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Biomedical subjects

E Cirino

Publications and source records attributed to E Cirino.

At least 19 recordsLinked to original sources

[Pancreatic pseudocysts. Clinical contribution].

Aim of this study was to compare, taking into consideration data from the literature, the various diagnostic examinations and therapeutic modalities nowadays available to manage patients affected by pancreatic pseudocysts. Personal experience regarding three patients with post-necrotic pancreatic pseudocysts is reported; these patients complained of epigastric pain with nausea and tenderness in the upper abdominal quadrants. Diagnosis was made by CT. In one case a progressive decrease of the pseudocyst was observed; the second patient was treated by a pseudocyst-jejunostomy; the last patient initially underwent a trans-gastric percutaneous drainage for infection of the pseudocyst and afterwards an open pseudocyst-gastrostomy. All patients were cured, even if the second patient during the postoperative course developed a pleuric effusion, which was treated by thoracentesis. Pancreatic pseudocysts in 20% of cases resolve spontaneously, as observed in one of our patients. In other cases, a surgical operation is needed, now feasible through an endoscopic, percutaneous, laparotomic or laparoscopic approach. The endoscopic and percutaneous approach are indicated only in selected cases, so that the "gold standard" treatment is still the laparotomic one, especially by a pseudocyst-jejunostomy, which also in our experience has given the best result. Very promising also, according to the latest data from the literature, seems the laparoscopic approach, by which a wide communication between the stomach and the pseudocyst is obtained.

Aged↗

[Intestinal invagination caused by colonic lipoma].

The observation of a case of intestinal intussusception caused by lipoma of the colon prompted the authors to review the literature on the subject and to examine the main characteristics of lipoma of the colon which represent the most frequent benign neoplasia of the large intestine after adenomatous polyps. Lipomas of the colon are localised in 90% of cases at the submucous level, are usually solitary, of varying size and may be sessile or pedunculated. They are almost always asymptomatic; only when they are of a reasonable size do they become manifest following alterations of the alveus, rectorrhagia, abdominal pain or the occupation of the colic lumen by the mass, or intestinal intussusception caused by the progression of the pedunculated lipoma. This difficult diagnosis may be aided by colonscopy with biopsy and dual contrast opaque enema. The prognosis of the disease depends on the presence or absence of complications and, in the case of the former, on early diagnosis and treatment. Lipoma of the colon of less than 2 cm may be electively removed endoscopically, those greater than 2 cm by laparotomy or laparoscopy. In emergency cases, it is advisable to perform a more or less extensive resection of the colon depending on the size of the tumour. In the case reported by the authors, an intussusception manouevre was first performed followed by left segmentary colectomy.

Adult↗

Rectal carcinoid tumors. Report of two cases.

Two cases of rectal carcinoid tumors are reported. In the first case the endoscopic diagnosis was intramural rectal neoformation. At histology, rectal carcinoid tumor with infiltration of the muscularis mucosae was diagnosed. Abdominoperineal resection was performed. The patient is still living 3 years following surgery. In the second case, the endoscopic diagnosis was non-adenomatous polyp. Endoscopic polypectomy was performed. At histology, rectal carcinoid tumor was diagnosed. The patient is still living 2 years following surgery.

Carcinoid Tumor↗

Sexual complications after abdominoperineal resection.

The sexual activity was studied in 28 males and 18 females, one year after abdominoperineal resection for low rectal carcinoma, using a questionnaire. Sexual desire, potentia coeundi and ejaculation, capacity for orgasm and sexual satisfaction in the male, and sexual desire, possibility of vaginal coitus, dyspareunia, orgasm capacity and sexual satisfaction in the female were analyzed. Among the female patients (18 cases), sexual desire was judged to be decreased in 77.77% (15 cases) and decreased capacity for orgasm occurred in 5.5% (1 case). Loss of sexual satisfaction and dyspareunia were present in 44.4% (8 cases) and 33.6% (6 cases) respectively. Among the male patients (28 cases), sexual desire decreased in 75% (21 cases), incomplete erection but sufficient for copulation occurred in 17.85% (5 cases), such as retrograde ejaculation in 10.71% (3 cases) and no ejaculation in 7.14% (2 cases) and impotentia coeundi in 25% (7 cases). In couples that reported a satisfying sexual activity, the first coitus occurred 6 months after surgery (range: 4 to 15 months). In no case was there separation of the couple after surgery.

Adult↗

[Acute cholecystitis].

