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Biomedical subjects

F Puma

Publications and source records attributed to F Puma.

At least 19 recordsLinked to original sources
PubMed2001

[The role of surgery in the treatment of small cell lung cancer].

Small cell lung cancer (SCLC) is a biologically aggressive tumor with a low long-term survival rate. SCLC is highly responsive to chemotherapy and surgery has a very limited role in its treatment because the disease is usually widely disseminated at the diagnosis. Good results from surgery have been reported in the small subgroup of T1-2 N0 M0 patients. In N1 peripheral SCLC, surgery in combination with other treatments, can obtain fair results. Surgical treatment does not influence the prognosis in SCLC as stage III and IV.

Aged↗
PubMed2000

Long-term safety and tolerance of silicone and self-expandable airway stents: an experimental study.

BACKGROUND: A variety of respiratory stents are currently available, but the ideal airway prosthesis seems far from being recognized. The objective of this study was to verify safety and long-term effect on the bronchial wall of three different types of airway stents. METHODS: Twelve healthy adult sheep were divided in three groups, scheduled to receive: (1) bare self-expandable metallic stents (Gianturco); (2) silicone stents (Dumon); and (3) covered self-expandable synthetic stents (Polyflex). Insertions were performed through a rigid bronchoscope under general anesthesia. Chest roentgenogram was performed 1 and 6 months after surgery, and flexible bronchoscopy after 6 months. Twelve months postoperatively, the animals were killed and a postmortem examination was carried out. RESULTS: All Polyflex stents migrated during the observation period; one late migration was observed in the Dumon group. Microscopic study showed: (1) Gianturco stents: full-thickness perforation of the bronchial wall covered by a thick layer of a chronic inflammatory infiltrate. Infection by Candida at the bottom of some ulcerations; (2) Dumon stents: mild bronchial inflammation (squamous metaplasia, submucosal inflammatory infiltrates; granuloma-like infiltrates). In case of displacement, no significant changes of the previously stented bronchus occurred; and (3) Polyflex stents: no changes of the previously stented bronchi. CONCLUSIONS: Gianturco stents proved unsafe in the long term, owing to the risk of severe airway wall damage. The Polyflex stent is well tolerated but presents a high migration rate. Silicone stents show several limitations but appear to be well tolerated by the host mucosa.

Animals↗
PubMed2000

The role of silicone stents in the treatment of cicatricial tracheal stenoses.

OBJECTIVE: Tracheal stenting for cicatricial stenoses is reserved for patients whose lesions are deemed inoperable for local or general reasons. The aim of our study was to verify the long-term results of silicone tracheal stents in such a clinical setting. METHODS: Clinical data of 45 patients treated by tracheal silicone stents, between 1987 and 1999, were reviewed. All patients had highly symptomatic cicatricial stenoses; they were selected for stenting rather than for surgery because of local and general conditions. This series has been divided in two groups according to the purpose of stenting: bridge to surgery or definitive treatment. Follow-up ranged between 12 and 83 months. Twenty-seven patients received a Montgomery T tube (Hood Laboratories, Pembroke, Mass), 16 a Dumon stent (Novatech, Plan de Gras, France), and 2 a Dynamic stent (Rusch, Kernen, Germany). RESULTS: No procedure-related mortality was observed. Nine patients underwent curative resection and reconstruction after a variable stenting period; one had a recurrent stenosis and was treated for palliation with a T tube. Tracheal stenting was performed for palliation as a definitive treatment in 37 patients. Among this group, 11 patients died of unrelated causes at a median of 10 months after the endoscopic treatment. The stent was permanently removed in 10 after a median interval of 32 months (range 9-70 months); in 4 others, symptomatic recurrence of the stenosis was observed within 6 weeks of stent removal. None of the patients successfully decannulated had a completely normal tracheal lumen but all remained asymptomatic because the residual stenosis was mild or well tolerated for concomitant limitation of physical activity. CONCLUSIONS: Long-term treatment with a silicone stent was safe and well tolerated in cicatricial tracheal stenoses. This procedure can be considered as a bridge to curative surgery or as a definitive treatment. The latter, generally performed for palliation, may provide satisfactory therapeutic results in selected patients, even in the presence of severe circumferential stenoses.

Adolescent↗
PubMed1998

Resection with curative intent after endoscopic treatment of airway obstruction.

