not homogeneous and so few cases have been reported.

Aged↗
PubMed1989

[Long-term evaluation of the treatment of perforated gastroduodenal ulcer using a median suture].

Simple suture associated with treatment using H2-antagonists has replaced gastroduodenal resection in the treatment of peptic ulcer. Forty-four patients were submitted to rafia suture for perforated gastric or duodenal ulcer (1972-1986). Fourteen were treated in the pre-H2-antagonist period and 30 in the post-H2 antagonist period. Patients were followed up: Vissick classes I and II represent 58.3% of cases in the pre-H2-antagonist period and 95.8% in the post-H2-antagonist period. Two patients from the first period were subjected to gastroduodenal resection. In no patient of the second period was further ulcer therapy necessary. In patients of the first period, oesophagogastroduodenoscopy evidenced duodenal ulcer in one case and erosive duodenitis in two cases; erosive duodenitis was present in one patient of the second period. The choice of rafia would appear to be a valid one. Follow-up after a longer period should provide confirmation.

Duodenal Ulcer↗