Biomedical subjects

R Cirocchi

Publications and source records attributed to R Cirocchi.

At least 19 recordsLinked to original sources

PubMed1998

Rupture of the azygos vein in blunt chest trauma.

Isolated traumatic laceration of the azygos vein is a rare condition that is mainly associated with violent deceleration traumas. Diagnosis is crucially based on radiologic evidence of massive right pleural bleeding and hemorrhagic shock. Surgical exploration needs to be early and concomitant with resuscitation, prognosis largely depending on timely intervention. Median sternotomy provides the most advantageous access because it can be quickly performed and allows for surgical exploration.

Accidents, Traffic↗

PubMed1997

[Pre- and postoperative color Doppler ultrasonography of myocutaneous flaps in reconstructive surgery of the breast].

The authors present their experience in the study of blood supply of flaps. The machine used to study both pre and postoperatively the myocutaneous flap is the echo-color Doppler, a brand new device which has recently been used in investigating the morphology and the blood supply. The use of such method has provided us with the following information: detailed ultrasound structure of the skin, subcutaneous and muscular tissues of the examined flap; localization of vessels within the flap; size of the vessel in its whole length; quality and speed of both the arterial and venous flow. Such information is very important for the surgeon to plan in detail the reconstruction by knowing the blood supply of myocutaneous flap.

Breast↗

PubMed1997

[Use of Doppler color ultrasonography in the microsurgical treatment of idiopathic varicocele].

The aim of this paper is to evaluate the role of Doppler and echo color-Doppler in the microsurgical treatment of varicocele. Since December 1993, 87 consecutive patients underwent microsurgical treatment of varicocele. The study demonstrates that Doppler and Color-flow-Duplex scanning provide an accurate, non-invasive method to identify the position of accessory spermatic veins, evaluating at the same time the flow characteristics of the microsurgical anastomosis.

Evaluation Studies as Topic↗

PubMed1997

[Upper digestive hemorrhage as a rare manifestation of ectopic pancreas with gastric localization].

The Authors report two cases of ectopic gastric pancreas, one of them causing a massive upper gastrointestinal hemorrhage, representing an infrequent complication of the disease. A literature review on the subject was then performed, and the importance of a differential diagnosis of the ectopy versus gastric malignancies, with relevant prognostical and management implications was assessed.

Adult↗

PubMed1997

Anatomo-clinical study of rectus abdominis myocutaneous flap.

At the Plastic and Reconstructive Surgery Department of Perugia, 52 patients were examined by color flow duplex scanning, in order to study rectus abdominis myocutaneous flap vascular supply before surgical procedures. This ultrasound technique permits a precise and accurate measurement of blood flow volume and velocity within the epigastric arteries (which represent the superior and inferior vascular pedicles of the flap) and makes it possible to detect the exact location of the perforating branches with their cutaneous distribution. This preoperative evaluation, pointing out vascular pathologies which contra-indicate the use of rectus abdominis flap, can be considered a great help for the reconstructive surgeon in the choice of the operative procedure and can surely lead to a significant decrease in postoperative complication rate.

Adolescent↗

PubMed1997

["Hepatoid" gastric tumor].

In this study the Authors describe two cases of hepatoid adenocarcinoma of the stomach: one is characterized by the presence of alpha-fetoprotein (AFP) high levels of the serum both pre and post-operating and by the very positive response to the adjuvant chemotherapy (how the return to the normality of such values demonstrates). The other is instead characterized by the presence of post operating hepatic metastasis, event which is very frequent in this kind of neoplasm, but presents many problems concerning the differential histological diagnostics with the primitive hepatocarcinoma (problems which are nowadays not completely solved). Moreover the Authors relate to this study the revision of the international literature of the main characteristics and of prognosis of this particular and rare neoplasm.

Adenocarcinoma↗

PubMed1996

Surgical care in octogenarians.

The general surgical profile of octogenarians compared with that of younger patients, and risk factors predictive of operative mortality and morbidity, were determined retrospectively using a computer database for all patients admitted between 1989 and 1993. There were 934 admissions of octogenarians and surgery was performed in 447 cases (47.9 percent). The admission rate of patients over 80 years of age increased during the 5-year period from 4.6 to 9.0 per cent, and was significantly higher than that of geriatric patients aged 65-79 years (P < 0.01). Emergency admissions (63.6 percent) and operations (42.3 percent) were more frequent in patients aged over 80 years (P < 0.01); emergency operations increased during the 5 years from 38 to 59 percent. Altogether, 83 deaths and 171 complications were recorded. The mortality rate of octogenarians was greater than that of younger patients (P < 0.01). Postoperative mortality and morbidity rates were 10.1 and 32.2 percent respectively. After multiple logistic regression analysis with stepwise backward elimination, an American Society of Anesthesiologists score of II-V (P < 0.01), the presence of two associated diseases (P < 0.01) and laparotomy procedures (P < 0.03) appeared to be independent risk factors for postoperative mortality and morbidity.

