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Biomedical subjects

G Vadalà

Publications and source records attributed to G Vadalà.

At least 19 recordsLinked to original sources
PubMed2001

[Tension-free hernioplasty in the aged. A report of 94 cases].

BACKGROUND: Tension free inguinal hernioplasty has become the procedure of choice in the elderly. The operation of originally popularized by Lichtenstein and Shulman gives the best early result with low complication rates. METHODS: Between January 1991 and December 1996, 94 subjects over 70 with inguinal hernia were submitted to hernioplasty. The tension-free technique was adopted utilizing a polypropylene mesh. Peridural anesthesia was the method used in 67 procedures, local anesthesia in 27 procedures. RESULTS: The mean hospital stay was 48 hours (short stay surgery). Noteworthy general complications were not observed. Superficial wound infection occurred in 2 patients; superficial skin hematoma in 4 patients. No recurrences were observed (mean follow-up 60 months). The primary inguinal hernias in the aged is due to a progressive deterioration of the inguinal floor (collagenolylis, overpowers net collagen synthesis and deposition in the floor of the inguinal canal). CONCLUSIONS: Tension-free inguinal hernioplasty, originally popularized by Lichtenstein and Shulman, is simple to perform and gives excellent results with low complication rates. Current evidence suggests it as operation of choice in the elderly.

Age Factors↗
PubMed1999

[The hemorrhagic complication of peptic ulcer].

The hemorrhagic complication of peptic ulcer is a pathology which is still responsible for a high mortality. After reviewing the etiopathogenesis and physiopathology of hemorrhagic complications in the light of the recent discoveries regarding H. pylori, the authors report their experience and confirm the important role of surgery in the treatment of this pathology. Resolution is improved by the use of surgical staplers which are regarded as particularly valuable in emergency surgery where the need to cut operating times has undoubted advantages in terms of patient survival.

Adult↗
PubMed1999

[An update in the treatment of intra-abdominal abscesses].

BACKGROUND AND AIMS: Intra-abdominal abscesses represent a relatively severe complication in gastroenterological surgery owing to their association with high levels of morbidity and mortality. METHODS: The authors report their experience between January 1990 and January 1996 in 11 patients with intra-abdominal abscesses secondary to emergency surgery for gastroenterology in 10 cases and gynecology in 1 case. After the lesion had been identified using ultrasonography and CT, it was emptied, washed with antibiotic and drained using Seldinger's ultrasonographic and CT-guided technique. Small abscesses (less than 5 mm) were completed removed. RESULTS: The following results were obtained: the immediate disappearance of pain and fever, accompanied by improved general conditions, restoration of canalisation and closure of the abscess cavity (on average between 10 and 15 days). CONCLUSIONS: In conclusion, ultrasonographic-CT guided drainage of postoperative intra-abdominal abscesses, which were previously managed using surgical methods, appears to be the best treatment, relying on the use of imaging techniques and thereby allowing both morbidity and mortality to be reduced.

Abdomen↗
PubMed1999

[Splenic metastases].

Splenic metastases are found with a frequency varying from 2.4 to 7.1%. The primary tumours most often followed by metastases are breast, lung, pancreas and melanoma. They may also be the direct extension of retroperitoneal tumours and carcinoma of the pancreas. The authors report a case which came to their attention; by examining the literature, they discover the rarity of this pathology which confirms the possibility of this localisation for both intra-abdominal and extra-abdominal tumours.

Adenocarcinoma↗
PubMed1999

[Laparoscopic surgery of perforated duodenal ulcer].

