Biomedical subjects
Publications and source records attributed to L Napolitano.
The Authors have examined 30 patients post-total thyroidectomy and registered a transient decrease of calcemia in 9 and a decrease of PTH in 11. Serum albumin and calcitonin were always normal. In all the patients calcemia and PTH returned to normal values in 7 days except in 2 patients in whom the values were normalized after one month.
The Authors present 9 cases of gastro-enteropancreatic neuro-endocrine biologically inactive tumors. In 5 cases the tumor site was appendicular. In 4 patients an appendectomy was performed, in one patient a right hemicolectomy and the patients after a period of 3-9 years are well and disease free. In a patient with a gastric carcinoid and a single hepatic metastasis a total gastrectomy with an hepatic metastasectomy were performed but the patient died 16 months thereafter. In a case localized to the right colon with a single hepatic metastasis a right hemicolectomy was performed with a metastasectomy but the patient died after 12 months. In a case localized to an ileal loop a segmental resection was performed followed by a medical therapy with octreotide and the patient is well and disease free after 3 years. In a case localized to the pancreas with widespread lymphatic metastasis it was performed a simple biliary diversion (coledocho-duodenostomy) followed by medical therapy with octreotide. Surprisingly after 4 years the patient is alive and a TC control shows a decrease of the pancreatic tumor and of the lympho glandular tumefactions.
A surgical treatment of patients with lung cancer non-microcitoma and isolated adrenal metastasis has been reported in literature although limited in number and follow up. The Authors report 12 cases of patients operated for lung cancers non-microcitoma and isolated adrenal metastasis. One patients was lost in the follow up, two patients died 3 and 6 months after the adrenalectomy. The other patients are alive after 88, 39, 36, 17, 13 months after the adrenalectomy. Four of these patients are also disease free. Other 4 patients, more recently operated, are alive and disease free after 3, 3, 9 and 9 months after the adrenalectomy. The Authors believe that a surgical treatment is justified in these patients, considering the results of the series reported in literature and also their own results.
The authors report a series of patients suffering from chronic pancreatitis and underline the high frequency of biliary pathology in these subjects. The authors remind, then a research performed, some years ago, by one of them. In such a research the performing of an anastomosis between the pancreatic duct and the biliary common duct in a series of experimental animals caused an acute pancreatitis or in the surviving animals a chronic pancreatitis. The authors believe that a biliary pathology may be responsible not only of an acute pancreatitis but also of a chronic pancreatitis.
In the last years laparoscopic cholecystectomy has become the "gold standard therapy" in the treatment of symptomatic cholelitiasis, but it is necessary to keep into account some problems and risks that can arise from laparoscopic technique. One of these risks is represented surely by the disregarding of a gallbladder carcinoma. The authors report a case of peritoneal seeding of an unsuspected gallbladder carcinoma following laparoscopic cholecystectomy. The first histologic diagnosis was chronic ulcerous cholecystitis with adenomiosis but 2 months later the metastasis developed at the umbilical port site, at another port site and to the right lobe of the liver. Another histological sampling of the gallbladder specimen was performed and this time a little intra mucous gallbladder adenocarcinoma was found (T1 stage). While the most part of literature data concern advanced stage of the disease at the time of operation (T2, T3) only few reports regard early stage neoplasm. Therefore this risk is present not only in advanced stages of gallbladder carcinoma but even in cases of early stage cancers. After a laparoscopic cholecystectomy all specimen should be opened and inspected. If there is a gallbladder wall irregularity and if there was a bile spillage it is advisable to perform a preoperative histologic examination.
The authors, after a short review of the literature present 6 cases of cancer of the common bile duct. One was localized at the hepatic hilus, three in the middle of the c.b.d., two in the distal choledochus. In each case a c.b.d. resection was performed associated in one case to a minor hepatic resection, in two cases to a Whipple operation.
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The authors examine the value of different imaging techniques (CT, MRI) in the diagnosis of the involvement of the mesenteric-portal vessels in the pancreatic cancer. In 20 jaundiced patients they obtained in all cases a correct diagnosis about the etiology of the jaundice. The correspondence of the preoperative imaging study with the involvement of the mesenteric-portal vessels was respectively 73% for the CT and 78% for the MRI. In all cases the intra-operative echography allowed a correct diagnosis of the vascular involvement.
The main complementary techniques for "finger fracture" in liver resections are evaluated. It is retained that transparenchymal resections should be limited to segmental resections (uni-, bi- or trisegmentectomies), while in case of extensive resections (lobectomy or extensive lobectomy) an operation with extraparenchymal preparation of the hepatic pedicle and possibly of the suprahepatic vein is preferable. Lastly a casuistry of 24 hepatic resections for primary or metastatic tumours is presented.
The Authors review the international literature about the frequency of vascular involvement (inferior vena cava and aorta) in the lymph node lumbo-aortic metastases of the testicular neoplasm. They report a case of a patient with an aortic involvement from lymph node metastases of a mixed (seminoma and germ cell) cancer of the left testis. They performed en bloc resection of the bulky metastases including the aorta involved. The literature data as well as the outcome of the operated case show a moderate survival also in patients with advanced disease.
The Authors, after a review of the literature, report a case of multiple lipomas of the left colon. They analyse the diagnostic, pathogenetic and therapeutic features of this rare pathology.
