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Biomedical subjects

R Cotellese

Publications and source records attributed to R Cotellese.

52 records · Page 3Linked to original sources
PubMedDate not supplied

[The surgical treatment of primary hyperparathyroidism: clinical experience].

The primitive hyperparathyroidism (PHPT) constitutes still cause of discussion both from the diagnostic point of view and from the therapeutic one although surgical successes are generally reported. Between the most important problems there is the increase of the HPT asymptomatic or oligosymptomatic patients with the decisional difficulties in the timing of the surgical treatment and the difficult framing of the HLP disease associated with MEA and the relating surgical failures. Besides some authors support an unilateral dissection of the neck in patients with adenoma diseases diagnosed before the intervention against the traditional address of a bilateral exploration. Our experience is based on 31 patients subjected to intervention of parathyroidectomy for primitive HPT: 26 carriers of adenomas, of which 1 double, and 5 of diffused hyperplasia. We have effected 25 simple parathyroidectomy for adenoma, 1 resection of three parathyroid glands for double adenoma, 2 subtotal parathyroidectomy (7/8) for diffused hyperplasia. 2 patients had new surgical treatment for persistent hypercalcemia, and they were respectively carriers: 1 of a second ectopic adenoma and 1 of asymmetrical hyperplasia; 2 patients finally, operated in other hospitals had a second exploration and they were affected from MLP. In 26 patients we had very good results, in 2 persistence of hypercalcemia (patients who had a second look) and 3 hypocalcemia.

Biopsy↗
PubMedDate not supplied

[Isolated cystic cervical lymphatic metastasis from occult papillary carcinoma of the thyroid: unusual and rather difficult diagnosis].

Thyroid papillary carcinoma, exceptionally, can appear with cervico-lateral metastases in absence of thyroid evident disease. In that case we can have an infected branchial cyst, therefore is very important a correct preoperative diagnosis with FNAB. In literature were described 30 cases of cervico-lateral cystic masses that the histology revealed as occult papillary carcinoma metastases. Our experience is about 80 cases of papillary carcinoma, in only 2 cases the cancer was evident as a tight-elastic tumour in cervico-lateral region, hypoechogenic to the US scan with irregular and thick wall: one of the patient had multinodular goiter; the other one didn't have clinical of US scan character of thyroid disease. FNAB on lymph nodes shows doubtful cells evidence. Both patient had a total thyroidectomy with functional cervico-lateral and MAS lymphadenectomy. In one patient histology showed a papillary carcinoma of 4 mm in the right lobe, in the other patient the cancer was unknown. FNAB, in all doubtful cases, is the most important diagnosis test.

Adult↗
PubMedDate not supplied

[Neoadjuvant radiochemotherapy of rectal cancer: our experience].

Postoperative chemoradiotherapy is the recommended standard therapy for patients with locally advanced rectal cancer. In recent years, encouraging results with preoperative radiotherapy have been reported. From 2000 at January 2005 we treated 11 patient and our results suggest that preoperative radiotherapy combined with chemotherapy increases the chances of tumor downstaging and downsizing and facilitates sphincter-sparing surgical procedures.

Adult↗
PubMedDate not supplied

[Thyroid microcarcinoma: our experience].

The thyroid microcarcinoma is definited differentiated carcinoma of max 1 cm in diameter. We have reviewed clinical and histopathological results of 54 consecutive patients with papillary and follicular thyroid microcarcinoma and operated in the our clinic in the period 1985 to 2004. Several variables, such as older age, multifocality, bilateral disease, and extrathyroidal spread at initial assessment, may have some adverse prognostic significance. We recommend total thyroidectomy accompanied by modified neck dissection if enlarged nodes are diagnosed.

Adult↗
PubMedDate not supplied

[Goiter recurrences after surgical resection].

A personal experience about 135 pz. with non-toxic goitre treated by mono o bilateral thyroidectomy and followed during 5 years (2-8) to evaluate the incidence of recurrences is reported. The recurrences were 10.5%, especially after monolateral thyroidectomy (9 pz.). Therefore the authors stress the importance of a more accurate surgical indication, a wider resection of the gland and a careful follow-up to undertake opotherapy when hypofunction appears.

Combined Modality Therapy↗
PubMedDate not supplied

The value of segmental pressure measurement in the assessment of peripheral vascular disease.

In 60 patients with symptomatic peripheral vascular disease a study was performed to evaluate the reliability of segmental pressure measurement in detecting and localizing vascular lesions. Five groups of limbs with different pressure patterns were identified: normals, distals disease (diabetics), aorto-iliac disease, aorto-iliac and superficial femoral disease, superficial femoral and distal disease. The comparison with angiography showed the high efficacy of this method (when combined with Doppler study of the arteries) to localize and quantify the lesions. The combination with femoral intraarterial pressure measurement allows to predict exactly the segmental pressure after segmental vascular reconstructions. It is concluded that segmental pressure measurement (with the described technique) selects patients for angiography and surgery and can predict the outcome of vascular reconstruction.

