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F Mosca

Publications and source records attributed to F Mosca.

At least 235 records · Page 13Linked to original sources
PubMed1995

Comparative evaluation of contact ultrasonography and transcystic cholangiography during laparoscopic cholecystectomy: a prospective study.

BACKGROUND: The role of intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) is controversial. While many advocate its routine use, others argue for a selective approach. Recent reports showed laparoscopic contact ultrasonography (LCU) as a viable alternative to IOC. However, no prospective data were available to compare the accuracy, efficacy, and safety of the two diagnostic procedures. OBJECTIVE: To evaluate the benefits and disadvantages of LCU and IOC during LC. METHODS: Seventy-eight patients who underwent LC at Pisa (Italy) and Dundee (Scotland) university hospitals were entered in a prospective data registry. Details of operative technique and results of LCU and IOC were analyzed by reviewing videotape recordings of each procedure. RESULTS: Laparoscopic cholecystectomy was achieved in 73 patients, with five requiring conversion to the open procedure. The success rate of IOC was 90% (64/71). Performance of IOC demanded more than twice the time needed for LCU. Eleven percent (8/71) of cholangiograms were abnormal, with a false-positive rate of 1% (1/71). Laparoscopic contact ultrasonography detected all four instances of unsuspected ductal stones but none of the three cases of anomalous biliary anatomy. Clinically relevant incidental findings were picked up by LCU in six patients. CONCLUSIONS: Laparoscopic contact ultrasonography proved to be extremely accurate in the detection of ductal stones but less reliable in the disclosure of anomalous biliary anatomy. The essential role of IOC in providing a clear spatial display of the biliary tract was confirmed. Since the two procedures are complementary, their combined use is advisable in difficult LC to avoid retained common bile duct stones and prevent iatrogenic complications.

Adenoma↗
PubMed1995

Unsuspected choledochal cyst during laparoscopic cholecystectomy.

Cystic dilation of the extrahepatic bile ducts is rarely encountered during elective biliary surgery planned for different indications. We report here on a patient with unremarkable preoperative workup and normal intraoperative anatomy of the cystic pedicle in whom a type I choledochal cyst containing a large stone was detected by the combined use of laparoscopic contact ultrasonography and intraoperative cholangiography. This case report highlights the importance of intraoperative imaging modalities of the ductal system not only in preventing iatrogenic injuries and their related complications, but also in detecting unsuspected associated biliary pathology which might significantly change the course of surgical intervention.

Adult↗
PubMed1995

Prognostic value of histological grading in ductal adenocarcinoma of the pancreas. Klöppel vs TNM grading.

A new histological grading system with prognostic correlation for pancreatic cancer was proposed by Klöppel et al. in 1985. Histological sections from 60 ductal adenocarcinomas operated on between January 1980 and December 1990 were retrospectively reviewed in order to compare Klöppel's grading with standard TNM's grading and assess their prognostic value. Klöppel grading was determined through the following histologic and cytologic factors: number duct-like structures, mucus production, neoplastic epithelium, arrangement and pleomorphism of nuclei, and mitotic activity. A score from 0 (well differentiated) to 2 (poorly differentiated) was given to each factor. The mean value obtained dividing the sum of the different values by the number of parameters was used to construct a malignancy scale and therefore allocate each patient to his Klöppel grading. The concordance index K between the two grading systems was relevant (K = 0.85 p < 0.001). There was no relation either between gradings (Klöppel or TNM) and preoperative duration of symptoms or between gradings and UICC stages. TNM's G2 grades of malignancy, N status, and tumor stage were significantly related to survival time (p < 0.05). Klöppel's grading does not show any advantage over the classical and simpler TNM's grading, even though it can be considered more objective and therefore more easily reproducible. This characteristic further should be enhanced by the introduction of a malignancy scale such as the "mean value."

Aged↗
PubMed1995

Efficacy of octreotide in the prevention of pancreatic fistula after elective pancreatic resections: a prospective, controlled, randomized clinical trial.

BACKGROUND: A prospective, randomized controlled clinical trial was conducted in 33 Italian surgical departments with the aim of evaluating the efficacy of octreotide in the prevention of pancreatic fistula after elective pancreatic resections. METHODS: Between July 1990 and May 1992, 278 patients were enrolled in the study. Fifty-four dropped out because of unresectable disease and six were excluded because of protocol violation; the remaining 218 were randomly assigned to the octreotide group (n = 111) or to the placebo group (n = 107). There were 131 men and 87 women with a mean age of 58.2 +/- 11.7 yrs. Pancreaticoduodenectomy was the most common operation performed (n = 143), sixty-four percent of patients had a pancreatic or periampullary cancer; chronic pancreatitis accounted for 8.2% of cases. RESULTS: Mortality rate was 6.9%. A pancreatic fistula occurred in 31 patients (14.2%), 9% in the octreotide group and 19.6% in the placebo group (p < 0.05). Morbidity rate was significantly lower in the octreotide (21.6%) than in the placebo group (36.4%) (p < 0.05). When specific pancreatic complications were grouped together and evaluated, they occurred less frequently in the treated (15.3%) than in the placebo group (29.9%) (p < 0.05). CONCLUSIONS: Octreotide was able to reduce significantly the incidence of pancreatic fistula after elective pancreatic resections.

Aged↗
PubMed1995

Bronchopleural fistula: successful selective bronchial occlusion with a Fogarty's catheter in a preterm infant.

A preterm infant (26 weeks' gestation) mechanically ventilated for respiratory distress syndrome developed severe interstitial emphysema of the right lung with a bronchopleural fistula, pneumothorax and mediastinal shift. Selective occlusion of the right main bronchus with a Fogarty's catheter produced rapid improvement in the clinical condition and radiological features. Occlusion of the main bronchus in a newborn with a bronchopleural fistula and pulmonary interstitial emphysema is an easily performed manoeuvre that can be life-saving.

