Biomedical subjects

L Lepre

Publications and source records attributed to L Lepre.

50 records · Page 3Linked to original sources

PubMedDate not supplied

[Layered and mass sutures in the closure of median laparotomies].

A retrospective comparison of 2830 patients with midline abdominal incision closures was made. Dehiscences, infections, hernias were compared examining continuous mass closures (group A) versus interrupted mass closures (group B) and interrupted layered sutures (group C). The three groups were well matched for known risk factors for each of the above complications. Mass closures produced a significant higher number of infections (p = 0.0006) and hernias (p = 0.0001). There was no significant difference in the rate of dehiscences in the three suture groups (p = 0.07). A significant correlation was found in all three groups between the incidence of infections and that of outcoming incisional hernias. In the current study layered closure of the of the midline abdominal wounds yielded better results when compared with both running mass and interrupted mass closures. The knowledge of these findings might help when choosing the procedure to close a midline abdominal incision.

Female↗

PubMedDate not supplied

[Ambulatory closed surgery for the treatment of pilonidal sinus].

Pilonidal disease (PD) is a common chronic disorder of the sacrococcygeal region afflecting young people. Despite several methods for treating PD have been described, the management remains controversial. Recent reports have advocated different surgical approaches such as open or closed technique, but recurrence plagues all forms of therapy. We conducted this case review to evaluate the validity of an outpatient closed technique in the treatment of chronic pilonidal disease. Between January 1997 and July 1999, 65 consecutive patients with quiescent chronic PD were electively treated by surgical excision of the cyst and primary closure. There were 47 men (72%) and 18 women (28%) in this study. Patients ranged in age from 14 to 47 years, the average age being 21 years. The median healing time was 8 days and the median time to return to full work was 20 days (range 10-25). Infection and recurrence rates were 1.5% and 4.6% respectively. There was no correlation among recurrence rate, postoperative infection, or prior surgery. Cyst excision and primary closure is a safe, low cost operation with a very high long-term success rate and a negligible rate of complications. It can successfully be performed under local anaesthesia in an outpatient facility.

Adolescent↗

PubMedDate not supplied

[Carcinoma of the male breast. Prognostic factors and outcome of surgical treatment].

A retrospective study was made on 18 male patients with breast carcinoma treated at the Department of Surgery "Pietro Valdoni" of the University "La Sapienza" of Rome, Medical School. Demographics, pathology, stages, and treatment were determined from clinical reports. All patients but one underwent modified radical mastectomy. The length of follow up averaged 57.5 months. Five years actuarial survival rate was 62%. In the current study the Authors suggest that the clinical, prognostic and treatment features of breast carcinoma in men are similar to those reported in literature for post-menopausal women.

Aged↗

PubMedDate not supplied

[Pancreatic pseudocysts: the surgical timing].

Forty-three cases of pancreatic pseudocysts (PPC) are reviewed. Various emergency and elective surgical therapeutical options have been employed: while external drainage has confirmed to represent the best procedure in emergency occurrences, cystojejunostomy has proved to be the treatment that better provides both optimal functional results and minimal mortality/morbidity in elective situations. Our study also confirms that the thickness of the pseudocystic wall is the only feature apt to determine whether or not a PPC is susceptible of internal surgical derivation, and that abdominal ultrasound scanning is the most sensitive and reliable diagnostic method to ascertain this prerequisite, thus providing a well-timed strategy for elective derivative operations.

Adult↗

PubMedDate not supplied

[Acute cholecystitis: elements for diagnosis and therapy].

The Authors report their experience in the surgical management of 439 patients with acute cholecystitis. Symptoms and laboratory findings at onset, preoperative diagnostic tools, associated disorders, surgical procedures as well as age-related postoperative morbidity and mortality and length of postoperative stay were analyzed. The most valuable investigation in the diagnosis of acute cholecystitis was ultrasound carried within the first 48 hrs, with positive results in 81% of cases. Tc-99m-HIDA biliary tract imaging proved to be a rapid, highly sensitive and specific, non invasive method of diagnosing acute cholecystitis in doubt cases. Morbidity (4.8%) and mortality (0%) rates in younger patients were inferior than those (22% vs 1.5%) observed in the elderly. Early and late results indicate that early cholecystectomy is the treatment of choice in acute cholecystitis.

Acute Disease↗

PubMedDate not supplied

Surgical treatment of duodenal diverticula.

Fourteen patients with duodenal diverticula are reviewed. The various aetiopathogenic assumptions and the different indications and surgical options are examined.

Adult↗

PubMedDate not supplied

[Biliary calculi in liver cirrhosis. Clinical, epidemiologic & therapeutic aspects].

BACKGROUND: Incidence of cholelithiasis in cirrhotic patients is twice of threefold that in non cirrhotic one. Cholelithiasis is often asintomatic, however, when complications occur, emergency surgery is burden by high rates of morbidity and mortality. Purpose of the current study is to state the clinical features and to assess the outcome of elective surgery in these patients. METHODS: Sixtyseven consecutive patients with liver cirrhosis (Group A) who underwent elective surgery for biliary stones were retrospectively reviewed. Preoperative clinical features, surgical procedure, postoperative morbidity and morality were recorded and compared with those of the 3291 non cirrhotic patients (Group B) observed in the same period and submitted to elective surgery for biliary stones. RESULTS: Stone involvement of the biliary tract (A vs B:31.3% vs 20.5%), cholangitis (A vs B:23.8% vs 13.0%) and acute biliary pancreatitis (A vs B:4.4% vs 0.7%) were found to be more frequent among cirrhotic patients. In Group A postoperative morbidity and mortality in Child-Pugh A and B were found to be not statistically different from those of Group B patients. CONCLUSION: Authors conclude that definitive biliary surgery may be considered as a successful and safe indication in the treatment of cirrhotic patients in Child-Pugh A and B grade. Conservative approaches are considered as more suitable in Child-Pugh C patients, and definitive elective procedures should be considered for these patients only when an improvement of their liver function can be achieved.

