Biomedical subjects

Francesca Rovera

Publications and source records attributed to Francesca Rovera.

31 records · Page 2Linked to original sources

PubMed2006

Technological advances in minimally invasive surgery.

Advances in technology continue at a rapid pace affecting several aspects of life; medicine is no exception. Minimally invasive surgery is, by its nature, a highly technological specialty of surgical practice. The development of new instruments and new technologies during the last few years have allowed complex procedures that were previously considered unsuitable for minimally invasive surgery. The aim of this article is to review some of these advances and the impact they are having on the managements of different surgical problems.

Biotechnology↗

PubMed2006

Thyroid surgery: new approach to dissection and hemostasis.

The essential objectives for thyroidectomy are avoidance of injury to the recurrent laryngeal nerves (RLNs), conservation of the parathyroid glands, an accurate haemostasis, and an excellent cosmesis. In the last 10 years, major improvements and new technologies have been proposed and applied in thyroid surgery, among these mini-invasive thyroidectomy, regional anaesthesia, and intraoperative neuromonitoring. Moreover, new devices for achieving dissection and haemostasis have been proposed. The purpose of ligating vessels is to maintain the surgical site free from an excess of blood and reduce blood loss in patients. This chapter reviews relevant medical literature published in the English language since 1990 on thyroid surgery techniques with well-controlled trials on haemostasis and dissection. Searches were last updated October 2005.

Clinical Trials as Topic↗

PubMed2005

Surgical resection for gastrointestinal stromal tumors (GIST): experience on 25 patients.

BACKGROUND: Gastrointestinal stromal tumors (GIST) are infrequent and diagnosis and prognosis could be troublesome. We present short and long term results of surgical resection for GIST at the Department of Surgery, University of Insubria, during a period of 17 years. MATERIALS AND METHODS: All patients' data, tumor characteristics, surgical procedure and survival data were analyzed retrospectively. Tumors were divided in risk classes using the classification proposed by Fletcher, based on tumor size and number of mitosis. RESULTS: Between 1987 and 2004, 25 patients underwent surgical resection for GIST. Stomach was the most common site of localization. Complete resection was achieved in 88% cases, while in 12% radical resection was not possible. The mean tumor size was 9.2 cm (1.2-30 cm): <5 cm diameter in 14/25 cases (56%), 5-10 cm in 5/25 (20%) and >10 cm in 6/25 (24%). Mitotic count was <10/50 HPF in 68% (17/25) and >10/50 in 32% (8/25). Using Fletcher's classification, tumors were divided in very low (11/25, 44%), low (4/25, 16%), intermediate (6/25, 24%) and high-risk (4/25, 16%) groups. The 5-year overall survival was 65% and 34% respectively with a statistically significant difference between tumors <5 cm and >10 cm in diameter and between complete and incomplete resection. High-risk tumors had a significantly shorter survival than low or very low risk. CONCLUSION: Our experience confirms that GIST's are uncommon and aggressive cancers. The prognosis is strictly related to tumor size and number of mitosis. Although significant advances on new chemotherapeutic regimes have been made, to date, only radical surgery offers the chance of long-term survival.

Duplicate Publication↗

PubMed2005

Injection of colorectal cancer cells in mesenteric and antimesenteric sides of the colon results in different patterns of metastatic diffusion: an experimental study in rats.

BACKGROUND: This experimental study was designed to investigate the differences in pattern of local growth and diffusion of colorectal cancer cells injected into either mesenteric (M) or antimesenteric (AM) sides of the colon. METHODS: A total of 1 x 10(6) colonic adenocarcinoma cells (line DHD/K12-TRb) were injected into the cecal wall of BDIX syngeneic male rats at an M or AM site of the colon. At six weeks after injection, all animals were sacrificed and the presence or absence of tumor in the cecum as well as regional metastasis and peritoneal carcinomatosis were determined. RESULTS: Six weeks after injection, macroscopic tumor growth was observed in 27/37 (72%) animals in group M and 21/32 (65%) in group AM (P = 0.98). In group AM, diffuse peritoneal carcinomatosis was present in 19/21 rats (90.4%) versus 3/27 rats (11%) in group M; this difference was statistically significant (P = 0.025). Regional mesenteric lymph nodes were the only location in which tumor was detected in 23/27 rats (85%) in group M versus 2/21 (9.5%) in group AM; this difference too was statistically significant (P = 0.031) CONCLUSION: The patterns of diffusion of tumors implanted in mesenteric and antimesenteric sites of the colon appear to be different, although the reason for this is not clear.

Journal Article↗

PubMed2005

Antibiotic prophylaxis in colorectal surgery.

