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Biomedical subjects

M Casaccia

Publications and source records attributed to M Casaccia.

At least 19 recordsLinked to original sources
PubMed1999

Laparoscopic palliation of unresectable pancreatic cancers: preliminary results.

OBJECTIVE: To assess the feasibility of laparoscopic gastroenteric and cholecystenteric bypass procedures for palliation of inoperable cancer of the pancreas. DESIGN: Prospective study. SETTING: Teaching hospital, Italy. SUBJECTS: 6 patients (4 men and 2 women, range 53-72 years, median 64) who presented between July 1995 and April 1997 with inoperable pancreatic cancer. INTERVENTIONS: Laparoscopic gastroenterostomy for duodenal obstruction. Four patients had already had endoscopic biliary decompression. 2 patients also had laparoscopic cholecystojejunostomy for biliary obstruction at the time of the laparoscopic gastroenterostomy. MAIN OUTCOME MEASURES: Morbidity and mortality. RESULTS: The procedure was completed laparoscopically in all patients. There was no perioperative mortality and morbidity was low (1 bleeding from the drain and 1 paralytic ileus). The median postoperative stay was 4.5 days (range 4-6). CONCLUSIONS: Laparoscopic gastroenterostomy, together with cholecystojejunostomy in selected patients with inoperable pancreatic cancer, offers a less invasive alternative to open surgery with a short hospital stay and rapid return to normal activity.

Digestive System Surgical Procedures↗
PubMed1998

Randomized multicenter comparison of conventional anticoagulation versus antiplatelet therapy in unplanned and elective coronary stenting. The full anticoagulation versus aspirin and ticlopidine (fantastic) study.

BACKGROUND: Dual therapy with ticlopidine and aspirin has been shown to be as effective as or more effective than conventional anticoagulation in patients with an optimal result after implantation of intracoronary metallic stents. However, the safety and efficacy of antiplatelet therapy alone in an unselected population has not been evaluated. METHODS: Patients were randomized to conventional anticoagulation or to treatment with antiplatelet therapy alone. Indications for stenting were classified as elective (decided before the procedure) or unplanned (to salvage failed angioplasty or to optimize the results of balloon angioplasty). After stenting, patients received aspirin and either ticlopidine or conventional anticoagulation (heparin or oral anticoagulant). The primary end point was the occurrence of bleeding or peripheral vascular complications; secondary end points were cardiac events (death, infarction, or stent occlusion) and duration of hospitalization. RESULTS: In 13 centers, 236 patients were randomized to anticoagulation and 249 to antiplatelet therapy. Stenting was elective in 58% of patients and unplanned in 42%. Stent implantation was successfully achieved in 99% of patients. A primary end point occurred in 33 patients (13.5%) in the antiplatelet group and 48 patients (21%) in the anticoagulation group (odds ratio=0.6 [95% CI 0.36 to 0.98], P=0.03). Major cardiac-related events in electively stented patients were less common (odds ratio=0.23 [95% CI 0.05 to 0.91], P=0.01) in the antiplatelet group (3 of 123, 2.4%) than the anticoagulation group (11 of 111, 9.9%). Hospital stay was significantly shorter in the antiplatelet group (4.3+/-3.6 versus 6. 4+/-3.7 days, P=0.0001). CONCLUSIONS: Antiplatelet therapy after coronary stenting significantly reduced rates of bleeding and subacute stent occlusion compared with conventional anticoagulation.

Administration, Oral↗
PubMed1998

Outcome of laparoscopic transabdominal preperitoneal inguinal hernia repair.

The long-term efficacy of laparoscopic inguinal hernia repair is unknown. This retrospective study was conducted to determine the efficacy of this operation in comparison with the open technique and to evaluate the possible factors of recurrence. We have evaluated the clinical outcome in a group of patients who underwent laparoscopic procedures between January 1995 and December 1996, with the aim of assessing the incidence of recurrence and of long-term complications. Sixty-three patients underwent laparoscopic transabdominal preperitoneal repair by use of a large mesh. We were able to examine 58 of these patients at a median follow-up time of 15 months since their operation. Four patients had developed a recurrence, and two patients had significant symptoms consistent with nerve damage. The recurrence rate of 7% is similar to that reported for open operations but higher than that reported for early follow-up after laparoscopic operations. Our study illustrates the value of long-term follow-up for the assessment of efficacy following laparoscopic inguinal hernia surgery.

