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Biomedical subjects

N Picardi

Publications and source records attributed to N Picardi.

At least 145 records · Page 8Linked to original sources
PubMedDate not supplied

[Identification of an objective reference parameter for the reconstruction of a large incisional hernia following physiological principles].

Repairing a parietal defect of a large incisional hernia should not be limited to the closure of the breach by means of the modern biocompatible prosthetic sheets, but must also be able to restore a correct intra abdominal pressure, otherwise the derangement from the normal respiratory dynamics and the circulatory stasis in the abdominal veins and in those of the lower limbs remain unaltered. Over-correcting the parietal abdominal tension on the contrary can cause a dangerous compartmental syndrome. The attempts of an intraoperative measurement of the correct intra abdominal pressure restoration has been generally hampered from the condition of curarization of the patient during the operation. Using the automatic mechanical ventilator fixed at volume and not at pressure priority, as usual, can offer the possibility to calibrate, following objective parameters, the propriety of the surgical repair still during the final phases of the reparative operation. The simplicity and ingenuity of the here proposed method and the normal availability in every operative theatre of the necessary means for this measurements described, requires attention among the surgeons and a large diffusions of its simple use.

Aged↗
PubMedDate not supplied

[Clinical research on the possibility that renal cysts may be responsible for the appearance of hematuria].

New techniques of study, namely echography, urography, TC, give evidence of a great number of asymptomatic renal cysts in the everyday experience. Then also if haematuria was classically considered one of the symptoms of renal cysts, there are now many reasons to consider such evidence very infrequent, and downright there are some valid doubts that renal cysts may cause haematuria at all. So the authors have analysed 113 patients, most of them coming from Institute of Radiology of Chieti University Faculty of Medicine; all of them had renal cysts diagnosed by echographs and/or urography but only a minority were just from the beginning studied for haematuria, whereas the majority for many different symptoms. Total cases was then divided into two groups: one of 102 patients, all without haematuria; 78 of them had been studied only with echography, whereas other 24 patients had been examined both with echography and urography. The second group, of 11 cases, included all the patients who had both renal cysts and haematuria. Only in two cases of this second group was lacking evidence of any associated pathology which must be responsible for haematuria, whereas in all the other 9 cases a different aetiology of the haematuria was demonstrated, for simultaneous presence of various pathologies (cystopyelitis with associated prostatis, haemorrhagic cystitis, bladder diverticula and renal papillomas and upper urinary ways tumours), all much easier responsible by themselves of haematuria, also if with different features from case to case.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMedDate not supplied

[Rare malformation of the bile ducts of surgical interest].

Variations from normal anatomy of extrahepatic biliary tract, especially if on the basis of a congenital defect, are often dangerous for the surgeon, as hidden cause of a possible injury during surgery. During a cholecystectomy performed for lithiasis in non functioning gallbladder, whose preoperative cholangiogram revealed nothing of suspect, the dissection of cystic duct was regular at its normal junction with the Common Bile Duct (CBD). Because of the scheduled intraoperative cholangiogram, it was however not severed but only dissected free. The gallbladder was therefore detached from the liver in anterograde progression, after hemostasis and section of a normal cystic artery. During the detaching of gallbladder from the liver what seemed a very large "hepato-cystic" duct coming to the infundibulum was met: for caution the cholangiogram was then made proximally to such "hepato-cystic" duct that instead revealed to be the main right hepatic duct coming to the infundibulum of gallbladder without confluence with the left hepatic duct. The biliary tract going from the gallbladder to the supposed CBD was in fact the cystic duct, as the Heister's valvulae clearly show on the cholangiograms. Cholecystectomy was therefore performed proximally to the confluence of right hepatic duct, and the postoperative course was uneventful. Such kind of extrahepatic tract derangement must be very rare, because of the apparent lacking in literature of any similar case, also if the possibility is mentioned.(ABSTRACT TRUNCATED AT 250 WORDS)

Bile Ducts↗
PubMedDate not supplied

[Direct exeresis of adenoma of the parathyroid glands].

