Donor graft lithiasis in kidney transplantation.
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Adult↗
Biomedical subjects
M Sianesi
Publications and source records attributed to M Sianesi.
[Colorectal endometriosis].
The Authors present their experience from 1980 to 2001 in the treatment of 5 cases of endometriosis. The median age is 26.5 years, the symptomatology was the presence of abdominal pain feces mixed with blood in two patients and in three cases a colorectal localization as well as a pelvic endometriosis. In a case the Authors have treated the patient with a surgical approach and in the others with a medical therapy with LH-RH analogs. Pathogenesis, symptomatology, diagnostics, medical and surgical therapy of this disease are also analyzed.
Adult↗
[Early complications of thyroid surgery].
The complications in thyroid surgery reported in literature are variables. The Authors describe the experience on 803 thyroidectomy from 1 January 1995 to 31 December 2000. The knowledge of the embryologic origin of the parathyroids glands, of the causes of haemorrhage and the improvement of the surgical technique has permitted a lower incidence of complications.
Adult↗
Thyroid function and goiter recurrence after thyroid lobectomy in elderly subjects.
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Adult↗
Breast cancer in pregnancy.
Breast cancer in pregnancy involves a psychosocial, religious, multidisciplinary medical decision. From 1991 the Authors have surgically treated six patients affected by breast cancer in pregnancy. The Authors, in this papers, review analysing current therapeutic approach for this disease.
Adult↗
[Endoscopic polypectomy with the use of endoloop in giant gastric polyp: a case report].
The gastric polyps are lesions found in 2-3% of endoscopic procedures. We point out the hystologic nature of these lesions to a correct therapeutic evaluation. The endoscopic polypectomy is today safe; we report our experience in an endoscopic polypectomy with use of endoloop for a giant gastric polyp.
Aged↗
[Medullary carcinoma of the thyroid gland].
We report the experience of the Institute of Surgical Pathology of the University of Parma on three patients with sporadic medullary thyroid carcinoma (MTC). MTC is a tumor of parafollicolor cells origin (C cells). The surgical excision of the thyroid tumor and cervical node metastases is potentially curative. The other therapeutic options are limited. Considerable emphasis has been placed on early diagnosis and surgery for multiple endocrine neoplasia (MEN) related MTC. Genetic screening promises earlier and accurate diagnosis (RET gene mutations are found in MEN).
Adult↗
[Diagnosis and surgical treatment of primary hyperparathyroidism].
Primary hyperparathyroidism (HPP) is increasingly being recognized because of the widespread use of multiphasic screening for hypercalcemia, in patients without clinical signs. Each year develop 100,000 new cases in the United States, females/males 5:2; the peak of incidence is in V-VI degrees decade. We analyze our patients from November 1975 to July 2000. We have performed 112 parathyroidectomy for HPP, 84 females and 28 males, median age 57.5 years. We have examined the surgical options, the value of PTH, calcium, and the number of pathological glands. The Authors discuss the invasive or non-invasive procedures and the surgical treatment.
Adolescent↗
[Gastric polyps: possible causes of pyloro-duodenal obstruction].
We reported three cases of transpyloric prolapsed polipoid lesions. Abdominal pain, early satiety are the most common presenting features. Endoscopies and polipectomy are important for a correct diagnostic evaluation. Large polyps (> 2 cm), if prolapsed, can require a surgical excision.
Aged↗
Pre-operative evaluation and treatment of patients with chronic venous insufficiency.
OBJECTIVE: To describe the use of radionuclide venography (RV) in the detection of the site(s) of blood reflux through incompetent perforating veins (IPVs) of the leg of patients with chronic venous insufficiency (CVI). EXPERIMENTAL DESIGN: Prospective study in which we evaluated our experience in the assessment and treatment of patients with moderate or severe CVI with a follow-up ranging between 6 and 48 months. SETTING: A surgical service of the Department of Surgery of the University of Rome "Tor Vergata". PATIENTS: Fifty-three patients with CVI that were referred to our service to be surgically treated. INTERVENTIONS: Physical examination, RV, and surgical procedures of ligation of IPVs. MEASURES: Based on pre- and post-operative physical examination and RV. RESULTS: The patency of deep venous system and the presence of 1 to 3 leg IPVs was confirmed preoperatively in all the limbs either with physical examination and RV. After surgery, non-ulcerated skin changes improved and all the ulcers healed within 45 days. Postoperative RV showed that the IPVs had disappeared from the affected areas in 56 limbs. Two ulcers recurred after two and six months respectively. CONCLUSIONS: RV showed to be a reliable method to exactly detect IPVs. This method is useful to guide the ligation of IPVs in patients with moderate or severe CVI.
