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Biomedical subjects

R L Rossi

Publications and source records attributed to R L Rossi.

At least 91 records · Page 5Linked to original sources
PubMed1984

Biliary carcinoma. A review of 109 cases.

One hundred nine patients operated on for bile duct carcinoma were reviewed. Herein, we reported 83 proximal duct tumors, 12 mid-duct tumors, and 14 distal third tumors. Resectability was 10 percent, 33 percent, and 100 percent, respectively, with an operative mortality of 0 percent, 25 percent, and 23 percent. The median survival time and 5 year survival rate for these resected groups were 21 months and 25 percent for proximal duct tumors, 8 months and 0 percent for mid-duct tumors, and 16 months and 20 percent for distal third tumors. Eighty-three patients were treated with strictly palliative procedures with an operative mortality of 19 percent, an adjusted median survival rate of 10.9 months, and a 5 year survival rate of 0. The 2 and 5 year survival rates of patients with well-differentiated tumors were 73 percent and 15 percent, respectively, whereas for patients with poorly differentiated lesions, it was 6 percent and 0. Although most patients require palliative decompressive procedures, resection should be attempted whenever possible. It is expected that nonoperative techniques will have an increased role in the treatment of poor-risk patients or those who have unresectable disease.

Adenocarcinoma↗
PubMed1984

Surgical management of cysts of the head of the pancreas.

Thirty patients with cysts of the cephalic portion of the pancreas treated by operation between 1966 and 1980 were reviewed to determine whether any variation existed from the usual treatment of cysts of the body and tail of the gland. Sixteen patients had chronic pancreatitis, six had acute pancreatitis, four had cysts of indeterminate causes, three had adenocarcinoma of the pancreas, and in one patient a cyst developed after external trauma. External drainage was used in 14 patients, internal drainage in ten patients, and combinations of cyst drainage and anastomosis of Wirsung's duct or resection were performed in six patients. No operative deaths occurred, and the rate of cyst recurrence was minimal. Diabetes mellitus developed in 40% of patients with chronic pancreatitis despite conservative management. Recurrent pain in 13 patients and the discovery of associated carcinoma in one patient at initial treatment and later in two others cast doubt on the usefulness of simple internal or external drainage of cysts for pain except in a setting of acute pancreatitis. Resection of the pancreatic head or drainage of dilated pancreatic ducts should more often be carried out in the primary treatment of cephalic cysts with pain due to chronic pancreatitis.

Acute Disease↗
PubMed1983

Segmental pancreatic autotransplantation for chronic pancreatitis.

Three patients who underwent 95 percent removal of the pancreas for chronic pancreatitis with autotransplantation of the body and tail of the gland to the femoral area are described. The follow-up periods are 18, 6, and 2 months. Pain lessened in all patients and none required exogenous insulin. Patency of the graft was documented in all patients by angiography, technetium scan, and Doppler studies. Percutaneous selective venous assays of both external iliac veins showed a high insulin concentration in the transplanted side, both early and late in the postoperative period. In one patient the operative insulin levels obtained at the completion of autotransplantation proved to be highest in the external iliac vein on the transplanted side, lowest in the iliac vein on the nontransplanted side, and intermediate in the portal vein. Subsequent biopsies of the autografts showed fibrosis of the gland and atrophy of the acinar tissue with preservation of islet tissue. This technique appears to offer a means of preserving endocrine function in selected patients who require extensive resection for chronic pancreatitis.

Adult↗
PubMed1983

Pyloric and gastric preservation with pancreatoduodenectomy.

Pyloric and gastric-preserving pancreatic resection was performed in 35 patients with no mortality. Twenty-seven patients were followed for at least 8 months postoperatively and are reported herein in detail. This variation in the Whipple procedure is associated with a satisfactory weight gain after operation for benign disease, does not produce the usual postgastrectomy digestive symptoms, and so far jejunal or anastomotic ulceration has not been a problem. We believe this variation of the Whipple procedure is the operation of choice for benign disease and for certain types of periampullary malignant growth.

Ampulla of Vater↗
PubMed1983

Segmental pancreatic autotransplantation for chronic pancreatitis. A preliminary report.

A patient who underwent 95% pancreatectomy with autotransplantation of the body and tail of the gland to the femoral area for chronic pancreatitis is presented. The pain resolved, and the patient's blood glucose level remained within normal limits. High levels of insulin were found in the iliac vein on the transplanted side. Patency of the graft was demonstrated by technetium scan and arteriography and followed by a color-coded Doppler imaging system. Segmental pancreatic autotransplantation offers a method of relieving pain with preservation of endocrine function in selected patients with chronic pancreatitis.

Blood Glucose↗
PubMed1983

The effect of thyroid hormone administration upon survival in patients with differentiated thyroid carcinoma.

