Search PubMed⌕ Search

Biomedical subjects

R L Rossi

Publications and source records attributed to R L Rossi.

At least 37 records · Page 2Linked to original sources
PubMed1994

Techniques of laparoscopic cholecystectomy. The difficult operation.

Laparoscopic cholecystectomy has settled as the treatment of choice for patients with gallstone disease. Injury to the bile ducts, still the main drawback of the technique, is decreasing progressively with better understanding of the mechanisms of injury and adequate training. With the expansion of indications for laparoscopic cholecystectomy, more difficult operations are being performed. Adequate understanding of the obstacles that may arise during the laparoscopic procedure as well as knowledge of specific maneuvers to deal with the difficult operation are important for the success and safety of the procedure.

Cholecystectomy, Laparoscopic↗
PubMed1994

Bile duct injuries. Spectrum, mechanisms of injury, and their prevention.

Bile duct injuries remain a relatively uncommon but potentially devastating complication of both open procedures and laparoscopic procedures. They may present immediately after a given operation or take years to be recognized. Despite the best intentions of the surgeon, many of these injuries are imminently preventable. Recent advances in laparoscopic procedures have served to remind us of lessons learned from the prelaparoscopic era with respect to injuries of the bile ducts. To conduct any operation safely on or near the biliary system, the surgeon should be familiar with the anatomy and its variations, the nature of the pathologic processes that may enhance the likelihood of causing harm, and, most important, his or her own limitations and the limitations of the system with which he or she has to work.

Bile Ducts↗
PubMed1994

Biliary reconstruction.

The success of the initial repair after bile duct injury is critical to the long-term patency and function of the biliary tract. Dissection of the hilar plate, obtaining adequate width of the hepatic duct opening, and accurate mucosa-to-mucosa anastomosis are essential to achieving satisfactory reconstruction of the biliary tract. The plan of treatment for bile duct injuries should be tailored to the individual patient based on the type, level, and extent of the injury, the timing of diagnosis, the overall status of the patient, and the available expertise. The goal of therapy is not necessarily to avoid surgery but to achieve the best long-term results in the most cost-effective manner and with the least morbidity and mortality. A coordinated multidisciplinary approach to the diagnosis and treatment of patients with biliary injuries is now the standard.

Bile Ducts↗
PubMed1993

Local resection for ampullary tumors. Is there a place for it?

Two of 14 patients with adenomas were without disease 25 and 43 months after ampullary resection. Two patients with an initial diagnosis of malignant neoplasm had no recurrence at 75 and 40 months; one underwent pancreatoduodenectomy at 8 months because of recurrence. Six of nine patients with initial diagnoses of villous adenoma were without disease at 1, 2, 16, 23, 46, and 51 months; three underwent conversion to pancreatoduodenectomy because of invasive carcinoma. Frozen-section studies revealed adenocarcinoma in two patients with villous adenoma but failed to show invasion in one patient. One patient with villous adenoma was mistakenly thought to have carcinoma based on results of frozen-section studies. Local ampullary resection is valuable in treating benign and selected premalignant and malignant ampullary lesions. The threshold for conversion to pancreatoduodenectomy should be low unless ampullectomy is performed with palliative intent.

Adenoma↗
PubMed1993

Acute relapsing pancreatitis as a complication of papillary stenosis after endoscopic sphincterotomy.

Endoscopic sphincterotomy has proven to be a safe alternative to surgery for selected types of biliary disease. Despite a relatively low morbidity, postprocedure complications are well described. This report presents an experience with three patients in whom acute relapsing pancreatitis developed as a possible complication of papillary stenosis after endoscopic sphincterotomy. None of the patients had a previous history of elevations in serum amylase levels before endoscopic sphincterotomy. After procedure, pancreatitis and subsequently acute relapsing pancreatitis with documented stricture of the pancreatic duct orifice developed in all three patients. After surgical transduodenal sphincteroplasty, no new episodes of acute relapsing pancreatitis occurred.

Acute Disease↗
PubMed1993

Ultrasonic mucosectomy of the gallbladder. A histological analysis.

The Cavitron Ultrasonic Surgical Aspirator (CUSA) may be used to remove mucosa of organs of the gastro-intestinal tract. A histological analysis was performed on gallbladders treated with a CUSA-mucosectomy to assess the extent and degree of mucosectomy and to evaluate parietal damage. The histological studies performed on three specimens of chronic cholecystitis revealed a complete mucosectomy except in areas where Rokitansky-Aschof sinuses were present. There was no evidence of parietal damage. The CUSA may be used to remove the mucosa of gallbladders without injury to other layers, and may have a potential application in procedures such as mucosal cholecystectomy.