Adult↗
PubMedDate not supplied

Encapsulated liquid crystal (ELC) thermography in peripheral arterial disease.

The correlation between peripheral pressures and skin temperatures was studied by encapsulated liquid crystal (ELC) plates in 66 patients with peripheral arterial disease. The study was also performed to evaluate the correlation between symptoms and temperature in four symptomatic groups of patients (with claudication, rest pain, ischemic ulcerations or gangrene and chronic ulcerations in diabetic patients). The correlation with temperature and pressure was positive (0.99) and so it was that one between symptoms and temperature. This method may be easily used in patients with peripheral arterial disease to evaluate the perfusion of the extremities and to compare bordering areas. Considering these data different new applications of this technique in peripheral vascular disease diagnosis can be suggested. The elevate velocity of the method (about 5 seconds) reveal also very fast variations of the perfusion and this may be useful to study functional decreases of blood pressure.

Arterial Occlusive Diseases↗
PubMedDate not supplied

Diabetes and surgery.

Diabetes mellitus is the metabolic disorder most commonly met by the surgeon. Hyperglycemia, hypoglycemia, electrolyte imbalance, vascular, renal and neurological complications and liability to infections must always kept in mind. An accurate preoperative evaluation is essential. The patient must be carefully controlled during the operation and in early postoperative period by i.v. glucose solution with i.v. or subcutaneous insulin. Schemes of treatment for diabetic surgical patients are proposed and results by a sample of 100 patients undergoing major surgical procedures are reported and discussed. Under adequate treatment incidence of complications in these patients is almost the same of not-diabetic patients. Continuous intravenous infusion of 10% glucose solution (500 ml every 6 hours) with potassium and insulin seems to be very safe if continuous monitoring of the blood and urine glucose and ketones is observed.

Blood Glucose↗
PubMedDate not supplied

[Surgical treatment of hyperthyroidism].

The most important problems of hyperthyroidism surgery are: the correct indication of operation, the choice of the best moment for operation and at last the extension of the resection. The authors experience include 365 patients with hyperthyroidism; 201 of them had monolateral autonomous nodules, 82 had diffuse multinodular goitre and 79 had Graves disease. In the first group of patients surgical treatment was total extracapsular isthmo-lobectomy, in the second group was performed subtotal thyroidectomy and in the third group was almost performed near-total thyroidectomy. Three relapses were found: two of that regarded patients with autonomous function nodule and one in patient with Graves disease. In 201 patients with toxic monolateral hyperfunction of the node, an extracapsular isthmo-lobectomy was performed. In the greater part of the 82 multinodular goiter cases a sub-total thyroidectomy was performed, as well as in 79 patients with Graves disease. Among the 3 recidive cases of hyperthyroidism (0.8%) one was recorded in a patient with Graves disease, (after subtotal thyroidectomy) and two in patients with hyperfunction of the node, (after isthmo-lobectomy). The authors justify the low incidence of recurrence by the choice of large extension of resection without a great number of complications.

Goiter↗
PubMedDate not supplied

[Resection therapy in the treatment of intrahepatic biliary lithiasis].

The authors report a case of intrahepatic lithiasis in a patient already operated of cholecystectomy and without lithiasis of the common bile duct. The lithiasis was present in the left lateral bile duct, was multiple and trapped behind a very narrow stricture. The stones were associated with a marked dilatation of the involved biliary ducts, cholangitis, fibrosis and atrophy of surrounding hepatic parenchyma. It was performed a resection of the II and III hepatic segments and the patient recovered completely and is well and disease free after one year. The authors believe, also on the base of the data reported by others, that in the intrahepatic lithiasis with strictures of the bile intrahepatic ducts the hepatic resection is the treatment of choice, especially when the lithiasis is present in a sectorial or segmental bile duct, preventing any stone recurrence.

Adult↗
PubMedDate not supplied

[Clinical considerations of cases of biliary ileus].

The authors report 6 cases of gallstone ileus due to cholecystoduodenal fistula. In 4 patients a simple enterolithotomy was performed, while in one case the enterolithotomy was associated to cholecystectomy and duodenal suture; in the last patient it was associated to cholecystectomy and gastric resection. Only one death was registered among the cases treated with enterolithotomy. The authors believe that the severity of the pathology, generally combined with other important diseases, needs an eclectic treatment depending on the patient status.

Aged↗