Adolescent↗
PubMed1998

Laparoscopic gastrojejunostomy in the palliation of pancreatic cancer: reflections on the preliminary results.

The aim of this study was to assess the feasibility of laparoscopic gastroenteric and cholecystenteric bypass procedures for palliation of inoperable cancer of the pancreas. Between July 1994 and January 1996, five patients underwent laparoscopic gastroenterostomy for duodenal obstruction due to pancreatic cancer. There were four men and one woman, ranging in age from 53 to 72 years (median 63). Four patients already had endoscopic biliary decompression. One patient underwent laparoscopic cholecystojejunostomy for biliary obstruction at the time of the laparoscopic gastroenterostomy. The procedure was completed laparoscopically in all patients. There was no perioperative mortality, and the morbidity was low. The median post-operative stay was 4 days (range, 4-6). Laparoscopic gastroenterostomy associated with cholecystojejunostomy in selected cases offers a less invasive alternative than open surgery, with a shorter hospital stay and more rapid return to normal activity.

Aged↗
PubMed1997

Role of reoperation in recurrence of adrenal cortical carcinoma: results from 188 cases collected in the Italian National Registry for Adrenal Cortical Carcinoma.

BACKGROUND: Recurrence of adrenal cortical carcinoma (ACC) after radical surgery is a common finding. Although successful reoperations have been reported with encouraging results, most published experiences are anecdotal and based on few cases. We report the results of surgical treatment for recurrent ACC in a multiinstitutional series. METHODS: One hundred eighty-eight cases of ACC were collected in a national registry. A complete follow-up was obtained in 179 cases. At initial diagnosis 92 patients had local disease (stage I or II). One hundred seventy patients underwent surgical treatment, considered radical in 140; in this group, recurrent disease was observed in 52 cases (37%) after a mean disease-free interval of 21.7 months. RESULTS: Adjuvant chemotherapy was ineffective in ameliorating the prognosis. The mean survival in 20 patients who underwent reoperation was significantly higher (15.85 +/- 14.9 months) than in nonreoperated cases (3.2 +/- 2.9 months). Five-year actuarial survival in reoperated patients is significantly better than in nonreoperated patients (49.7% versus 8.3%, respectively). CONCLUSIONS: Although the prognosis of this tumor is still poor, surgery is the only effective therapy; reoperation allows survival comparable to that observed in patients without recurrent disease. An aggressive strategy for recurrent ACC is advisable until prospective studies demonstrate a real effectiveness for chemotherapy.

Adolescent↗
PubMed1997

Initial experience of laparoscopic resection of adrenal tumours.

OBJECTIVE: To report our initial experience with laparoscopic resection of adrenal masses. DESIGN: Prospective study. SETTING: Teaching hospital, France. SUBJECTS: Five consecutive patients who required adrenalectomy between May 1993 and January 1994. INTERVENTION: Adrenalectomy through four trocars with the patient semisupine and in a slight reverse Trendelenburg position. MAIN OUTCOME MEASURES: Morbidity and mortality. RESULTS: Three left and two right adrenal glands were removed in a median time of 190 minutes. The patients were all women, median age 65 years (range 57 to 71). The aetiology included non-functioning adenomas (n = 2), primary aldosteronism, Cushing's adenoma, and a metastasis from a cancer of the bladder. The median tumour size was 5.5 cm (range 3 to 9). In one patient the procedure was converted to an open operation because exposure of the gland was inadequate. The median postoperative stay was 6 days (range 4-12). CONCLUSIONS: Our initial experience supports that from other centres in that we found that the laparoscopic approach is suitable for resection of adrenal masses.

Adenoma↗
PubMed1997

A rare laparoscopic diagnosis in acute abdominal pain: torsion of epiploic appendix.

