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G Ceccarelli

Publications and source records attributed to G Ceccarelli.

At least 19 recordsLinked to original sources
PubMed2006

[Laparoscopic colon-sigmoid resection with mesenteric artery preservation for diverticular disease].

AIM: About 2/3 of the Western population over the age of 80 years are affected by colic diverticulosis; 25% will develop diverticular disease with or without complications: fistula, obstruction, pericolic abscess, free perforation or hemorrhage. Laparoscopic approach for benign diseases of the colon such as diverticulosis, Chrohn's disease, etc. is unanimously considered as a very effective procedure. We have performed a retrospective analysis of 9 years with laparoscopic approach of the diverticular disease. The purpose of this study was to determine the feasibility, safety and benefits of laparoscopic approach. METHODS: From May 1994 to November 2002, 69 patients affected by non-complicated diverticular disease, were treated laparoscopically, at the Mininvasive Surgery Department of Spoleto. In the same period other 213 patients suffering from cancer of the colon-rectum were operated through laparoscopic surgery. A colosigmoid resection with mesenteric inferior artery preservation was performed in 46 cases (67%). RESULTS: We have performed only a laparoscopic colectomy technique (no hand-assisted procedures); the convertion rate was of 7.2%, the mean operative time was 145 min, no intraoperative complications were observed and finally the mean hospital stay was of 7.4 days (6-9). The postoperative complications were 1 case of infection of the umbilical scar and 1 case of pleural effusion with bronchopneumonia. CONCLUSIONS: Elective laparoscopic colectomy for diverticular disease is feasible, safe and gives very good results: minimum postoperative discomfort, rapid recovery, low mobility and postoperative stay, rapid return to normal activities. However, in some cases, this procedure can be extremely difficult because of previous inflammatory complications (adhesions, fistulas or stenosis), therefore, high surgical skills in laparoscopic-colic surgery are required.

Aged↗
PubMed2006

The biliopancreatic diversion. A comparison of laparoscopic and laparotomic techniques.

AIM: Morbid obesity has increased its frequency in the last 20 years in association with the increase of a country's richness. Bariatric surgery has developed a role which is becoming more and more important. The aim of this study, after 10 years of experience with the biliopancreatic diversion, is to compare the laparoscopic versus open technique RESULTS METHODS: From March 1993 to December 2004, 150 patients were operated by biliopancreatic diversion. We divided our experience into 2 groups: laparotomic and laparoscopic techniques. We compared the following variables in the 2 groups: total operating time, intestinal functions, postoperative pain, patient's discharge and recovery time, major postoperative complications, postoperative mortality, late complications, incisional hernia incidence and anastomotic ulceration. RESULTS: We found a significant difference in both the reduction of the postoperative pain and the recanalization time in the laparoscopic group. Equally, we found a reduction in the incidence of abdominal wall complications, especially the reduction of incisional hernia and infections. The mean operative time was longer in the laparoscopic group, in particular due to the hard learning curve. CONCLUSIONS: The laparoscopic biliopancreatic diversion is a feasible and safe operation with good results: less postoperative discomfort, shorter recanalization and ospedalization time, less incidence of abdominal wall morbidity (incisional hernia). However, the procedure may prove difficult and it needs a highly experienced surgeon in laparoscopic technique.

Journal Article↗
PubMed2005

[Non palpable lesions of the breast: the Mammotome-biopsy in the preoperative management of breast cancer].

