Biomedical subjects

M Miccini

Publications and source records attributed to M Miccini.

At least 37 records · Page 2Linked to original sources

PubMed1998

[Learning curve for "tension-free" reparation of inguinal hernia].

A prospective randomized study of 106 patients with unilateral primary inguinal hernia who underwent "tension-free" mesh repair was carried out. Fifty-nine procedures (group A) were performed by a single experienced surgeon and 47 (group B) procedures were performed by a team of residents each with an experience level of less than ten cases. In group A the length of operation was statistically shorter; local anesthesia was more frequently used in group A, while intra-operative sedation and general anesthesia were more frequently used in group B. A subgroup of twenty patients (group C) operated on by residents with a personal experience of at least 5 tension free repairs was selected. No statistically significant difference in operation time and in anesthesia used were found between group A and group C. No significant difference was found between group A and group B in morbidity rate, mean postoperative stay, median time to return to work, and recurrence rate. Because easy, efficacy, and minimally invasive, the tension-free mesh repair remains the gold standard in the treatment of inguinal hernia.

Adult↗

PubMed1998

[Primary neuroendocrine carcinoma of the skin: clinical case].

A case of Merkel cell carcinoma of the skin is described. It is a rare primary skin tumor originating within the dermis with an aggressive biologic behavior. Clinical presentation of these tumors are not sufficiently distinctive to allow the preoperative diagnosis. Wide surgical excision with postoperative irradiation to the local site and regional lymphatics is recommended as the therapy of choice. Indications for chemotherapy are discussed and the guidelines for an appropriated follow-up are reported.

Aged↗

PubMed1997

Familial and psychological risk factors of ulcerative colitis.

BACKGROUND: The aetiology of ulcerative colitis is still unknown. Several theories have been proposed taking into account psychological influences. AIMS: The present study was undertaken to test the hypothesis of a relationship between certain individual psychological patterns, stress, some familial variables, and ulcerative colitis. PATIENTS: A series of 122 patients with ulcerative colitis and a matched hospital control population were independently studied by a team of physicians and a team of psychologists. METHODS: State-Trait Anxiety Inventory (Form Y) and Sacks' sentence completion tests were submitted to all subjects in both populations. RESULTS: Data showed significantly higher anxiety trait and state in ulcerative colitis patients, whilst 84% of ulcerative colitis patients showed a variety of obsessional traits and an affectivity state characterized by introversion and emotional immaturity. A link was found with regard to relationship with mother, to the condition of single children in the male ulcerative colitis population (41% vs 18% controls), and to last born daughters in the female ulcerative colitis group (47.5% vs 27.9% controls). In addition, a previous stressful life event within the 12-month period prior to the investigation was found in 44.3% of ulcerative colitis patients and in 10.7% of controls. CONCLUSIONS: Psychological disturbances and familial condition are proposed as risk factors, if not actual aetiological variables of ulcerative colitis.

Adult↗

PubMedDate not supplied

Clinical significance of serum gastrin levels in patients with colorectal cancer.

AIMS: An association between elevated serum gastrin levels and the presence of human colorectal cancer has been reported, and gastrin has been shown to stimulate the growth of experimentally induced colon neoplasia. The aim of this study was to determine the preoperative and postoperative concentrations of serum gastrin in 53 patients with colorectal cancer and to assess the correlation between gastrin levels and tumor characteristics and prognosis. MATERIALS AND METHODS: A prospective study was performed over a six-year period during which 53 patients received potentially curative surgery for colorectal cancer. The prognostic variables used for the analysis included age, sex, tumor site, stage and degree of differentiation, preoperative and postoperative serum values of carcinoembryonic antigen (CEA) and gastrin, cancer-related mortality, and survival. CEA and gastrin serum values were determined using radioimmunological methods. Follow-up was carried out with clinical and radiological tests. RESULTS: The mean preoperative gastrin concentration was 51.2+/-27.4 pg/mL (range 12-146). Significantly increased serum gastrin concentrations, which returned to normal after surgery, were detected only in patients with well-differentiated cancer (74.2+/-28.3 pg/mL; moderately differentiated, 52.1+/-23.8; poorly differentiated, 29.9+/-12.3, p=0.02). The prognosis was unrelated to serum gastrin level; instead, tumor stage, preoperative CEA value, and degree of differentiation affected patient survival. CONCLUSIONS: This study showed that the serum gastrin concentration is not an appropriate clinical oncogenic factor. Although occurring only in well-differentiated tumors, serum gastrin is unrelated to the prognosis of patients with colorectal cancer.

Adult↗

PubMedDate not supplied

[Effects of octreotide (somatostatin analog SMS 201-995) on superior mesenteric artery blood flow in swine. An experimental study using Doppler color ultrasonography].

The effect of octreotide on splanchnic haemodynamics was investigated in 25 domestic pigs by mean of US-colordoppler. In a blind-operator design the superior mesenteric artery (SMA) blood flow was evaluated before and after i.m. injection of 5, 10, 20, 25 micrograms/kg or of an equivalent volume of saline solution. Seven serial measurements were taken every 10 min in each pig excluding the higher and the lower values. The administration of 5 and 10 micrograms/kg determined a rapid and stable (3 hours) decrease of the SMA blood flow (6 and 8.5% respectively) (p < 0.05). The blood flow decreased by 27-29% (p < 0.001) in response to the administration of 20 and 25 micrograms/kg respectively. The reduction started 30 min after injection and the blood flow remained lower than basal for up to 5 hours. Because of the mean standard error of US blood flow assessment is 10% due to the interobserver and intraobserver variations, we considered statistically significant only the reduction occurred after the administration of 20 or 25 micrograms/kg. Authors findings suggest that high dose of octreotide is effective in reducing the splanchnic haemodynamics in the pig. Such animal can be used in experimental setting planed to assess the effect of splanchnic blood flow reduction.

