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Biomedical subjects

N Di Lorenzo

Publications and source records attributed to N Di Lorenzo.

At least 19 recordsLinked to original sources
PubMed1996

Laparoscopic resection of gastric leiomyoblastoma.

Smooth muscle gastric tumors represent 2% of resected neoplasms of the stomach. Clinically, they are often silent and incidentally found at endoscopy or radiologic examination. These tumors can be histologically classified as benign (leiomyoma) or malignant (leiomyoblastoma), but clinical behavior is not strictly related to this classification. When symptomatic, they are present with anemia in 50% of cases due to mucosal ulceration. Surgical removal of the tumor is the accepted therapy, leaving a margin of surrounding free tissue: this treatment can be performed by laparoscopy, usefully associated with gastroscopy. We present one case of a patient with severe anemia due to bleeding from an ulcerated leiomyoblastoma 5 cm in diameter that we resected with combined gastroscopic-laparoscopic technique. We isolated the portion of gastric wall where the mass was located and resected the specimen under gastroscopic control. The postoperative period was uneventful, and the patient recovered promptly with minimal pain and discomfort.

Aged↗
PubMed1996

Surgical treatment of thoracic disc herniation: a reappraisal of Larson's lateral extracavitary approach.

Twenty patients with thoracic disc herniations underwent removal of the transverse process, articular facet, pedicle, and rib--a procedure described by Larson as the lateral extracavitary approach. Eleven patients presented with myelopathy: five mild, nine moderate, and four severe. Fifteen patients showed significant neurologic improvement after the operation and five patients none. Postoperative follow-up ranged from 1 to 8 years. The pros and cons of each of the surgical approaches to this type of lesion are considered with reference to the published data.

Adult↗
PubMed1996

[Diverticulitis of the cecum: description of 2 clinical cases].

The authors describe two cases of cecal diverticulitis pointing out the rarity of the disease in particular in Western countries. The disease is often asymptomatic although in the case of diverticulitis, which represent the most frequent complication of the disease, the patient becomes symptomatic. The symptomatology in these cases is similar to an acute appendicitis with which it is constantly confused. Surgery is the most common therapy and the type of operation is based on the clinical condition of the patient and local anatomical-surgical situation.

Cecal Diseases↗
PubMed1996

Intramedullary astrocytoma with cartilage formation. Case report.

A case of intramedullary astrocytoma with cartilage formation is reported. The presence of bone or cartilage in a glioma is most unusual and has been described only in the brain, characteristically in ependymomas and astrocytomas of the midline. As far as we know, the present is the first intramedullary case. The histological and immunohistochemical findings are discussed in the light of the various hypotheses that attempt to explain the presence of cartilage within a glioma.

Adult↗
PubMed1995

"Conservative" cranio-cervical decompression in the treatment of syringomyelia-Chiari I complex. A prospective study of 20 adult cases.

STUDY DESIGN: This study was designed to investigate prospectively a series of patients with syringomyelia-Chiari I complex operated on by a minimally invasive procedure. OBJECTIVE: The objective was to determine whether a relatively simple and low-risk osteo-dural decompression would obtain as good clinico-radiological results as those observed after the commonly used, more complex posterior fossa surgery. SUMMARY OF BACKGROUND DATA: The majority of hypotheses concerning the pathogenesis of syringomyelia link it to the existence of some derangement of the cerebro-spinal fluid flow at the cranio-spinal level and, consequently, surgical procedures are directed toward decompressing the cranio-cervical junction; however, there is no clear-cut evidence that simple osteo-dural decompression should be associated with manipulation of nervous tissue for the purpose of restoring to normal an altered cerebro-spinal fluid flow dynamic. METHODS: The procedure consisted of a small suboccipital craniectomy and laminectomy of C1 (when necessary C2 as well), followed by dura mater opening. Exploration and plugging of the obex, resection of arachnoid adherences, or amputation of the amygdala(e) were never performed. Every effort was made to keep the arachnoid intact. The series included 20 patients with progressive disease treated according the above-mentioned criteria. RESULTS: Mortality and morbidity were nil and MRI controls showed shrinkage of the syrinx in all cases. At long-term follow-up (average, 2.4 years), 8 patients were considered improved, 11 stabilized, and 1 patient continued to deteriorate despite the collapse of the cord cavity. CONCLUSION: Considering that the results of this "conservative" cranio-cervical decompression are at least comparable to those obtained with other surgical procedures, this procedure, which was not associated with mortality or morbidity, currently should be considered the first option in the treatment of syringomyelia-Chiari I complex.

