Biomedical subjects
Publications and source records attributed to M Nardi.
Secondary neoplasm of the thyroid mimicking a primary thyroid lesion is a very rare finding. A case of squamous and anaplastic cell carcinoma of the uterine cervix metastatic to the thyroid is described.
PURPOSE: To report a free-floating dislodged pigmented cyst in the anterior chamber and to describe the ultrasound biomicroscopic (UBM) features of the lesion. METHODS: Case report. RESULTS: A 26-year-old man presented with noise in his left eye in the prone position. Slit-lamp examination revealed a small pigmented mass lesion at the 6 o'clock position in the anterior chamber, slowly moving with changing head postures. UBM revealed an unfixed dislodged pigmented cyst with a thin wall and no internal reflectivity, changing its shape from ovoid to circular. Five years later, the anterior segment does not show any modification and the cyst has not changed in size or appearance. CONCLUSIONS: Cysts of the iris pigment epithelium arise in the posterior iris layer. They may be central, midzonal, peripheral, or dislodged. Dislodged cysts may be repositioned and fixed or free-floating in the vitreous or in the anterior chamber. Surgical removal must be considered only for a rapid enlargement or significant reduction in endothelial cell count. UBM can distinguish solid from cystic lesions, giving detailed information on internal structure, reflectivity, shape, and thickness.
PURPOSE: To evaluate the efficacy and safety of bimatoprost 0.03% as an alternative to filtration surgery in patients with uncontrolled glaucoma. DESIGN: Interventional study. METHODS: A total of 83 consecutive patients (83 eyes) awaiting glaucoma surgery were enrolled in eight ophthalmic centers. Reasons for listing were inadequate intraocular pressure (IOP) control despite medical therapy and documented progression of visual field loss. All patients discontinued the previous treatment and were switched to bimatoprost 0.03% QD (one drop at 9 pm). The primary efficacy outcome was a 20% IOP reduction from baseline at each timepoint. IOP was measured at day 7, day 30, day 60, and day 90 of treatment; less than 20% IOP reduction was considered as a failure. RESULTS: An IOP reduction of at least 20% was achieved in 74 patients (89.1%) after 7 days and in 64 patients (86.5%) after 30 days. Sixty-two patients (74.6%) maintained IOP readings 20% lower than baseline after 60 and 90 days. In these patients, visual field indices improved in 8 eyes (13%), and remained unchanged in 54 eyes (87%). Ocular side effects were conjunctival injection (15.6%), burning sensation (9.6%), foreign body sensation (4.8%), and eyelash growth (2.4%). CONCLUSIONS: This preliminary study shows that bimatoprost 0.03% could represent a useful therapeutic tool that might defer filtration surgery.
BACKGROUND: Changes in refraction follow surgery on the extraocular muscles. We examined corneal topography before and after medial or lateral rectus muscle recession using a computer-assisted topographic analysis system. METHODS: A total of 36 patients (52 eyes) were examined. Measurements were taken 1 day before surgery and 1, 15, and 30 days after surgery. RESULTS: A significant change in astigmatic power was detected 1 day after surgery in the meridian of the recessed muscle, evidencing a localized flattening of the cornea. Induced astigmatism decreased over time. At 30 days following surgery, 6% of patients evidenced a residual change higher than 1 diopter (D); 12% evidenced a residual change higher than 0.5 D. CONCLUSION: The increase of astigmatic power recorded 1 day after surgery is higher for medial rectus muscle recession than for lateral rectus muscle recession. Corneal topography changes, located mainly in the meridian of the recessed muscle and the optical zone, are greatly reduced or gone within 1 month of surgery.
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Diverticular disease of the colon has been recorded with increasing frequency and approximately 25-30% of symptomatic patients require surgery for complications. Controversy still surrounds the best operative approach for the management of diverticular disease, particularly when it presents with complications. The three-stage operation has, for the most part, been abandoned because of its unacceptably high morbidity and mortality rates. Today it is generally believed that performing two-stage surgery is a wise decision, namely segmentary resection either without (Hartmann's procedure) or with anastomosis, protected by a covering colostomy. However, the ideal intervention is a one-stage surgical procedure (segmentary resection and primary anastomosis without a covering colostomy), but this can only be performed in selected patients. The aim of this study was to analyse the clinical course and the medical and surgical therapy retrospectively in 79 patients with symptomatic diverticular disease in order to identify the best therapeutic procedure; specifically, the severity of septic complications was evaluated using Hinchey's classification. The authors conclude that most patients with symptomatic diverticular disease require specific medical therapy. If surgical treatment is necessary (complicated diverticular disease), Hartmann's procedure is still a valid surgical option, particularly in the presence of diffuse faecal peritonitis. Colonic resection and primary anastomosis are certainly a satisfactory treatment, because of their low morbidity and mortality rates, but this surgical approach is only feasible in selected patients. Finally, it is a matter for the individual surgeon's experience to select the best surgical procedure in any particular situation, depending on age and general state, local findings and the extent of peritonitis.
Acute mesenteric ischaemia is the result of inadequate blood flow to all or part of the small intestine and the right half of the colon. Irrespective of the cause of the ischaemic insult, the end results are similar, namely, a spectrum of bowel injury ranging from completely reversible alterations of bowel function to transmural haemorrhagic necrosis of the intestinal wall. Depending on the degree of ischaemia and the length of bowel involved, a wide variety of clinical presentations are observed. Mesenteric infarction is a pathology which is encountered fairly often in elderly patients where the concomitance of other diseases make its prognosis more severe, especially since the diagnosis is usually late. The pessimism expressed more than 70 years ago concerning this disease is still shared by many physicians today. The authors report on their experience with 37 cases of mesenteric infarction. The median age of the patients was 77 years (range: 66-91). The mortality rate was 67.5% (25 deaths) which is in line with the results in the literature. The median hospital stay was 17 days (range: 10-71). The authors emphasise the difficulty of diagnosing and treating this entity, also in view of the fact that, in most centres, it is impossible to perform emergency selective angiography of the superior mesenteric artery. The need for an early specific diagnosis is stressed, because the therapeutic options may vary widely in relation to the different causes of acute intestinal ischaemia.
