Sonographically guided percutaneous ethanol injection (PEI) has been recently used with excellent results in the treatment of toxic and pretoxic thyroid adenoma. The aim of the present study was to assess the efficacy of PEI also in the treatment of "cold" thyroid nodules. Twenty patients, each with a single thyroid nodule, underwent PEI. In all cases the nodules were found to be cold by thyroid scintiscan. A total of 16.1 mL +/- 3.1 mL of ethanol was injected once a week. No adverse effects were observed during therapy. A striking nodular shrinkage was obtained in all cases, ranging from 72.8% to 97.6% (mean 84.5%, p < 0.001 vs pretreatment volume). These preliminary results suggest that PEI is an effective and safe therapy that may be useful in the treatment of thyroid nodules as an alternative to other therapies (surgery, L-thyroxine).

Adolescent↗

PubMedDate not supplied

Percutaneous ethanol injection treatment of autonomously functioning single thyroid nodules: optimization of treatment and short term outcome.

Twenty-five patients with solitary autonomous thyroid nodules (15 nontoxic, 10 toxic) received percutaneous ethanol injection treatment (PEIT) under sonographic guidance in 4-7 sessions (1-2 weekly). To test different doses, smaller nodules (volume less than 15 mL) were given 0.75-2.8 mL ethanol/mL nodular tissue while larger nodules received 0.5-1 mL/mL. Except for 1 patient who developed hyperpyrexia, no relevant adverse effects were observed. A slight, asymptomatic increase in serum thyroid hormone levels was observed in both groups during the treatment. Three months after treatment, a biochemical and clinical remission of hyperthyroidism was observed in 8 of 10 patients with toxic nodules. A significant increase of TSH level was seen in both groups (p less than 0.01). Significant shrinkage of volume (p less than 0.001) as well as structural alterations of nodules were consistently recorded at sonography. A linear relationship (r = 0.98; p less than 0.0001) between pretreatment volume and volume reduction was found both for large and small nodules, thus suggesting that even limited ethanol doses may be therapeutically effective. A recovery of extranodular parenchyma activity at scintiscan occurred in 16 (64%) of 25 patients. These data confirm that PEIT is effective in obtaining functional ablation and in inducing remission of hyperthyroidism. Adverse effects are infrequent. In spite of the small patient sample, a 0.5-1 mL ethanol dose per each mL of tissue appears as effective as larger doses and seems appropriate for treatment.

Drug Evaluation↗

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[Intestinal reconstruction after a Hartmann intervention: a high-risk procedure?].

BACKGROUND/AIM: Restoration of the bowel continuity after Hartmann's procedure has been reported to carry a high rate of both general and anastomosis-related complications. Aim of the study was to test the hypothesis of the Hartmann's procedure reversal as high-risk surgery. STUDY DESIGN, SETTING: Retrospective analysis of a cases series, University hospital, Italy. MATERIAL: Forty patients (male n = 25; female n = 15) with a mean age of 64.8 yrs. (range 35 to 82 yrs.) who underwent manual (n = 4; 10%) or stapled (n = 36; 90%) colorectal anastomosis. The mean interval between the Hartmann's procedure and the colostomy closure was 259 days. MAIN OUTCOME MEASURES: Mortality, morbidity, anastomotic complications. RESULTS: No death was recorded. The overall complication rate was 37.5 per cent (n = 15 patients), being wound infection the most common (n = 9). Complications of the colorectal anastomosis were observed in n = 5 patients (12.5%). In details, four patients (10%) developed stenosis of the anastomosis and one (2.5%) bled from the suture line. No instance of leak was observed. Surgery was required to correct a recurrent stenosis of the colorectal anastomosis. CONCLUSION: Restoration of the bowel continuity after Hartmann's procedure is safe and has an acceptable rate of general and anastomosis-related morbidity. Most of the anastomotic complications will resolve without further surgery.

Adult↗

PubMedDate not supplied

[Echography in the surgical emergency].

Abdominal sonography represents the diagnostic method of choice in case of acute abdomen. On the bases of their experience on more than 1200 consecutive examinations performed in case of acute abdomen the author evaluate the fields of application of sonography in acute patients. A decisional algorithm in trauma patients based on sonographic results is presented. The actual indications of sonography abdominal non traumatic pathology are presented: paying particular attention to acute gastro-intestinal diseases. The therapeutic role of interventional sonography in the acute abdomen is also discussed.

Abdomen↗

PubMedDate not supplied

Effect of blood transfusions on disease-free interval after rectal cancer surgery.

