Search PubMed⌕ Search

Biomedical subjects

M Bezzi

Publications and source records attributed to M Bezzi.

At least 91 records · Page 5Linked to original sources
PubMed1986

Preoperative staging of rectal cancer: validity of the abdominopelvic angio-C.T.

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.

Adenocarcinoma↗
PubMed1985

Surgical treatment of liver metastases from colorectal cancer.

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.

Actuarial Analysis↗
PubMed1983

Intraoperative high-resolution hepatosonography in the detection of occult metastases in colorectal carcinoma.

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.

Colonic Neoplasms↗
PubMed1983

Intraoperative high-resolution ultrasonography in the localization of occult endocrine pancreatic tumours.

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.

Adenoma↗
PubMedDate not supplied

Percutaneous management of benign biliary strictures with balloon dilation and self-expanding metallic stents.

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.

Adult↗
PubMedDate not supplied

Metallic stents in benign biliary strictures: three-year follow-up.

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.

Adult↗
PubMedDate not supplied

Transjugular intrahepatic portosystemic shunt in portal vein thrombosis: role of the right gastric vein with anomalous insertion.

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.

Collateral Circulation↗
PubMedDate not supplied

Clinical experience with covered wallstents for biliary malignancies: 23-month follow-Up.

PURPOSE: To evaluate the effectiveness of partially covered metallic Wallstents to prevent tumoral ingrowth in patients with neoplastic obstruction of the biliary tract. METHODS: Twenty-one patients with malignant obstructive jaundice have been treated with Wallstents partially covered with a polyurethane polymer. In total, 36 covered stents (8 and 10 mm in diameter, 70 and 90 mm long) were deployed. All the stents were free from covering at both ends. RESULTS: Jaundice was successfully treated in 100% of cases. There were no problems related to the releasing system during stent positioning, no major complications, and no incompatibility reactions to the materials composing the endoprostheses. At 23-month follow-up, 6 patients are still alive and 15 are dead; of these 15 patients, 11 died in the first 6 months and the last 4 died between 6 and 23 months. Seven patients had an obstructed stent; in four of these, cholangioscopy showed the presence of tumoral ingrowth and in one it showed necrotic tissue with biliary pigments and inflammatory cells. No biopsy specimen was obtained in the remaining two patients with stent obstruction. The follow-up, ranging from 7 to 23 months, showed a primary patency of 46.8% and 24.6% and an assisted patency of 66.3% and 59% at 6 months and 23 months, respectively. CONCLUSIONS: Covered metallic stents are effective and may produce improved survival in patients with malignant biliary obstruction (27. 8% at 23 months). Stent patency, however, is similar to that of uncovered stents. Modifications in the design of the covering membrane may reduce stent obstruction resulting from disruption of the plastic covering.

Aged↗
PubMedDate not supplied

Metallic stents in malignant biliary obstruction: results of a multicenter European study of 240 patients.

PURPOSE: In this retrospective multicenter study, the authors analyzed the clinical efficacy of different metallic stents in the palliative treatment of patients with neoplastic obstructive jaundice. PATIENTS AND METHODS: Two hundred forty patients were treated in four European centers. Causes of obstruction were pancreatic carcinoma (n = 84), biliary neoplasm (n = 99), metastases in hilar nodes (n = 34), primary or secondary liver tumors (n = 4), and other tumors (n = 19). A total of 388 metallic stents were used: 300 Wallstents, 35 nitinol Strecker stents, 40 Gianturco-Rosch Z stents, and 13 tantalum Strecker stents. RESULTS: Overall 25- and 50-week survival rates were 42% and 16%, respectively; the 30-day mortality rate was 14.6%. Two deaths were related to the procedure (0.8%); 19 patients (8%) had major complications. The 25-week patency rate was significantly higher for the nitinol Strecker stents and the Wallstents (78% and 67%, respectively) than for the Z stents and the tantalum Strecker stents (30% and 20%, respectively) (P < .01 and P < .001, respectively). Average patency was 8.3, 5.9, 2.3, and 4.0 months, respectively. Reintervention due to stent obstruction was necessary in 53 patients. CONCLUSION: The Wallstent and the nitinol Strecker stents were the most effective in achieving long-term palliation. Patency was significantly affected by the level of obstruction but not by the type of obstructing tumor.

Aged↗
PubMedDate not supplied

Self-expandable nitinol stent for the management of biliary obstruction: long-term clinical results.

