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Biomedical subjects

S Leardi

Publications and source records attributed to S Leardi.

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

[Hyperthyroidism in the elderly].

UNLABELLED: Hyperthyroidism in elderly patients is not to be under-evaluated, since it is characterized in such age range by particular clinical and prognostic features. Based upon literature survey and their clinical experience, the authors discuss in the present paper clinical, diagnostic and therapeutic problems of hyperthyroidism in geriatric patients. MATERIAL AND METHOD: In the period between 1978-2003 out of 1804 patients surgically treated for thyroid disease (non neoplastic in 1470 pts.), 180 subjects presented hyperthyroidism (17%). 36 were in geriatric age-range (mean age 76 yr.; 29 females and 7 males). 26 presented a Multinodular Toxic Goiter (72.2%), whereas 9 patients complained of Plummer Adenoma (25%); only 1 patient showed Basedow disease (2.7%). RESULTS: As far as ASA classification, there were 7 ASA I, 27 ASA II and 2 ASA III. Compression of digestive tract and/or respiratory airway represented a surgical indication in 15 patients (41.6%). 12 (33.4%) were operated due to predominant cardiac symptoms (tachycardia, atrial fibrillation). The remaining 9 patients (25%) were treated for the concomitance of atypical symptoms of hyperthyroidism. We performed 15 total thyroidectomy, 7 "near totally", 8 sub-total, 6 hemithyroidectomy in case of Plummer adenoma. Postoperative mortality was nihil; p.o. morbidity was 5.5% for medical conditions (pneumonia) and surgery-related (1 laryngeal recurrent paralysis and 1 hypoparathyroidism) in 5.5%. Post-operative follow-up, conducted at 6 and 12 months from the operation, showed regression of hyperthyroidism and regression or improvement of all clinical symptoms complained by the patient. CONCLUSION: Surgical treatment seems to be the only immediate and definitive cure for hyperthyroidism. Geriatric age does not seem to be a surgical contraindication.

Aged↗
PubMedDate not supplied

[Postoperative esophageal-visceral fistulae: their prevention and treatment].

A series of 12 cases of esophageal anastomotic leakage following esophageal surgery observed from 1969 to 1989 is retrospectively analyzed. In the period 1969-1975 6 patients were treated in emergency and the mortality rate was 66.6%, while the remaining 6 patients observed from 1975 to 1989 were treated conservatively with total parenteral nutrition (sometimes associating adequate surgical drainage): the mortality rate was 16.6%. In conclusion, not only in the treatment of anastomotic leakage, but also in its prevention, artificial nutrition has a crucial role. The outcome of thoracic and abdominal fistulas depends mainly on adequate drainage, not necessarily surgical. Cervical fistulas heal in 2-4 weeks, but strictures arise frequently and respond to endoscopic dilatation.

Adult↗
PubMedDate not supplied

[The role of blood transfusion on the postoperative morbidity of tumors of the colon and rectum].

UNLABELLED: Previous studies have demonstrated that perioperative blood transfusions in patients with colo-rectal cancer may be related to a poor p.o. prognosis. Blood transfusions have been reported to exert an immunosuppressive action thus representing a risk factor of p.o. septic complication. MATERIAL AND METHOD: 100 patients were investigated retrospectively (60 M. and 40 F., mean age 61.7 yrs, range 18-86). Location of the tumour was rectum in 49 cases, sigmoid in 33, descending colon in 9 and ascending colon in 9. Dukes' staging of the tumour was A in 16 cases, B in 34, C in 30, D in 20. 61% of the patients received blood transfusions, before the operation in 10, during the operation in 13, after the operation in 16. 22 patients received blood transfusions before, during and after the operation. P.o. septic complications were then correlated to number and timing of blood transfusions, sex and age of the patients, location of neoplasm, Dukes' staging, surgical technique, severe anemia and malnutrition. RESULTS: P.o. septic complications were observed in 25 patients, without significative correlation with patients sex and age, site and staging of the tumour, surgical technique, preoperative anemia and/or malnutrition. A statistically significative increase in the incidence of septic complications was observed only in transfused patients compared to non transfused (34% vs. 10.3% - X2 = 5.62, p less than 0.01). This was noted regardless the presence of advanced disease, location of the tumour, surgical technique employed. The increased incidence of septic p.o. complications was observed even comparing transfused to non-transfused grouped accordingly to the different factors considered in the study.(ABSTRACT TRUNCATED AT 250 WORDS)

Colorectal Neoplasms↗
PubMedDate not supplied

[Intrahepatic lithiasis. Apropos of 36 cases of "regional" intraheptic lithiasis].