BACKGROUND/AIMS: To assess retrospectively the impact of perioperative blood transfusions on disease-free interval after curative surgery of rectal cancer. METHODOLOGY: One hundred and seven (107) subjects (65 men and 42 women, median age: 67) underwent anterior resection of the rectum for rectal cancer between 1990 and 1996. Thirty-six (37%) were transfused perioperatively. Outcome variables measured were: age, sex, distance of the tumor from the anal verge, type of stapled anastomosis, protective colostomy, cancer-free margin in the specimen, grading and staging, leak of the suture line, transfusion, number of blood units given, and adjuvant therapy. RESULTS: Transfusion, nodes involvement and adjuvant therapy had a significant impact on disease-free interval at the univariate analysis. The estimated probability of cancer-free survival at 5 years was 81% for the not transfused, and 63% for the transfused patients (P < 0.05). At multivariate analysis, nodes involvement resulted significantly and independently related to time to recurrence (P < 0.05) but also perioperative blood transfusion showed an important role as independent risk factor for rectal cancer relapse (P = 0.05). CONCLUSIONS: This study suggests that blood transfusion is likely to have a detrimental effect on disease-free interval after resective surgery of rectal cancer.

Adult↗

PubMedDate not supplied

Quality of life after total anorectal reconstruction: long-term results.

The aim of the study was to assess the long-term quality of life (minimum 8 years after surgery) of patients undergoing total anorectal reconstruction for low rectal cancer. The quality of life of 27 patients undergoing total anorectal reconstruction (mean age: 73.07 years) and 27 healthy subjects (mean age: 73.50 years) randomly chosen from the population was analysed and compared using general standardized questionnaires and specific fecal continence scales. Twenty-one out of 27 patients were clinically evaluated and personally interviewed by the same surgeon who had performed the reconstruction some years before. Quality of life analysis yielded good global results, also in the light of the mean age of the patients. Fecal continence was obtained in 81% of patients. All of them report a good physical, psychological and social situation. There was no statistically significant difference (P = ns) in quality of life between these 27 total anorectal reconstruction patients and the control population. In adequately selected patients, total anorectal reconstruction is proposed as a technique capable of guaranteeing good quality of life as well as being a safe technique for the treatment of low rectal cancer.

Adult↗

PubMedDate not supplied

[Emergency surgery: the extraordinary trip of an idea].

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Emergency Treatment↗

PubMedDate not supplied

"What you see is not what you get". A plea to remove a 'normal' appendix during diagnostic laparoscopy.

BACKGROUND: Diagnostic laparoscopy (DL) is a well established alternative option to coeliotomy for suspected appendicitis. When a 'normal' appendix is found, appendectomy is often believe unnecessary. Little is known however about how normal a normal appearing appendix is. In this study we postulated that a normal appendix seen at DL, may show pathological indications at microscopy, and thus, to leave the appendix untouched may be unsafe. METHODS: A retrospective review of data from 48 patients which, in a five year period (1995-1999), had virtually normal appendices removed as completion of DL for lower abdominal pain. RESULTS: No procedure-related drawback and no subsequent complications were recorded. Symptoms subsided in all the patients. Mean hospital stay was 2.1 days. When receiving specimens, incidence of pathologic changes of the appendix were observed in 58 percent of the cases (n = 28). The negative predictive value of DL was 41 percent. CONCLUSIONS: Due to the consistently false negative rate of DL, and the low morbidity rate for laparoscopic appendectomy, we support incidental appendectomy in patients with lower abdominal pain.

Abdominal Pain↗

PubMedDate not supplied

Clinical evaluation of hepatic lesions: guidelines for diagnostic protocols and injury severity scores.

The standardisation of diagnostic procedures according to an adequate sequence is a mandatory in determining the therapeutic strategy in liver traumas. In a series of 26 consecutive cases of trauma of the liver, 3 of them penetrating, we adopted a diagnostic algorithm based on the extensive use of sonography and "Injury Severity Scores" in addition to the standard clinical procedures. The treatment of the lesions was surgical in 21 cases (81%) and conservative in 5 (19%); post operative mortality was 14% and overall mortality 11.5%. None of the cases treated by conservative approach had to be submitted to surgery during the follow-up period. Sonography, carried out by surgical staff within 30' from observation and at definitive intervals, allowed a correct surgical approach in all cases; a similar sensitivity was obtained by sonography also in the cases treated conservatively and submitted to C.T. evaluation. The absolute correlation between Revised Trauma Score, Injury Severity Scale, classes of severity of the lesions and subsequent surgical survey suggest that this scoring system could be adopted in the first triage of traumatic lesions of the liver. Sonography could be preferred to diagnostic peritoneal lavage in the screening of cases with circulatory instability; furthermore, it could be a valid alternative to C.T. in hemodynamically stable patients.

Adolescent↗

PubMedDate not supplied

Inoperable thyroid carcinoma: palliation with percutaneous injection of ethanol.

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Aged↗

PubMedDate not supplied

Laparoscopic sonography: a real alternative to cholangiography during laparoscopic cholecystectomy?

BACKGROUND/AIMS: The routine use of intraoperative cholangiography (CGP) during laparoscopic cholecystectomy (LC) is still under debate. Previous reports suggest that intraoperative sonography can replace CGP in the evaluation of common duct lithiasis during open cholecystectomy. The present study was performed to evaluate the possible role of sonography during LC. PATIENTS AND METHODS: 45 patients were submitted to laparoscopic sonography of biliary tree during LC. In all cases, CGP was performed. RESULTS: In 37 cases, sonography did not show the presence of stones; in 7 cases, common bile duct stones were identified by sonography; one false negative was observed. A sensitivity of 87.5%, a specificity of 100% and an overall accuracy of 97.8% were obtained. A false positive was obtained with CGP with a sensitivity of 100%, a specificity 97.3%, and an overall accuracy of 97.8%. CONCLUSIONS: Laparoscopic sonography can represent an adequate substitute for CGP as a screening procedure during LC.

