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Biomedical subjects

R Bergamaschi

Publications and source records attributed to R Bergamaschi.

At least 91 records · Page 5Linked to original sources
PubMed1998

Results of pancreatogastrostomy after pancreatoduodenectomy in 160 consecutive patients.

BACKGROUND: The advantages of pancreatogastrostomy over pancreatojejunostomy after pancreaticoduodenectomy are still debated. This study analyses the results of pancreatogastrostomy to identify factors that could influence immediate outcome. METHODS: During a 10-year period, 160 consecutive patients underwent a pancreatogastrostomy. There were 109 men (68 per cent) and 51 women (32 per cent) with a mean(s.d.) age of 59(10) (range 22-82) years; 27 patients were older than 70 years. The following parameters were assessed: mortality rate, morbidity, reasons for reoperation, length of hospital stay, duration of nasogastric tube and drainage. RESULTS: Hospital mortality rate was 3 per cent; overall morbidity rate was 30 per cent. The reoperation rate was 12 per cent, mainly because of bleeding at the pancreatic margin. Delayed gastric emptying occurred in 36 patients. The overall rate of pancreatic fistula was 2.5 per cent. Age, sex, indications for pancreatoduodenectomy, and the texture of the pancreatic remnant did not influence the occurrence of pancreatic fistula or delayed gastric emptying. CONCLUSION: This study confirmed that pancreatogastrostomy is a safe procedure with low mortality and morbidity rates.

Adult↗
PubMed1998

Open versus laparoscopic gastrojejunostomy for palliation in advanced pancreatic cancer.

To assess short-term outcome of open (OGJ) versus laparoscopic (LGJ) gastrojejunostomy in palliation of gastric outlet obstruction (GOO) caused by advanced pancreatic cancer, 22 OGJ patients were compared with 9 diagnosis-matched LGJ controls operated on at the same hospital between 1991 and 1996. Patients undergoing OGJ and LGJ were comparable for age, gender, weight, American Society of Anesthesiologists grading, and previous extensive abdominal surgery, but not for gastroenterostomy performed as a prophylactic procedure (9 vs. 0, respectively). Mortality (5 vs. 1, p = 1.5), overall morbidity (9 vs. 3, p = 0.42), operating time (113.6 +/- 24.5 minutes vs. 125 +/- 15.2 minutes, p < 0.5), time to oral solid food intake (7.2 +/- 0.9 days vs. 5.3 +/- 1.3 days, p < 0.5), nonsteroidal anti-inflammatory drug consumption (7,563.6 +/- 3,381.3 mg vs. 2,044 +/- 673 mg, p < 0.5), opioid consumption (688.5 +/- 258.6 mg vs. 2,910.5 +/- 2,659.9 mg, p < 0.5), delayed-return gastric emptying (5 vs. 1, p = 0.12), postoperative hospital stay (14.6 +/- 1.9 days vs. 10.1 +/- 1.8 days, p < 0.5), survival (5.7 +/- 0.8 months vs. 4.6 +/- 0.6 months, p < 0.5), and further hospital stay before death (9.8 +/- 3.3 days vs. 11.6 +/- 3.4 days, p > 0.5) were not significantly different in 22 OGJ and 9 LGJ patients, respectively. Estimated blood loss was significantly lower in LGJ patients (270.2 +/- 45.8 ml vs. 66 +/- 15.7 ml, p < 0.01). When 13 of 22 patients undergoing OGJ for treatment were compared with 9 LGJ patients, only estimated blood loss (p < 0.01) and hospital stay (p < 0.05) were significantly reduced in LGJ patients. Recurrent GOO before death occurred in one patient (1 of 22, 4.5%) 9 months after OGJ. LGJ for palliative treatment of GOO in advanced pancreatic cancer offered (in spite of the learning curve) reduced estimated blood loss and hospital stay when compared with OGJ.

Aged↗
PubMed1997

[Laparoscopic sigmoidectomy].

