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Biomedical subjects

L Lepre

Publications and source records attributed to L Lepre.

At least 37 records · Page 2Linked to original sources
PubMed1997

Idiopathic recurrent pancreatitis successfully treated by hepatic vagotomy.

Idiopathic recurrent pancreatitis and sphincter of Oddi disorders have been increasingly found to be concomitant problems. Treatment of this condition requires disruption of the integrity of the sphincter of Oddi. The case of a 16-year-old girl with sphincter of Oddi motor disorders and idiopathic recurrent pancreatitis who was successfully treated with hepatic vagotomy. This result, if confirmed, could add to our present knowledge of the physiopathology and pathogenesis of sphincter of Oddi motor disorders.

Acute Disease↗
PubMed1996

Is there a causal connection between bile acids and colorectal cancer?

Bile acid composition was assessed in 50 patients with colorectal cancer as compared to that in a control group of 50 subjects. The two groups were age- and sex-matched. The overall bile acid values were similar in both groups, while the relative concentrations of primary and secondary bile acids were different, a significant increase in the patients with colorectal cancer being observed. This finding thus seems to confirm the existence of a link between colorectal cancer and cholelithiasis. Both conditions share common risk factors, such as alterations in cholesterol metabolism and bile acid composition.

Adult↗
PubMed1996

The long-term outcome of hepaticojejunostomy in the treatment of benign bile duct strictures.

OBJECTIVE: The authors review the treatment and outcome of patients with benign bile duct strictures who underwent biliary enteric repair. SUMMARY BACKGROUND DATA: The authors conducted a retrospective review of all clinical records of patients referred for treatment of benign bile duct strictures caused by surgery, trauma, or common bile duct lithiasis or choledochal cyst. The authors performed univariate and multivariate analyses of clinical and pathologic factors in relation to patient outcome and survivals. METHODS: Eighty-four patients with documented benign bile duct strictures underwent hepaticojejunostomy, choledochojejunostomy, and intrahepatic cholangiojejunostomy during a 15-year period (January 1975 to December 1989). Morbidity, mortality, and patient survival rates were measured. RESULTS: Early and late outcomes correlated neither with demographic and clinical features at presentation nor with etiologic or pathologic characteristics of the stricture. Best results correlated with high biliary enteric anastomoses and degree of common bile duct dilatation independently of bile duct stricture location. CONCLUSIONS: High biliary enteric anastomosis provides a safe, durable, and highly effective solution to the problem of benign strictures of the bile duct. Transanastomotic tube stenting is unnecessary. Endoscopic and percutaneous transhepatic dilatation seems more appropriate for the treatment of patients in poor condition and those with anastomotic strictures.

Adult↗
PubMed1996

[The role of identification of the recurrent laryngeal nerve in thyroid surgery].

Recurrent laryngeal nerve paralysis in the most serious complication of thyroid surgery. Five-hundred and sixty eight-consecutive operations for benign disease of the thyroid were retrospectively analyzed. Bilateral identification of the inferior laryngeal nerve was performed in 447 cases, whereas in 121 patients the identification was unilateral. The rate of primary postoperative vocal cord paralysis was 3.7% and permanent palsy rate was 0.8%. Present results compared with those of Literature confirm that recurrent nerve paralysis is a less frequent complication when the nerve is routinely identified and correctly prepared.

Female↗
PubMed1995

[Cholelithiasis and diabetes].

The occurrence rate of diabetes was analyzed in 3370 consecutive patients admitted and surgically treated for biliary lithiasis at the I Department of Surgery-University of Rome "La Sapienza"-between 1959 and 1993. The incidence of such association was found to be overlapping with that of normal population. The natural history and the outcome of patients surgically treated for biliary lithiasis do not seem to be burdened by a concurrent diabetes. Diabetes was in turn found to be correlated with a more frequent presence of stones in the biliary tract. Possible causes of this correlation are discussed. The need in these patients of a more accurate diagnostic approach and specific therapeutic solutions is stressed.

Adult↗
PubMed1995

[Mirizzi syndrome. Diagnostic and therapeutic considerations on 27 cases].