Nosocomial infections are the most frequent complications observed in surgical patients. In colorectal surgery, the opening of the viscera causes the dissemination into the operative field of microorganisms originating from endogenous sources, increasing the chance of developing postoperative complications. It is reported that without antibiotic prophylaxis, wound infection after colorectal surgery develops in approximately 40% of patients. This percentage decreases to approximately 11% after antibiotic prophylaxis. Specific criteria in the choice of correct antibiotic prophylaxis have to be respected, on the basis of the microorganisms usually found in the surgical site, and on the specific hospital microbiologic epidemiology.

Anti-Bacterial Agents↗

PubMed2005

Influence of new technologies on thyroid surgery: state of the art.

The history of thyroid surgery starts with Billroth, Kocher and Halsted, who developed the technique for thyroidectomy between 1873 and 1910. In general, the essential objectives for thyroidectomy are conservation of the parathyroid glands, avoidance of injury to the recurrent laryngeal nerve, an accurate hemostasis and an excellent cosmesis. In the last 20 years, major improvements and new technologies have been proposed and applied in thyroid surgery; among these are mini-invasive thyroidectomy, new devices for achieving hemostasis and dissection, regional anesthesia and intraoperative neuro-monitoring.

Biotechnology↗

PubMed2003

Infections in 346 consecutive video-assisted thoracoscopic procedures.

BACKGROUND: Postoperative infections, as related to risk factors, in patients undergoing video-assisted thoracoscopic surgery (VATS) procedures have been studied infrequently. MATERIALS AND METHODS: We evaluated 346 consecutive patients who underwent VATS procedures between October 1996 and June 2002 at our center. Patients preoperatively were free of chest infections and were divided into two groups: Group A (n = 139) who underwent lung wedge resection; group B (n = 207), who underwent pleural biopsy (n = 183) or biopsy of a mediastinal mass (n = 24). We recorded prospectively the following preoperative infection risk parameters: Hemoglobin concentration, hematocrit, serum albumin concentration, lymphocyte count, length of preoperative stay, duration of surgery, blood transfusion, age, comorbidity, and chronic obstructive pulmonary disease specifically (COPD, measured as FEV(1) <70% of expected). Short-term antibiotic prophylaxis was given to 94% of patients in group A and to 90% of patients in group B. As outcome measures we recorded the occurrence of postoperative infections within 30 days (surgical site infection, pneumonia, empyema) and the final patient outcome. RESULTS: Patients who developed postoperative infections (all the above types included) were 17/346 (4.9%), the difference between group A (5.0%) and group B (4.8%) being not significant. The overall surgical site infection rate was 1.7%. Groups A and B showed a similar incidence of surgical site infection (2.8% vs. 1.0%; p = NS), of pneumonia (2.8% vs. 3.4%; p = NS), and of empyema (0.7% vs. 2.0%; p = NS). Among assessed infection risk parameters, a FEV(1) <70% of expected was the only parameter associated with a significantly increased incidence of surgical site infection (p < 0.05). CONCLUSIONS: This prospective study confirms that the wound infection rate is low (1.7%) after minimally invasive VATS procedures. The cumulative incidence of postoperative infections (including wound infection, pneumonia, empyema) was similar after lung wedge resection and after pleural or mediastinal mass biopsy procedures. Among the infection risk parameters, COPD was the only parameter associated with a significantly increased incidence of postoperative infection. Our results suggest that patients with COPD who undergo VATS for lung wedge resections and for pleural/mediastinal biopsy should receive antibiotic prophylaxis to prevent surgical site infection.

Adult↗

PubMed2003

The rationale of early enteral nutrition.

Malnutrition is a well-known risk factor significantly influencing the occurrence of postoperative infectious complications. There is consensus that nutritional support is an essential component of the multidisciplinary treatment of surgical and critically ill patients. Nutritional support of surgical patients can be carried out with different modalities, depending on the underlying disease and on the patient's general condition. Several studies have shown that the early administration of enteral nutrition promotes the restoration of gastrointestinal mucosa integrity; with total parenteral nutrition such beneficial effect is not observed. The timing of feeding also influences the clinical outcome. During the last few years, standard enteral preparations have been modified by the addition of immunonutrients, such as arginine, glutamine, omega-3 fatty acids, nucleotides and others. These substrates have been shown to up-regulate host immune responses, to control inflammatory responses and to improve nitrogen balance and protein synthesis after injury. A recent study reported that in patients with cancer of the gastro-intestinal tract the nutritional supplementation given only preoperatively was as effective as the combined pre- and postoperative (perioperative) approach, and it could reduce gastro-intestinal side effects. This is probably due to the effect of the immune-enhancing diet on the immune and inflammatory responses.

