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Biomedical subjects

D Mazza

Publications and source records attributed to D Mazza.

At least 55 records · Page 3Linked to original sources
PubMed1997

A rare laparoscopic diagnosis in acute abdominal pain: torsion of epiploic appendix.

Torsion of an epiploic appendix is seldom diagnosed preoperatively because of the difficult differential diagnosis with other diseases causing acute abdominal pain, particularly appendicitis. The classic McBurney approach overlooks many infarcted epiploic appendixes. The use of diagnostic laparoscopy in acute abdominal pain can show an infarcted epiploic appendix to be at the origin of pain. Four patients were admitted for acute abdominal pain and moderate tenderness in lower quadrants and were operated on for suspected acute appendicitis. In all cases laparoscopy found the torsion of an epiploic appendix, which was resected, and a normal cecal appendix. Postoperative course was uneventful. In case of acute abdominal pain in the lower quadrants of suspected appendiceal origin, laparoscopy should be routinely performed not only in women but also in men to avoid overlooking other intraperitoneal diseases that can be the cause of symptoms.

Abdomen, Acute↗
PubMed1996

Physical, sexual and emotional violence against women: a general practice-based prevalence study.

OBJECTIVE: To determine the prevalence of domestic violence, childhood abuse and sexual assault experienced by women attending general practitioners. DESIGN: A cross-sectional, questionnaire-based prevalence survey. SETTING: 15 general practices in metropolitan Melbourne between November 1993 and February 1994. SUBJECTS: 3026 women over the age of 18 attending for a consultation. RESULTS: The response rate was 72%. Over a quarter of women in relationships had been victims of physical or emotional partner abuse in the previous year, one in 10 having experienced severe physical violence. Thirteen percent of women had experienced rape or attempted rape, 10% had been severely beaten during childhood and 28% had experienced childhood sexual abuse involving physical contact. The abuse had been disclosed to the woman's doctor by only 27% of those who had experienced partner or childhood physical abuse (mostly because the doctor had never asked) and 9% of those who had experienced sexual abuse (mostly because the woman did not see it as relevant to the consultation). CONCLUSION: There is a high prevalence of physical, sexual and emotional violence against women as well as poor communication about this violence to their general practitioners. RECOMMENDATION: Medical practitioners should be more proactive in questioning women about violence.

Adult↗
PubMed1996

Transjugular intrahepatic portosystemic shunt and liver transplantation.

Transjugular intrahepatic portosystemic stent shunting (TIPSS) appears to be an attractive, nonsurgical procedure to overcome complications of end-stage liver disease. During the period August 1992 to February 1995, 23 adults who had previously undergone TIPSS received liver transplants. These patients were compared to 36 cirrhotic patients, grafted during the same time period, in relation to the implantation technique, the intraoperative use of blood products, and the length of their hospital stay. These groups were comparable for previous right upper quadrant surgery, splanchnic vein modifications, and Child-Pugh classification. Liver transplantation was performed electively in all TIPSS patients. Ten patients (43.4%) presented with a significant shunt stenosis at a median follow-up time of 4.5 months (range 2.5 to 30 months). At transplantation 8 of the 23 TIPSS patients (34.8%) had specific TIPSS-related modifications i.e., extrahepatic portal vein aneurysm formation (n = 2), dislocation of the distal end of the stent into the inferior vena cava (n = 4) or into the main portal vein trunk (n = 1), bilioportal fistula (n = 1), and pronounced phlebitis of the inferior vena cava and hepatic veins due to redilation of shunt stenosis (n = 4). The intraoperative blood product requirement at transplantation was similar in the 23 TIPSS-patients and in the 36 cirrhotic patients who received transplants without the TIPSS procedure during the same time period [median 800 ml (range 0-20300 ml) vs median 620 ml (range 0-7600 ml), respectively]. There was also no difference between the two groups in length of hospital stay [median 18 days (range 0-34 days) vs median 19 days (range 0-66 days), respectively]. We conclude that TIPSS plays an important role in the management of life-threatening complications of end-stage liver disease arising in potential liver transplant candidates. TIPSS should be considered as a temporary, effective bridge to elective transplantation and not as a means to lower the blood product requirement at transplantation. Specific TIPSS-related modifications should be recognized early by the transplant surgeon in order to adapt the technique of graft implantation.