Aged↗
Prevalence of thyroid cancer in hyperthyroid patients treated by surgery.
A retrospective study has been carried out to evaluate the prevalence of malignant thyroid tumors in 202 patients submitted to surgery for hyperthyroidism. Thyroid cancer was diagnosed in 12 cases (5.9%); the final histologic examination revealed nine papillary carcinomas, one follicular carcinoma, and two Hürthle cell carcinomas. Concurrence of hyperthyroidism and thyroid cancer was more frequent in patients with single toxic adenomas than in those with toxic diffuse or multinodular goiters. In five cases thyroid malignancy was detected in the context of the hyperthyroid lesion (three toxic adenomas and two diffuse goiters). In eight patients the malignant lesion showed a maximum diameter of less than 1 cm, although in five of these cases unfavorable histologic features, such as minimal capsular invasion or multifocality, were present. All patients presenting with thyroid cancer are currently alive and apparently free of residual disease. It is concluded that hyperthyroid patients, particularly those with single toxic adenomas, should be carefully evaluated to exclude the presence of an associated malignancy and to plan the most appropriate therapeutic options.
Adult↗
[The histopathological and microbiological aspects in a model of acute acalculous cholecystitis: an experimental study].
The early stages of acute acalculous cholecystitis (ACC) have been difficult to investigate due to the animal models developed and utilized over the past years. A new model of animal AAC induced by intra-abdominal sepsis is presented. Under general anesthesia 35 guinea pigs underwent laparotomy. The designed model included ligation and prick of the caecum in 25 animals (group A), while 10 animals served as control group (group B). Seven days after these experimental procedures animals underwent relaparotomy and were submitted to cholecystectomy and sacrifice. Histological studies of the specimen revealed various degrees of cholecystitis in all the gallbladders of survived animals from group A. Gallbladders of animals from group B were histologically normal. Gallbladder bile of 15 survived animals from group A were cultured. Bile cultures were negative in 10, while culture of gallbladder bile were positive in 5; the pathogen cultured were Streptococcus Faecalis and Streptococcus Sp. The results of this study suggest that intra-abdominal sepsis induces gallbladder inflammation of various degrees. This directly supports the theoretical relationship indicating that sepsis and shock could produce AAC. Moreover this model proved that AAC, in early stages, is primarily induced by inflammatory processes, while infection of the bile do represent a late event.
Acute Disease↗
[Surgical treatment of pancreatic pseudocysts].
The Authors report their experience of 62 consecutive patients with pancreatic pseudocysts observed within the period 1973-1993. Spontaneous resolution of the pseudocyst occurred in 16 cases. Forty-five patients were surgically treated (31 post-necrotic cysts, 5 post-traumatic cysts and 9 retention cysts); operations included internal drainage in 32 (cystojejunostomy in 13, cystogastrostomy in 18 and cystoduodenostomy in one), external drainage in 8 and pancreatic resection in 5 patients. One patient underwent percutaneous catheter drainage of a post-necrotic pseudocyst. Indications for surgery included complications, nonresolution or persistence of symptoms, and extension. The operative mortality and morbidity rates were higher in the patients submitted to external drainage (22.2% vs 6.2%; 55.5% vs 21.8% respectively). On the basis of the results the Authors conclude that the internal drainage, particularly cystojejunostomy, should be considered the operation of choice for pancreatic pseudocysts because of the lower mortality and morbidity. On the contrary, external drainage is indicated for infected or ruptured pseudocysts.
Adult↗
Gastric carcinoid tumor and its precursor lesions. Ultrastructural study of a case before and after antrectomy.