Seven hundred sixty-one patients with operable differentiated thyroid carcinoma were treated between 1931 and 1970. Median follow-up time was 18 years and ranged from 5 to 40 years. Sixty-three percent of the patients were followed more than 15 years, and 46% were followed more than 20 years. Because resections usually spared sufficient thyroid tissue for homeostasis, thyroid hormone was not routinely prescribed after operations performed before 1960. Altogether 244 patients with papillary carcinoma and 76 patients with follicular carcinoma received thyroid hormone, while 296 patients with papillary carcinoma and 45 patients with follicular carcinoma did not receive thyroid hormone after operation. With papillary carcinoma, 14% of men greater than 40 and women greater than 50 years of age (high risk) but only 2% of men less than or equal to 40 years of age and women less than or equal to 50 years of age (low risk) died of disease (P 0.0001). Twenty-six percent of high-risk but only 4% of patients with low-risk follicular cancer died (P 0.0001). However, there was no statistically significant improvement in survival times with use of thyroid hormone when patients were categorized by risk group and pathology. These data support the importance of age and sex in previously described risk groups; these factors supersede the effects of adjuvant treatment. This absence of effect on survival times calls into question current recommendations for routine use of thyroid hormone after surgical therapy. Conceptually, such absence of adjunctive hormone effect on survival time after operation is similar to hormonal effects in other endocrine cancers, which may nevertheless provide good palliation in some cases.

Adenocarcinoma↗
PubMed1981

Parietal cell vagotomy for intractable and obstructing duodenal ulcer.

Parietal cell vagotomy can be accomplished with minimal morbidity and mortality. Symptoms and signs of delayed gastric emptying early after operation are common and occur more frequently in patients with preoperative gastric outlet obstruction than in those without, a difference that is statistically significant. These symptoms are generally mild and transient. Dumping and diarrhea were not problems in our series. In patients with preoperative gastric outlet obstruction, parietal cell vagotomy with pyloroduodenal dilatation achieved good or excellent results in 79 percent of patients; however, the possibility of a higher recurrence rate requires further evaluation and suggests caution and selectivity in the use of this procedure. The recurrence rate of 3 percent of these patients without gastric outlet obstruction and a very good or excellent clinical result in 91 percent of these patients appear acceptable and encourage us to continue to use parietal cell vagotomy as the procedure of choice in patients with intractable duodenal ulcer. Most patients with recurrent ulcer have been treated medically with success. Close long-term clinical follow-up studies will be required to assess better the success of this procedure.

Adolescent↗
PubMed1981

A technique of biliary tract reconstruction with complete follow-up in 44 consecutive cases.

Forty-four consecutive stricture repairs by one surgeon with long-term follow-up study are reported. Sutured anastomoses were performed in 39 patients. Essentials of the sutured repair include minimal dissection of the proximal duct, a one-layer anastomosis, mucosa-to-mucosa apposition, and a preference for hepaticojejunostomy with a T-tube stent. Eighty-six per cent of the patients treated by this technique achieved satisfactory results. This technique is the procedure of choice for repair of biliary stricture.

Cholestasis↗
PubMed1980

Parietal cell vagotomy.

Although long-term follow-up data have not been obtained, it appears that parietal cell vagotomy for the treatment of intractable duodenal ulcer is withstanding the test of time. Operative mortality and morbidity are low, as is the incidence of side effects. The majority of patients who have a recurrent ulcer improve with medical therapy, and only a minority require reoperation.

Dilatation↗
PubMed1980

Intubation techniques in biliary tract surgery.

In surgical management of diseases of the biliary tract, tubes are frequently used to achieve decompression, stent an anastomosis, or form tracts for later instrumental manipulation. The T tube, the modified Y tube, and the transhepatic tube are each efficacious in particular situations, and should be carefully selected to improve long-term results.

Bile Ducts↗
PubMed1980

Management of benign biliary stricture.

A description of our current approach to management of benign biliary strictures is presented with emphasis on the importance of preservation of ductal blood supply during reconstruction. Although we have repeatedly stressed the primary importance of prevention of these injuries by a carefully performed cholecystectomy, the frequency with which cholecystectomy is carried out will undoubtedly result in an ongoing small number of such serious injuries. Therefore, continued refinement of the technique of biliary reconstruction and careful evaluation of results are important.

Bile Ducts↗
PubMed1980

Mass in the head of the pancreas: a practical approach.