Torsion of an epiploic appendix is seldom diagnosed preoperatively because of the difficult differential diagnosis with other diseases causing acute abdominal pain, particularly appendicitis. The classic McBurney approach overlooks many infarcted epiploic appendixes. The use of diagnostic laparoscopy in acute abdominal pain can show an infarcted epiploic appendix to be at the origin of pain. Four patients were admitted for acute abdominal pain and moderate tenderness in lower quadrants and were operated on for suspected acute appendicitis. In all cases laparoscopy found the torsion of an epiploic appendix, which was resected, and a normal cecal appendix. Postoperative course was uneventful. In case of acute abdominal pain in the lower quadrants of suspected appendiceal origin, laparoscopy should be routinely performed not only in women but also in men to avoid overlooking other intraperitoneal diseases that can be the cause of symptoms.

Abdomen, Acute↗
PubMed1997

[Hepatic resection and transplantation for hepatocellular carcinoma in patients with cirrhosis].

OBJECTIVES: Liver resection and liver transplantation are the only curative treatments for hepatocellular carcinoma in patients with cirrhosis. The aim of this retrospective study was to compare survival and tumor recurrence in patients with cirrhosis after hepatic resection or liver transplantation for hepatocellular carcinoma in patients with cirrhosis. METHODS: Between March 1988 and March 1995, 34 patients underwent liver resection and 30 patients with cirrhosis had liver transplantation for hepatocellular carcinoma. The probability of survival and recurrence were studied according to clinical, biological and pathological factors, defined in liver specimens. Comparisons were performed by the actuarial method and log rank test. RESULTS: Five-year survival after resection and transplantation was 13% and 32.6%, respectively, and 5-year recurrence was 92.6% and 40.9%, respectively (P < 0.01). The diameter of nodules was a significant predictive factor of recurrence in resected patients; the number of nodules was a significant predictive factor in transplanted patients. The combination of these two factors could be used to identify two groups: patients with large carcinoma (diameter > 5 cm and/or number of nodules > 3), and patients with small carcinoma (diameter < or = 5 cm and number of nodules < or = 3). The five-year survival rate of large hepatocellular carcinoma was 17.3% after resection and 0% after transplantation. The five-year survival rate of small hepatocellular carcinoma was 0% after resection and 69.3% after transplantation (P < 0.01). The five-year recurrence of large hepatocellular carcinoma was 72.3% after resection and 100% after transplantation. The five-year recurrence of small hepatocellular carcinoma was 82.6% after resection and 11.1% after transplantation (P < 0.01). CONCLUSIONS: Liver transplantation seems to be the best treatment for small hepatocellular carcinoma, mainly because of a lower recurrence rate. On the other hand, both treatments had a high recurrence rate in large hepatocellular carcinoma.

Carcinoma, Hepatocellular↗
PubMed1996

Laparoscopic cholecystectomy in cirrhotic patient.

Cholecystectomy is associated with increased risk in patients with liver cirrhosis. Moreover, cirrhosis and portal hypertension have been considered relative or absolute contraindication to laparoscopic cholecystectomy. As experience with laparoscopic cholecystectomy increased, we decided to treat cirrhotic patients via this approach. Between January 1994 and April 1995, nine patients with a Child-Pugh's stage A cirrhosis underwent elective laparoscopic cholecystectomy with intraoperative cholangiography. There was no significant per- or post-operative bleeding and no blood transfusion was necessary. There was no mortality and very low morbidity. Median hospital stay was 3 days. This series suggests that well-compensated cirrhosis can not be considered a contraindication to laparoscopic cholecystectomy.

Adult↗
PubMed1996

[Prehospital management of acute myocardial infarct in an experimental metropolitan system of medical emergencies].