The authors have examinated 35 patients 4 - 5 years after a previous episode of acute oedematous biliary pancreatitis. 20 patients had been cholecystectomized while 15 had not been operated. The patients of the first group didn't show any impairment of the endocrine or exocrine pancreatic function while the patients who were not cholecystectomized in 4 cases on 15 showed an impairment of the exocrine pancreatic function valued with the elastase-1 test in the stools. In 2 patients there was also a slight impairment of the glucose metabolism. The authors suppose that the persistance of a biliary disease can affect the pancreatic function.
The Authors, after a short review of small bowel tumors, point out that recently a laparoscopic approach for these tumors has been suggested and some cases have been reported. The Authors present two cases of patients operated for small bowel tumor using a laparoscopic technique: the first case for a stromal tumor (GIST), the second case for an adenocarcinoma in advanced stage with multilobar lung metastases. The first patient is alive and disease free after one year, the second died after six months for tumor progression. The Authors believe that laparoscopic technique can be employed with satisfying results also in the treatment of small bowel tumors with moderate trauma and invasiveness.
The Authors report 66 cases of patients aged 75 years or older who underwent laparoscopic cholecystectomy: 28 cases presented a clinical picture of acute cholecystitis, 3 cases had associated common bile duct stones. A high percentage of patients had cardiovascular disease: 29 patients presented with cardiopaties, of these 9 cases had a history of myocardial infarction, 31 patients had artheriosclerotic hypertension, associated, in 7 patients with signs of brain ischemia. Five patients were suffering from Parkinson's disease, 7 were carriers of diabetes, 2 had liver cirrosis. Three patients were converted due to extensive presence of adhesions from previous surgery. Morbidity and mortality rates were respectively 12% and 1.5%. The Authors think that laparoscopic technique widens indications and reduces risks of cholecystectomy also in elderly patients.
It is emphasized that currently only surgery offers a real hope of improving the prognosis of patients suffering from liver metastases and many data from the Literature supporting this contention are reported. Indications and prognostic factors for the surgical treatment of these lesions are evaluated. A series of 36 patients operated on for hepatic metastases and the relative technical procedures are presented. In 33 cases the primary tumor was a colorectal carcinoma. Two right lobectomies and 34 minor resections or segmentectomies were performed. No peroperative mortality was observed. The survival rate was 70% after 1 year, 51% after 2 years, and 27% after 3 years.
OBJECTIVE: Laparoscopic adrenalectomy is unanimously recognised as the gold standard for the surgical treatment of adrenal lesion. Also the role of laparoscopic adrenalectomy (LA) for metastasis is controversial. This study, in according with literature dates, aimed to confirm that patients are most likely to have prolonged survival after resection of adrenal metastases and confirms that oncological outcome of laparoscopic adrenalectomy are similar with open adrenalectomy. PATIENT AND METHODS: The study included patients who underwent LA from 2000 to 2005. Indications for LA were adrenal masses with no radiological evidence of involvement of the surrounding structure, or solitary metastases with well-controlled primary cancer. The variable evaluated were port-site and intra-addominal recurrence, distant metastasis and survival time. Primary tumors were the followings: lymphoma non-Hodgkin, lung cancer. Patients age was mean 69 (range, 62-77), the lesions were at right adrenal gland. No conversion to open surgery occurred. No complication were observed. Mean operative time was 100 minutes (range, 90-110). No postoperative complication occurred. Mean diameter of the tumor was 4.5 cm (range, 4.2-4.8 cm). Tumor free margins were obtained. Mean hospital stay was 3 day. At follow-up mean of ten months (eight-twelve months) there was any sight of distant metastases and the patient was alive. CONCLUSION: LA seems to be a feasible option if the principles of oncological surgery are respected. Adrenalectomy for metastasis, with intent to prolong survival, should be offered to patient with favourable tumor biology, such as those with significant DFI.
A personal experience about 135 pz. with non-toxic goitre treated by mono o bilateral thyroidectomy and followed during 5 years (2-8) to evaluate the incidence of recurrences is reported. The recurrences were 10.5%, especially after monolateral thyroidectomy (9 pz.). Therefore the authors stress the importance of a more accurate surgical indication, a wider resection of the gland and a careful follow-up to undertake opotherapy when hypofunction appears.
Sixty-three patients with autonomous thyroid nodule were studied, thirty-five from an endemic goiter area (EA) and twenty-eight from a non-endemic goiter area (NEA). Clinical history, physical examination, ultrasonography, thyroid hormone levels, and fine needle aspiration (FNA), were utilized to investigate whether or not iodine deficiency determined differences in the latency of progression to toxicity, the seriousness of illness and thyroid hormone levels. No significant difference was observed in the age of onset of nodularity, while the latency of progression to toxicity was significantly decreased in the EA (p less than 0.001). The ultrasonographic pattern did not show significant volume variations between the EA and NEA, but there was a slight prevalence of multinodular lesions in EA. No significant difference in serum thyroid hormone levels was found between the two areas in non toxic patients, while at the onset of hyperthyroidism higher levels of FT were observed in the EA than in the NEA. FNA showed a prevalence of colloid lesions in EA, while hyperplastic lesions prevail in the NEA. Forty-two patients underwent surgery: the extent of surgery was greater in patients from the EA. In conclusion, in iodine deficient areas earlier clinical thyrotoxicosis and a higher prevalence of hypoactive thyroid nodules were observed. Furthermore, in EA, the autonomous nodule in non toxic phase is more frequently associated with colloid lesions than hyperplastic lesions.