Analysis of Variance↗

PubMedDate not supplied

[Recurrent liver metastases from colorectal cancer: their surgical treatment].

Records of 8 patients undergoing repeated operation for isolated hepatic metastasis were reviewed for operative morbidity and mortality, survival, disease-free survival. The mean interval between the initial colon operation and first hepatic resection and that between the first and the second hepatic operation were calculated. Both were found to be correlated with survival of these patients. Repeat hepatic operation for recurrent colorectal metastasis to the liver yields comparable results to first hepatic resections in terms of operative mortality and morbidity, survival, disease-free survival. Repeated hepatic operation is the most successful for of treatment for isolated recurrent colorectal metastasis.

Adult↗

PubMedDate not supplied

[Functional results of experimental autologous transplantation of the pancreas].

The autotransplant of the left lobe of the pancreas in the latero-cervical region has been successfully performed in 38 adult beagles with a mean cold ischemia time of 52 minutes. Juice volume and amylase, protein and bicarbonate outputs were resumed postoperatively as soon as 6 hours. A single case of thrombosis of the mesenteric vein occurred; all other pancreatic grafts showed good histological vitality at 30 days. This procedure of autografting is proposed as a valid experimental model for the pathophysiologic study of acute pancreatitis.

Acute Disease↗

PubMedDate not supplied

[Cholelithiasis in men. Observations on a case series of surgically treated 3,047 patients].

Age and clinical presentation as acute cholecystitis have widely been found to be predictors of outcome after cholecystectomy. Recently, male gender has been cited in several studies as a possible prognostic factor. A single Institution cholecystectomy registry (3.047 cases between 1959-1997) comprising 966 (31.7%) men and 2.81 (68.3%) women was retrospectively analysed. Men experienced significantly higher rate of major complications (5.3% vs 3.2%; p < 0.01) and mortality (1.55% vs 0.62%; p < 0.03). By logistic regression analysis, it was found that male gender, acute cholecystitis, respiratory and cardiovascular system disease were significantly related to postoperative morbidity. Age older than 65 years, male gender, respiratory and cardiovascular diseases were factors negatively affecting operative mortality.

Acute Disease↗

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

[Acquired abnormalities of the biliary tract. Preoperative diagnosis and surgical risk in the laparoscopic era].

Acquired anomalies of the biliary tract are rare. The aim of this work was to examine their frequency and to assess potential associated danger when performing a laparoscopic cholecystectomy. A retrospective analysis of clinical charts of 3.870 patients undergoing elective cholecystectomy between 1959 and 1997 was performed. Eighteen cases of choledoco-duodenal fistula, 9 of cholecysto-duodenal and 12 of cholecysto-choledochal fistulas were observed. Two cases of acquired absence of the cystic duct and one cholecysto-colic fistula were also encountered. The traditional contrastographic radiology showed to be more accurate in defining presence and nature of the acquired anomalies. Etiopathogenesis of the main anomalies and consequent risks in performing laparoscopic cholecystectomy were discussed.

Aged↗

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

[Use of ileostomy and colostomy as temporal derivation in colorectal surgery].

A retrospective study on 41 patients with primary stoma creation after low anterior resection of the rectum was made. Among the 41 patients 24 had a loop colostomy (Group A) and 17 had a loop ileostomy (Group B). The two groups were well matched for each of the data analysed and there was no significant difference in the rate of complications related to stomas creation and closure. In this study the Authors suggest that loop ileostomy is the best procedure to electively defunctionate colorectal anastomoses.

Adenocarcinoma↗

PubMedDate not supplied

[Pica and intestinal occlusion: a clinical case].

Accidental or voluntary foreign bodies ingestion is a frequent reported event in emergency departments. Complication, foreign body shape related are not often observed and, once occurred, just few a cases need an open surgery approach, about 1%. The Authors report the case of a young woman with pica admitted to their Department in an emergency setting for acute intestinal obstruction due to the ingestion of not specified amount of elastics, which required an open surgery operation.

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

[Cecal volvulus].

A retrospective study on 18 patients with cecal volvulus surgically treated was made. Demographics and clinical data, as well as treatment were determined from clinical reports. The operative procedures employed were cecostomy (56%), cecopexy (22%) and right colectomy (22%). The length of follow up averaged 63 months and there was one recurrence. The Authors suggest that cecostomy should be employed in patients with viable bowel, and resection should be limited to cases with gangrene.

Cecal Diseases↗

PubMedDate not supplied

[Primary adenocarcinoma of the ureter. Case report].

Primary ureteral adenocarcinoma is an infrequent histological type of urinary neoplasm. Many authors consider intestinal metaplasia the pivotal event of the pathogenetic process, whether it occurs on a pre-existing urothelial carcinoma or on a normal urothelium. Diagnosis is essentially based on case history and clinical findings (hematuria and pain) and on diagnostic imaging. Treatment is surgical and the ideal procedure is nephroureterectomy with excision of a bladder margin adjacent to the ureteral opening and ispilateral para-aortoiliac lymphadenectomy. A 76-year-old man with primary adenocarcinoma of the ureter case is reported.

Adenocarcinoma↗

PubMedDate not supplied

[Aneurysmal cysts of the jaws. The nosological picture and a clinical case report].

After discussing the classification of aneurysmatic cyst with particular reference to its characteristics for differential diagnosis with other pathologies of various origin, a personal case is reported. The diagnosis and treatment protocol of the clinical case in question is presented together with clinico-therapeutic problems and the results obtained with the diagnostic and therapeutic aids used.

Adult↗

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↗