The race from chronic pancreatitis to pancreatic cancer.
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Animals↗
Biomedical subjects
Mario Sianesi
Publications and source records attributed to Mario Sianesi.
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↗
Gastrointestinal stromal tumours: an analysis based on personal experience.
We present our experience in the treatment of 18 patients affected by gastrointestinal stromal tumours (GIST) from January 1988 to march 2002. The ratio M.F was of 2:1 and the median age of 68.6 years. In 13 patients the tumours were located in the stomach while in 5 patients in the jejunum ileum area. In 7 patients the neoplasms were malignant. All the patients were operated and in 11 patients a partial gastric resection was carried out. 2 patients had a total gastrectomy and 5 had a small bowel resection. The diagnostic and therapeutic options and the uncertain prognosis of these neoplasms are discussed.
Aged↗
Progressive familial intrahepatic cholestasis.
Progressive familial intrahepatic cholestasis (PFIC) is a heterogeneous group of autosomal recessive childhood cholestasis of hepatocellular origin. PFIC 1, also known as Byler disease, was first described in Amish kindred. It is characterized by cholestasis often arising in the neonatal period and it leads to death due to liver failure. PFIC 1, like Benign Recurrent Intrahepatic Cholestasis (BRIC) which is the benign form of the same disease, recognizes mutations in the ATP8B1 gene. PFIC 2 disease is clinically similar to PFIC 1 but it has a different gene mutation causing a defect in the Bile Salt Export Pump (BSEP), exclusively expressed in the liver and involved in the canalicular secretion of bile acids. PFIC 3 usually appears later in life and it has a higher risk of portal hypertension, gastrointestinal bleeding and liver failure. This particular form of disease (the only one with high serum values of g-glutamil transpeptidase), is associated to a genetic defect in the class III multidrug resistance protein (MDR). External biliary diversion and ursodeoxycholic acid therapy, should be considered as the initial therapy in these patients, even if liver transplantation still seems to be the only solution for most patients.
Cholestasis, Intrahepatic↗
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↗
[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↗
[Gastric polyps: a clinical contribution].
The incidence of diagnosis of gastric polyps is now higher than in past years owing to the introduction of endoscopy in the diagnosis and treatment of upper digestive tract disease. One hundred and sixty-four polyps removed from January 1984 to August 2000 were analyzed. The median age of the patients was 61.4 years (range: 16-84 yrs). Polypoid lesions were more frequent in males (M:F = 1.5:1). Seventy-nine patients were asymptomatic (48.2%). Sixty-four percent of the polyps were located in the antrum. We diagnosed 73 hyperplastic polyps, 27 adenomatous lesions, 8 inflammatory polyps and 56 pseudopolyps. Malignant lesions were detected in 9 adenomatous polyps (4 type I and 5 type II early gastric cancers). Endoscopy is the examination of choice in the diagnosis and treatment of gastric polyps. We confirm that there is a relationship between histological type, neoplastic change and the size of the polyps.
Adolescent↗
Value and limits of emergency colonoscopy in cases of severe lower gastrointestinal haemorrhage.
Acute bleeding of the lower gastrointestinal tract causes complex diagnostic problems. Colonoscopy is subject to discussion as the first method of diagnosing lower digestive tract bleeding. From June 1998 to September 2001 we observed 80 patients with acute bleeding (45 males and 35 females; mean age: 65.5 years). All patients underwent an emergency colonoscopy. In 15 cases we carried out an angiography and in 9 a scintigraphy (always after colonoscopy). Colonoscopy detected the cause of the bleeding in 69 patients (86.2%) during the first examination. Angiography and scintigraphy revealed the haemorrhage in 8 (53%) and 7 (77.7%) cases, respectively. Ten cases were treated during colonoscopy; 31 underwent surgery. We consider an emergency colonoscopy as the first method for diagnosing the causes of bleeding. If this examination fails we consider arteriography and scintigraphy as second-line approaches for obtaining a diagnosis.
Adult↗
[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↗
[Therapy of post-necrotic pancreatic pseudocysts: invasive treatments and their results].
