Biomedical subjects

Maria Francesca Arcuri

Publications and source records attributed to Maria Francesca Arcuri.

12 recordsLinked to original sources

PubMed2006

Dunbar's syndrome and superior mesenteric artery's syndrome: a rare association.

Celiac artery compression syndrome (CACS) and superior mesenteric artery syndrome (SMAS) are 2 rare diseases, widely described in literature. Their association has not been specifically investigated; in fact, few cases have been reported. For this reason we reviewed our experience from January 1974 to June 2004. We report 59 patients affected by CACS and 28 by SMAS. Coexistence of both syndromes in 8 patients was observed. These 8 patients were successfully treated with duodenojejunal bypass and decompression of the celiac trunk. In this paper, we analyze the pathogenesis, clinical presentation, diagnosis, and treatment of these syndromes, emphasizing their common aspects. The misdiagnosis of this association may justify in some cases the controversial results reported regarding the surgical treatment of these syndrome.

Adolescent↗

PubMed2006

Preliminary experience in minimally invasive videoassisted thyroidectomy (MIVAT).

BACKGROUND: We report our initial experience in the treatment of thyroid disease with Minimally Invasive Videoassisted Technique (MIVAT) introduced by Miccoli. METHODS: We have treated from July to September 2005, 5 patients, with MIVAT. The procedure is carried out through an incision of 15-20 mm 2 cm on sternal notch and the thyroidectomy is performed by dedicated instruments. RESULTS: We have surgically treated 3 follicular hyperplasias, one Hurthle adenoma and one papillary carcinoma. The mean time of thyroidectomy was 98 +/- 14 minutes; four cases were discharged after 24 hours and one case after 48 hours for a postoperative hypertension. No hypocalcemia, no nerve palsy. Cosmetic result and postoperative pain were excellent. CONCLUSION: MIVAT is a safe, reproducible technique with an indication in a minority of patients candidates to thyroidectomy and is characterized by a better postoperative discomfort.

Adult↗

PubMed2005

The utility of serum PTH assessment 24 hours after total thyroidectomy.

BACKGROUND: Hypocalcemia is the most frequent complication following total thyroidectomy. This prospective study examines the predictive value of parathyroid hormone (PTH) levels measured 24 hours after surgery. MATERIAL AND METHODS: A total of 1006 consecutive patients (mean age, 54.8 years; female/male ratio, 4/1) underwent total thyroidectomy for benign or malignant thyroid from January 1995 to November 2003. Serum calcium, phosphorus, and PTH were measured preoperatively and at 24 hours after surgery. All patients underwent preoperative examination to assess cord motility. RESULTS: A total of 253 (25.1%) patients presented with hypocalcemia demonstrated by clinical and laboratory findings. In 101 cases the hypocalcemic syndrome manifested after 24 to 36 hours whereas in 5 of 101 cases, symptom onset was between 48 and 72 hours. Serum calcium levels lower than 7.5 mg/dL were recorded in all the 101 cases. In 239 of 253 cases serum calcium returned to normal values within 7 days following surgery. PTH at 24 hours was below normal levels in 49 of the 101 patients but was within normal limits in 52 cases. The incidence of hypocalcemia was higher in patients undergoing surgery for malignant thyroid ( P < 0.05). CONCLUSIONS: We do not consider PTH levels at 24 hours postoperatively as predictive of hypocalcemia.

Calcium↗

PubMed2003

Old and new TNM in carcinoma of the gastric antrum: analysis of our personal experience.