Aged↗

PubMed1996

[Intestinal lymphangiectasis in adults].

Although rarely, several conditions may cause malabsorption through lymphatic obstruction. Primary lymphangiectasia, a genetically determined disease characterized by diarrhoea, steatorrhoea and protein-losing enteropathy, is one of these conditions. The Authors report their experience in three cases of small bowel lymphangiectasia occurring in adults and discuss diagnostic and therapeutic problems of the disease.

Adult↗

PubMed1996

Acute appendicitis. How many uncorrect diagnosis? A clinical and histological evaluation of 124 cases treated with emergency procedure.

Acute appendicitis is a very common disease in western countries, affecting the entire population with higher prevalence in younger people. The diagnosis of the disease is still basically performed through the clinical evaluation of the patient, while peripheral White Cell Count or imaging techniques such as ultrasonography are poorly helpful. Therefore, a great number of patients is operated without finding a severe involvement of the appendix at intraoperative observation. To evaluate the rate of false acute appendicitis and to correlate the histological involvement with the clinical behavior of the disease the Authors carried a prospective study during a period of 28 months on 124 patients with a diagnosis of acute appendicitis treated on emergency basis.

Acute Disease↗

PubMed1996

[Penetrating wounds of the thorax].

From January 1989 to December 1993 at the Institute of Clinical Surgery of the University of Perugia, 5 patients were under observation for penetrating chest injuries. Two of them had show-wounds, one a slash, one a stabbing and slash and one a cutting blow. One of the patients with shot-wounds died on the operating table from a haemorrhage while the other was saved by surgery. One patient successfully underwent surgery for loss of tissue in the thorax walls. Another had a mini-thoracotomy plus lung suture which were successful. Finally, in the patient with a slash in the front region of the thorax and a slight pneumothorax, we inserted a chest thorax tube and so obtained a complete re-expansion of the lung. Total mortality was 20%. Surgical exploration of the thorax we believe is necessary wherever there is a risk of haemorrhage or possible lung damage requiring only surgery. According to many authors, video-thoracoscopy has the advantage of a reliable diagnosis and above all, enable us to repair lung wounds without opening the thorax. In one of our patients we could have avoided the mini-thoracotomy and used thoracoscopy to repair the lung damage.

Adult↗

PubMed1996

[Flail chest].

From January 1989 to December 1993 at the Department of Clinical Surgery at the University of Perugia, 7 patients were under observation for multiple costal fractures and flail chest. One of them died almost immediately after his admission and therefore received no more than the initial medical treatment. Another died 17 days after costal osteosynthesis of cerebral complications. Four others successfully underwent a costal osteosynthesis, while the 7th patient received medical therapy with a positive outcome. In the case of a critical flail chest with very serious physio-pathological consequences, if the fractures are in technically favourable places, we think it is better to stabilize immediately, since the operating trauma is minimum and in many cases the patient is already intubated and curarized.

Female↗

PubMed1995

[Primary cancer of the gastric stump. Apropos of 8 cases].

The authors review their experience of 8 cases of primary carcinoma of the gastric stump during the period 1989-1992. During the same period, 164 gastric cancers were treated in the same department. Mean duration between primary gastric resection and diagnosis of gastric stump carcinoma was 30 years (6 to 42 years). All patients underwent a Billroth II primary gastric resection. Only 4 patients underwent radical surgical resection of their gastric stump carcinoma; 2 patients underwent only explorative laparotomy for very advanced and unresectable gastric stump carcinoma; 2 patients were inoperable because of their general status. This series of 8 cases of gastric stump carcinoma emphases the importance of endoscopic investigations during follow-up of patients with gastric resection, in order to diagnose and treat resectable gastric stump carcinoma.

Aged↗

PubMed1995

[Thoracic trauma].