BACKGROUND: Endoscopic treatment of malignant central airway obstructions usually is done for palliation. The exact role of such a procedure as preparatory to operation remains controversial. METHODS: From 1987 through 1996, 24 patients at our institution underwent tracheobronchial pulmonary resection after preliminary endoscopic treatment. During the same period, 304 patients underwent 449 operative rigid bronchoscopies for airway obstructions, most involving the use of a neodymium:yttrium-aluminum-garnet laser. The indications for operation were squamous cell carcinoma in 14 patients, bronchial gland tumors in 8 patients, and papillary thyroid cancer infiltrating the trachea in 2 patients. The total resection rate was 9.5% (5% for squamous cell carcinoma, 75% for low-grade malignant bronchial tumors, and 75% for papillary thyroid cancer). The median period between operative rigid bronchoscopy and operation was 18 days. RESULTS: No complications were observed after endoscopic treatment. There were two perioperative deaths (adult respiratory distress syndrome after carinal resection and pulmonary embolism after pneumonectomy) and one major complication (poor postoperative pulmonary function after pneumonectomy). No anastomotic complications were observed in the tracheobronchoplastic procedures. Follow-up was possible in every patient but 1: 6 patients died at a median of 30.5 months after operation (range, 3 to 46 months), 2 patients are alive with disease, and the rest are alive without evidence of disease at a median of 21 months (range, 2 to 61 months). CONCLUSIONS: Most patients who require endoscopic therapy for malignant airway obstructions are not candidates for operative resection. Preliminary endoscopic relief of obstruction can increase operability and improve surgical results in a highly selected group of patients.

Adult↗
PubMed1996

Bone heterograft for chest wall reconstruction after sternal resection.

BACKGROUND: Experimental and clinical results of chest-wall reconstruction with bone heterograft after sternectomy are reported. METHODS: Seven dogs underwent subtotal or total sternectomy and reconstruction by implantation of a cortico-spongy bone heterograft sandwiched between two layers of a reabsorbable mesh. RESULTS: No major postoperative complications were observed. The implant has shown favorable mechanical and biological properties. Six and 9 months after operation all animals were sacrificed and pathologic examination showed good incorporation of the implanted bone with only partial resorption of its spongiosa. Subsequently, 2 patients underwent sternal resection with different indications and reconstruction was achieved by the technique developed experimentally. No complications were observed. Excellent immediate chest-wall stabilization was obtained, persisting for a follow-up period longer than 6 months. CONCLUSIONS: In comparison with autologous bone, sterile bone heterograft seems to offer the same mechanical properties with a significantly reduced surgical trauma.

Adult↗
PubMed1994

Severe subglottid stenosis, well-tolerated for many years.

A 45 year old man was admitted to our hospital due to dyspnoea. At the age of 1 yr, he had undergone orotracheal intubation for croup diphtheria resulting in dysphonia. He was in good health up to the age of 39 yrs when exertional dyspnoea arose. He had had irregular therapy by aerosol without improvement. At admittance, the flow-volume curve indicated an impairment at high flows (peak expiratory flow (PEF) and maximum expiratory flow at 75% (MEF75%)). Fibreoptic bronchoscopy revealed a thin and smooth diaphragm, with a small (7-8 mm) central orifice in the subglottid area. CO2 laser therapy improved symptoms by increasing the cross-sectional area of the diaphragm orifice.

Dyspnea↗
PubMed1992

Chest wall stabilization with synthetic reabsorbable material.

Experimental results and preliminary clinical experience with synthetic reabsorbable materials in chest wall reconstruction are reported. Six beagle dogs underwent chest wall resection involving three or four consecutive ribs. Reparative procedure was performed by construction of a polydioxanone-band grid, anchored to the adjacent undamaged ribs. A mild wound infection developed in 1 animal but resolved without rejection of the prosthesis. The experimental material has shown favorable properties, both mechanical and biological. Subsequently, 11 patients, with different indications, underwent reconstructive procedures of the chest wall with reabsorbable prostheses. No complications have occurred. Long-term stability was excellent in all patients, with a mean follow-up longer than 6 months. The advantages of reabsorbable compounds are pointed out along with the possible applications for chest wall reconstruction after chest wall resection.

Absorption↗
PubMed1989

[Embryologic and anatomo-surgical presuppositions in intraoperative injuries of the spleen. A clinical study].

Records related to 2559 patients submitted to main abdominal surgery have been reviewed. Accidental splenic injury and subsequent splenectomy occurred in 4.5% of cases. A study of the embryological development and anatomical patterns of the splenic peritoneum has been carried out as well as an analysis of the site and the shape of the capsular damage in order to assess the mechanism of injury. Avulsion of splenic capsule occurring from traction on the peritoneal attachment of the spleen appears to be the most common mechanism of injury. Previous surgery and geriatric age seem to be factors predisposing to splenic injury.

Abdomen↗
PubMed1986

Oxytocin increases extrapancreatic glucagon secretion and glucose production in pancreatectomized dogs.