Various tumor node metastasis (TNM) classifications have been proposed for staging of gastric carcinoma, including the fourth edition of the TNM classification and the Japanese Research Society for Gastric Cancer (JRSGC) system. In 1997 the fifth edition of TNM classification introduced the concept of the number of metastatic lymph nodes. We review our experience with staging gastric cancer in light of both the fourth and fifth editions of the TNM classification system. From January 1986 to December 1997, we performed subtotal resection in 193 patients with carcinoma of the gastric antrum. A total of 147 patients presented with criteria from the fifth TNM edition. We compared data from these patients with data from the fourth TNM edition. We analyzed 84 females and 63 males whose average age was 68.9 years. The average number of lymph nodes removed was 16.7. We used the Kaplan-Meier method to analyze survival. In accordance with the fourth TNM edition, we recorded 82 patients who were pN0, 36 who were pN1, and 29 who were pN2; according to the fifth edition, 82 patients were pN0, 33 were pN1, 17 were pN2, and 15 were pN3. Average follow-up was 26.7 months, and average survival was 56.9 months for N0 patients, 38.7 months for N1 patients, and 24.5 months for N2 patients staged according to the fourth edition. According to the fifth edition, survival was 39.3 months for N1 patients, 33.6 months for N2 patients, and 10.3 months for N3 patients. The survival curve was statistically different (P<0.001) between N0 and N1 patients according to the fourth edition; there was no significant difference between N1 and N2 patients. According to the fifth edition, the difference in survival probability was P<0.001 between N0 and N1 patients and N2 and N3 patients. The fifth TNM edition presents a greater ease of stratification in bringing together and mediating diverse cultural experiences between West and East. This staging lays the basis for a more accurate comparison between the groups.

Adenocarcinoma↗

PubMed2003

Hyperparathyroidism associated with thyroid pathology.

BACKGROUND: The pathological association between thyroid and parathyroid gland disease is here discussed. The multiphase analyzer has revealed a new type of subclinical primary hyperparathyroidism (HPP) and the role of surgery in these cases is not clear. METHODS: This is a prospective study of all cases of thyroid disease in association with parathyroid disease treated surgically in our Institute from July 1999 to June 2001. RESULTS: Of the 221 thyroidectomies carried out, 29 patients had an elevated preoperative serum level of parathyroid hormone (PTH). An ultrasonography examination was performed on all patients and a preoperative scanning with 99Tc-MIBI on 11 of 29 patients. We examined intraoperatively 19 cases of HPP (14 parathyroid adenoma, 5 hyperplasia). In 10 cases we observed a normal size of the parathyroid gland and we did not perform a parathyroidectomy. CONCLUSIONS: All patients with elevated serum parathyroid hormone and serum calcium levels before thyroidectomy should be considered candidates also for surgery to the parathyroid glands. The pathological association between thyroid and parathyroid gland diseases is not rare. We must conduct an accurate neck exploration in all these cases.

Adult↗

PubMed2002

Percutaneous endoscopic gastrostomy after Billroth II gastrectomy.

Percutaneous endoscopic gastrostomy (PEG) is a valid alternative to surgical gastrostomy to provide nutritional support in patients unable to ingest food. Previous Billroth II gastroresection is no longer a contraindication. We describe our experience with 5 cases of PEG placement in patients who had previously undergone Billroth II gastroresection.

Aged↗

PubMed2002

Percutaneous endoscopic gastrostomy after Billroth II gastrectomy.

Percutaneous endoscopic gastrostomy (PEG) is a valid alternative to surgical gastrostomy to provide nutritional support in patients unable to ingest food. Previous Billroth II gastroresection is no longer a controindication. We describe our experience with 5 cases of PEG placement in patients who had previously undergone Billroth II gastroresection.

Aged↗

PubMedDate not supplied

[Cervico-mediastinal goiter].

We analyzed 824 patients treated by thyroidectomy in our Institute from January 1995 to December 2000. We observed the presence of cervicomediastinal goiter in 117 patients (14.9%), 92.7% of whom presented euthyroidism. Sternotomies were performed in 15 patients (10 midline and 5 hemi-clamshell). On the basis of our own experience and the reports in the literature, we analyse the diagnostic and surgical approach to the therapy of cervicomediastinal goiter.

Diagnosis, Differential↗

PubMedDate not supplied

[Pancreatic pseudocysts: endoscopic treatment. Personal experience].