Adult↗
PubMed1996

Laparoscopic cholecystectomy in cirrhotic patient.

Cholecystectomy is associated with increased risk in patients with liver cirrhosis. Moreover, cirrhosis and portal hypertension have been considered relative or absolute contraindication to laparoscopic cholecystectomy. As experience with laparoscopic cholecystectomy increased, we decided to treat cirrhotic patients via this approach. Between January 1994 and April 1995, nine patients with a Child-Pugh's stage A cirrhosis underwent elective laparoscopic cholecystectomy with intraoperative cholangiography. There was no significant per- or post-operative bleeding and no blood transfusion was necessary. There was no mortality and very low morbidity. Median hospital stay was 3 days. This series suggests that well-compensated cirrhosis can not be considered a contraindication to laparoscopic cholecystectomy.

Adult↗
PubMed1996

Psychotropic drug use by women: could violence account for the gender difference?

Cross-national studies show that the female to male ratio of psychotropic drug use is approximately 2:1. Twenty per cent of female general practice patients are prescribed psychotropic drugs. The reasons behind this remain unclear but research points to the higher levels of psychopathology either experienced or reported by women. Recent studies have shown a strong association between the experience of domestic violence and sexual abuse and the development of mental ill health. It may be that women who use psychotropic drugs represent a group who are more likely to be victims of violence. If this is the case then doctors should be incorporating questioning about violence when thinking of prescribing such drugs. Further research is necessary to clarify whether or not a relationship exists between psychotropic drug use by women and a previous or current history of physical or sexual abuse.

Crime Victims↗
PubMed1996

[Course of the recurrence of hepatitis C virus infection after liver transplantation].

OBJECTIVES: Hepatitis C virus recurrence is frequent after orthotopic liver transplantation. The aim of this study was to evaluate the clinical, biological, and histological characteristics of recurrence. METHODS: One hundred and ten patients (91 males, mean age 49 years) with liver transplantation were followed up for more than 1 year (mean: 26 months, range: 12-71). Hepatitis C virus serologic 2nd generation tests were performed before and every 3 months after transplantation in all patients. Serum RNA was detected every 6 months after transplantation by polymerase chain reaction. A percutaneous liver biopsy was performed every year in all patients and in case of abnormal biological liver tests. RESULTS: In 44 patients (40%), hepatitis C virus serology was positive before transplantation, and was unchanged after transplantation. In this group histologic chronic hepatitis was observed in 35 patients (79.5%). The mean Knodell score was 8.4 +/- 2.3, associated with an increase in serum aminotransferases (> twice the upper limit of normal) in 26 cases (74.3%) and with serum RNA in 33 cases (94.3%). The Knodell score was not significantly higher 2 years or more after transplantation than before (9.5 +/- 3.9 vs 7.2 +/- 3.5). In 66 patients with negative hepatitis C virus serology before transplantation, no changes were noted after transplantation. In this group, histologic chronic hepatitis was found in 14 cases (21.2%) associated with serum hepatitis C virus RNA in 7 cases. Actuarial survival rates of the two groups were 97.1% and 91.2% at 2 years, and 93.5% and 86.7% at 5 years, respectively. No death clearly related to hepatitis C virus recurrence was observed. CONCLUSION: Hepatitis C virus recurrence after liver transplantation is frequently associated with chronic hepatitis, and a progressive increase in liver lesions. Nevertheless, the 5-year survival rates was not different in these patients compared to patients with negative hepatitis C virus serology before transplantation.

Adult↗
PubMed1995

Psychotropic drug use by women: current prevalence and associations.

