Biomedical subjects

D Pisaniello

Publications and source records attributed to D Pisaniello.

27 records · Page 2Linked to original sources

PubMedDate not supplied

Repair of complex giant ventral hernias with polypropylene and omentoplasty.

The Authors in this report describe their experience with complex giant ventral hernias repaired by omentoplasty and polypropylene meshes. They explain their own technique of using the omentum when there is a lack of tissue and the need of an autologous tissue to place between the viscera and the above-lying polypropylene mesh. Among the 5 patients repaired, 4 had a giant sub-umbilical midline ventral hernia and one had a giant border ventral hernia. In all patients, the omentum was placed between the viscera and the mesh, which was fixed by interrupted sutures to the above-lying musculoaponeurotic plane. No complications, signs of bowel obstruction, or recurrences occurred. The Authors stress the omentum as an ideal tissue because of its biocompatibility and prevention of adhesions and fistulas allowing the use of a rigid and efficient prosthesis such as polypropylene. Thus, on the basis of their own short- and long-term good results, they suggest, whenever possible and necessary, the use of omentoplasty to repair complex giant ventral hernias.

Aged↗

PubMedDate not supplied

Management of testicular seminoma. Our experience.

BACKGROUND: The authors report their experience in the management of seminomas. MATERIALS: They examine 12 cases of seminoma among a series of 19 patients with testicular germ cell tumours observed at the Second Surgical Department of the Second University of Naples. RESULTS: Their results showed a better prognosis for patients in early stage of the disease who underwent surgery and adjuvant prophylactic radiotherapy; good survival rates for patients in advanced stages of the disease were achieved by the combined use of surgery, adjuvant radiotherapy and chemotherapy. DISCUSSION: The authors discuss risk factors, clinical and diagnostic features of seminomas, relating their prognosis with the combined use of both surgery and adjuvant therapies. They consider total orchiectomy, followed by prophylactic radiotherapy, the treatment of choice, especially in stages IA and IIA. They don't perform the routine retroperitoneal lymphadenectomy, differently from American authors, who always achieve it to stage the disease. CONCLUSIONS: The authors stress the improvement in the prognosis of seminoma, which has actually reached the 98% of five-year survival rate, for stages I and II.

Adolescent↗

PubMedDate not supplied

Current management of male breast cancer.

Male breast cancer represent 1% of all male cancers. The authors, by a review of literature, analyze risk factors and genic mutations involved in the development of such cancer. They discuss instrumental procedures of diagnosis and screening, histologic features and surgical approach of male breast cancer. Furthermore, they suggest adjuvant therapies stressing the importance of an early diagnosis and of the absence of nodal involvement to improve the outcome of male breast cancer.

Breast Neoplasms, Male↗

PubMedDate not supplied

[Abdominal actinomycosis and retroperitoneal fibrosis. Considerations on a clinical case].

Abdominal actinomycosis is a rare disease which often resembles an acute suppurative infection or/and abdominal tumour causing abscesses, fistulas and massive fibrosis. The preoperative diagnosis is difficult and surgical exploration is always needed because of major involvement of visceral and retroperitoneal structures. The disease can be diagnosed with certainty only on the basis of findings of bacterial colonies in histopathologic sections and typical sulphur grains in secretions from fistulas. The authors describe a case of abdominal actinomycosis involving the caecum and right colon, causing extensive retroperitoneal fibrosis and a fistula tract with an external cutaneous orifice at the level of the right iliac crest. These features resembled an acute appendicitis at first, and several surgical explorations were required before a correct diagnosis could be achieved. Abdominal actinomycosis can be treated by simple administration of antibiotics. With a correct diagnosis, medical therapy alone has proved effective in a substantial percentage of patients, thus avoiding the need for surgery, if important visceral or retroperitoneal structures are not involved. Abdominal actinomycosis always requires a careful differential diagnosis and must be considered in patients presenting abdominal tumours associated with abscesses and/or fistulas since early and efficient medical therapy, along with surgical intervention, where necessary, can lead to definitive recovery. Useful diagnostic tools are abdominal CT and selective FNAB.

Actinomycosis↗

PubMedDate not supplied

[Total implantable venous systems in day surgery].