The laparoscopic approach has emerged as an alternative to trephine stoma construction. In the present series, eight patients underwent laparoscopic faecal diversion. We performed two endsigmoidostomies and six sigmoid loop ostomies. Indications for diversion included inoperable obstructing pelvic carcinoma in three patients, perianal fistulas in another three--and faecal incontinence in one patient. A temporary loop-sigmoidostomy was performed in one patient after anal sphincteroplasty. Three or four ports were used. After mobilisation, the sigmoid colon was pulled through the abdominal wall. When an end-sigmoidostomy was performed the bowel was transected intra-abdominally. There were no operative complications and all stomas functioned early and well. Laparoscopic sigmoidostomy is safe and allows intra-abdominal exploration and mobilisation of the colon without the inconvenience of a mid-line surgical wound.

Adult↗
PubMed1997

Prognosis of myasthenia gravis: a retrospective study of 380 patients.

The 9139 follow-up records of 438 myasthenia gravis (MG) patients were reviewed. Excluding those patients who were diagnosed 5 or more years after symptom onset (n = 37) and those who experienced only oculomotor symptoms throughout follow-up (n = 21), there were 380 patients. A survival analysis approach was used to assess the influence of prognostic factors on the following endpoints: (a) stable complete remission, (b) complete remission of at least 6 months and (c) pharmacological remission of at least 6 months. Early diagnosis was associated with a better prognosis with respect to all endpoints. Thymectomy also improved the prognosis but only for those patients without thymoma. Later MG onset was associated with a higher tendency to achieve pharmacological remission.

Adult↗
PubMed1997

Intracorporeal colorectal anastomosis following laparoscopic left colon resection.

BACKGROUND: The aim of this study was to assess the impact of an intracorporeal double-stapled colorectal anastomosis upon the outcome of laparoscopic left colon resection. METHODS: Fifty-four selected patients underwent elective laparoscopic left colon resection for benign disease. Once resection was completed, a 33-mm suprapubic port allowed insertion of the anvil of a circular stapler into the colon, which was closed by a handsewn purse-string suture using the T-needle technique. The circular stapler was passed transanally to perform a double-stapled anastomosis. Specimens were delivered in a plastic bag via the suprapubic port. RESULTS: There were no deaths. Minor intraoperative and postoperative complications occurred in 3.7% and 9.2% of the patients, respectively. Median operating time was 125 min (range 80-210 min). Complete proximal and distal doughnuts were obtained in all patients and anastomoses were all methylene blue tight. Median hospital stay was 4 (range 3-7) days. CONCLUSIONS: Fashioning double-stapled colorectal anastomoses intracorporeally is feasable and safe.

Adult↗
PubMed1997

Immediately recognizable benefits and drawbacks after laparoscopic colon resection for benign disease.

BACKGROUND: A prospective assessment of the impact of laparoscopic colon resection (LCR) was carried out in order to quantify immediately recognizable benefits and limitations of this approach. METHODS: Elective LCR was attempted in 95 selected patients (mean age 64 years, range 39-81 years) presenting with benign disease of the colon. A completely intracorporeal approach was adopted. Results were compared with a control group of 90 patients who had previously undergone open colectomy (OC) by the same surgeons at the same institution. RESULTS: There were no perioperative deaths. Intraoperative complications included difficult extraction of accidentally detached anvil (n = 1), air leak at colonoscopy (n = 2), and conversion to OC (n = 1). Operating time was significantly longer after LCR compared with OC (180 +/- 10.3 vs 116 +/- 97, p < 0.001). Passage of flatus (3.5 +/- 1.2 days vs 4.4 +/- 1.4, p < 0.5) and morbidity (4 vs 3, p = 0.48) were not significantly different in the two groups. Hospital stay was significantly shorter after LCR (5.2 +/- 1.3 days vs 12.2 +/- 1.9 days, p < 0.001). Theater and ward costs were, respectively, significantly increased ($2,829.6 +/- 340 vs $1,422 +/- 318, p < 0.001) and decreased ($2,600 +/- 366 vs $6,022 +/- 916, p < 0.001) in LCR patients compared with the OC group. There was no significant difference in total hospital costs ($10,929 +/- 369 vs $9,944 +/- 1,014). CONCLUSIONS: LCR does not appear to offer any immediately recognizable advantages.

Adult↗
PubMed1997

Pelvic ultrasonography in patients with Turner syndrome: age-related findings in different karyotypes.