Adult↗

PubMedDate not supplied

[Prognostic risk factors in patients operated on for perforated peptic ulcer. A retrospective analysis of critical factors of mortality and morbidity in a series of 40 patients who underwent simple closure surgery].

STUDY OBJECTIVE: To identify factors affecting mortality and morbidity in patients operated on for perforated peptic ulcer. DESIGN: Retrospective analysis. SETTING: University Hospital, Italy. PATIENTS: Forty patients consecutively operated on for perforated peptic ulcer by simple suture procedure performed either by laparotomy (n = 26) or laparoscopic (n = 14) approach. MEASUREMENTS AND MAIN RESULTS: Mortality was 20% (n = 8) and morbidity in survivors was 25% (n = 8). Compared to survivors, non-survivors were older (mean age 79.3 yrs. vs 60.0 yrs., p < 0.01), had worse APACHE II and SAPS scores (mean 20.1 vs 8.5, p < 0.001; and 13.1 vs. 5.5, p < 0.0001 respectively), were treated later (mean interval from outbreak of symptoms to surgery 30.8 hrs. vs. 11.1 hrs., p < 0.01), and the size of their perforation was larger (mean 15.1 mm. vs. 8.6 mm, p < 0.05). The laparoscopic approach was the only factor that significantly was associated with morbidity in survivors (p < 0.01). The presence of at least two risk factors, enhanced the probability of death. CONCLUSION: Old age, great APACHE II and SAPS scores, delay in treatment and large size of the perforation were associated significantly to mortality in perforated peptic ulcer patients. Efforts should be made perioperatively for patients having these risk factors.

APACHE↗

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[Is it possible to use "Medline" for assuring the quality of the scientific and research production of a medical school?].

Object of our Faculty investigation is a research made in the attempt to carry out an evaluation of efficiency and to offer a tool that might be useful to the future allocation of resources, structures and attribution of responsibility. The need of Faculty inspections in the fields of Didactics, Research, Attendance is becoming more and more important in the current phase of renewal. This work offers an example of inspection by means of Medline, performed on a given number of individuals and Institutions. The inspection of qualified scientific production has been thus performed on a sample of 808 individuals and 58 Institutions: the samples have been grouped according to their roles and to their university/hospital allocation within the "Azienda Ospedale di Pisa", Azienda c.d., which is conventionally headed by the Faculty of Medicine of the University of Pisa. As already suggested, the tool used for the inspection has been Medline. The collected data produce an x-ray which is in the whole very indicative, either in quantitative and in qualitative terms. The results are listed in tables (in anonymous). The criteria of application and the analysis of the results align themselves to the indications of the Conference of University Chancellors. The attempt to develop a method of inspection which shows as objective as possible might give heart to those who very often feel left out from the evaluation and determination of university initiatives. All this is therefore meant to satisfy the needs of the many who are currently seeking steadier values of support in order to obtain a sound renewal.

Educational Measurement↗

PubMedDate not supplied

Laparo-endoscopic "rendezvous": a new technique in the choledocholithiasis treatment.

BACKGROUND/AIMS: Endoscopic sphincterotomy for common bile duct stone clearance during laparoscopic cholecystectomy may fail due to difficulties in cannulating the papilla major. In this study we propose a new technique that facilitates the cannulation of the papilla and the common bile duct stone clearance during a standard laparoscopic cholecystectomy. Its clearance percentage, complication rate and post-operative stay have been evaluated and compared with standardized procedures such as open surgery and endoscopic sphincterotomy before laparoscopic cholecystectomy. METHODOLOGY: In a group of 16 patients presenting with cholelithiasis and common bile duct stones or papillitis, the sphincterotome was driven across the papilla into the choledochus by a Dormia basket passed in the duodenum through the cystic duct during laparoscopic cholecystectomy. Measures of outcome were clearance rate, mortality, morbidity and hospital stay. Furthermore, data obtained from this sample of patients were compared with those from another two groups of 16 patients in which choledocholithiasis was managed either by endoscopic sphincterotomy performed before laparoscopic cholecystectomy or by open cholecystectomy and trans-duodenal sphincterotomy. RESULTS: The rate of cannulation of the papilla and of the common bile duct stone clearance was 100% when the combined endo-laparoscopic approach was used in 15 patients with endoscopic sphincterotomy (93,7%) and in 15 patients with open sphincterotomy (93,7%), cholecystectomy was successful in every case. The groups were statistically similar with regard to complications; none of the patients required blood transfusion. The mean post operative stay was 95.2 hours (range 48-240) for the first group, 350.1 hours (range 192-1680) for the second and 69.7 hours (range 24-132) for the third. CONCLUSION: The laparo-endoscopic rendezvous, though still in evolution, is an efficacious method which can be used during the laparoscopic strategy of common bile duct clearance.

Adult↗