UNLABELLED: Total implantable venous system (port-cath)in day surgery. AIMS: Most of patients underwent to a total implantable venous system (port-cath) can be treated in day surgery. METHODS: Since January 2000 to March 2003 we have implanted 31 port-a-cath, preferring access in subclavia v. We've treated all patients in day surgery and we've performed a Rx-control with a medium follow up of two hour. RESULTS: We have not reported any early complication, only 3 late complications: a device malfunction, a "kinking" reservoir and an infection of the subcutaneous pocket. The last two complications have required the explantation of the device. In difficult catheterizations can be helpful to use a pediatric kit. The rules of an aseptic and antiseptic operative procedure and the utilization of a short term antibiotic prophylaxis can avoid infective complications. We have proposed, after the device implantation, cardioaspirina like preventive therapy of septic and no septic thrombosis. In the thrombotic occlusion of the catheter we propose the use of activase. In malfunction's prevention we propose a lateral placement (to the skin incision) of the subcutaneous pocket and a 45 degrees reservoir rotation. CONCLUSIONS: The total venous system (port-cath) implantation can be mostly performed in day surgery, improving the compliance of the patients with a low cost procedure.

Ambulatory Surgical Procedures↗

PubMedDate not supplied

[Interstitial laser photocoagulation in liver tumours: our experience].

Interstitial lasertherapy (ILT) is one of the percutaneous thermal procedures allowing the ablation of primary or secondary hepatic lesions. This technique can be performed without general anaesthesia, since the patient is completely painless, in spite of the high temperatures reached, because there are no sensitive fibers around the lesion. This study includes patients with small hepatocarcinomas (< 2 cm) non peripherically sited, far from the gallbladder and the hepatic hilum. Twenty patients suffering from 24 cirrhotic hepatocarcinomas (two patients showed two nodules) have been enrolled for the present study. Mean diameter of lesions was 1.8 cm (1.3-2 cm). One or more 21 G (length 20 cm) Chiba's needles were inserted under sonographic view into the lesions. The laser energy was switched on at 4 Watts for 4-6 minutes, until an amount of energy of 900-1800 Joule was reached. All the patients were discharged 48 hours after the procedure. Triphasic CT-scan with contrast were performed 7 to 14 days after ILT, in order to check its efficacy. CT-scan showed complete necrosis in all the nodules ranging from 1.5 to 3 cm. All the patients received only one IL T session, whose longest duration was 20 minutes. No major complications occurred. ILT of small hepatocarcinomas is a safe, efficient procedure, also feasible without anaesthesia. Differently from percutaneous radiofrequency, in fact, it shows the advantage of less pain, that can avoid the need for general anaesthesia.

Aged↗

PubMedDate not supplied

[Bile leakage after laparoscopic cholecystectomy: report of three cases in our experience].

Laparoscopic cholecystectomy (LC) is associated with an higher incidence of bile duct injury than open cholecystectomy. There has been concern and the reason why bile leakages are more frequent with LC is yet unclear. Bile collections can occurr because of major about (75%) or minor (about 25%) injuries. Anyway, external biliary decompression is a key factor in the treatment, in order to avoid an emergency intervention. The Authors report their experience concerning 3 cases of bile leakages among a series of 458 LC. Only in one of the three cases the subhepatic space was not drained and an emergency laparotomy was performed. The Authors, on the basis of their own experience and of the data reported in literature, suggest the routinary intraoperative placement of a drainage into the subhepatic space, to be removed, if no complications occur, one day after surgery.

Adult↗

PubMedDate not supplied

[Interstitial laser treatment of small hepatocarcinoma on cirrhosis without anesthesia: feasibility study].

OBJECTIVE: We evaluated if interstitial laser photocoagulation (ILP) under ultrasound (US) guidance of intraparenchymal small HCC (<2 cm) in cirrhosis can be safely and effectively performed without any anesthesia. PATIENTS AND METHODS: Twelve cirrhotic patients with 14 nodules of HCC (diameter 1.2-2.0 cm; mean: 1.7) underwent ILP. All procedures were performed without local or general anesthesia. Necrosis of the nodules was evaluated with triphasic contrast-enhanced CT. RESULTS: Post-treatment CT showed complete necrosis in all cases. Pain occurred in 5 patients during the treatment was treated with iv pain-killer and only in 1 case the procedure was stopped before the scheduled time. No major complication occurred. CONCLUSIONS: ILP under US guidance is feasible without any anesthesia in patients with small intraparenchymal HCC.

Aged↗

PubMedDate not supplied

[Male breast cancer. Five years experience and literature review].

Male breast cancer is an uncommon disease and its aetiology, clinical behaviour and treatment is not well-known . Retrospective studies show that age and stage-matched breast cancer in men and women are compared. Nevertheless, the poor mammary tissue in man allow a rapid local infiltration, late diagnosis and poor survival rate. The Authors report their five years experience and with a short literature review they summarise what is currently known about this uncommon neoplasm in terms of prognostic factors, therapy and survival.

Breast↗