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Biomedical subjects

M Simi

Publications and source records attributed to M Simi.

80 records · Page 5Linked to original sources
PubMedDate not supplied

[Is intraoperative cholangiography always indicated during videolaparoscopic cholecystectomy?].

Opinion is divided whether intra-operative cholangiography should be performed routinely or on a selective basis during laparoscopic cholecystectomy. The aims of the present study were to assess the safety, utility and indications of intraoperative cholangiography performed during laparoscopic cholecystectomy. 11 operative cholangiograms were attempted in 63 patients who underwent laparoscopic cholecystectomy (17.4%). Duration of post-operative hospitalization and interval to return to full activity were identical in the two groups. Cholangiography increased the duration of operation (mean 20.1 min: p < 0.01) and the total charges for the operation by almost L. 200,000. Cholangiograms were performed successfully in 100% of the patients and changed operative management in 2 patients. There was not false negative or positive study. No complications or deaths occurred that were due to cholangiography. In follow-up ranging from 1-9 months, there has been no clinical evidence of bile duct injury or retained common bile duct stones. The inescapable conclusion is that an absolute indication for performing cholangiography is unclear anatomy of biliary system. Whereas to document the presence of common bile duct stones, intra-operative cholangiography, neither routine nor selective, is needed. Patients who present with clinical or biochemical signs of choledocholithiasis, a history of cholangitis, acute biliary pancreatitis, or an abnormal CBD on sonogram should have preoperative ERCP and ES before contemplated laparoscopic cholecystectomy. Further advances and confidence with laparoscopic CBD exploration may further change the approach to these patients in the future. In this case selective intra-operative cholangiography is mandatory. However, additional prospective analysis of this patient subgroup is needed.

Adolescent↗
PubMedDate not supplied

[Ménétrier's disease associated with a gastric ulcer: a clinical case report and review of the literature].

The authors report on a case of Ménétrier's disease, associated with antral gastric ulcer. The patient came at our observation after a severe high digestive bleeding. On the basis of the endoscopic diagnosis of gastric ulcer and because of the failure of medical treatment with continuous bleeding, the patient underwent subtotal gastrectomy. The histological examination of the specimen confirmed the benign nature of the gastric ulcer but revealed also the presence of Ménétrier's disease. After three years, an endoscopic control excluded the presence of the disease in the remaining stomach. The association between gastric ulcer and Ménétrier's disease is of difficult pathophysiological explanation in the literature. The presence of the ulcer, however, does not seem to influence the clinical evolution of the disease or the treatment, which, moreover, has not been codified as yet. In fact, cases of Ménétrier's disease are reported to have been cured with cortisol, anticholinergic, anti-H2 receptor and antifibrinolytic preparations or by surgery (subtotal gastrectomy, total gastrectomy). However, as in our patient, spontaneous remission of the disease with no treatment have been reported. The Ménétrier's disease, the treatment of which has yet to be codified, is still a difficult situation, in particular when associated to gastric ulcer.

Biopsy↗
PubMedDate not supplied

[The current state of adjuvant treatment in carcinoma of the resected colon].

After radical surgery for colo-rectal cancer, the prevention of local recurrence and/or distant metastasis, represents the key factor of the active measures adopted by surgeons and oncologists. Recent trends of the research in this field, show that an effective chemotherapy is the goal to achieve. Our review of the literature on this subject, is aimed to make some remarks about the results of the main randomized protocols of adjuvant chemotherapy conducted in recent years, comparing the efficacy of different treatments. We should consider two ways of administering the chemotherapy: the systemic route, the classic one, and the portal route, especially designed to prevent liver metastasis. At the end of our review, we can conclude the following: poly-chemotherapy (MF or MOF) did not show real advantages compared to 5-FU alone the combination of 5-FU + Levamisole, showed an undoubtable efficacy in Dukes' C colorectal cancer the efficacy of intra-portal vein chemotherapy for Dukes' B colorectal cancer, has been proved in one report only, therefore we are waiting for a confirmative answer from the several similar investigations prompted recently. The analysis of such investigations may contribute, in future, to establish new protocols combining chemotherapy with immunotherapy and particularly, systemic chemotherapy with loco-regional one.

Antineoplastic Combined Chemotherapy Protocols↗
PubMedDate not supplied

[THe video laparoscopic experience of the general surgeon in cholecystectomy in childhood].

Despite the exponentially increasing number of laparoscopic cholecystectomies on adults to date, there is a paucity of reports in the literature about this new technique in pediatric patients. From September 1992 to February 1995, 140 patients underwent laparoscopic cholecystectomy. Since July 1993, in our institution, five pediatric patients (three females and two males) with a diagnosis of cholelithiasis underwent laparoscopic cholecystectomy. The age of the patients ranged from 6 to 15 years (mean 8.8 years) and they weighed 18-58 kg (mean 28.4 kg). All five patients had biliary cholic and ultrasound evidence of cholelithiasis. One patient had associated hematological disease (sickle cell disease). All 5 children were operated using the laparoscopic approach technique. Operative cholangiography was performed in cases with ductal and vascular intraoperative anatomy unclear. No operation was converted to open cholecystectomy. Intraoperative cholangiography was performed successfully (100%). The mean time of surgery was 50.2 minutes (range from 38 to 68). There were no operative complications. The mean hospital stay was 2.2 days (range 2 to 3 days). All five returned to their activity within a week. No long-term complications were seen in all patients throughout an average follow-up period of 10.6 months (range 8-14). The benefits of laparoscopic cholecystectomy in children are clear and obvious. It is safe and effective and should now be the treatment of choice for cholelithiasis in pediatric patients.

Adolescent↗
PubMedDate not supplied

[Proctological surgery in the one-day surgery regimen: the preliminary results with 232 patients].

Simple anorectal surgery can be routinely employed on a one-day surgery (ODS) bases; however complications such as bleeding, urinary retention, and postoperative pain represent a limitation in this respect. In this paper we report preliminary results of our experience in surgery for haemorrhoids, anal fissures and fistulas, achieved in two years on 232 patients. Our protocol includes admission in the morning of the operation and preoperative evaluation by means of ECG, coagulation profile, assay of beta-HCG for female patients. The patients, prepared with a self-administered enema and perianal applications of prilocaine-lidocaine ointment, is taken in the operative room were a venous line is placed and an anaesthesiologist proceed to monitoring of ECG, blood pressure and oximetry. 211 patients were operated under locoregional anaesthesia performed by the surgeon by means of bilateral pudendal nerves blocking. Whereas the remaining underwent general or spinal anesthesia. With this approach we performed 106 haemorrhoidectomies, 96 sphincterotomies, 19 of which with posterior anoplasty and 30 fistulectomy or fistulotomy. 60 mg of ketorolac have been injected locally at the end of operation in order to improve postoperative pain control. Patients undergoing hemorrhoidectomy, anoplasty, fistulotomy or fistulectomy were discharged after 24 hours whereas those undergoing sphincterotomy went home the same day. We reported 4 early postoperative complications in the haemorrhoids group with an incidence of 1.7% (two bleedings, one urinary retention and one fever) treated conservatively. Postoperative pain resulted adequately controlled by a low dosage of NSAID (a mean of 3.7 doses of 30 mg ketorolac/patient). Our satisfactory results seem to suggest continuing the practice of one-day surgery in proctology.

Adult↗