BACKGROUND AND AIM: Endoscopic diagnostic and therapeutic possibilities have been increased by videolaparoscopy. The method enables an immediate reliable diagnosis to be made, associated with possible surgical treatment. METHODS: The authors report their laparoscopic experience relating to the treatment of perforated duodenal ulcer from 1972 to 1995 in 8 patients divided into two groups. Jacob Palmer's laparoscopic operator was used in the first group together with Menghini's needle for the aspiration of peritoneal effusion; the operation was performed under local anesthesia with nitrogen monoxide insufflation using Taylor's technique number I. The second group underwent ulcorrhaphy with omentopexy, again using a laparoscopic route, together with abundant lavage and accurate aspiration of fibrin. RESULTS: The patients in the first group made a prompt recovery in terms of their general conditions following the remission of fever, pain, diminished leukocytes and an early renewal of canalisation; cicatrisation of the ulcer was confirmed by the endoscopic control on day 15. Patients in the second group showed early deambulation approximately 4 hours after surgery; canalisation occurred after about 6 hours and all patients were discharged on day 3. The eradication of Helicobacter pylori led to complete resolution, as was confirmed by subsequent follow-ups. CONCLUSIONS: Laparoscopy was found to be extremely useful both in the immediate diagnosis of acute abdomen following perforated ulcer and in its surgical treatment as a result of the introduction of operating laparoscopes and in particular videolaparoscopes, together with surgical instruments that allow careful abdominal cleansing and ulcorrhaphy. In the authors' opinion, the latter procedure is the most suitable for managing this pathology.

Adult↗
PubMed1999

[Cholecystic-choledochal calculi. Endolaparoscopic treatment].

BACKGROUND AND AIM: Common bile duct calculosis is a pathology which has always been treated using traditional laparotomic surgery. The introduction of endoscopic papillosphincterotomy and mini-invasive and videolaparoscopic methods has drawn attention to the fact that these methods may be able to replace conventional surgery. METHODS: The authors examine the epidemiological and clinical aspects of common bile duct calculosis, reporting their experience in ten female patients treated during the period from 1992 to 1997, all of whom presented jaundice, pain and fever. Of these, eight underwent papillosphincterotomy using an endoscopic approach, followed by laparoscopic removal of common bile duct calculi within 24 hours. In two cases it was necessary to resort to conventional methods owing to difficulty in cannulating the papilla caused by a diverticulum in one patient and stenosis in the other, and the tenacious synechiae between the common bile duct and the gallbladder. RESULTS: The postoperative period was free of complications. CONCLUSIONS: The associated treatment, namely endoscopic papillosphincterotomy and endoscopic cholecystectomy proved a valid alternative to traditional laparotomic treatment, demonstrating a good level of reliability and safety for patients and reductions in terms of resources and hospitalisation time.

Aged↗
PubMed1999

[Use of surgical staplers in emergency surgery].

BACKGROUND AND AIM: Over the past decade the use of surgical staplers has resulted in a substantial change in both elective and emergency surgery for gastrointestinal pathologies. A large number of studies have now affirmed the safety, reliability, simplicity, rapidity and usefulness of these instruments. They offer many advantages, above all the possibility of shortening operating times and thus reducing morbidity and mortality, especially in emergency surgery. METHODS: The authors describe their experience in treating 68 cases of emergency intestinal resection from 1980 to 1997 which were treated with the help of automatic staplers. Twenty-three cases of hemicolectomy (right and left) were performed; 17 sigmoid resections for diverticulitis; 15 gastric sections using Billroth II; 7 Meckel's diverticuli; 6 total gastrectomies. GEA 50 and 75 staplers were used for the intestine, TA 50, 90, 90 Plus and Roticulator, Circular staplers for esophagus, stomach and rectum. Patients were predominantly male: 40 males and 25 females with a ratio of 2:1. RESULTS: Complications included a fistula caused by dehiscence of the esophagojejunal anastomosis which lead to death in 30 days; 3 cases of hemorrhage of the gastroenteric anastomosis which regressed with medical therapy. CONCLUSIONS: In conclusion, mechanical staplers have led to considerable savings in time and a reduced number of postoperative complications.

Adult↗
PubMed1999

[Update on the treatment of choledocholithiasis].

Primitive or residual common bile duct calculi following common bile duct surgery can now be treated with minimum surgery using an endoscopic or X-ray guided approach. Having examined the etiopathogenetic theories, the authors analyse the treatment, in particular the possibility of endoscopic papillosphincterotomy and X-ray guided dilatation of the papilla, affirming that the latter can be extremely valuable in cases where it is difficult to canalize the latter.