From January 1989 to December 1992, in the Institute of Clinical Surgery of the University of Perugia, 102 patients were admitted for thoracic trauma. Two patients with an open thoracic trauma, both presenting multiple shot-wounds, underwent an explorative thoracotomy. One of them died on the operating-table from hemorrhage, while the other was saved by a wedge-resection. A 3rd explorative thoracotomy was successfully performed on a patient with internal thoracic trauma and severe hemothorax. Among the 100 patients with an internal thoracic trauma, mortality was 6%, but only one of the 6 deceased, had no lesions other than a fail chest. As a matter of fact 38 patients presented lesions in other parts of the body. Simple and complicated multiple costal fractures, found in 84 cases, were the most frequent lesions observed. Seventeen of the 38 patients with pneumothorax and/or pleural effusion had a chest tube applied. Three patients were operated for a diaphragmatic hernia with a positive outcome. Only 75 patients received medical treatment without surgery. Six of the patients with multiple costal fractures presented flail chest. One of them (mentioned above) died almost immediately after his admission and therefore received no more than the initial medical treatment. Four others, aged over 65, successfully underwent a costal osteosyntesis, while the 6th patient received medical therapy with a positive outcome. In the case of a critical flail chest with severe patho-physiological consequences, if the fractures are in technically favourable sites, the Authors believe it is better to immediately stabilize the thorax, since the operating trauma is minimum and in many cases the patient is already intubated and curarized.

Adult↗

PubMed1994

[Diagnostic and therapeutic problems of "second look" in acute intestinal ischemia].

The authors present their diagnostic approach to acute intestinal ischemia. They underline the need for early specific diagnosis because the therapeutic options vary widely in relation to different types of acute intestinal ischemia. Selective arteriography preceded by an aortogram is considered the diagnostic "gold standard". Although at present mesenteric ischemia is a serious, and often lethal, disease, an aggressive therapeutic approach can improve the outcome of this group of patients.

Acute Disease↗

PubMed1994

[Intestinal obstructions caused by colorectal carcinoma in the aged].

Colorectal cancer is the second most common malignancy of the adult population in the United States. It is exceeded only by lung cancer among males and breast cancer among females. Malignancies of the colon and rectum are responsible for approximately 12 per cent of all adult cancer deaths. These tumors appear as surgical urgency by intestinal obstruction for 15-20 per cent and by perforation for 3-8 per cent of all cases. It often occurs in elderly patients; in fact, urgent surgical operations are especially performed in patients older than seventy. The mortality rate for urgent surgical operation in elderly patients is about 32-54 per cent. This high mortality is even due to concurrent pathologies and particular locoregional and/or general alterations induced by tumor. The authors studied all patients older than 75 years affected by colorectal cancer and treated by choice or by urgency at Dept. of Surgery of the University of Perugia from January 1987 to February 1993 to individualize some clinical, anatomo-pathological and therapeutical significant characteristics about colorectal cancer in geriatric age.

Age Factors↗

PubMed1993

[Digital imaging in the surgical detection of breast neoplasms].

Microcalcific clusters represent good indicators for breast cancer detection. The Authors evaluated 98 cases of breast microcalcifications in patients with no palpable lesions. The patients had undergone mammography, biopsy and excised specimen's radiography to confirm that the target lesion was adequately removed. The presence of microcalcifications was detected through a computerized instrument which allows the digitalization of the image.

Breast Diseases↗

PubMed1993

Preoperative evaluation of inferior vena cava involvement secondary to malignant abdominal neoplasms.

The authors report their experience of different imaging techniques (US, CT, MRI, and cavography) used to evaluate inferior vena cava involvement due to abdominal malignant neoplasms. The study is a retrospective analysis of preoperative data on 15 patients of both sexes in comparison with intraoperative and/or pathological findings. All patients underwent ultrasonography, with good results in all the venous segments studied, as for the CT scan; the limitation of both techniques is the unsafe evaluation of venous wall involvement when the neoplastic tissue is confined inside the vessel. The results obtained using MRI seem to be very encouraging, but we only studied three cases with this technique, and so cannot assess the real value of the method. In nine patients we performed inferior cava phlebography: we believe this to be a very reliable exam to demonstrate vessel wall invasion, even if it is a very invasive procedure, its limits being the inability to observe proximal thrombotic extension when the vein is completely obstructed by the tumor. On the basis of their experience the authors suggest a multi-technique imaging diagnostic procedure for preoperative staging with a view to obtaining as much information as possible to correctly program surgical procedure.

Abdominal Neoplasms↗

PubMedDate not supplied

[Neoplastic involvement of the inferior vena cava].

Inferior caval vein invasion not infrequently complicates advanced neoplastic lesions. Primitive caval neoplasms (leiomyosarcomas) or other tumors such as renal carcinomas, pheochromocytoma, as well as liver, testis, and retroperitoneal tumors most likely cause caval invasion. In the past, caval invasion was a clear index of non operability, while today, a modern multidisciplinary approach allows to treat successfully even so advanced diseases. In the present report the Authors analyze the cases treated at the Dept. of Surgery of the University of Perugia, and review the most important international reports on this subject illustrating the new possibilities offered by IVC substitution with biological or artificial grafts.

Adenocarcinoma↗