Adjuvants, Immunologic↗

PubMedDate not supplied

Tubular adenoma of the breast in an 84-year-old woman: report of a case simulating breast cancer.

Tubular adenomas of the breast are rare and they mainly occur in young women. They must be differentiated from other benign lesions and from malignant breast cancer. Preoperative diagnosis is difficult because both radiologic and cytohistologic examinations performed before surgery are often not diagnostic; therefore, in most cases, surgical excision is the only way to reach a precise diagnosis and a definitive treatment. This article describes a case of an 84-year-old woman suffering from tubular adenoma of the breast. The authors underline the difficulty in preoperative differentiation between benign and malignant breast lesions.

Adenoma↗

PubMedDate not supplied

Idiopathic sclerosing encapsulating peritonitis: a case report.

Sclerosing encapsulating peritonitis is an uncommon but potentially lethal condition, which can lead to severe complications such as bowel obstruction, enterocutaneous fistualas and necrosis. The treatment is debated because of the high morbidity and mortality of the surgical approach. The aim of this study was to contribute to achieving a better approach to surgical treatment of sclerosing encapsulating peritonitis. This report describes an even rarer case of idiopathic sclerosing encapsulating peritonitis diagnosed intraoperatively, observed in the Insubria University Department of Surgery in Varese, Italy, where surgery was mandatory due to the sudden onset of the disease and lack of a definitive diagnosis. Temporary ileostomy and partial resection of the peritoneum were performed. At present (December 2002) the patient is alive and well. Management of sclerosing encapsulating peritonitis is controversial, but the surgical treatment should be as conservative as possible. Guidelines for the treatment of sclerosing encapsulating peritonitis are needed.

Humans↗

PubMedDate not supplied

The PRE.DI.CA. project for radiographic lung cancer screening in cigarette smokers.

In heavy cigarette smokers and former smokers who have accumulated a high risk of lung carcinoma, a primary objective is early detection. Annual chest x-ray screening is a readily available, low cost method to detect asymptomatic lung carcinoma at an early stage (stage I) and, after radical resection, to improve the 5-year survival rate. A project of annual chest x-ray screening, named PRE.DI.CA. was started, for the early diagnosis of asymptomatic lung cancer in the high risk population of heavy cigarette smokers and former smokers, males and females, aged 45-75 years, in the province of Varese. Over a 7-year period, 4.598 heavy smokers enrolled in the PRE.DI.CA. lung project underwent 14.461 chest x-ray examinations. 45 asymptomatic lung cancers were detected and defined histologically. In the province of Varese it was possible to establish early diagnosis of lung carcinoma with annual chest x-ray screening of asymptomatic high risk smokers. 52% stage I diagnosis was achieved at the incidence screening.

Aged↗

PubMedDate not supplied

[Major thoracic trauma--sternal trauma].

From 1999 to 2003, 101 patients (M/F = 83/18, mean age = 46 +/- 18 y) with thoracic trauma have been admitted to the Center for Thoracic Surgery in Varese. Over 50% of pts. with major thoracic trauma were treated by chest tube drainage; however, surgery was necessary just in 16/101 pts.; 29 pts. were admitted to ICU; deaths were 3/101. The Authors recorded 23/101 sternal fractures. Routine blood test, chest radiography and EKG were performed in all patients; in case of abnormal EKG, echocardiography was performed; in case of widened mediastinum, chest CT was mandatory. 13/23 pts. showed associated injuries, 12 pts. a non-aligned sternal fracture, 7 pts. mediastinal hematoma. Simple observation in hospital was indicated in 15/23 pts. with sternal fractures; chest tubes were positioned in 3 pts. (hemopneumothorax) and one patient was surgically treated because of painful sternal pseudoarthrosis (2 months after trauma). Admission in ICU was necessary in 3 pts. with non-aligned sternal fracture, mediastinal hematoma and associated injuries. No patient with sternal fracture died.

Female↗

PubMedDate not supplied

The surgeon's approach to preoperative evaluation of esophageal cancer: recent developments.

Esophageal resection for cancer is still associated with high morbidity and mortality. Postoperative complications may be either patient- or surgeon-related. Patient-related factors include age, malnutrition, immunodepression and associated diseases. Surgeon-related factors are surgical experience, hospital volume and multidisciplinary approach. In the last 20 years major improvements and new technologies have been proposed and applied in esophageal surgery: its evolution depended on a thorough knowledge of surgical anatomy and technique, as well as on important developments in pre- and postoperative care. Preoperative evaluation is defined as the process of clinical assessment that precedes the induction of anesthesia. The principle is to gain information about the patient that could lead to modify his/her management, and improve outcome.

Colon↗