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Biomedical subjects

P Nobili

Publications and source records attributed to P Nobili.

28 records · Page 2Linked to original sources
PubMedDate not supplied

[Surgical treatment of acute necrotic-hemorrhagic pancreatitis].

The clinical course of an episode of acute pancreatitis varies from a mild transitory form to a severe necrotizing form characterized by multisystem organ failure and mortality in 20% to 40% of cases. Mild pancreatitis does not need specialized treatment, and surgery is necessary only to treat underlying mechanical factors such as gallstones or tumours of papilla of Vater. On the other hand, patients with severe necrotizing pancreatitis need to be identified as early as possible after the onset of symptoms to start intensive care treatment. Patients with infected necrosis, approximately 10 to 20%, must undergo surgical intervention, which consists of an organ-preserving necrosectomy followed by postoperative drainage-lavage or the method of "open abdomen". The Authors report a series of 20 patients operated on for acute necrotizing pancreatitis from 1998 to 2000. They describe the indications and methods of treatment, in particular the additional procedure following necrosectomy.

Female↗
PubMedDate not supplied

[Intestinal obstruction caused by colorectal neoplasms].

The Authors report their ten-year experience in 85 cases of colorectal carcinoma presenting with large bowel obstruction. They underline the high morbidity and mortality of such condition related to the late diagnosis and the poor general conditions of the patients. After reviewing the literature they point out that the best treatment consists in dealing both with the intestinal obstruction and its cause during the same operative time. The post-operative mortality after radical treatment is acceptable especially when compared to derivative procedures.

Adult↗
PubMedDate not supplied

[Primary gastric lymphoma: our experience].

The authors report their experience with 10 cases of primary gastric lymphoma observed in 10 years. Nonspecific symptomatology and bioptic features often misleading to benign lesions (pseudolymphoma) explain why an early diagnosis is difficult to achieve. A correct surgical treatment, with careful pre- and intraoperative staging, associated to pre- and postoperative chemo- and radiotherapy, allows good results in terms of survival.

Adult↗
PubMedDate not supplied

[A case of xanthogranulomatous pyelonephritis. Diagnostic and therapeutic problems].

The use of the modern diagnostic imaging techniques allows in most cases a diagnosis of nature of the lesions involving parenchymal organs. The authors report a case of renal xantogranuloma, rare pseudotumoral inflammatory pathology, treated by radical extended nephrectomy on the basis of a pre-operative diagnosis of malignant tumor. Despite the risk of false positives, in front of a renal mass whose nature is sufficiently characterized by the imaging techniques, the routine use of more invasive investigations such as arteriography and percutaneous needle biopsy seems not justified.

Female↗
PubMedDate not supplied

[Comparison of 67 pancreatic head tumors and 27 periampullary tumors].

The authors, in the period from Jan. 1980 to Dec. 1990, observed 67 patients with tumor located in the head of pancreas and 27 patient with periampullary tumors. These included 18 tumors originated from the ampulla of Vater and 9 from distal common bile duct. Operability rate ranged from 62.6% pancreatic carcinoma to 94.4% tumors of ampulla, according to the tumor location. Resectability rate ranged from 9.5% for pancreatic adenocarcinoma for 94.1% to ampullary tumors. Considering 23 resections, 18 were pancreatoduodenectomies and 5 local excisions for tumor of ampulla. Mortality was 7.7% after non resectional treatment and two patients (8.7%) died in the immediate postoperative period after radical resection. Multivariate analysis on all patients operated (n. 65) revealed that 5 years survival rate was significantly related to intent of operation (palliative = 0 - curative = 8.6%), histologic type, and site. In fact no patient with pancreatic adenocarcinoma achieved a 5 years survival rate. Two patients with adenocarcinoma of ampulla survived 5 years. Cancer of the head of pancreas is quite malignant because, owing to pancreas position, an early diagnosis is very hard. Most times resective surgical treatment is impossible because of the cancer diffusion.

Adenocarcinoma↗
PubMedDate not supplied

[Cystic dilatation of the common bile duct].

The Authors report a case of cystic dilatation of the common bile duct and a review of the Literature. The lesion is a congenital malformation of infancy or childhood, being rare in adult life. The main symptoms are biliary colic with jaundice and fever. Modern techniques such as abdominal ultrasonography, CT, ERCP, PTC generally provide to achieve preoperative diagnosis. When radical surgery is possible the complete excision of the cyst is the management of choice. The case reported is classified as type 1 of Todani's classification. Surgical management consisted in a complete excision of the cyst. Bile flow was re-established by hepaticojejunostomy.

Adult↗
PubMedDate not supplied

[Spontaneous bilio-digestive fistulas of lithiasis origin: our experience].

The Authors report their experience with spontaneous bilio-digestive fistulas of lithiasic origin. They examine the difficulties of diagnosis and treatment of this pathology also in consideration of probable complications, in particular the biliary ileus, in old patients often presenting metabolic or cardiopulmonary disorders, which contribute to worsen the prognosis.

Adult↗
PubMedDate not supplied

[Color Doppler echography in the study of pseudo-occlusion of the internal carotid].

The differentiation of pseudo-occlusion from complete internal carotid artery occlusion may have important clinical consequences for patients with the former tend not to benefit from reconstructive surgery. The Authors report a case in which color-Doppler duplex-scanner revealed a persisting string-like lumen that was not demonstrated by angiography. The Authors believe that ultrasonography may in future permit the reliable differentiation of pseudo-from complete carotid occlusion, thereby reducing the need for angiography.

Arteriosclerosis↗
PubMedDate not supplied

[Surgical treatment of tumors of the ampulla of Vater by local resection].

The cases of six patients suffering from Vater's ampulla neoplasia were studied 1981 and 1995. All cases are described both clinically and in terms of diagnostic techniques. All patients underwent a transduodenal excision of the neoplasia. A number of factors provided an indication for ampullectomy: the extremely high surgical risk, the suspected benign nature of the lesion or the very small size of the neoplasm associated with no pre-surgery finding of lymphadenomegaly in the area. The following issues were analysed: the accuracy of results obtained by a correct pre-surgery diagnosis, short and long term complications and mortality related to surgery. All patients received a five years post-surgery follow-up. Results show that the ampullectomy can be considered, in selected cases, as a valuable alternative to pancreatoduodenectomy even if further and wider studies are necessary in order to obtain an accurate definition of the correct pre-surgical diagnostic approach and surgical indications.

Adult↗