The ultrasonic detection of insulinomas during surgical exploration of the pancreas.
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Biomedical subjects
Publications and source records attributed to M Bezzi.
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The sonographic appearance of 141 hepatic and abdominal hydatid cysts was studied in 63 patients undergoing therapy with benzoimidazolic compounds. The cysts were evaluated for size, margins of the cyst wall, and echo pattern of cyst contents to establish the response to the drugs. Changes seen on ultrasound (US) scans were classified as decrease in size, detachment of the cyst membrane, and appearance of echogenic material (matrix) in the cyst cavity. These findings, particularly the diffusely hyperechoic pattern, are explained on the basis of the action of the drugs. Twenty-one patients underwent surgery at the end of treatment. The US patterns of treated hydatid cysts are similar to those seen, though more rarely, in cases of spontaneous parasite involution in long-standing hydatidosis.
Three patients with clinically suspected pseudoaneurysm as a complication of femoral puncture were referred for ultrasound (US) evaluation with both conventional duplex Doppler US and color Doppler imaging. Pseudoaneurysm (n = 2) and simple hematoma (n = 2) were depicted with both Doppler systems, and a separate pseudoaneurysm and a hematoma were found in one patient. These diagnoses were confirmed surgically. Distinctive Doppler spectral waveforms and color Doppler findings enabled confident diagnoses. Color Doppler imaging allowed faster detection of intraaneurysmal flow, and the track between the injured artery and the pseudoaneurysm was identified only with color Doppler imaging. Duplex Doppler US with color Doppler imaging allows for the rapid, unequivocal diagnosis of pseudoaneurysm, thus enabling prompt treatment without the need for invasive diagnostic modalities.
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A series of 475 patients who underwent surgery for rectal carcinoma were followed up and entered this study. Sexual and bladder function before and after surgery with respect to the surgical procedure was considered. 221 patients gave suitable information about their urinary function: bladder dysfunction was observed in 20% of amputated patients as against 13-14% of resected patients. 144 patients (103 males and 41 females) were available for a follow-up study of the sexual function. Sexual intercourse, libido, erection, ejaculation, dyspareunia, vaginal humidification, orgasm were the parameters examined. Almost all of them were more affected after abdominoperineal resection than after low anterior resection with manual or stapled anastomosis, although the difference was not always significant. In a few instances the rates were inverted. It is believed that these dysfunctions are not related to the type of surgery, but to required extent of radicality. Extreme care should be always taken when dissecting the end portion of the rectum to avoid injuries to the hypogastric plexus and the pudendal nerve.
The role of preoperative staging in the treatment of rectal cancer is emphasized. To this purpose, the use of abdominopelvic angio-C.T., which was carried out in 14 cases, is examined. Preoperative staging obtained by this method is compared with the postoperative one assessed by UYCC classification, modified by AYCC. Its diagnostic and prognostic role is evaluated in relation to the other methods. The validity of abdominopelvic angio-C.T. for a correct therapeutic approach is confirmed.
The experience with 28 patients undergoing hepatic resection for metastases from colorectal cancer is reported. In 15 cases the metastases were synchronous, in 13 metachronous, appearing 12 to 60 months after surgery of primary cancer. Six patients underwent right lobectomy, 2 left lobectomy, 9 left lateral segmentectomy, 6 right wedge resection and 2 bilateral wedge resection. In 20 cases the lesions were solitary, in 8 multiple. Overall operative mortality was 14.2%. Mean survival for synchronous metastases was 16 months with 3 patients living beyond 12 months, and 26 months for metachronous metastases with 4 patients living beyond 12 months. The obtained results are analyzed on the basis of staging of primary cancer, of the metastatic disease and type of resection, examining the morbidity and cause of long term mortality. It is evidenced that, even if correct pre- and intraoperative staging of metastatic disease is impossible, an aggressive surgical approach is the treatment of choice in surgically resectable liver metastases from colorectal cancer.