Antrectomy has been proposed as the preferential treatment of hypergastrinemic patients with nonantral gastric carcinoids since it removes the main growth factor for the tumors and their precursor lesions, ie, hypergastrinemia. To investigate the cellular basis of the mechanism for postantrectomy regression in nonantral endocrine cells, a light and electron microscopic morphometric study was performed in a case of enterochromaffinlike-cell gastric carcinoid associated with hypergastrinemia before and 4 and 10 months after antrectomy. The withdrawal of sustained hypergastrinemia obtained by antrectomy was associated with a progressive reduction of the volume density, cross-sectional area, and number of profiles of endocrine cells in the remaining nonantral mucosa, in which gastrin-dependent proliferations were regarded as the carcinoid precursor lesions. Ultrastructural morphometry demonstrated that the changes selectively involved the enterochromaffinlike cells, ie, the specific cell target for the trophic action of gastrin and the usual component of gastric carcinoids. The volume fractions of enterochromaffin and X cells (producing serotonin and endothelin, respectively) were increased 10 months after antrectomy. Persistence of a modest elevation of gastrin levels, likely due to the occurrence of gastrin cells in areas of pyloric metaplasia of the nonantral mucosa, did not prevent the hypotrophic effects of antrectomy.
Aged↗
Longitudinal study of bone loss after thyroidectomy and suppressive thyroxine therapy in premenopausal women.
The effects of suppressive doses of L-thyroxine on the appendicular and axial bone mineral content were followed for 12-36 months after total or subtotal thyroidectomy in 15 premenopausal women. Compared to age-matched controls, these patients had a more marked bone loss of the spinal bone mineral content (2.6 +/- 1.9% vs 0.2 +/- 1.2% per year). The changes in radial cortical bone density were not significantly different from the control group. We conclude that when a suppressive therapy with L-thyroxine is necessary the rate of bone loss should be monitored at regular intervals.
Adult↗
"Adenomatous polyps of the gallbladder" adenomas of the gallbladder.
The finding of adenomatous polyps of the gallbladder is a rare occurrence and an unusual clinical problem. Among 2,145 patients who underwent cholecystectomy for gallbladder disease only 9 (0.4 per cent) presented with adenomatous polyps. There were 6 women and 3 men, aged 17 to 70 years. Preoperative ultrasonographic diagnosis was made in only 1 of 7 patients with gallstones, in contrast polypoid lesions within a gallbladder without stones were easily confirmed by both ultrasonography and oral cholecystography in the remaining 2 patients. All polyps were 1.0 cm or less in size and without histologic evidence of malignant change. The clinical significance of this rare condition is discussed, with particular reference to a possible role in development of gallbladder carcinoma. Surgical treatment should be advocated regardless of clinical manifestation when the polyp exceeds 1.0 cm in diameter or rapid growth of the lesion is seen on ultrasonographic follow-up examinations.
Adenoma↗
Papillitis: a critical appraisal based on intraoperative radiomanometric evaluation.
Disagreement still prevails over intraoperative diagnosis of papillitis as shown by the variability in incidence reported with a wide range of percentage. A study, concerning 2957 biliary operations for benign diseases has been carried out in order to analyse the incidence of papillary disorders. Two periods have been considered: before and after the intraoperative employment of radiomanometry. Primary benign stricture of the papilla, diagnosed in 0.1% of the cases in the first period, was not found in the second period; papillitis associated with lithiasis of the gallbladder was recognized in 2.5 and 0.3% of the cases respectively (no cases in the last four years); papillitis associated with common bile duct stones was found, according to the period considered, in 11.6 and 2.4% of cases (1.4% in the last four years). These results seem to suggest that benign papillary stenosis is a rare pathologic entity, often overdiagnosed or misjudged, and that planning of surgical treatment of common bile duct stones should be carefully considered, taking into account this remark in order to avoid unnecessary procedures.
Ampulla of Vater↗
Physiopathologic role of microlithiasis in gallstone pancreatitis.
A study of 108 patients with acute or acute relapsing gallstone pancreatitis was carried out in order to evaluate the incidence of biliary lithiasis and microlithiasis. The severity of pancreatic damage associated with both clinical states and the physicochemical characteristics of the minute stones were also evaluated. The results suggest that the risk of acute pancreatitis is increased in patients with microlithiasis and that in patients with acute pancreatitis due to microlithiasis the lesions are more severe. These results warrant the conclusion that cholecystectomy should be performed upon all patients with echographically detected microlithiasis, even in the absence of symptoms. Early surgical treatment must be performed whenever pancreatitis develops.
Acute Disease↗