Pseudocyst is a complication of acute and chronic pancreatitis. Today endoscopic drainage is reported as being the treatment of choice for these complications. Endoscopic drainage was performed in 15 patients with a pseudocyst bulging into stomach or duodenal lumen as detected by CT and endoscopic examination. All 15 cases treated from January 1991 to December 2001 (11 men, 4 women; median age: 55.7 years [range: 33-81] were successfully drained. The mean hospital stay was 4.8 days. No mortality or major complications were observed and the compliance was very good. The procedure is safe and we believe that endoscopic drainage should be the procedure of choice for pseudocysts which bulge into the gastrointestinal lumen.

Adult↗

PubMedDate not supplied

[Post-thyroidectomy hypocalcemia: clinical and laboratory findings].

Hypocalcaemia is a possible sequela of thyroidectomy, the causes of which are not fully understood. Today, correct surgical technique is the most important factor in decreasing the incidence of hypocalcaemia. We analysed 1223 patients (930 total thyroidectomies, 293 hemi-thyroidectomies) treated in our institute from January 1995 to July 2003. Serum calcium, ionized calcium, parathyroid hormone and phosphoraemia were screened pre- and postoperatively. Hypocalcaemia, as defined by a serum calcium concentration below 8.5 mg/dL, occurred in 241 patients (25.1%). In 90.9% of these patients, serum calcium was normal 7 days after thyroidectomy. In three patients we registered permanent hypoparathyroidism 180 days after thyroidectomy. We found a statistically significant difference in the incidence of hypocalcaemia between patients treated for benign disease and those treated for malignant disease with a greater incidence in the latter group (P < 0.05). Several factors are important in determining the incidence of post-thyroidectomy hypocalcaemia but the inadvertent excision of the parathyroid gland, ischaemia and injury are the main causes of the lowering of serum calcium concentrations.

Adolescent↗

PubMedDate not supplied

[The changes in the emergency surgical treatment of diverticulitis in the last thirty-years].

BACKGROUND: The surgical management of diverticulitis in emergency is controversial: The primary reconstructive surgery or Hartmann's procedure? METHODS: The Authors have analyzed our experience on 409 cases of diverticulitis from January 1975 to December 2004; 101/409 were treated in emergency and divided in two groups before and after December 1994. The patients were divided on Hinchey's classification, type of surgical procedure, ASA status and complications. The Authors have analyzed all cases by t-Student and chi2 analysis. RESULTS: No difference between two groups on age, sex, concomitant diseases are observed. The hospital stay in patients treated in emergency was 10.2 days to 7.1 days in patients operated after 24 hours (p<0.05). The incidence of primary anastomosis in the second group is higher (p<0.03). The incidence of leaks in two groups was respectively 27.2% and 10.3% (p<0.005). The deaths were 12/101 (11.8%); 9 of these in III-IV stages of Hinchey's classification. DISCUSSION: In the lasts ten years the surgical approach to diverticulitis in emergency is changed. The individual risks factors, the Hinchey's stage, play an important role in decision making. The Authors have registered a major indications to primary anastomosis in emergency.

Colonic Diseases↗

PubMedDate not supplied

[Hypocalcemia after thyroidectomy: analysis on 804 treated patients].

BACKGROUND: Hypocalcemia is a possible sequela of thyroidectomy; the causes are not fully understood. METHODS: We analyzed 804 patients (594 total thyroidectomy, 209 emithyroidectomy) treated in our Institute from January 1995 to December 2000. Serum calcium, ionized calcium, parathyroid hormone (PTH), fosforemia were screened pre- and postoperatively. RESULTS: Hypocalcemia, defined by a serum calcium less than 7.5 mg/dL, occurred in 126 patients (21.2%). In 90.6% of these patients the serum calcium was normal at seven days after thyroidectomy. In two patients we have registered at 180 days after thyroidectomy a permanent hypoparathyroidism. CONCLUSIONS: Several factors are important in the incidence of postthyroidectomy hypocalcemia but the inadvertent excision of parathyroid gland, ischemia and injury are the major causes of lowering of serum calcium concentration.

Adult↗