Adult↗
PubMed1998

[Ogilvie's syndrome].

"Ogilvie's syndrome" or the idiopathic dilatation of the colon is an infrequent pathology whose underlying physiopathology is not yet well known. On the basis of their experience and having reviewed the literature, the authors affirm that this syndrome is caused by the inhibition of gastrointestinal hormones which, under the control of the neurohypophysis, contribute to colon motility. This supposition is backed up by the fact that medical treatment with somatostatin or octreotide leads to the resolution of the disorder.

Adolescent↗
PubMed1998

[An update in the diagnosis and treatment of tumors of the hepatic portal].

BACKGROUND: Cholangiocarcinoma affecting the cross of the bile ducts is a tumour which has, although treatments, a high rate of mortality. METHODS: Between January 1986 and January 1996 six patients affected by Klatskin's tumor were studied; three of them underwent operation and were treated with insertion of a T tube (Kerr), whereas the other three were managed endoscopically with trans-tumoral stenting. RESULTS: The survival rate was about seven months for patients who underwent operation and fifteen months for patients managed with endoscopic stenting. CONCLUSIONS: After a review of the literature and according to personal experience, it is underlined that only an early diagnosis can achieve best results, since the latest knowledge about hepatic anatomy derived from transplants allows more extensive resections.

Aged↗
PubMed1996

[Treatment of stage IV breast carcinoma].

The authors report a study carried out in 4 patients with stage 4 breast cancer. The treatment protocol was selected according to age and the general conditions of patients. Two out of four patients were treated with adjuvant chemotherapy associated with cyclophosphamide, adriblastin, 5-fluorouracil and folic acid; one patient received neoadjuvant chemotherapy with the same treatment protocol, while the fourth patient was treated with hormone and immunotherapy. Results were satisfying given that survival was considerably increased in 3 patients together with an improvement in general conditions.

Breast Neoplasms↗
PubMed1995

[Laparoscopic appendectomy].

The authors report their experience of 6 cases of appendicectomy using a laparoscopic route of which 5 were performed under local anesthesia and 1 under general anesthesia. The results indicate that this new technique is easy to perform and as rapid and safe as the traditional operation. The possibility of using local anesthesia, the lack of complications when operating on obese patients, the lower incidence of wound infections and rapid postoperative mobilisation all argue in favour of this alternative approach to conventional open surgery.

Adolescent↗
PubMed1995

[Complications of ileal lymphoma].

Non-Hodgkin lymphoma of the ileum accounts for some 3% of all extranodal onset lymphoma and 20% of gastrointestinal lymphoma given that the ileum is more frequently affected than the jejunum and duodenum. The large majority of primary extranodal lymphomas present a diffuse histological structure and in particular involve the cervico-fascial and gastrointestinal regions. Moreover, it is not uncommon to find an association between gastroenteric involvement and Waldeyer's ring (cervico-fascial region). Primary intestinal involvement may not present specific symptoms and remain silent for some time. It is manifested by the onset of complications caused by occlusion and perforation. Two cases of ileal lymphoma were treated at the Institute of Emergency Surgery of Catania University between 1992 and 1993. They were complicated by intestinal perforation and occlusion respectively. Both patients underwent emergency intestinal resection. Surgery represents the elective treatment for primary forms, followed by polychemotherapy and radiotherapy. Prognosis depends on the spread of disease and the hystotype. The administration of NTP and somatopstatin resulted in a shorter postoperative period with fewer surgical complications.

Combined Modality Therapy↗
PubMed1994

[Synchronous tumors of the colon].

Although rare, synchronous tumors of the colon represent an important clinical manifestation of cancer of the colon. The paper reports a study carried out in 437 patients with the aim of evaluating the incidence of synchronous tumours and identifying the most useful diagnostic tools for diagnosis. On the basis of the results obtained the authors conclude that the incidence of synchronous tumours of the colon ranges between 1-3% and that in comparison to other methods pancolonoscopy enables a complete diagnosis for a prophylactic approach to multiple tumours.

Adenocarcinoma↗