Mirizzi's syndrome is characterized by compression and/or stenosis of the common bile duct as a consequence of a stone impaction in the cystic duct or in the gallbladder neck. Clinical outcome, diagnostic pathway and operative management in 27 patients are presented. Ultrasound is referred as the first screening method, while E.R.C.P. and/or percutaneous transhepatic cholangiography allow to confirm the diagnosis. Surgical approach is considered to be of choice and technical expedients are suggested to prevent intraoperative damage and to repair defects of the common bile duct.

Adult↗
PubMed1993

[Cancer of the distal pancreas: comments on its diagnosis and therapy].

The authors report 14 cases of neoplasms involving the pancreatic body and tail. Duration and characteristics of symptoms at outbreak, diagnostic work-up, resection rates, morbidity and operative mortality are statistically analysed and compared with those found in the same period in patients with cancer of the pancreatic head. A number of important differences between these two locations are detected and analytically discussed.

Carcinoma↗
PubMed1993

[The impact of technology on the diagnosis and treatment of pancreatic carcinoma].

Between 1960 and 1989, 207 patients with cancer of the head of the pancreas were diagnosed in the 1st Surgical Department of the University of Rome "La Sapienza". While in the first period (1960-'74) diagnosis was performed on the basis of clinical signs and traditional radiological findings, imaging and endoscopy became progressively the main diagnostic tools in the second one (1975-'89). The authors analyse how the different diagnostic approach has influenced the therapeutical outcome. Earlier diagnosis, increased resectability, proper surgical indication, decreased morbidity and mortality, improvement of survival are the achieved results.

Carcinoma↗
PubMed1993

[Leiomyosarcoma of the gallbladder: a clinical case].

A case of primary leiomyosarcoma of the gallbladder is reported together with a review of the literature. The nonspecific clinical picture of the disease and the consequent high frequency of misdiagnosis are stressed. Cholecystectomy combined with chemotherapy and radiotherapy is the treatment of choice suggested.

Aged↗
PubMed1993

The impact of ultrasonography on the prognosis of pancreatic cancer.

The authors review 207 consecutive patients admitted for pancreatic cancer from 1960 to 1989 to the 1st Department of Surgery of the University of Rome "La Sapienza", in order to ascertain whether ultrasonography contributes to achieving the ideal goal of early diagnoses. The results achieved show a higher number of early diagnoses (< 1 month from first symptoms) performed by means of US, and a concurrent increase of cases amenable to radical surgery during the period 1975-1989, and basically from 1985 to 1989. Diagnostic imaging, namely US, is therefore deemed to provide earlier diagnoses and higher rates of pancreatic resectability.

Female↗
PubMedDate not supplied

Giant phaeochromocytoma: case report.

A case of giant phaeochromocytoma occurring in a 47-year-old man with no signs or symptoms of catecholamine secretion is reported. Abdominal ultrasound scanning, chest X-ray, computed tomography and magnetic resonance imaging were preoperatively performed. The patient was operated through a thoracoabdominal incision and section of the left hemidiaphragm. The giant retroperitoneal mass was en-bloc resected together with the left adrenal gland. Macroscopic sectioning showed a smoothly rounded 29 x 21 x 12 cm tumour attached to a normal left adrenal gland, weighing 4050 gr. The huge size of the neoplasm, the several areas of necrosis, the size and monomorphic appearance of the cells, and the large number of mitotic figures afforded a diagnosis of malignant phaeochromocytoma.

Adrenal Gland Neoplasms↗
PubMedDate not supplied

[Effects of octreotide (somatostatin analog SMS 201-995) on superior mesenteric artery blood flow in swine. An experimental study using Doppler color ultrasonography].

The effect of octreotide on splanchnic haemodynamics was investigated in 25 domestic pigs by mean of US-colordoppler. In a blind-operator design the superior mesenteric artery (SMA) blood flow was evaluated before and after i.m. injection of 5, 10, 20, 25 micrograms/kg or of an equivalent volume of saline solution. Seven serial measurements were taken every 10 min in each pig excluding the higher and the lower values. The administration of 5 and 10 micrograms/kg determined a rapid and stable (3 hours) decrease of the SMA blood flow (6 and 8.5% respectively) (p < 0.05). The blood flow decreased by 27-29% (p < 0.001) in response to the administration of 20 and 25 micrograms/kg respectively. The reduction started 30 min after injection and the blood flow remained lower than basal for up to 5 hours. Because of the mean standard error of US blood flow assessment is 10% due to the interobserver and intraobserver variations, we considered statistically significant only the reduction occurred after the administration of 20 or 25 micrograms/kg. Authors findings suggest that high dose of octreotide is effective in reducing the splanchnic haemodynamics in the pig. Such animal can be used in experimental setting planed to assess the effect of splanchnic blood flow reduction.