Cholecystitis↗
PubMed1992

Primary adenocarcinoma of third and fourth portions of duodenum. Favorable prognosis after resection.

Duodenal adenocarcinoma, a rare malignant lesion, is associated with a poor 5-year survival. Few series have addressed differences between resectable tumors of the proximal and distal duodenum. We reviewed records of 17 consecutive patients with adenocarcinoma of the duodenum who underwent resection: 10 had adenocarcinoma of the proximal duodenum, and seven had tumors of the distal duodenum. Most patients underwent pancreatoduodenectomy. Five patients with adenocarcinoma of the distal duodenum underwent segmental resection. No perioperative deaths occurred. Six of 10 patients with proximal tumors died of metastatic disease. Of the seven patients with tumors of the distal duodenum, five are alive without evidence of disease, and two died of unrelated causes. The survival of patients with adenocarcinoma of the distal duodenum is surprisingly good, and segmental resection is the procedure of choice.

Academic Medical Centers↗
PubMed1992

Laparoscopic bile duct injuries. Risk factors, recognition, and repair.

Records of 11 patients undergoing biliary reconstruction after laparoscopic cholecystectomy are reviewed. Ductal injuries resulted from failure to define the anatomy of Calot's triangle. Risk factors include scarring, acute cholecystitis, and obesity. Presenting findings included anorexia, ileus, failure to thrive, pain, ascites, and jaundice. All patients required hepaticojejunostomies, which were multiple and above the hepatic bifurcation in four patients. Given the extensive nature of these injuries and the frequent need for intrahepatic anastomosis and early stenosis of repairs by referring physicians, we recommend reconstruction be undertaken by an experienced hepatobiliary surgeon. To avoid injuries, a greater appreciation of risk factors and anatomic distortion and variance and strict adherence to principles of dissection and identification of anatomic structures are suggested. The use of cholangiography and a low threshold for conversion to the open procedure are advised.

Academic Medical Centers↗
PubMed1992

Mediastinal goiters. The need for an aggressive approach.

We reviewed the cases of 52 patients with substernal goiters to examine clinical presentation, workup, technique of removal, malignancy, and outcome. Half of the patients were asymptomatic; half had at least one compressive symptom. Chest film was the most used; computed tomography or magnetic resonance imaging was by far the most useful study. Thyroid scans often failed to show the intrathoracic goiter. Fine-needle aspiration was not helpful because of the gland's inaccessibility. Seventeen percent (nine) of the thyroids showed malignancy, 21% (11) including incidental papillary carcinomas. These were not identified by duration of goiter, symptoms, or fine-needle aspiration. Except for lymphomas, prognosis was good after resection. Removal was almost always accomplished via cervical incision, with low morbidity and no deaths. The threat of compression, the substantial chance of malignancy, and the safety of resection mean that the presence of substernal goiter is an indication for surgery.

Academic Medical Centers↗
PubMed1991

Surgical management of nonparasitic cystic liver disease.

We report clinical features, surgical management, recurrences, and follow-up study of 12 patients with simple hepatic cyst, 11 patients with polycystic liver disease, and 19 patients with cystadenoma who were surgically treated over a 25-year period. The median age of patients was 48 years, and 37 women and 5 men were in the series. The most common presenting symptom and physical finding were chronic abdominal pain and tenderness in the right upper quadrant. The most commonly associated disease was polycystic kidney disease, which was an associated finding in 5 of the 11 patients with polycystic liver disease (45%). The most valuable diagnostic studies in all groups were computed tomography and ultrasonography. The location of the disease was bilobar in patients with polycystic liver disease, with a right lobe predominance in 18% of patients. The right lobe was also predominant in 83% of patients with simple hepatic cyst and 58% of patients with cystadenoma. Of all solitary cystic lesions in the left lobe, 75% of them were cystadenomas. Of the 66 surgical procedures performed, aspiration was associated with a failure rate of 100%; partial excision, a failure rate of 61%; and total excision and liver resection, a failure rate of 0%. Orthotopic liver transplantation was performed in three patients and was associated with two early deaths. Partial excision relieved symptoms in three patients (43%) with polycystic liver disease. Total excision, enucleation, or liver resection with cyst(s) is the treatment of choice for non-parasitic cystic lesions of the liver.

Adult↗
PubMed1991

Common operative problems in hepatobiliary surgery.