Adolescent↗
PubMed1995

[Laparoscopic treatment of hepatic cysts].

Laparoscopic treatment of simple hepatic cysts is reported. Recent indications to conservative surgical treatment for this benign disease are considered and different therapeutic options are analyzed. Surgical technique adopted in two cases observed is illustrated. In conclusion, the Authors consider laparoscopic treatment as an effective method for a mini-invasive surgical approach.

Aged↗
PubMed1995

[Cryptorchidism: current views].

Cryptorchidism is a pathological condition which affects up to 6% of newborns. Main etiopathogenetic hypotheses are the hormonal and the dysgenetic one. Ultrasonography is useful in locating testis in the inguinal canal, while in the management of intraabdominal testis, laparoscopy is considered the best diagnostic technique and, in many cases, can be coupled with surgical management. Medical treatment with LH-RH or with hCG or, better, combined (LH-RH+hCG) is recommended before the second year. Impairment of fertility is a complication mainly in subjects with a history of bilateral cryptorchidism. Undescended testis has a risk of malignant degeneration ranging from 3% to 18% and for this reason some authors suggest a gonadal biopsy after puberty.

Cryptorchidism↗
PubMed1995

Iatrogenic spinopelvic cerebro-spinal fluid fistula. Case report.

Perineurial cysts usually affect the lumbosacral spinal nerve roots, but sometimes they can erode the sacrum and reach the retroperitoneal space. In such cases misdiagnosis can lead to an improper treatment and cause serious complications. A presacral mass was diagnosed in a young woman during routine ultrasound investigation, and an exploratory laparotomy was performed. A large, fluid-containing cyst was found and marsupialized into the pelvis. After operation the patient experienced headache, vomiting and VI cranial nerve palsy whenever she stood up. By radiculography a iatrogenic spinopelvic cerebro-spinal fluid fistula was diagnosed, which required further surgery to be repaired. The presence of a giant perineurial cyst in the pelvis in unusual but must be considered in the differential diagnosis of presacral masses; the exceptionally rare case reported in this paper is exemplar of the harmful complications that an incautious procedure can determine.

Adult↗
PubMed1994

Severe exacerbation of post traumatic syringomyelia after lithotripsy. Case report.

A case of post traumatic thoracic syringomyelia is reported which presented with an acute and severe worsening of the spinal cord condition after extracorporeal shock wave lithotripsy was performed for ureteral stone. The worsening was probably caused by the shock waves reverberating the fluid within the intramedullary cavity producing further damage to the spinal cord.

Humans↗
PubMed1993

The acrylic-wire option in cervical spine fixation. A retrospective study.

This retrospective study was undertaken to assess the stability of the cervical spine after fixation with acrylic wire implants. Of the 44 patients with various pathological conditions of the cervical spine selected for this treatment in the course of 20 years, 36 were considered suitable for long-term follow-up evaluation. In 30 cases (83%) the stability of the spine was rated good. It is concluded that the acrylic-wire combination is a valuable surgical option in certain conditions i.e. old age, short life expectancy, poor general health, mental disease, in which long confinement in bed or in orthopaedic appliances is poorly tolerated.

Acrylic Resins↗
PubMed1993

Ultrasound-guided brain biopsy: a personal experience with emphasis on its indication.