BACKGROUND: Feasibility, safety and efficacy of prehospital management of acute myocardial infarction (AMI) and prehospital thrombolysis have been widely demonstrated. On this background, in March 1992 we started up an Emergency Medical Service (EMS)--Servizio per le Emergenze Cardiologiche Territoriali, SECT--aimed to prehospital care of overall cardiac emergencies (CE), including AMI. The Service, operating in the metropolitan area of Turin (130 Km2, 964,000 inhabitants), is based on a properly equipped ambulance, manned with a physician and a nurse, skilled in treatment of CE. METHODS: From March 1992 to December 1994, 5000 missions were performed, 2586 (51.7%) for chest pain, 1383 (53.5%) of presumed cardiac origin. Within the latter group, 426 (30.8%) cases of AMI, 109 (7.9%) cases of suspected AMI and 848 (61.3%) cases of angina were identified and treated. Decision time in AMI patients (pts) was 189.4 +/- 289.5 min (median 73), longer in pts over 70 years and in women. By means of a direct phone line between Emergency Communication System and metropolitan Coronary Care Units (CCU), 303/423 (71.6%) AMI pts, were directly admitted to CCU. Prehospital thrombolysis (PT) was performed in 211/426 pts (49.5%), with delay from symptom onset of 126.8 +/- 106.1 min (median 93). A rtPA "front loaded" regimen was used, with a full heparin and ASA as adjunctive therapy. Exclusion criteria for PT in 215 pts were: age > 75 years in 109 pts (50.7%), delay from symptom onset > 6 hrs in 55 (25.6%), ST depression in 33 (15.3%), contraindications to thrombolysis in 18 (8.4%). Eligibility to PT was 8.1% in chest pain pts and 43.5% in pts with AMI diagnosis at discharge. Another group of 38 pts underwent thrombolysis in hospital, after a review of inclusion criteria, with a longer delay of 231 +/- 184 min (median 150). RESULTS: Out-of-hospital diagnosis was confirmed in 91% of both AMI pts and PT pts, and in 56.7% of suspected AMI pts. Overall complication rate was 32.1%, with similar rates in PT treated pts and not PT treated pts. Prehospital mortality rate was 0.7%. In-hospital mortality rate was 5.2% in PT pts with confirmed AMI, and 16.2% in not PT pts with confirmed AMI. CONCLUSIONS: Our experience confirm efficacy of out-of-hospital management of AMI within an EMS designed to treat overall CE, considering successful treatment of complications and early thrombolysis with reduction of time delay. Inclusion of SECT in the growing up "118" Emergency Medical System raises logistic questions. Process will be completed when the "medical final authority" will submit each intervention to a full evaluation in terms of efficiency and efficacy, and will not only prepare, as now happens, dispatch and intervention protocols.

Adult↗
PubMed1995

[Out-of-hospital cardiac arrest in an experimental model of the management of cardiologic emergencies in a metropolitan area].

Since March 1992, an emergency medical system--EMS--(Servizio Emergenze Cardiologiche Territoriale, SECT) operates in the metropolitan area of Turin (130, 16 Km2), for a population of 964,000 inhabitants. SECT is based on a mobile intensive care unit, staffed with a physician and a nurse, trained in advanced cardiopulmonary resuscitation (CPR) and equipped to treat all cardiac emergencies. According to the "Utstein Style" we report the demographic and clinical features of the patients (pts) suffering Cardiac Arrest (CA) and the impact of SECT on out-of-hospital CA. During 26 months of activity, SECT performed 3,648 missions (most important among these: 457 acute myocardial infarction, 723 angina, 523 arrhythmias, 270 acute heart failure, 154 cardiac arrest), and managed 207 confirmed CA (154 calls for CA, 53 CA occurred after team arrival because of other symptoms). Resuscitation was attempted in 135 pts, in 72 pts medical personnel accerted an irreversible death state. 86% of CA occurred at home. In all cases a cardiac etiology was presumed. All CA were witnessed: 53 by EMS personnel, 82 by lay bystander. In 53 EMS witnessed CA, ventricular tachycardia (VT) or ventricular fibrillation (VF) was showed in 47.2%, asystole in 43.4%, other rhythms (Oth) in 9.4%. Return of spontaneous circulation (ROSC) was obtained in 52.8% pts, 76% in VT/VF Group. 43.4% were admitted alive to intensive care unit (ICU), 68% in VT/VF Group. 37.7% were discharged alive, 64% in VT/VF Group. In 82 lay witnessed CA initial rhythm was VT/VF in 31.7%, asystole in 59.7%, Oth. In 8.6%. CPR was attempted by lay bystander in 28% of cases. ROSC was obtained in 18.3%. CPR was attempted by lay bystander in 28% of cases. ROSC was obtained in 18.3% pts, 42.3% in VT/VF Group. 15.8% were admitted alive to ICU, 34.6% in VT/VF Group. 9.7% pts were discharged alive, 23% in VT/VF Group. Discharged alive rate in lay attempted CPR cases was 17.4%. The collapse-EMS CPR interval was 16 +/- 6.13 min (range 4-29), with a collapse-call receipt interval of 8.57 +/- 5.75 min (range 1-23) and a call receipt-EMS CPR interval of 8.06 +/- 3.56 min (range 2-19). The same intervals are significantly longer in not attempted CPR cases: respectively 26.53 +/- 10.73 min (range 10-65) -p < 0.001-, 19.29 +/- 11.3 min (range 5-60) -p < 0.001- and 8.26 +/- 3.96 (range 3-25) -p = NS-. Although far from the international effectiveness standards, SECT seemed to improve the out-of-hospital CA prognosis. High rate of CA occurred at home, time delay in early access link, better trend in survival in lay bystander attempted CPR cases and lack in early defibrillation lead to strategies for system improvement through targeted CPR training as well as semiautomatic external defibrillators introduction.