Real-time ultrasonography was performed in 142 patients with Turner syndrome, aged 0.57 to 21 years, with different karyotypes (45,X [4896], X mosaicism [17%], and X structural abnormalities [35%]). Ovarian and uterine volumes were calculated and the data collected in a mixed longitudinal and cross-sectional mode. Thirty-eight patients were followed longitudinally during pubertal age (10 to 18 years bone age) for ovarian data. Patients with Turner syndrome were divided into two groups according to the presence or absence of detectable ovaries. Patients with Turner syndrome with detectable ovaries showed the first increase in ovarian volume at about 9 years of bone age; this increase was continuous and more evident only after 14 years of age and appeared later than in control subjects. When followed longitudinally during puberty, the ovaries showed a hormonal function in some cases. Girls with X mosaicism had the highest percentage of bilateral detectable ovaries and the greatest total ovarian volume; about 50% of them had spontaneous breast appearance and 38.5% had spontaneous menarche. They showed also the lowest gonadotropin levels, when bilateral ovaries were present during puberty. On the contrary, patients with the 45,X karyotype had the lowest percentage of detectable ovaries, ovarian volume, and spontaneous breast appearance. In our patients with Turner syndrome, uterine measures increased significantly with age and this was more evident in subjects with detectable ovaries after 13 years of bone age. Compared with control subjects, they showed significantly lower uterine measures, and patients with X mosaicism had greater and more progressive increments. In conclusion, pelvic ultrasonography in Turner syndrome is particularly useful in detecting ovaries and their possible increase in volume. These data, linked with karyotype pattern and gonadotropin levels, have prognostic value in predicting the future sexual development of these patients.

Adolescent↗
PubMed1997

Soluble CD8 and ICAM-1 in serum and CSF of MS patients treated with 6-methylprednisolone.

OBJECTIVE: We studied the effects of large doses of 6-methylprednisolone (6-MP) on serum and cerebrospinal fluid (CSF) soluble CD8 (sCD8) and intercellular adhesion molecule-1 (sICAM-1) levels in clinically active multiple sclerosis (MS) patients. MATERIAL AND METHODS: Paired serum and CSF samples were from 16 patients with definite MS, treated with 6-MP (1 g daily for 6 d) during an active phase of the disease. sCD8 and sICAM-1 levels were determined with ELISA before and after the therapy. RESULTS: Before 6-MP treatment, sCD8 levels in CSF were higher in MS patients than in patients with noninflammatory neurological disease and in healthy controls; sICAM-1 levels in serum and in CSF were higher in MS patients than in the two control groups. Ten of the 16 patients showed clinical improvement at the end of the treatment. After the therapy, serum and CSF sCD8 levels increased, whereas serum and CSF sICAM-1 levels decreased. There was no correlation between clinical improvement and laboratory parameters. We evaluated sCD8 and sICAM-1 in serum samples from 10 patients 6 months after the 6-MP treatment, when the disease was clinically silent. Neither sCD8 nor sICAM-1 levels differed from those of the control groups. CONCLUSIONS: Our results suggest that high doses of 6-MP can influence serum and CSF sCD8 and sICAM-1 levels in active MS. At least part of the efficacy of corticosteroid treatment in MS might be ascribed to its effect both on the suppressive circuits of immune response, and on the expression of an adhesion molecule that favours lymphocyte trafficking across the blood-brain barrier.

Adult↗
PubMed1997

MRI and brainstem auditory evoked potential evidence of eighth cranial nerve involvement in multiple sclerosis.

An MS patient experienced sudden hearing loss. Brainstem auditory evoked potentials, previously normal, showed substantial abnormalities that suggested the impairment of the distal part of the acoustic nerve. MRI detected a small hyperintense lesion along the acoustic nerve; the lesion decreased in size and then disappeared after steroid treatment. This demonstrates that a demyelinating lesion in the distal tract of the eighth cranial nerve may cause an acute hearing loss in MS.

Adult↗
PubMed1997

[Value of oncologic follow-up of patients operated for colorectal cancer. A prospective study of 1000 patients].

OBJECTIVE: The purpose of our prospective study was to evaluate the contribution of follow-up in resected colorectal cancer. METHODS: One-thousand patients with colorectal adenocarcinoma who underwent radial resection from January 1975 to January 1990 were prospectively divided into two groups: the first group (n = 442, 42%) entered a 5-year follow-up protocol and the second group (n = 558, 56%) was free to make unscheduled visits in case of symptoms. RESULTS: Recurrence was found in 31.5% of the patients in the first group compared with 33% in the second group. Chorioembryonic antigen was the most accurate test detecting recurrence: 77% of the cases (97% for hepatic metastasis). Surgical resection of recurrent tumors was performed in 37% of the group 1 patients (curative resection in 15%) and in 9% (curative resection in 1.5%) of the group 2 patients (p < 0.001). 5-year survival after recurrence in group 1 was 11.5% versus 1% in group 2 (p < 0.01). CONCLUSION: These results emphasize the rational for a follow-up program in patients undergoing surgery for colorectal cancer.