Bronchial Fistula↗
PubMed1995

Segmental organization of the pig liver: anatomical basis of controlled partition for experimental grafting.

Segmental anatomy has been investigated on 54 pig livers by bench-top radiology and ultrasonography of hepatic and portal vessels and bile ducts and dissection of suprahepatic veins. Eight segments were recognized, homologous to those of the human liver. Major variations were found only of arterial distribution. The inferior vena cava invariably ran within the parenchyma of the right lobe and close to the liver hilum; suprahepatic veins were also entirely intraparenchymal. Therefore, the pig liver can easily be divided into two halves, but only the right one can be used for reduced-size grafting into a recipient.

Animals↗
PubMed1995

[Role of thymopentin in the prevention of post-splenectomy infections].

The Authors evaluated the efficacy of thymopentin in the prevention of post-splenectomy infections. 14 splenectomized patients treated by thymopentin (50 mg s.c. every other day in the 4 weeks following splenectomy) were compared with 14 splenectomized control patients. Clinical evaluations and measurement of CD4 and CD8 lymphocyte subpopulations were made preoperatively and then after 3 and 6 months from splenectomy. Hyperthermia (37.5-38 degrees C) "sine materia", which disappeared spontaneously in 4-5 weeks, was observed in the post-operative phase in 4 control patients and in 1 patient treated by thymopentin. No statistical difference was demonstrated comparing pre- and post-operative percentages of CD4 and CD8 lymphocytes in the treated and control groups.

Adolescent↗
PubMed1995

Glutathione conjugation with 1-chloro-2,4-dinitrobenzene (CDNB): interindividual variability in human liver, lung, kidney and intestine.

The rate of glutathione conjugation with 1-chloro-2,4-dinitrobenzene (CDNB) was measured in specimens of human liver (n = 93), sigmoid colon (n = 56), renal cortex (n = 67) and lung (n = 68). In the liver there was a weak but significant (r = - 0.247 p = 0.017) negative correlation between the activity of glutathione transferase and the liver donor's age. Such a correlation was not found in the renal cortex, lung and colon. In the renal cortex and in lung the rate of glutathione conjugation with CDNB was a little but significantly (p < 0.05) higher in women than men, whereas no sex-dependent difference was observed in the liver and colon. The distribution of glutathione transferase activity was polymorphic in the mucosa of colon and renal cortex of men but not in that of women. Smoking seems not to affect the glutathione conjugation rate with CDNB in lung. The activity of glutathione transferase was 2-, 6-, and 7-fold greater in liver than in the renal cortex, lung and colon, respectively. There was a large interindividual variability of the hepatic glutathione transferase activity, and because this variability, 15% of the population studied catalyzed the glutathione conjugation with CDNB at a rate similar to those of the renal cortex and duodenum. The subjects with low expression of the hepatic glutathione transferase should be more exposed to the effects of toxic and carcinogenic compounds.

Adult↗
PubMed1994

Percutaneous alcohol sclerotherapy of simple hepatic cysts. Results from a multicentre survey in Italy.

The increased use of Ultrasonography (US) has led to increased detection of simple hepatic cysts. For symptomatic cysts treatment is necessary. Until some years ago surgery was the only therapy. We have treated a large number of patients with Percutaneous Alcohol Sclerotherapy (PAS) and evaluated retrospectively the efficacy of this approach. Data on 21 patients with symptomatic simple hepatic cysts were reviewed retrospectively. Cysts had a mean diameter of 9 cm (range: 7-15 cm). PAS was always performed under local anesthesia and US guidance. 25% of the volume was replaced with 95% ethanol and then completely aspirated after 20-30 minutes. No complications or deaths occurred. In all patients symptoms disappeared after treatment. In 15 out of 21 cases there was no evidence of residual cyst on US, computed tomography (CT) or magnetic resonance (MRI). In 6 patients with shorter follow-up, cysts showed a mean reduction in diameter of 50%. The mean follow-up was 18 months (range 6-60 months). We conclude that PAS is easy with low risk for the patients and with good long-term results; it should therefore become the procedure of choice for simple hepatic cysts.

Adult↗
PubMed1994

Three-dimensional versus two-dimensional video system for the trained endoscopic surgeon and the beginner.

Because of the lack of depth perception in current two-dimensional endoscopic video systems, the performance of fine motor movements is impaired. Endoscopic surgeons are generally able to cope with this limitation, and the performance of complex procedures becomes easy with experience. To assess the value of three-dimensional vision, two groups of surgeons, with and without experience in endoscopic surgery, underwent dexterity tests at a simulator. Data from use of two- and three-dimensional video systems were analysed and are discussed in this paper. The three-dimensional system improved the ability to perform endoscopic procedures, particularly when the highest degree of hand-eye coordination was needed. A common sensation of ocular fatigue, related to the prolonged use of this equipment, may limit its usefulness in advanced endoscopic procedures.

Clinical Competence↗
PubMed1994

A new experimental model for colorectal carcinogenesis in the rat.

A total of 130 rats were used in various experiments to prepare a new model for colorectal carcinogenesis. The experiments resulted in the development of a surgical technique that creates a subcutaneous cecal hernia, which allows the direct injection of the promoting substance, human bile from percutaneous biliary drainage, into the bowel of the rat. The method permits a direct, complete, and very easy access of a specific amount of the substance to be tested onto the colonic mucosa. The results have proven to be uniformly effective and easily reproducible and to ensure safe management of the animal.

Animals↗