The only therapy for primary hyperparathyroidism (PHPT) is total surgical removal of all parathyroid tissue responsible for hypersecretion. The biggest difficulty for such treatment is the preoperative differential diagnosis between simple parathyroid adenoma (incidence up to 85-90% of PHPT) and diffuse gland hyperplasia (incidence up to 50% of PHPT). Total removal of all parathyroid tissue is not only needless if the aetiology of the syndrome is a simple adenoma, but moreover it is responsible of a completely unnecessary and deeply disabling hypoparathyroidism. It is therefore of the utmost importance to make any preoperative effort for an accurate aetiological diagnosis, and to try the exact localization of the eventually responsible adenoma with all modern diagnostic tools. In spite of any preoperative effort very often the resolution of such problem must be relied to the surgical exploration of all sites of possible hyperplastic gland, with intraoperative hystological study of multiple biopsies. But only a relative help comes from peroperative biopsy, because it is not so easy to reach intraoperatively an hystological certainty in discriminating between hyperplastic and adenomatous tissue on fresh specimens. In the case report a single adenoma of the right lower parathyroid was localized preoperatively with combined researches, mainly with echography, and its surgical removal demonstrated curative at all. The massive lithiasis of left residual kidney was then successfully treated by shock waves. Echography can give therefore a relevant help in preoperative diagnostics of a parathyroid adenoma; is foreseeable its useful employment also intraoperatively, avoiding so an extensive bilateral dissection of all parathyroid sites, responsible of postoperative scarring that hinders any postoperative morphological control and makes dangerous any neck reintervention.

Adult↗
PubMedDate not supplied

[Correlation between post-cholecystectomy syndrome and biliary reflux gastritis. Endoscopic study].

Experimental reports have proved that bile acids damage the gastric mucosa. Moreover it is now accepted that duodenogastric reflux occurs in 20-30% of cholecystectomized persons. The Authors, with the purpose of defining a correlation between gastric mucosa damage by duodeno-gastric reflux and postcholecystectomy syndrome have taken into consideration two groups of 14 patients each. To the first group belonged cholecystectomized patients, who had episodic, often postprandial pain, constant heart burn, with associated vomiting and Hypochromic anemia. To the second group belonged asymptomatic patients with previous cholecystectomy. All these patients were endoscoped (EGDS), and their endoscopic biopsy specimens were surveyed. 99Tc HIDA cholescintigraphy was performed in all the groups of patients, after endoscopy. In 85% of symptomatic patients we found, during endoscopy, reflux of bile into the stomach with associated reddish and inflammatory change of antral mucosa vs. 7.14% of the control group. Atrophic chronic gastritis was found in 71.43% of endoscopic biopsy specimens of Symptomatic vs. 14.28% of asymptomatic patients. Superficial chronic gastritis was found in 28.57% of symptomatic vs. 50% of asymptomatic patients. At last we found active atrophic or superficial antral gastritis (Whitehead) in 90% of symptomatic patients vs. 0% of asymptomatic people. The Authors conclude that there is a positive correlation between duodenogastric reflux and postcholecystectomy syndrome when biliary reflux is correlated with an histological finding of antral active chronic gastritis.

Bile Reflux↗
PubMedDate not supplied

[Arteriovenous fistulas].

Three cases of arteriovenous fistulae observed in recent years at the University of Rome's 3rd Surgical Clinic, and of different site, entity are aetiology, are presented. The recent international literature is reviewed and the more outstanding clinical and therapeutical features of this form are discussed.

Adolescent↗
PubMedDate not supplied

[Surgical choices and approaches in treating tumor metastases].

In oncology metastatization modifies the prognosis and the quality of life of patients. Otherwise metastases are apt to make the surgeon to modify in many cases his operative decisions, and moreover means and times of the demolitive surgical procedures for curative purpose. Namely the presence of metastases at the diagnosis is not necessarily the cause of a refusal for potentially curative operations, both for sincrone or methacrone metastases, because there are still possible, also if less frequently, the hopes of success, especially if they are localized in particular target organs. Actual knowledge about pathogenesis of metastases during surgical procedures, induces us to adopt particular caution in demolitive operations, to avoid the risk that surgery facilitate their insurgence or dissemination. Finally the clinically primitive metastases pose diagnostic problems minimally different from what was the current strategy previously. The study consider these various facets of the problem, on the basis of personal experience and of literature data, and proposes operative protocols that are actually generally accepted.