Actuarial Analysis↗
PubMed1997

[Splanchnicectomy using thoracoscopy].

A technique of thoracic splanchnicectomy under video thoracoscopic control is reported. This simple and non aggressive procedure is indicated for very painful forms of pancreatic cancer and for some cases of chronic pancreatitis. It should relieve pain for a longer period than splanchnic nerve injection or radiotherapy.

Aged↗
PubMed1996

[Mega-esophagus: treatment by celioscopic approach].

Heller's procedure is widely used as the most appropriate method for treating achalasia. We performed the procedure laparoscopically in three patients with good results. Two females and one male, age 40, 60 and 68 years, presented with long-term recurrent dysphagia due to achalasia which did not respond to endoscopic dilatation. Heller's procedure was performed laparoscopically in all three with no particular difficulty. In our cases we also attached the anterior border of the greater curvature to the left side of the myotomy and fixed it to the right diaphragmatic pillar to reduce reflux. The procedure would appear to have less risks than laparotomy since visualization of the operative fields is better. Laparoscopy will undoubtedly become the preferred procedure for achalasia.

Adult↗
PubMed1996

Open-door laminoplasty in pediatric spinal neurosurgery.

Multilevel laminotomy entails the risk of instability of the spine. In this paper we propose an application of the open-door laminoplasty technique in pediatric spinal neurosurgery. A standard laminotomy is performed at one side while a groove is drilled out at the other side to preserve the internal periosteum of the lamina. This allows a rolling elevation without complete separation of the laminae. The advantages of such a method are discussed.

Child↗
PubMed1996

Absorption of glycine irrigating solution during endoscopic transanal resection of rectal tumors.

PURPOSE: This study was undertaken to evaluate the potential metabolic complications of 1.5 percent glycine irrigating solution during endoscopic transanal resection (ETAR) of rectal tumors. METHODS: Thirteen consecutive frail patients (mean age, 81 (range, 57-91) years) undergoing 18 ETAR were prospectively studied from July 1993 to January 1995. Indications for ETAR included palliation of advanced rectal cancer (12 patients) and an extensive villous tumor (1 patient). A 27-French two-way Iglesias resectoscope was used. Packed cell volume, blood glucose, and serum concentrations of sodium, potassium, and creatinine were measured before, during (at 45 minutes), and after (at 6 and 24 hours) ETAR. Plasma concentration of glycine and hemoglobin levels were both measured preoperatively and at 45 minutes and 24 hours, respectively. Variables studied included resection time, volume and rate of irrigating fluid, height of irrigating fluid bag above operating table, resectate weight, occurrence of intraperitoneal and extraperitoneal perforation, blood loss, and clinical symptoms. RESULTS: Two patients were excluded. Mean operating time was 456 minutes. A mean of 192.3 liters of irrigant was infused into the rectum. Mean irrigation rate was 43,330 ml/minutes. Mean height of irrigating fluid bag was 692 cm. Extraperitoneal perforation occurred in two patients. Blood loss exceeded 200 ml in four patients, one of whom complained of nausea (operating time, 110 minutes). Mean rise in p-glycine at 45 minutes (10,028 mol/l; 387 percent of preoperative values) was significant (P = 0.006). Changes in packed cell volume, b-hemoglobin, b-glucose, s-sodium, and s-creatinine levels were not significant. There was significant correlation between p-glycine and s-creatinine levels at six hours (P = 0.033), between p-glycine levels and fall in s-sodium at 24 hours (P = 0.037), and between levels of b-hemoglobin and packed cell volume at 24 hours (P = 0.0004). There was a positive linear correlation between p-glycine and operating time (r = 0.7; P = 0.0026) and between p-glycine and volume of irrigating fluid (r = 0.5; P = 0.0386). CONCLUSIONS: Operating time best predicts increase of p-glycine in ETAR.

Adsorption↗