BACKGROUND: Breast tumour takes first place for frequency in women in Western Countries and is in constant increase. The diagnosis of the so-called non palpable lesions is increased remarkably above all due to the diffusion of mammographic screening and to a greater awareness of the problem. Furthermore it is helped by an important development of mininvasive diagnostic methods: the traditonal cytology with fine needle is supported by various trans-skin bioptic procedures (micro-histological examination). This methods almost always replaces the surgical excisional biopsy and frozen intraoperative examination, still used but reserved for particular cases. PATIENTS AND METHODS: In our Department of General and Mininvasive Surgery, from December 1999 to September 2004, we carried out 214 biopsies, with the collaboration of the radiological Service, under echographic guidance using vacuum--assisted biopsy (Mammotome) with 11-Gauge needle. The results are examined and discussed here in this report with regard to diagnostic accuracy, quantity and quality of information, significant for subsequent surgical management. RESULTS: Of 214 biopsies carried out with Mammotome technique, 89.3% of the cases are clinically non palpable lesions, with a average diameter of 8 mm. The average age of patients was 57.6 years (range 31-88). There are 90 cases of positive malignant pathology (42%). In the atypical ductal iperplasia and radial scar cases (6%) surgical removal of lesion was carried out which confirmed the previous bioptic diagnosis in 100% of cases. The 19% of patients submitted to a Mammotome biopsy was subject previously to cytology with fine needle. Comparing the results of both methods the diagnostic reliability of Mammotome was significantly superior (p < 0.05) as also the amount of information obtained (histotype, invasivity, grading, estrogen receptor, etc.); discomfort linked to the procedure, valued as pain (VAS), resulted inferior to the discomfort of biopsy with fine needle. The only complication of Mammotome biopsy is represented by haematoma in the biopsy site (8% of cases). The number of false negatives was one case due to incorrect targeting. CONCLUSION: In the present situation, the choice of method is conditioned by the degree of radiological suspicion, taking into account the information obtained thereby, in order to ensure the appropriate surgise management. Mammotome biopsy of non palpable lesions of the breast, in our experience, is preferable if suspicion of malignancy is high. In this way a correct preoperative strategy can be prepared. Including the sentinel lymphnode method. Consequently a decision regarding the type of surgery can be taken (generally conservative), as well as making easier the intraoperative localisation of lesion by positioning the metallic clips during biopsy.

Adult↗
PubMed2004

[Neoplastic residues in the trocar tract in oncologic laparoscopic surgery].

AIM: The laparoscopic approach to malignant diseases runs up against both old and new problems: respect for the principles of radicality, operating times, the postoperative course and surgical complications, long-term oncological results in terms of survival and recurrence of the disease. One of the problems which has received most attention regards the onset of a metastasis on a trocar scar or a mini-laparotomy recurrence. Trocar site tumor recurrences have been described in the literature following laparoscopic surgery in almost all abdominal malignant pathologies (colorectal, gynaecological, pancreatic, etc.) and even after thoracoscopy. The real frequency is currently of the order of 1% (0-2%) in colic surgery and of 14% (10-17%) after cholecystectomy for occult gallbladder carcinoma. METHODS: A retrospective survey was carried out of our laparoscopic experience; between 1994 and 2002 213 colic resections were carried out for cancer; we also observed 18 occult carcinomas of the gallbladder in 2386 laparoscopic cholecystectomies for lithiasis. RESULTS: Respectively 2 cases (11%) of trocar site neoplastic recurrences in gallbladder carcinoma and 2 cases (0.9%) from colon carcinoma were observed. CONCLUSIONS: The real extent of the problem would appear to be on a much lesser scale at the moment than was initially thought, especially as regards colic surgery. The multifactorial aetiology of the problem explains the importance of their prevention, on the basis above all of rigorous respect for the rules and protocols of laparoscopic technique.

Aged↗
PubMed2004

[Russell's syndrome: a case of long-term survival and review of the literature].

We report the case of a two years old, normally eating child, affected by organic macies and severe dystrophy. After the negative response of blood and laboratory examinations let us exclude a malabsorption syndrome, only the performance of neuro-radiologic exams showed evidence of a subthalamic tumor as the cause of a "Diencephalic syndrome". Diencephalic syndrome or Russell's syndrome is a diencephalic tumor induced disease, which sets in the first time of life. The disease clinical markers are a severe emaciation with appetite preservation and absence or very scarce evidence of any telltale neurological sign. The tumoral histo-pathology most frequently shows a low grade of malignancy astrocytoma, whose eradication is very often difficult because of particular anatomic site. Treatment of choice includes an excisional biopsy with chemotherapy and radiotherapy. We report a clinical case of long-term survival and review of the literature.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2003

[Archeology in medicine: digging up into the tophi of Popes, Dukes and Kings].

According to an Anglo-Saxon pun, "gout is the king of diseases and the disease of Kings". In fact, it is well-known that in past times a quantity of famous persons, including Kings and Popes, were affected with this rheumatic disorder. In this paper biographical anecdotes on several Popes (Pius III, Julius II, Julius III, Clement VIII, Innocent XI, Clement XII and Pius VIII), King George IV and Queen Anne of England, as well as on some members of the Lorraine lineage, all suffering from gout, are sketched out. These historical data are briefly discussed in relation to the celebrated Hippocrates's aphorisms on gout.

Catholicism↗
PubMed2003

[Laparoscopic right hemicolectomy with intracorporeal anastomosis. Technical aspects and personal experience].