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A case of pancreatic bleeding pseudocyst communicating with the stomach, developing after post-operative acute pancreatitis is reported. The successful treatment by selective embolization is described and alternative methods of management are reviewed.
During surgery of colorectal cancer, real time B-mode high resolution ultrasound scanning was employed intraoperatively in 25 consecutive patients free of metastases at preoperative evaluation, to localize hepatic deposits. Results showed that intraoperative ultrasonography is a safe and simple technique providing the surgeon with accurate informations which may affect surgical technique as for -) extended indications for hepatic resection -) reduction of resections oncologically useless -) a more correct staging of resected colorectal cancer -) reduction of false positives at second look guided by CEA elevation.
Intraoperative pancraticosonography was employed in six patients to localize suspected endocrine tumours and to study the specific ultrasonic features. The cases included four insulinomas, one case of occult G-cell apudoma and one case of beta-cell microadenomatosis. Endocrine tumours are generally hypoechoeic and well defined with smooth borders. The study confirms that real-time operative high resolution sonography is a reliable technique to assist in the diagnosis of occult endocrine tumours and to guide the surgical approach.
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Seventy patients with benign biliary strictures were treated by means of percutaneous balloon dilation and stenting. Patients with stenoses relapsing during catheter stenting (18/70) were treated with self-expanding metallic stents. Results were evaluated in 56 patients; in patients without sclerosing cholangitis (n = 47) the patency rate with both modalities of treatment was 96%, while in the patients with secondary sclerosing cholangitis (n = 9), it was 33%, for a total success rate of 86%. The average follow-up was 23 months (range 3-72 months). Major complications included one death for septic shock (1%), three severe hemorrhages (4%), two of which required arterial embolization, two pleural effusions (3%), and one liver abscess following arterial embolization. Moderate fever for 1-2 days was a common finding after percutaneous puncture and balloon dilation. Percutaneous management of benign biliary strictures so far has been attempted only in surgical failures or in complicated cases. In view of our midterm results it may well become the initial treatment in many patients.
Eighteen patients with recurrent benign biliary strictures (BBS) were selected for metallic stents placement because they failed to respond to percutaneous balloon dilatation. None were candidates for surgical corrections. We used "Z" single or double stents in 17 cases and a Wallstent in 1 case. After more than 3 years of follow-up (average period 37 months, range 30-41 months), 10 patients (55.5%) were asymptomatic without signs of bile stasis; 5 patients (27.7%) had recurrence of symptoms and were eventually retreated; and 3 patients (16.6%) died, 2 of obstructive jaundice and liver failure and 1 of metastatic gastric cancer. Recurrence was due to stent occlusion by tissue ingrowth in 3 cases, stent migration in 1 case, and an inflammatory lesion of the papilla of Vater in another case, with patency of the metallic stent. The overall patency rate, at 3-year follow-up was 68.7%. In our series, the main factor determining long-term patency of metallic stents has been reactive tissue ingrowth. Nevertheless, long-term results obtained with metallic stents in recurrent benign biliary strictures should be considered satisfactory. In selected patients, metallic stents may represent the only long-term treatment available for maintaining bile flow.
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Transjugular intrahepatic portosystemic shunt (TIPS) was performed in two patients with portal vein thrombosis. In both patients, hepatopetal flow had been maintained by an anomalous insertion of the right gastric vein (RGV) into the portal vein bifurcation and into the left portal branch respectively. In one patient, the main portal trunk could not be recanalized and the RGV was used as an accessory portal vein to place one stent for TIPS. In the other case, access through the partial portal-vein occlusion was gained and three stents were placed from the hepatic vein to the main portal vein distal to the thrombus. In portal vein thrombosis, the aberrant insertion of the RGV into the left or right portal branches may maintain patency of the intrahepatic portal system and, in case of unsuccessful recanalization of the porta, may represent the sole pathway for placing a TIPS.