OBJECTIVE: To determine the current prevalence of psychotropic drug use by women and any association between use and demographic variables. DESIGN: A cross-sectional, questionnaire-based survey. SETTING: Metropolitan Melbourne between November 1993 and February 1994. SUBJECTS: Consecutive women aged over 18, attending 15 randomly selected general practices for a consultation. OUTCOME MEASURES: Psychotropic drugs taken in the last year and duration of their use, reported by the doctor from the patients' clinical notes and patient interview. Patient demographic characteristics. RESULTS: The questionnaire was returned complete for 2048/3026 women. Of these, 20.4% had taken at least one psychotropic drug for at least a month in the past year. Most of these women had taken the drug for longer than 12 months and a quarter had taken more than one psychotropic drug in the past year. Psychotropic drug use by women was significantly associated with increasing age, having been married, parity, lower educational attainment, manual occupation, unemployment and being supported by a government pension. CONCLUSIONS: Psychotropic drug use by women is common and mostly long term. Psychotropic drugs should be prescribed carefully and judiciously, with continual review of the indications for their use and with an awareness of the association with social situation.

Adult↗
PubMed1995

[Surgical treatment of benign hepatic tumors. A safe and efficient choice].

Benign liver tumors often require surgical treatment because of the diagnostic difficulties of their nature and because of annoying symptoms. With the aim of assessing if surgery is a safe therapeutic option we reviewed the data concerning 36 consecutive patients who underwent hepatic resection during the period January 1988-January 1993 at our Institution for 42 presumed benign liver tumors. Patients had a preoperative assessment consisting of biochemical tests, abdominal echography and contrast-enhanced scan in all cases, magnetic resonance imaging in 6 cases, celiacmesenteric angiography in 14 cases and percutaneous liver biopsy in 5 cases. We realised 5 major hepatectomies and 31 minor resections. There was no perioperative mortality. The postoperative complication rate was 5.5%. Mean hospital stay was 15.1 days (range 5-35 days). On follow-up, ranging from 4 to 60 months (mean 24 months), all patients are alive, without recurrence and free of symptoms. Histologic examination of specimens showed cavernous hemangioma in 20 cases, focal nodular hyperplasia in 19 cases and hepatic adenoma in 3 cases. Histologic findings were in accord with preoperative diagnosis in 57.9% of cases of cavernous hemangioma, in 42.8% of cases of focal nodular hyperplasia and in no case of hepatic adenoma. Our experience confirms that accurate preoperative diagnosis of presumed benign liver tumors is difficult in spite of complete radiologic investigations and liver biopsy. For this reason and for the risk of dangerous complications, such as malignant transformation and intraperitoneal hemorrhage, we believe that surgery is the treatment of choice in the majority of cases. This attitude, when realised in a center with experience in hepato-biliary surgery and using modern technical features is safe and efficient.

Adolescent↗
PubMed1994

Recurrence of hepatitis C virus after liver transplantation.

The hepatitis C virus is a common cause of chronic hepatitis after orthotopic liver transplantation (OLT). We evaluated 95 consecutive patients who underwent OLT at our institute between March 1988 and November 1992 and who had a follow-up period longer than 3 months. All patients had a second-generation test (ELISA + RIBA) for HCV antibodies (HCV Ab) before and monthly after OLT; all had a polymerase chain reaction (PCR) test for detection of viral RNA after the operation. Whenever biochemical abnormalities (hypertransaminasemia 2 times the normal range) were seen, a percutaneous liver biopsy was performed. Forty-two HCV Ab+ patients before OLT remained positive after OLT. In this group the PCR test was positive in 32 cases (78.5%). In 13/42 (30.9%) cases (all PCR+) with hypertransaminasemia histological examination showed signs of viral C hepatitis (score of Knodell minimum 3, maximum 12, median 5.5). Of 53 HCV Ab patients before OLT, only 1 became HCV Ab+ and PCR+ 15 months after OLT. In the remaining 52 patients 15 were PCR+. Twenty of 53 patients (37.7%) had a liver biopsy because of hypertransaminasemia: in no case did histology show any signs of hepatitis C. In conclusion, viral C recurs often after OLT for post-hepatitic C cirrhosis. The histological graft lesions are in most cases moderate. We did not observe any deaths related to viral C infection in grafted patients. According to our results post-hepatic C cirrhosis remains a good indication for OLT.

Adult↗