Acute cholecystitis is a non-rare disease, the incidence of which was increasing in the last years parallel to biliary lithiasis, which in 90% of cases is the first cause of such pathology. From the anatomopathological standpoint, we distinguish three types of acute cholecystitis: catarrhal, suppurative and gangrenous. The most frequently remarked symptom is ache at right hypochondrium. Only in 30% of cases cholecyst can be palpated, in form of ovoid mass; typical is the positiveness of Murphy's manoeuvre; constant is fever, but not subicterus. The introduction of new methods of ascertainment, exempt from any risks, simple to be performed and remarkably careful, made the diagnostics of acute cholecystites easier: parietal cholecystotomography, hepato-biliary scintigraphy, echotomography (first approach investigation), computerized axial tomography and laparoscopy almost always succeed in dispelling doubts. By using more than one of these investigations, a diagnostic accuracy, touching on 100%, can be reached. The differential diagnosis should be placed with: peptic ulcer, acute pancreatitis, acute appendicitis, gonococcus perihepatitis, virus hepatitis, acute pyelonephritis, right basal pneumonia. The complications an acute cholecystitis can occur are: perforation (localized, in free peritoneum or in a hollow organ), choleperitonaeum, necrosis of hepatic parenchyma, acute pancreatitis. Due to the possible arising of such complications, the mortality unfortunately is not indifferent (5%), especially in patients already weakened by other chronic diseases. Still discussed is the question as to when performing operation. In fact, there are three trends: intervention in immediate emergency, in postponed emergency, or in remote time (preceded by a medical treatment). The Authors prefer the intervention in postponed emergency, as, in their experience, they remarked the poor effectiveness of the delay medical treatment, also involving a greater difficulty in the technical execution of the intervention and a longer stay in hospital. From 1973 up to 1983, 241 cases of acute cholecystitis (158 women and 83 men) were hospitalized at the First Aid Surgical Centre of the Catania University. Eight patients refused the surgical intervention. The remaining 233 underwent, depending upon the seriousness of the affection, the associated diseases and the different reactiveness to the medical treatment, operation: in immediate emergency (26.1%); in postponed emergency (67.8%; in remote time (6.1%). The mortality was 2.2%, with the lowest percentage in the second group.

Acute Disease↗

Ampicillin-associated colitis. Case report.

A case of ampicillin-associated colitis is described. The authors stress the importance of emergency colonoscopy for the correct diagnosis and treatment of severe diarrhea and hemorrhage occurring during treatment with antibiotics.

Adult↗

[Our experience in laparoscopic diagnosis in general and emergency surgery (author's transl)].

After a brief review of the history of laparoscopy starting from the first endoscope, the authors remark on the great usefulness, ease, and essential harmlessness of the procedure. They list all the possible uses of laparoscopy in general and emergency surgery, exemplifying their claims with the illustration of personal cases and recommending widespread use of the method in surgery.

Acute Disease↗

[The indications for laparoscopy in the diagnosis of hemoperitoneum (author's transl)].

In consideration of the well-known difficulties associated with the precise diagnosis of hemoperitoneum, the authors offer their personal experience in support of laparoscopy as a diagnostic aid in such dramatic events. They review 23 cases of emergency laparoscopy performed in the First Institute of Clinical Surgery of the University of Catania between January 1978 and January 1979. Recalling that the procedure was applied to patients as young as 3 and as old as 80, they confirm the opinion expressed from other quarters, namely that laparoscopy is an essentially harmless and rapid procedure conducive to very accurate diagnosis in view of appropriate planning of therapeutic treatment.

Adult↗

[Coloportal fistula in ulcerative colitis (massive penetration, through the splenic vein, of barium and air into the portal system during barium enema)].

The authors describe one case of massive penetration of barium and air through the splenic vein into the portal system during administration of a radiopaque enema to a woman suffering from hemorrhagic proctitis in the florid phase. They provide a detailed description of this rare clinical case and discuss the possible etiology and pathophysiology of the observed event.

Barium Sulfate↗

[Intestinal obstruction and incomplete obstruction from mesenteric cyst formation in children (author's transl)].

In the light of three cases of their own observation, of children with mesenteric cysts causing complete or incomplete intestinal obstruction, the authors review the existing literature on the subject, discuss the etiology, clinical aspects, and therapeutic methods for the correction of such pathology, and conclude by calling attention to mesenteric cysts as possible causes of intestinal transit disorders in the pediatric age group.

Child↗

[Peripheral vascular trauma (author's transl)].

The authors review several existing classifications of traumatic events affecting the peripheral blood vessels; after discussing the symptoms of such events and diagnostic guidelines, they outline therapeutic approaches and emphasize above all the need for prompt surgery with the least possible delay after the injury. They review of cases of their own observation, and conclude by highlighting the basic concepts of modern surgery in this field of pathology.

Accidents, Traffic↗