Laparoscopic adjustable silicone gastric banding for the treatment of morbid obesity.
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Biomedical subjects
Publications and source records attributed to C Garrone.
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OBJECTIVE: This clinical study evaluated the results of and defined the indications for laparoscopic fenestration of symptomatic nonparasitic hepatic cysts, either solitary or diffuse. SUMMARY BACKGROUND DATA: Different surgical treatments have been proposed for highly symptomatic hepatic cysts: enucleation, fenestration, hepatic resection, and liver transplantation. The advent of laparoscopic surgery has given new opportunities but, at the same time, has increased the uncertainties concerning the proper management of these patients. METHODS: Eight patients with solitary cysts and nine with polycystic liver and kidney disease (PLD) were seen during a period of 2 years. After a careful review of the symptoms, 6 patients were excluded from surgical treatment and 11 (4 solitary cysts and 7 PLD) were treated by laparoscopic fenestration. Postoperative morbidity and mortality rates, hospital stay, and clinical early and late results were evaluated. RESULTS: In the solitary cyst group, there was no surgical morbidity or deaths, and a complete regression of symptoms occurred in all patients. No recurrences were observed. In the PLD group, two patients had to be converted to laparotomic fenestration (28%). There were no deaths, and the surgical morbidity was limited to two cases of postoperative ascites. Symptomatic relief was obtained in 80% of patients, but the symptoms recurred in 60%. A subgroup of PLD at high risk for recurrence was identified. CONCLUSIONS: The best indications for laparoscopic fenestration seem to be solitary cyst and PLD characterized by large cysts mainly located on the liver surface (type 1), whereas PLD characterized by numerous small cysts all over the liver (type 2) should be considered a contraindication to laparoscopic fenestration.
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The videocelioscopic technique is becoming increasingly widely used in the treatment of cholelithiasis. In view of the results obtained, the authors underline the advantages of this method in geriatrics.
Personal experience of the treatment of renal oncocytoma is compared with reported data. Furthermore the problems relating to the diagnosis and treatment of this tumour, characterised, in many cases, by its lack of symptoms and tricky histopathological classification, are examined in greater depth.
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We present a case report about a patient affected by an "insular" thyroid carcinoma, a poorly differentiated carcinoma, situated morphologically and biologically in an intermediate position between the well-differentiated (papillary and follicular) and the totally undifferentiated thyroid tumors. We believe that its separation from other types of thyroid cancer will lead to a more accurate estimate of its prognosis and a more aggressive therapeutic approach.
A clinical case of cloacogenic anal carcinoma is reported. These neoplasms, deriving from embryonal residuals at different levels of the ano-rectal junction, have a better prognosis than squamous carcinomas; the surgical alternative to abdomino-perineal resection is a simple local exeresis for small tumours that do not invade the muscular layer, with a good radical result as reported by the literature.
Spontaneous rupture of the spleen in primary amyloidosis is an uncommon event. After a review of the pertinent literature (10 case-reports between 1948 and 1987) a case of spontaneous splenic rupture with hemoperitoneum is presented. The diagnosis depends on the demonstration of amyloid deposit in splenic and hepatic tissues.
In carcinoid syndrome, calcitonin administration proved to have an effective action in reducing symptomatology. During the perioperative period, treatment with somatostatin, thanks to the ease of administration of the drug and the reductive action of gastroenteric secretion, demonstrated its usefulness in countering the action of serotonin. In the present case, the data reported in the most recent literature on the use of the two drugs in the carcinoid syndrome are confirmed.
Ascending colon angiodysplasia is a cause of colorrhagia, particularly if the patients are more than 55 years old. Therapy is primarily surgical and it consists generally in right hemicolectomy. Two cases personally observed are reported and a survey of the literature is made.
A series of 14 patients (6 males and 8 females) suffering from gallbladder cancer has been examined. Postoperative mortality, mean survival, quality of life understood as time free from symptomatology, and the incidence of early postoperative complications in relation to the various types of radical and palliative intervention performed were evaluated.
After reviewing the international literature, the Authors report an uncommon case of sparganosis localized in a submandibular gland.
The effectiveness of marker CA 15-3 is assessed for the purposes of early diagnosis of breast cancer and its monitoring and data are compared with that of CEA. The results obtained in a series of 71 breast tumours show that CA 15-3 presents high positivity for T2 (66.2%) and possesses greater diagnostic sensitivity and accuracy than CEA.
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Serological tests used in pancreatic diseases, especially isoamylase analysis and trypsin radioimmunoassay are presented. The results show that these markers are helpful in the diagnosis of chronic pancreatic diseases.