The pace of change in hepatobiliary surgery requires a sound foundation in basic surgical principles. Further reductions in morbidity and mortality rates and appropriate use of alternative therapies require careful attention to preoperative risk assessment and patient selection. To operate safely and successfully on the liver and bile ducts, the surgeon must be well versed in normal and variant hepatobiliary anatomy, understand the underlying disease and therapeutic alternatives, and known techniques of reoperative biliary surgery. Surgeons who operate on the gallbladder must be prepared to confront a host of unexpected and difficult operative problems. Bile duct injuries must be repaired properly at the first attempt. Complex biliary operations require a great level of technical expertise and judgment to obtain successful results and should only be undertaken by experienced hepatobiliary surgeons. As proficiency with the more routine procedures improves, increasingly complex and extensive procedures become possible. We must constantly police ourselves to be certain that these more extensive procedures truly benefit our patients.

Bile Ducts↗
PubMed1991

Common difficulties and complications in pancreatic surgery.

Pancreatic surgery requires dedicated surgeons to optimize results. Difficult operative situations faced during the course of pancreatic procedures and ways of dealing with them are suggested. The horizons of surgery on the pancreas will expand as the morbidity and mortality rates fall.

Humans↗
PubMed1991

Analysis of morbidity and mortality rates in right hepatectomy with the preoperative APACHE II score.

Morbidity and mortality rates in 70 patients who underwent major liver resection for liver tumors (primary and metastatic) were determined and correlated with the preoperative APACHE II score. Patients were divided into three groups according to their preoperative APACHE II score: low (0 to 3), mid (4 to 7), and high (8 and above). A higher score was closely correlated with increased postoperative morbidity and operative mortality rates. The group with low scores had a postoperative morbidity rate of 34% and a mortality rate of 0%, the group with mid scores had a postoperative morbidity rate of 54% and a mortality rate of 3%, and the group with high scores had a postoperative morbidity rate of 80% and a mortality rate of 20%. Age did not correlate with morbidity. It was therefore postulated that morbidity and mortality rates were related to the combination of points for abnormal physiologic variables and points for chronic health, or APACHE II score minus points for age. As the combination of these points increases the postoperative morbidity and operative mortality rates increase significantly (from 24% in the 0-point group to 69% in the greater than or equal to 3-point group). Also the two deaths occurred in the group with 3 or more points. The preoperative APACHE II score may be used by clinicians to evaluate before surgery the risk of postoperative morbidity and death in elective major liver surgery.

Adult↗
PubMed1990

Clinical and pathologic correlations in patients with periampullary tumors.

Perioperative data on 87 patients undergoing pancreatoduodenectomy for periampullary tumors were correlated with pathologic study of operative specimens to identify the accuracy of diagnosis and the factors affecting survival. Accuracy of endoscopic retrograde cholangiopancreatography and computed tomography in locating lesions was 75% and 44%, respectively. Histologic diagnosis before or at the time of resection was available in only 61% of the patients. Carcinoma was correctly diagnosed clinically by the pathologist or the surgeon in 95% (83/87) of patients with 4 patients found to have benign disease on final pathologic examination. Intraoperative diagnosis of site of origin was incorrect in 18% (16/87) of patients. In 28% (23/83) of patients, pathologists identified nodal metastatic disease missed by the surgeon. Survival correlated with nodal and margin status and tumor grade. Tumor size demonstrated no predictive capacity. Although preoperative diagnostic accuracy is less than optimal, surgeons can usually diagnose malignant lesions but more often fail to identify tumor origin and nodal disease. We continue to advocate resection for patients with periampullary lesions thought to be malignant and resectable without a positive histologic diagnosis.

Adult↗
PubMed1990

Resective operations for biliary carcinoma.

Records of 25 consecutive patients who underwent resection for proximal bile duct tumor (3 extended right hepatic lobectomies, 6 left hepatic lobectomies, 16 skeletonization resections) and records of 21 patients who underwent pancreatoduodenectomy for distal bile duct carcinoma were reviewed to assess the value of resective therapy. The operative mortality rate for patients with resected proximal bile duct tumor was 4 per cent (0 per cent for liver resection) and that of distal bile duct tumor, 4.6 per cent. The 3- and 5-year actuarial survival rates for patients with proximal bile duct tumor were 44 per cent and 35 per cent, respectively; all except one patient eventually died of disease. Survival was better for patients who had curative resection (margins microscopically free of tumor). The 5-year actuarial survival rate for patients with distal bile duct carcinoma was 58 +/- 12 (SE) per cent, with patients who had negative nodes surviving longer than patients with positive nodes. When major hepatic resection and pancreatoduodenectomy can be performed in selected patients with low operative mortality, patients with bile duct carcinoma should be assessed by an experienced hepatobiliary multidisciplinary group before a decision is made in favor of palliative, endoscopic, or percutaneous techniques because surgical resection appears to offer the best possible long-term survival and probably the best quality of palliation.

Actuarial Analysis↗