Adult↗

PubMedDate not supplied

[Non-resectable neoplasms of the biliary duct: palliative surgery vs non-surgical management].

A retrospective analysis comparing the results of biliary enteric anastomoses and non-operative management in unresectable bile duct carcinomas was carried out. Twenty-four patients underwent surgical drainage (Group A), and 29 were managed with transhepatic or endoscopic stent (Group B). Concomitant medical diseases were more frequent in group B patients (16.6% vs 48.2%, p < 0.03). Group A and group B were comparable in morbidity (29.1% vs 41.3%), mortality (12.5% vs 13.7%) and 1-year survival rate (21% vs 17%). Median survival was 4.2 months in group A and 2.6 in group B. Jaundice relief was achieved in 70.8% of group A patients and in 68.9% of group B. Group B patients experienced more cholangitis (p = 0.001) and required more hospital readmission (p = 0.0015). Quality of life was better in group A patients, however difference did not reach statistical significance. Therefore, low risk patients with unresectable hilar bile duct tumor and yet good life expectancy may benefit from surgical palliation.

Aged↗

PubMedDate not supplied

[Carcinoma of the splenic flexure. Nosological and therapeutic contribution].

Twenty-one patients undergoing colectomy for carcinoma of the splenic flexure from November 1996 throughout October 1993 were studied retrospectively. Clinical and prognostic features were compared with those of other colon cancers treated in the same period at the same Institution. No differences in symptoms at onset and stage distribution were found in the two groups. The complex removal of the cancer tissue was achieved with the resection of the major part of the transverse colon, splenic flexure, descending colon and its mesocolon. The splenic flexure cancer did not show a worse prognosis than other colon cancers.

Adenocarcinoma↗

PubMedDate not supplied

[Recurrent high anal fistula: treatment with the use of seton].

The functional impact of treating patients with high recurrent fistula in ano by a cutting seton fistulotomy was assessed in 28 cases. Functional outcome following treatment with this technique was evaluated with regard to fistula eradication and effect on fetal continence. All patients had a history of previous fistula surgery. The fistula was cured in 27 patients with no reports of altered continence at follow up. Reported data suggest that cutting seton is effective in treating complex, recurrent, high fistula in ano. Exact identification of internal and external orefices and avoidance of internal sphincterotomy are stressed as the technical landmarks responsible for such a result.

Adult↗

PubMedDate not supplied

[Inflammatory fibroid polyp of the stomach. Report of a case].

Inflammatory fibroid polyp (IFP) is a rare lesion of the gastroenteric tract more frequently occurring at the level of the stomach. The etiopathogenesis of IFP as well as the nature of the cells constituting these lesions remain unknown. Abdominal pain and anaemia due to chronic blood loss are the most common presenting features but neither radiology and CT scanning nor endoscopy are capable to achieve any conclusive diagnostic information. Histologic examination of the specimen obtained by endoscopic or surgical excision is considered to be the only way for the definitive exclusion of a neoplastic nature. A case of IFP treated by means of total gastrectomy is presented.

Biopsy↗

PubMedDate not supplied

[Increased blood amylase levels in the postoperative period after liver resection].

Preoperative and postoperative values of amylase were assessed in patients submitted to hepatic resections for primary or secondary liver tumours. Among these 40 had underlying liver cirrhosis and 18 normal liver. Preoperative serum amylase levels were increased in patients with cirrhosis. Postoperative amylase levels were found to be overlapping to preoperative one both in patients with normal and cirrhotic liver when no Pringle's manoeuvre was used in the course of surgery. A significant postoperative increase in serum amylase levels was detected in the group of patients where liver resection was carried out under Pringle's manoeuvre. Two patients of the cirrhotic group developed mild pancreatitis. It is suggested that portal congestion relates morphological changes of pancreas and hyperamylasemia and that Pringle's manoeuvre, if prolonged, carries a potential risk of pancreatitis especially in patients with underlying liver cirrhosis.

Adult↗

PubMedDate not supplied

[Treatment of cecal diverticulitis].

Twenty-three cases of acute solitary diverticulitis of the cecum are reviewed. Cecal diverticulitis continued to be almost indistinguishable from acute appendicitis although longer duration of symptoms and lesser incidence of nausea and vomit are reported. A correct preoperative diagnosis is then seldom performed. On the basis of this experience appendectomy is recommended when diverticulitis is diagnosed in order to avoid further clinical complications. If a carcinoma cannot be completely ruled out or an abscess or rupture is present, then a right colectomy should be performed.

Abscess↗

PubMedDate not supplied

[Preoperative bowel cleansing: outpatient versus inpatient preparation].

This study investigated the safety and efficacy of preoperative outpatient bowel preparation (OBP) and compared it with inpatient bowel preparation (IBP). Records of patients who underwent OBP and IBP for elective colorectal surgery from January 1995 to December 1997 were compared. All patients were instructed to take during the three days before surgery metronidazole (1.5 g pro die) while an oral polyethylene glycol solution was used for the oral lavage during the 12 hours before operation. The two groups, 65 patients, were uniform for age, sex, diagnosis and operations performed. The OBP group had a shorter length of hospital stay (median 9 vs 10 days; p = ns) whereas the complication rate was similar including infectious complications. Data on operating time, perioperative fluid and blood requirements, perioperative diuresis were not significantly different in the two groups. Outpatient bowel preparation for elective colorectal surgery is safe and effective while offering short hospital stay and therefore reduction in medical care cost.

Aged↗