Brain Neoplasms↗
PubMedDate not supplied

[Localization of preclinical nonpalpable lesions of the breast].

The discovery of mammary neoplastic node in a preclinical stage, most of all not yet palpable, represents the best chance for the surgeon to obtain a real curative exeresis therapy retaining also gland's aesthetics. This kind of situation is more frequent today, because the increased utilization of mammography, ultrasonography and their matched use with the aim to investigate into a population of women with a specific risk. In fact, their sequential use offers the best possibilities of a real earlier diagnosis. In this event the conservative surgical treatment ranks its best curative and aesthetic result. The author's target, based on their own experience, outcomes the comparison between mammography and ultrasonography, pointing out a reliability of the latter similar to the mammography's one upon a specific target at least. The other aspect considered is the possibility of a preoperative localization of the neoplasm using different kind of marks to get the radical tumour exeresis centred on the suspect mass and conservative at its best. The experience suggests more usefulness of metallic marks strung down mammography control, even without using radio-stereotaxic that permits a higher precision but needs adequate facilities with unavoidable more elevated costs. It is finally layed emphasis on the importance of identifying a population at risk to logically utilize, and not indiscriminately, the most modern diagnostic resources.

Adult↗
PubMedDate not supplied

[The role of endoscopy in managing esophageal lesions caused by caustic fluids].

In the paper is described the chronological outline adopted from the authors about the endoscopic treatment in case of oesophageal caustications, both in the emergency and, respectively, after one week and after one month. It is emphasized the importance of an endoscopic recognition within 6/12 hours after the caustic ingestion, to prevent the immediate acute complications, the later acute complications and the scarring evolutions of the healing. Important parameter for a clinical evaluation is represented by the volontariety of ingestion to which is connected the quantity of ingested caustic and than the extension of oesophageal lesions.

Accidents, Home↗
PubMedDate not supplied

[Scleronodular retrosternal Hodgkin's disease with cervical protrusion].

The case of a retrosternal localization of Hodgkin disease is a very infrequent one, and its presentation as an inflammatory tumor is exceptional indeed. This case report of a young woman affected by a cervical tumour projecting in front of the sternal bone, both with fever and tenderness, gave a mistaken address toward a diagnosis of suppurative thyroiditis. But the rare evenience of this thyroidal affection made the diagnosis very improbable and the patient was treated by partial exeresis of the cervical mass and drainage of its apparently suppurative content. At the pathologic study the mass revealed its true nature, also if very unusual: the appearance of the specimen, studied also with immuno-chemical methods, revealed its true nature of scleronodular Hodgkin disease probably born on a thymic cyst remnant. Also the possibility of a suppurative evolution from a pyriform laryngeal sinus is discussed, but simply on a differential diagnostic basis for the original hypothesis of an inflammatory mass. The correct diagnosis instead offered the patient the possibility of the correct chemo-radio-therapeutic treatment and of final cure.

Adult↗
PubMedDate not supplied

[Reconstructive treatment with multiple tissue expanders after an extensive skin burn of the lower extremity].

The paper refers to an experience of skin reconstruction of a widely damaged lower limb as result of a hot water burn injury in a young girl. Evidence is given to adopted reconstruction times, and to the decision not to recur to flap transposition by skin innests, but to the tissue expansion technique, also to avoid new aesthetic damages. The peculiarity of the experience is in the employment of a multiple number of tissues expander, to meet characteristic problems of the limbs related to this reconstructive technique, particularly in presence of heavy burn scars. It is also widely illustrated the operatory phases and times which are necessary to obtain an optimal functional result, with very satisfying aesthetic final appearance.

Adult↗