BACKGROUND: Laparoscopic colo-rectal surgery has gained wide acceptance as a treatment in a variety of benign and malignant diseases. The reproducibility and safety of all the principal colo-rectal procedures has been demonstrated, but some indications are still controversial. A great part of surgeons perform right hemicolectomy by laparo-assisted technique and consider it more difficult than left hemicolectomy. METHODS: A retrospective analysis of a series of 180 laparoscopic colon resections performed between 1994 and 2001 is presented. Surgical indications were: 46 cases of benign disorders and 134 colonic malignancy. The right hemicolectomy were 27 (15%): 2 benign and 25 malignant diseases. The technical aspects of completely laparoscopic right hemicolectomy is described in details. A completely mechanical intra-corporeal anastomosis is always performed. To remove the bowel specimen from the abdominal cavity it is put it in a large bag and pull it out of a 3-4 cm enlargement of a trocar-site (in the umbilical scar). RESULTS: Data of the 27 laparoscopic right hemicolectomy were analysed: there was 1 conversion to open surgery; no intra-operative complications were observed; the postoperative period was complicated by 1 anastomotic fistula. The median operative time was of 150 minutes. No case of port-site recurrence was observed. CONCLUSIONS: The laparoscopic colo-rectal surgery can reproduce in selected patients, the techniques performed in open surgery with minimally invasive treatment. It is possible to perform a completely laparoscopic right hemicolectomy after an adequate training in advanced laparoscopy, anyway there are many advantages: less postoperative pain, short-term postoperative ileus, earlier return to daily activity.

Adult↗
PubMed2000

Combined treatment of fourth ventricle ependymomas: report of 26 cases.

BACKGROUND: This study investigated the relevance of prognostic factors and the impact of histological features in posterior fossa ependymoma. METHODS: The charts of 26 patients (aged 1-59 years, mean 20.6 years; 11 adults) with posterior fossa ependymoma operated on between January 1983 and December 1994 were reviewed and patients followed up (mean: 93 months). RESULTS: Gross total resection was performed in 18 patients (69%), subtotal in seven patients (27%), biopsy in one patient (4%). One patient (3.8%) developed respiratory complications and died. All patients underwent posterior fossa radiotherapy (5000 cGy) after surgery. Four children first received chemotherapy and then radiotherapy only when at least 3 years old. Eleven patients (42%) received radiotherapy and subsequently chemotherapy. The 5-year survival rate was 90% for adults and 40% for children (</= 6 years). CONCLUSIONS: This review suggests that a) younger patients (</= 6 years), despite multimodality treatment, have a poor prognosis; b) the microanatomical location of the tumor (lateral recess, roof, and floor) influences the extent of tumor removal (p < 0.05); c) longer survivals are associated with complete removal (p < 0.05); d) the histological feature most often related to a poor prognosis is a high mitotic index (p < 0.05), whereas vascular proliferation (p = 0.149), necrosis (p = 0.215), nuclear atypia (p = 0.384) and high cellularity (p = 0.786) do not affect survival; e) histological classification (WHO) does not reflect different survival rates between ependymomas and anaplastic ependymomas (p = 0.082).

Adolescent↗
PubMed2000

Shoulder-hand syndrome in neurosurgical patients treated with barbiturates. A long term evaluation.

OBJECTIVES: To assess the incidence of shoulder-hand syndrome (SHS) in neurosurgical patients (head injuries, intracranial ruptured aneurysms and intracranial meningiomas), treated with barbiturates. SHS is a chronic condition characterized by intense tenderness and functional impairment affecting one hand, the shoulder or both. Barbiturates have been identified as cause of SHS, although there is controversial evidence on the incidence of this disorder in patients started on long-term Phenobarbital (PB) therapy. METHODS: One hundred and twenty-six neurosurgical patients, treated with barbiturates, and a control group of 108 patients, treated with carbamazepine or phenytoin, were enrolled. Both groups were followed up for at least 24 to 36 months. RESULTS: Thirty-five PB-treated patients (27.6%) experienced SHS. In these patients SHS developed during the first 7 months of therapy and regressed after PB discontinuation or, in 2 cases, after dosage reduction. None of the patients in the control group developed SHS. CONCLUSIONS: The occurrence of SHS in the study group was much more common than that reported previously. This higher incidence should depend upon the coexistence of separate risk factors such as age over 50 years, surgery and intracranial pathology. Early diagnosis and rapid withdrawl of treatment are important for symptomatic relief and full functional recovery.

Adult↗
PubMed1998

[Varicocele. Ligation of the internal spermatic vein using laparoscopic approach].