Out of 2,700 operations for cholelithiasis and its sequelae (1960-1976), 36 cases (1.3%) of intrahepatic lithiasis (i.l.), namely proximal to the origin of the common hepatic, were observed. The prime objective of treatment namely removal of calculi, was achieved indirectly (hepatocholedochus and/or papilla) in 84% of cases, directly (hilar) in 16%. The second objective, that of ensuring optimal bilio-enteric drainage, was achieved by papillostomy or hepaticojejunostomy depending on the lumen of the bile way (respectively less or more than 2 cm.). Operative mortality was nil, while long-term results have proved poor in 9.6% of cases. The i.l. problematic is dealt with in detail on the basis of this series.

Adolescent↗
PubMedDate not supplied

[Is intraoperative cholangiography always indicated during videolaparoscopic cholecystectomy?].

Opinion is divided whether intra-operative cholangiography should be performed routinely or on a selective basis during laparoscopic cholecystectomy. The aims of the present study were to assess the safety, utility and indications of intraoperative cholangiography performed during laparoscopic cholecystectomy. 11 operative cholangiograms were attempted in 63 patients who underwent laparoscopic cholecystectomy (17.4%). Duration of post-operative hospitalization and interval to return to full activity were identical in the two groups. Cholangiography increased the duration of operation (mean 20.1 min: p < 0.01) and the total charges for the operation by almost L. 200,000. Cholangiograms were performed successfully in 100% of the patients and changed operative management in 2 patients. There was not false negative or positive study. No complications or deaths occurred that were due to cholangiography. In follow-up ranging from 1-9 months, there has been no clinical evidence of bile duct injury or retained common bile duct stones. The inescapable conclusion is that an absolute indication for performing cholangiography is unclear anatomy of biliary system. Whereas to document the presence of common bile duct stones, intra-operative cholangiography, neither routine nor selective, is needed. Patients who present with clinical or biochemical signs of choledocholithiasis, a history of cholangitis, acute biliary pancreatitis, or an abnormal CBD on sonogram should have preoperative ERCP and ES before contemplated laparoscopic cholecystectomy. Further advances and confidence with laparoscopic CBD exploration may further change the approach to these patients in the future. In this case selective intra-operative cholangiography is mandatory. However, additional prospective analysis of this patient subgroup is needed.

Adolescent↗
PubMedDate not supplied

[Ménétrier's disease associated with a gastric ulcer: a clinical case report and review of the literature].

The authors report on a case of Ménétrier's disease, associated with antral gastric ulcer. The patient came at our observation after a severe high digestive bleeding. On the basis of the endoscopic diagnosis of gastric ulcer and because of the failure of medical treatment with continuous bleeding, the patient underwent subtotal gastrectomy. The histological examination of the specimen confirmed the benign nature of the gastric ulcer but revealed also the presence of Ménétrier's disease. After three years, an endoscopic control excluded the presence of the disease in the remaining stomach. The association between gastric ulcer and Ménétrier's disease is of difficult pathophysiological explanation in the literature. The presence of the ulcer, however, does not seem to influence the clinical evolution of the disease or the treatment, which, moreover, has not been codified as yet. In fact, cases of Ménétrier's disease are reported to have been cured with cortisol, anticholinergic, anti-H2 receptor and antifibrinolytic preparations or by surgery (subtotal gastrectomy, total gastrectomy). However, as in our patient, spontaneous remission of the disease with no treatment have been reported. The Ménétrier's disease, the treatment of which has yet to be codified, is still a difficult situation, in particular when associated to gastric ulcer.

Biopsy↗
PubMedDate not supplied

[THe video laparoscopic experience of the general surgeon in cholecystectomy in childhood].

Despite the exponentially increasing number of laparoscopic cholecystectomies on adults to date, there is a paucity of reports in the literature about this new technique in pediatric patients. From September 1992 to February 1995, 140 patients underwent laparoscopic cholecystectomy. Since July 1993, in our institution, five pediatric patients (three females and two males) with a diagnosis of cholelithiasis underwent laparoscopic cholecystectomy. The age of the patients ranged from 6 to 15 years (mean 8.8 years) and they weighed 18-58 kg (mean 28.4 kg). All five patients had biliary cholic and ultrasound evidence of cholelithiasis. One patient had associated hematological disease (sickle cell disease). All 5 children were operated using the laparoscopic approach technique. Operative cholangiography was performed in cases with ductal and vascular intraoperative anatomy unclear. No operation was converted to open cholecystectomy. Intraoperative cholangiography was performed successfully (100%). The mean time of surgery was 50.2 minutes (range from 38 to 68). There were no operative complications. The mean hospital stay was 2.2 days (range 2 to 3 days). All five returned to their activity within a week. No long-term complications were seen in all patients throughout an average follow-up period of 10.6 months (range 8-14). The benefits of laparoscopic cholecystectomy in children are clear and obvious. It is safe and effective and should now be the treatment of choice for cholelithiasis in pediatric patients.

Adolescent↗