Results of a study using the treadmill test on 32 patients with peripheral Fontaine's stage II arterial disease are described. The aim of the study was to evaluate the utility of the test in assessing useful information concerning the site of the lesion. Patients were divided in three classes depending on the arterial segment involved (iliac-femoral, femoro-popliteal, associated lesions) as resulted from the velocimetric and angiographic evaluation. Ankle pressure and WI, at rest and after stress test, PFWD and RT were evaluated. The authors conclude that data achieved with the dynamic test are related to the arterial involvement, allowing to differentiate obstructive and stenotic lesions, but do not give information concerning the site of the lesion. Nevertheless it is a valuable means of highlighting arterial lesions well compensated at rest and with normal pressure values.
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BACKGROUND: Day-Surgery (DS) is a widely spreading reality, both for clinical advantages to patients and organizational and economic profit to hospitals. In the last years, DS has been proposed for the treatment of a large number of diseases as inguinal and crural hernias, varicose vein, benign anorectal and thyroid pathologies. Recently, also laparoscopic cholecystectomy (LC) has been realised as DS procedure, and the initial results are promising. OBJECTIVES: To determine both the clinical feasibility of LC in DS and the factors that can predict an extension of hospital stay. MATERIALS AND METHODS: The present study is a retrospective analysis of 166 patients who underwent surgery because of symptomatic cholelithiasis in a three-year period; all patients underwent elective LC in ordinary hospital-stay. In order to identifying the patients potentially eligible for LC in DS, we carried on a selection by means of 3 consecutive stages: stage A, selection on the basis of preoperative data, stage B, selection on the basis of intraoperative factors and stage C, selection on the basis of postoperative parameters. RESULTS: Out of 166 patients, only 33 (19,8%) would have been successfully treated in DS. CONCLUSIONS: This study showed that LC in DS can be realised in strictly selected patients, on the basis of rigorous clinical and organizational criteria; furthermore, a continuous training of surgeons and nursing staff, the implementation of tele-medical facilities and the improvement of anesthesiological techniques will allow to the best results.
A female patient was admitted to our Department for total thyroidectomy in amiodarone-induced thyrotoxicosis. The drug was prescribed for ventricular arrhythmia and atrial paroxysmal fibrillation in dilated cardiomyopathy due to chronic aortic regurgitation with left ventricular dysfunction (ejection fraction 35%; Class Functional NYHA III) and moderate-severe respiratory insufficiency. The cardiologist-anesthetist team has allowed to evaluate the surgical-cardiovascular-anesthesiologic risks and the balance between the improvement by the amiodarone administration for the arrhythmia, and the discontinuation of this treatment in order to prevent aggravation of the thyrotoxicosis. These hypotheses were subsequently discharged for the two reasons listed below: - several other antiarrhytmic drugs (that didn't show equivalent efficacy as amiodarone in preventing or converting such ventricular and atrial arrhythmias) may be proposed in the place of amiodarone. However, this could expose the patient to an arrhythmia; - a clear proof that the suspension of amiodarone can allow restoring normalization of the thyroid function doesn't exist. Therefore, the patient has been successfully submitted to the surgical intervention and in the follow-up we brought her back to a state of normalized thyroid function and cardiovascular conditions. In patients that cannot safely discontinue amiodarone or when medical therapy is ineffective in controlling thyrotoxicosis, thyroidectomy is the treatment of choice.
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.
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A child undergoing induction therapy for acute lymphoblastic leukemia suffered an aplastic crisis associated with B19 virus infection. Good response to the antiblastic therapy led to a burst in erythropoiesis favoring high viral replication, which was responsible for strong erythroblastic inhibition and severe viremia. The patient's B19 antibody response became evident very late, probably because of the antiblastic effect of the therapy; nevertheless, recovery was complete in little more than a week, favored by B19 IgG transfusion with a red blood cell concentrate. This report suggests that immunosuppressed subjects, as well as those suffering from hemolytic anemia must also be considered "at risk" for aplastic crisis due to B19 infection.
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The authors describe a case of giant vesical calculus in an 89 year old patient. The diagnosis, as in the other cases reported in the international literature, was made after a series of laboratory and instrumental exams, for groups reported by the patient in the lower abdomen. Operated for the removal of the vesical calculus, he was considered healed after a fortnight. The vesical calculus has a mixed composition and it weighs about 380 grams. The revision of the literature shows the various chemical composition of the vesical calculus that does not permit to identify a common aetiology. It is not possible to demonstrate if the formation of this kind of calculus is primary (in the urinary bladder) or if it is proper of the high urinary tract or mixed. The most recurrent causes being various and different confirm the mixed aetiopathologic theory. The diagnosis, often casual, is made thanks to the most common diagnostic exams; as it is difficult to make a complete cystoscopic control because the bladder is almost completely occupied by the lithiasic formation. The surgical therapy consists of a epicystotomy with a following removal of the calculus. In literature, moreover, cases treated with extra-body lithotripsy are not reported, on the contrary ot happens daily for the lithiasis of the high urinary tract.