It is now unquestionable that varicocele represents one of the main causes of male infertility, and thus requires appropriate surgical treatment. Inguinal and retroperitoneal methods have for some time been the most widely used. However, a significant postoperative morbidity and relatively long convalescence have prompted the search for alternative surgical techniques, such as percutaneous sclero-embolisation and microsurgery. Laparoscopic treatment of varicocele is a relatively recent surgical technique. The first studies by Sanchez de Badajoz date back to 1988 and to date a relatively small number of cases have been reported. The authors analyse the results in 54 patients treated over a period of two and a half years; 13 cases also presented inguinal hernia pathology which was treated during the same operation by applying a polypropylene graft again using a laparoscopic approach; the latter method has been routinely applied since 1992 in over 1000 cases with excellent results. The internal spermatic artery was always identified and preserved. No peri- or postoperative complications were observed. A follow-up was performed at 10 months after surgery and showed results which although referred to a relatively small series, were certainly better than those reported in the literature using traditional surgical techniques; in addition, this method also reveals interesting possibilities for the treatment of associated pathologies during the same operation, with obvious advantages in terms of costs and patient compliance.

Adolescent↗
PubMed1998

Mortality and morbidity in patients operated on for ruptured intracranial aneurysms.

It is generally agreed, mortality and morbidity rates, in patients operated on for ruptured intracranial aneurysm, strictly depend upon the state at admission. Nevertheless, a precise definition of surgical mortality is still not available. Even the term morbidity still remains rather controversial for the lack of accurate evaluation scales. The wide range of parameters, affecting the composition of sample and outcome of patients, such as age, blood at CT scan and atherosclerosis at angiography, makes harder a correct statistical analysis of mortality and morbidity. Moreover, the gap between bleeding and admission, the management and choice of treatment, the selection of unicentric or multicentric studies, the level of the hospital introduce even more striking bias errors. Recent papers reported concrete improvements obtained by means of both aggressive therapeutical behaviour and adequate intensive care management. Among factors, producing improvement of the overall outcome, have to be also reported the encouraging preliminary results supplied by the interventional neuroradiological techniques. However, the overall mortality rate of SAH remains high. Thus, a coded scheme for detection and prevention of risk factors significatively associated to mortality and outcome can be only worked out by employing an appropriate therapeutical behaviour and an adequate intensive care management. Furthermore, employment of feasible evaluation scales will be essential to point out the most accurate procedure for management and treatment of patients with intracranial ruptured aneurysm. We think CESE, developed by one of the authors, to be considered as an adequate method for the assessment of results at follow-up.

Aneurysm, Ruptured↗
PubMed1997

Toxicity of ricin and volkensin, two ribosome-inactivating proteins, to microglia, astrocyte, and neuron cultures.

Ricin and volkensin, two potent toxins belonging to the family of ribosome-inactivating proteins (RIPs), have been largely exploited in recent years in in vivo experiments of neuronal degeneration consequent to suicide transport or immunolesioning. We have determined both the toxicity of, and the inhibition of, protein synthesis by ricin and volkensin in in vitro cultures enriched in microglial cells, astrocytes, or neurons. In microglial cultures, 50% of toxicity (estimated by LDH released from dead cells) after 24 h exposure to RIPs was obtained with volkensin at 2.2x10(-12) M concentration and 50% of protein synthesis inhibition at 2x10(-14) M concentration. Both values were higher by about one order of magnitude in astrocyte-enriched cultures. Toxicity of, and inhibition of, protein synthesis by, ricin were lower for both cell types by about 1 order of magnitude as compared to volkensin. Cerebellar granule neurons in culture survived remarkably well to 24 h exposure to ricin or volkensin, although their protein synthesis was effectively inhibited by the two toxins with a potency similar to that found for astrocytes. These results demonstrate that glial cells, in particular microglia, are very sensitive to RIPs toxicity and should, therefore, be a primary target of these toxins when injected in vivo. Thus, the damage observed after in vivo experiments could be partly related to diffusion of toxic substances from early-affected glial cells.

Animals↗
PubMed1994

[Leprosy in the Bible].

"Leprosy" quotations in the Old and New Testament are quite well-known. The problem however exists if biblical "leprosy" is really the Hansen' disease or this name is referred to some other clinical situations. The paper evaluates the various possibilities and a "new" interpretation of the biblical meaning of "leprosy" is proposed.

Bible↗
PubMed1993

[Odontostomatology in the Bible].

Quotations in the Bible referring to the mouth and teeth are reported and commented on; special attention is addressed to the fact that, according to Bible Authors, teeth are more important from the socio-cultural and legal than from the medical point of view.

Bible↗