Between January 1989 and June 1991, 40 ultrasound-guided biopsies of supratentorial brain lesions exceeding 15 mm in diameter were performed. The apparatus used was Berger's neurobiopsy set, intraoperative 5 = MHz transducer, and a B-mode scanner. In 38 cases (95%) the procedure provided a histological diagnosis at the first attempt; in two patients, early in the present series, biopsy was repeated by computed tomography-guided technique due to insufficient samples. Operative mortality was zero and there were no septic complications. Clinical symptoms were stationary after the procedure in 34 cases; two cases temporarily worsened due to postbiopsy edema and subcortical hemorrhage, respectively; and four other cases showed an improvement as a result of evacuation of neoplastic cysts. Histologically, there were 24 primary malignant tumors, eight low-grade glial tumors, five metastatic tumors, two abscesses, and one lymphoma. The ultrasound method for brain lesion biopsy was found to be a simple, quick, and low-cost method that gave reliable results. It is indicated for supratentorial lesions over 15 mm in diameter that do not demand absolute anatomical accuracy.

Adult↗
PubMed1993

[Partial resection of the spleen for echinococcus cysts with ultrasonic surgical aspirator].

The superior extremity of the spleen was resected in a 52-year-old male patient due to a calcified echinococcus cyst, using an ultrasonic surgical aspirator (Cavitron). Blood loss was limited and no postoperative morbidity was reported. This method appears to be useful in all cases in which it is possible to avoid splenectomy in order to reduce the risk of uncontrolled postoperative infections.

Echinococcosis↗
PubMed1992

Craniocervical junction malformation treated by transoral approach. A survey of 25 cases with emphasis on postoperative instability and outcome.

An experience with 25 consecutive cases of craniocervical junction (CCJ) malformations operated upon via the transoral route is reported. Twenty-two patients also underwent posterior occipito-cervical stabilization with alloplastic material and in only one patient was transoral odontoidectomy and fusion with bone autograph performed. Indication for the transoral route consisted of an irreducible ventral compression of the cervicobulbar junction by the abnormal bone complex. Two patients died during the early postoperative period and the remaining 23 survivors were followed for an average of 3.5 years: 17 of these showed marked improvement and 5 a stabilization of the neurological disturbances. A further patient, who refused posterior stabilization, eventually died because of progressive cranial settling. Long-term results have shown this approach to be decisive in the surgical management of well-selected CCJ anomalies.

Adult↗
PubMed1992

Primary tumors of the cervical spine: surgical experience with 38 cases.

Thirty-eight primary tumors of the cervical spine were operated on in the Section of Neurosurgery, Department of Neurological Sciences, "La Sapienza" University of Rome between 1954 and 1988. Of these, 23 were malignant and 15 benign. The aims of surgical treatment in every case were tumor removal, decompression of the spinal cord, and conservation or restoration of vertebral stability. In no case was surgery confined to biopsy. Surgical stabilization was performed in 12 patients. Bone fusion was obtained with autologous bone (iliac crest, fibula) in benign tumors, whereas synthetic material (acrylic and metal) was used in malignant tumors. Past experience and greater awareness of the concrete possibilities of treating these tumors have led us to evolve the following strategy: 1. For aggressive benign tumors (osteoblastoma, giant cell tumors) and for malignancies in patients with fair life expectancy (solitary myeloma, chordoma): radical removal. 2. For benign tumors with low neoplastic potential and for malignant tumors in patients with poor life expectancy: conservative removal. Long-term results were gratifying in all benign lesions and low-grade malignancies even though two patients with chordomas needed reoperations. Sarcomas had relatively poor results.

Adult↗
PubMed1991

A comparison of computerized tomography-guided stereotactic and ultrasound-guided techniques for brain biopsy.

Forty-one patients with brain lesions underwent brain biopsy using either a computerized tomography (CT)-guided stereotactic approach or an ultrasound-guided technique. The cases were selected according to location and size of the mass lesion. Lesions 15 mm or less in diameter and those in the posterior fossa were biopsied by a CT-guided stereotactic technique (18 patients). Supratentorial lesions with a diameter larger than 15 mm were approached using ultrasound guidance (23 patients). These criteria for procedure selection provided a diagnostic yield of 94% for the CT-guided procedures and 91% for those guided by ultrasound. Safety for the two procedures was similar. The ultrasound procedure was more rapid, simpler, and less costly to perform. It is concluded that, with the protocol described, CT-guided stereotactic procedures could be reserved for cases in which absolute accuracy is mandatory.

Biopsy↗