Analysis of Variance↗
PubMedDate not supplied

[Recurrent liver metastases from colorectal cancer: their surgical treatment].

Records of 8 patients undergoing repeated operation for isolated hepatic metastasis were reviewed for operative morbidity and mortality, survival, disease-free survival. The mean interval between the initial colon operation and first hepatic resection and that between the first and the second hepatic operation were calculated. Both were found to be correlated with survival of these patients. Repeat hepatic operation for recurrent colorectal metastasis to the liver yields comparable results to first hepatic resections in terms of operative mortality and morbidity, survival, disease-free survival. Repeated hepatic operation is the most successful for of treatment for isolated recurrent colorectal metastasis.

Adult↗
PubMedDate not supplied

[The so-called postcholecystectomy syndrome after laparoscopic intervention].

Preoperative symptoms have been found to persist in up to 30% of patients after open cholecystectomy. No data exists about the influence of laparoscopic cholecystectomy on symptoms. A group of 109 elective patients who had undergone at least 12 months previously laparoscopic cholecystectomy were retrospectively studied. Pre- and postoperative symptoms were compared and patients satisfaction graded from 1 (excellent) to 5 (worst). More than two symptoms were present preoperatively in all patients. Postoperatively 75 patients were absolutely symptomless. 9 patients complained of only one symptom, and 25 patients continued to have two or more symptoms. The mean time to return to full activity did not correlate with the number of postoperative symptoms. Most patients (75) considered the procedure completely successful while only 6 were no better off postoperatively. The incidence of symptoms after laparoscopic and laparotomic cholecystectomy is similar. The patients should be advised that the presence of preoperative symptoms are not necessarily caused by gallstones and that cholecystectomy might be followed by the persistence of symptoms.

Cholecystectomy, Laparoscopic↗
PubMedDate not supplied

[Giant lipoma of the thigh: report of a case].

The clinical findings and surgical management of a 58 years old woman with a large lipoma of the thigh are reported. Giant lipomas of the thigh, infrequently observed, are of interest because causing functional limitation and lymphedema, due to their tendency to recur after surgical removal and their potential hazard of malignant transformation. Specific diagnostic tools are discussed. Surgical excision is the first-choice treatment of a giant lipoma of the thigh.

Female↗
PubMedDate not supplied

[Functional results of experimental autologous transplantation of the pancreas].

The autotransplant of the left lobe of the pancreas in the latero-cervical region has been successfully performed in 38 adult beagles with a mean cold ischemia time of 52 minutes. Juice volume and amylase, protein and bicarbonate outputs were resumed postoperatively as soon as 6 hours. A single case of thrombosis of the mesenteric vein occurred; all other pancreatic grafts showed good histological vitality at 30 days. This procedure of autografting is proposed as a valid experimental model for the pathophysiologic study of acute pancreatitis.

Acute Disease↗
PubMedDate not supplied

[Cholelithiasis in men. Observations on a case series of surgically treated 3,047 patients].

Age and clinical presentation as acute cholecystitis have widely been found to be predictors of outcome after cholecystectomy. Recently, male gender has been cited in several studies as a possible prognostic factor. A single Institution cholecystectomy registry (3.047 cases between 1959-1997) comprising 966 (31.7%) men and 2.81 (68.3%) women was retrospectively analysed. Men experienced significantly higher rate of major complications (5.3% vs 3.2%; p < 0.01) and mortality (1.55% vs 0.62%; p < 0.03). By logistic regression analysis, it was found that male gender, acute cholecystitis, respiratory and cardiovascular system disease were significantly related to postoperative morbidity. Age older than 65 years, male gender, respiratory and cardiovascular diseases were factors negatively affecting operative mortality.

Acute Disease↗