Infusion of oxytocin into normal dogs increases plasma levels of insulin and glucagon and glucose production and uptake. To determine whether infused oxytocin also increases glucagon secretion from extrapancreatic sites, pancreatectomized dogs, off insulin for 18 hr, were infused with oxytocin and plasma glucagon, and glucose production and uptake were measured using the [6-3H]glucose primer-infusion technique. The diabetic dogs, in the control period, had elevated plasma glucose and glucagon levels, an increased rate of glucose production, and a relative decrease in glucose uptake (decreased clearance). Infusion of oxytocin (500 microU/kg/min) caused a rise in plasma glucagon and glucose levels, increased glucose production, and further decreased glucose clearance. It is concluded that oxytocin can stimulate secretion of extrapancreatic glucagon, which contributes to the increased glucose production.

Animals↗
PubMed1983

Segmental and wedge resections for lung cancer: a palliative or curative procedure?

Among 1000 consecutive patients submitted to surgery for lung carcinoma, 24 underwent minimal resections. Minimal resections although occasionally curative are, as a rule, palliative procedures to be used in patients with limited cardio-pulmonary reserve or previously submitted to lung resection. Whenever possible lateral, muscle-sparing thoracotomy and wedge resections should be performed.

Adenocarcinoma↗
PubMed1983

[Significance of biliary lithiasic pathology in the etiopathogenesis of carcinoma of the large intestine].

With the purpose to study the eventual existence of a correlation between biliary lithiasis and colon-rectum carcinoma, the authors effected a retrospective study of the clinical material concerning 1283 patients hospitalized in the 1st Surgery Institute for large intestine carcinoma. The relative anamnestic data were compared with those of a control population. The results emerging from the research, checked in their statistic significance, seem to support the existence of such correlation. The hypothesis of a possible common etiopathogenesis of both diseases is proposed.

Adult↗
PubMedDate not supplied

[Surgical treatment of thyroid cancer in 243 cases].

The incidence of thyroid cancer, which accounts for 1-2% of all malignancies, constantly increasing. Its management requires an integrated approach, in which the surgeon plays a pivotal role, providing the basis for further treatment. At present, the extent of exeresis, the lymph-node dissection technique and the management of upper respiratory-digestive tract infiltration are still debatable issues. The authors report on their experience with 243 surgically treated thyroid malignancies over the period from January 1986 to December 1999. The operations performed were: total thyroidectomy 226 cases, lobo-isthmectomy 3 cases, total thyroidectomy + lung metastasectomy 1 case, total thyroidectomy + SE quadrantectomy 1 case, total thyroidectomy + monolateral modified neck dissection 30 cases, total thyroidectomy + bilateral modified neck dissection 17 cases, total thyroidectomy + radical neck dissection 1 case, total thyroidectomy + tracheal sleeve resection 5 cases. In 9 cases, extensive tracheal involvement (5.5 cm), age or neoplastic histology allowed only palliative treatment (endoscopic recanalization + tracheal endoprosthesis or tracheostomy. Nd-Yag laser endoscopic recanalization was performed in 2 patients as a preliminary stage in subsegmental radical treatment, and in 5 cases for palliation. Recurrent laryngeal nerve palsy occurred in 3 cases, long-term hoarseness in 2, and hypoparathyroidism in 4. The overall mean hospital stay was 4.8 days. Of 299 patients still alive, 215 are free of disease. Surgery is the treatment of choice, with the goal of completely removing the neoplasm, together with any anatomical structures involved in infiltration (muscles, respiratory-digestive tract, lymph nodes). Satisfactory palliation can be achieved by endoprosthesis deployment or tracheostomy in all cases where surgery is ruled out due to extent of disease, patient age or histological type.

Adult↗
PubMedDate not supplied

[Acquired abnormalities of the biliary tract. Preoperative diagnosis and surgical risk in the laparoscopic era].

Acquired anomalies of the biliary tract are rare. The aim of this work was to examine their frequency and to assess potential associated danger when performing a laparoscopic cholecystectomy. A retrospective analysis of clinical charts of 3.870 patients undergoing elective cholecystectomy between 1959 and 1997 was performed. Eighteen cases of choledoco-duodenal fistula, 9 of cholecysto-duodenal and 12 of cholecysto-choledochal fistulas were observed. Two cases of acquired absence of the cystic duct and one cholecysto-colic fistula were also encountered. The traditional contrastographic radiology showed to be more accurate in defining presence and nature of the acquired anomalies. Etiopathogenesis of the main anomalies and consequent risks in performing laparoscopic cholecystectomy were discussed.

Aged↗