Pancreatic pseudocysts are the most common lesions of the pancreas. Endoscopic and US-endoscopic techniques are today the best minimally invasive diagnostic and therapeutic procedures available for this pathology. From January 1980 to December 2001 we observed a total of 74 patients with pancreatic pseudocysts secondary to acute pancreatitis. Twelve patients were treated by medical therapy, 37 with a surgical approach, 15 by endoscopic drainage and 10 by CT-guided drainage. The mean size of the pseudocysts was 12.9 cm (range: 3.4 to 24 cm) and 69.4% were larger than 10 cm. CT-guided drainage had a 50% complication rate (P = 0.00814), a 20% mortality rate (P = 0.00463) and a 10% relapse rate. The surgical approach was associated with a complication rate of 18.9% and a 5.4% relapse rate. The endoscopic approach presented a 13% morbidity rate and a 6.6% relapse rate. CT-guided drainage is the therapeutic approach we use in emergency cases, but endoscopic therapeutic technique is the best procedure and is a valid alternative to surgical and CT-guided drainage. The shortest mean hospital stay (4.8 days) was observed with the endoscopic approach.
Adult↗
[Role of endoscopy in the treatment of non-variceal upper gastrointestinal hemorrhage].
Over the past three decades important progress has been made in the diagnosis and treatment of non-variceal upper gastrointestinal bleeding. We discuss the endoscopic techniques available today in combination therapies. The data in the literature regarding endoscopic techniques are discordant and no single technique has proved statistically superior in the management of bleeding. We believe that the initial injection approach is still the procedure of choice, particularly when performed by less expert endoscopists.
Electrocoagulation↗
Use of the transcystic guidewire in single-intervention treatment for cholecysto-choledocholithiasis. A case report and technical notes.
Videolaparoendoscopic treatment of choledocholithiasis in a single stage is an important option for this disease. We currently adopt this approach to choledocholithiasis in our department. We report here the case of a woman with stones in the biliary tract and gallbladder. After videolaparoscopic cholecystectomy we performed a transcystic cholangiography. A guidewire was used to show Vater's papilla during endoscopic papillosphinterotomy, because this was in a duodenal diverticulum that made it impossible to cannulate the papilla. We propose this method in all those cases in which, for anatomical reasons, the papilla cannot be easily cannulated.
Aged↗
[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↗
Bouveret's syndrome: a case report.
Duodenal obstruction due to a gallstone from a cholecystoduodenal fistula (Bouveret's syndrome) is a rare complication of gallstone disease. Patients present gastric outlet occlusion with vomiting, abdominal distension and a state of dehydration. Plain film of the abdomen, ultrasonography and CT scans reveal pneumobilia and the obstructing gallstone. Endoscopy is essential for diagnosis and therapy, with a view to the possibility to relieving the occlusion. Endoscopy, however, cannot be used to treat the fistula and is often unsuccessful because of the very large size of the stone. Surgical therapy can be effective both for relieving the occlusion and for fistula treatment. The authors report a case of Bouveret's syndrome successfully treated surgically in an otherwise healthy patient. In critically ill patients, the primary goal of therapy is relief of the occlusion.
Aged↗
Wireless capsule endoscopy in a case of small bowell obstruction: not always contraindicated.
Wireless capsule endoscopy is a new diagnostic technique used especially for investigating the entire small bowel. Recent studies have demonstrated its superior ability to detect and evaluate small bowel lesions compared to other radiological examinations. Performing video capsule endoscopy is regarded as contraindicated when an intestinal occlusion is documented. We present a case of hidden intestinal bleeding which underwent wireless capsule endoscopy and was treated successfully despite documented ileal stenosis.
Adenocarcinoma↗
[Rupture of the spleen in angiosarcoma: a case report and review of the literature].
Splenic angiosarcoma is a rare neoplasm originating from endothelial cells of the blood vessels. Its incidence is about 0.14-0.25 per million. We report the case of a patient admitted in a state of hypovolaemic shock with haemoperitoneum due to rupture of the spleen. Splenectomy was performed with evacuation of the haemorrhagic effusion. The blood was aspirated and in part instilled during the operation through intraoperative blood salvage due to the large haemoperitoneum. Histological examination revealed a splenic angiosarcoma. Splenic angiosarcoma should be suspected in cases of splenomegaly with unknown anaemia and no lymphoma, leukaemia or myelofibrosis, because of its neoplastic aggressiveness and its invariably fatal outcome. It is important to perform a splenectomy before splenic rupture owing to its negative impact on long-term survival.
Aged↗
[Considerations regarding the role of arterial embolization with an angiographic approach in the treatment of upper gastrointestinal bleeding: personal experience].
Upper gastrointestinal bleeding can be produced by varicose, inflammatory-ulcerative or neoplastic lesions of the eosophageal-gastric-duodenal anatomical district. The aim of this study was to define the role of arterial embolotherapy with an angiographic approach in the treatment of these conditions, starting from our personal experience and a review of the literature. The treatment of upper gastrointestinal bleeding is based on a multimodal approach in which arterial embolotherapy has its place alongside endoscopy and surgery.
Adult↗
[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↗