Aged↗
PubMed1995

Pathologic changes in a long-term heterotopic heart transplant survivor.

This report concerns the pathologic findings observed at autopsy in a 10-year-old heterotopic heart transplant under cyclosporine treatment. The allograft showed a diffuse multivessel atherosclerotic disease whereas in the recipient heart coronary arteries and aorta were focally affected by atherosclerosis. The proliferating cell nuclear antigen had significantly increased expression in the allograft vessels in comparison with the recipient.

Coronary Disease↗
PubMed1993

[Upper digestive hemorrhage. Comparison of terlipressin and octreotide].

The efficacy and tolerability of both Terlipressin and Octreotide in the treatment of upper digestive haemorrhage (oesophagus, stomach and duodenum) have been compared, at random, on 30 adult patients. Terlipressin dosage was 2 mg/4 hours i.v. during the first 24 hours, 2 mg/6 hours during the following 24 hours. Octreotide dosage was 50 micrograms i.v. and infusional therapy, 25 micrograms/hours, followed. Haemostasis was obtained in 100% of patients treated with Terlipressin and in 73% of patients treated with Octreotide. Rebleeding occurred in 3 patients treated with Terlipressin and 4 patients treated with Octreotide. Side effects occurred in 4 patients treated with Terlipressin and 8 patients treated with Octreotide. Terlipressin proved to have a better efficacy in comparison with Octreotide, and had less side effects.

Adult↗
PubMed1993

Pulmonary embolism due to compression of the inferior vena cava by a hepatic hemangioma.

We describe a 35-year-old man who had a pulmonary embolism with thrombosis of the inferior vena cava, apparently resulting from compression by a hepatic hemangioma. The diagnosis of pulmonary embolism was confirmed by pulmonary angiography; however, the hemangioma was detected only incidentally, as a hyperechoic mass, during an echocardiogram for intracardiac thrombosis. Abdominal sonography, computed tomography, celiac angiography, technetium 99m-labeled red blood cell scintigraphy, and ultrasound-guided liver biopsy all assisted in the diagnosis of hepatic hemangioma and its compression of the inferior vena cava. Because of the multisegmental and perihilar involvement of the tumor, surgery was not performed. For dissolution of the clots, the patient was given thrombolytic therapy followed by heparin administration. He was then placed on long-term warfarin therapy and is well after 5 years; the size of the hemangioma is unchanged. Cases of pulmonary embolism due to diseases of the upper abdominal organs are rare and probably underestimated. This case stresses the need for a systematic investigation of the abdomen when a pulmonary embolism is present without evidence of deep vein thrombosis.

Adult↗