Periampullary tumors, especially carcinoma of the ampulla of Vater and, to a lesser degree, carcinoma of the distal common bile duct and duodenum, are potentially and theoretically curable, even in the presence of regional lymph node metastases. Adenocarcinoma of the anatomic head of the pancreas or of the uncinate process, regardless of the status of the local lymph nodes, may be an incurable tumor because of its late clinical presentation. The treatment of choice for selected, curable carcinomas of the periampullary region is radical pancreatoduodenectomy. Carcinoma of the head of the pancreas should be resected when careful dissection does not reveal regional or distant lymph node involvement. Other presumed curable malignancies presenting as a mass in the pancreatic head, such as cystadenocarcinoma, islet cell carcinoma, and rare connective tissue sarcomas, also should be treated by the Whipple operation. If the remaining, distal pancreatic duct is unsuitable for anastomosis, total pancreatectomy should be completed. The so-called "regional pancreatectomy," as well as resection of portal and superior mesenteric veins, can be performed, but the value of these procedures has not been proved. Palliative bypass procedures should be performed for all malignant masses in the head of the pancreas if distant spread of disease is evident. The only exception is an islet cell carcinoma; this tumor can be resected with satisfactory palliation of symptoms of hypoglycemia despite the presence of advanced disease. Biliary enteric bypass also should be employed when diseased regional lymph nodes are associated with carcinoma of the head of the pancreas or large carcinomas of the periampullary duodenum. A side-to-side choledochojejunostomy is the preferred method of decompression. Gastrojejunostomy is a frequent companion procedure.

Common Bile Duct↗
PubMedDate not supplied

Occult well differentiated thyroid carcinoma presenting as cervical node disease.

Records of 92 patients with differentiated thyroid carcinoma presenting as cervical adenopathy without a palpable mass were reviewed to identify prognostic factors and to evaluate therapy. Patients were treated between 1940 and 1990 and were observed for 3 to 48 years (median 18 years). Follow-up data were obtained by chart review, correspondence, and telephone contact. Among the group, 20 patients had unilateral and 72 bilateral thyroid lobectomy, with node dissection in 77. Thyroid hormone was used in 50 patients and radioactive iodine in 20. Patients were younger than the overall population of patients with differentiated thyroid carcinoma, with more men and more multifocal thyroid disease. Risk group defined by age and sex was the most important determinant of survival. All women 50 years of age or younger and all men 40 or younger (low risk group) survived independent of the type of initial operation or use of thyroid-stimulating hormone suppression or radioactive iodine. Of the low-risk patients, 16% had recurrent disease but were treated successfully with surgery or radioactive iodine; 28% of the older patients (high risk) died of disease. A trend for better survival was noted in high risk patients undergoing bilateral thyroidectomy and in patients receiving thyroid suppression. Of the high risk patients, 26% had recurrent disease, with a 71% mortality rate. Age and sex are the primary determinants of survival. Therapy should be based on risk factors. Low risk patients should have conservative thyroid surgery and modified or limited node dissection.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma, Follicular↗
PubMedDate not supplied

Bile duct injury during laparoscopic cholecystectomy: mechanism of injury, prevention, and management.

Although several studies have shown a low incidence of bile duct injuries during laparoscopic cholecystectomy, concerns remain because of the sustained increase in the number of referrals for biliary reconstruction after the procedure. Twenty-one patients have been referred to our institution because of major bile duct injuries after laparoscopic cholecystectomy. The injury was recognized during the laparoscopic procedure in only 6 of the 21 (29%). Nineteen patients underwent hepaticojejunostomy at least once, one patient required hepaticojejunostomy and repair of a choledochoduodenal fistula, and one patient needed repair of a biliary colonic fistula. Hepaticojejunostomy above the bifurcation was required in 10 patients (50%), at the bifurcation in 3, and below the bifurcation in 7. Nine of the eleven patients in whom the initial repair was performed at the local hospital presented with early stricture (median 7 months). The common denominator of the development of bile duct injuries during laparoscopic cholecystectomy is the failure to identify the structures of the triangle of Calot. Specific steps during laparoscopic cholecystectomy to avoid bile duct injuries are described. Expertise in hepatobiliary surgery appears to optimize results of biliary reconstruction.

Adolescent↗
PubMedDate not supplied

Radical operations for carcinoma of the gallbladder: present status in North America.

Experience in the United States of America with the use of radical operations for carcinoma of the gallbladder was reviewed. Four studies using the Nevin clinicopathologic classification were combined for analysis. The 5-year survival rate for patients with stage I disease was 59%; stage II disease, 40%; stage III disease, 9%; stage IV disease, 7%; and stage V disease, 1%. Only one study analyzed the results of surgical procedures according to Nevin staging. No conclusions can be drawn from retrospective studies on the value of operations more radical than simple cholecystectomy. Responses to a questionnaire sent to prominent North American surgeons emphasized the controversial management of patients with this disease.

Gallbladder Neoplasms↗