PURPOSE: Technical characteristics and clinical efficacy of a new metallic stent for the management of biliary obstruction were investigated in a clinical study. PATIENTS AND METHODS: From February 1991 to January 1993, 35 self-expandable, nickel-titanium alloy wire-mesh stents (diameter, 10 mm; length, 6 cm) were placed in 19 patients with obstructive jaundice due to cholangiocarcinoma (n = 6), pancreatic carcinoma (n = 5), lymph node metastasis to the liver hilum (n = 5), gallbladder carcinoma (n = 2), and intraductal papillary mucosal hyperplasia (n = 1). RESULTS: Stent placement was successful in 18 of 19 patients. In one patient, stent dislodgement occurred after correct release; no other procedure-related complications or deaths occurred within 30 days following the procedure. Two (11%) of the remaining 18 patients are alive at 11 months; 16 (89%) died after a mean survival of 7.4 months. Two of three patients with stent obstruction underwent repeated intervention. Adequate palliation from jaundice was achieved without further intervention in 83% of cases. The mean stent patency was not less than 7 months. CONCLUSION: Use of these metallic stents reestablished bile flow in the occluded biliary tree. Their efficacy and patency rate were also adequate.

Aged↗
PubMedDate not supplied

Prosthetic graft infection: diagnostic and therapeutic role of interventional radiology.

PURPOSE: Aortic graft infection is a rare complication of aortic surgery associated with high mortality and morbidity rates. The aim of the study was to evaluate the authors' experience with diagnostic and interventional procedures in the management of aortic graft infection. METHODS: Six patients with clinical signs suggestive of graft infection were studied. Abdominal computed tomography (CT) was performed in all patients. Diagnostic work-up was performed with perigraft puncture for fluid aspiration and contrast medium injection to confirm clinical signs or CT findings of graft infection, and to detect graft-enteric fistulas. Percutaneous drainage of the peri-prosthetic abscess was performed as attempted therapy in four patients. RESULTS: In four patients, CT examination findings were considered positive for graft infection. Culture and cytologic examination of aspirates revealed numerous white blood cells but did not show any growth. In three patients, direct contrast medium injection into the perigraft space allowed the detection of a graft-enteric fistula. In three patients, percutaneous drainage was performed as preoperative therapy, allowing improvement of the surgical outcome; in one patient the catheter was left in place as an attempt at definitive therapy, allowing a complete recovery. CONCLUSIONS: The percutaneous approach to prosthetic graft infection permits both the drainage and aspiration of the fluid in the perigraft area for laboratory studies. Percutaneous drainage can offer the possibility of definitive cure in patients for whom surgical management is considered too risky or, at least, represents a temporizing maneuver to improve the patient's general condition before surgery.

Abscess↗
PubMedDate not supplied

Intra-arterial liver chemotherapy and hormone therapy in malignant insulinoma: case report and review of the literature.

BACKGROUND: Malignant insulinoma is a rare tumor. Metastatic disease confined to the liver can be treated with various locoregional treatments. CASE REPORT: We report a case of a young woman who developed liver metastases twelve years following resection of a pancreatic insulinoma positive to anti-insulin antibodies. With five cycles of intra-arterial locoregional chemotherapy (fluorouracil and epirubicin) to the liver and monthly hormone therapy (octreotide) the patient obtained a clinical complete response. After twelve months she is still disease free. CONCLUSION: Locoregional therapy for insulinoma metastatic to the liver might represent the treatment of choice; hepatic intra-arterial chemotherapy is an interesting therapeutic approach which deserves attention. The role of somatostatin analogs is limited to symptom control.

Adult↗
PubMedDate not supplied

[Lesions of the main bile duct: combined percutaneous-endoscopic treatment].

The authors report their experience in "minimally invasive" treatment of benign biliary lesions. More than 80% of them occur after injury to the bile ducts during cholecystectomy. The clinical experience reported in this work concerns three patients managed with a coordinated--percutaneous and endoscopic--approach. In all patients an ERCP with biliary sphincterectomy has been performed at first, followed by percutaneous biliary drainage with external-internal catheters. All drainage catheters have been removed after one year. No patient has evidence of recurrence after a mean follow up of 18 months. Only in a patient a recurrent cholangitis treated with antibiotic therapy has been observed. This preliminary study suggests that the "rendez-vous" technique may be useful for the initial management of biliary strictures in most patients. This association improves the success rate and can avoid surgery. The role of surgery is reserved to few selected cases and particularly to lesions which are detected at the time of the operation.

Adult↗