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T Bacchella

Publications and source records attributed to T Bacchella.

86 records · Page 5Linked to original sources
PubMedDate not supplied

[Pyogenic hepatic abscess: report of 51 cases].

Pyogenic hepatic abscesses are uncommon. We report our findings in 51 patients with pyogenic liver abscess treated from 1975 through 1992. Twenty-eight patients were men and twenty-three were women. The median age of patients was 46 years (range, 13 to 77 years). Fever was present in 100% of patients, abdominal pain in 58.8% and jaundice in 39.2%. Twenty eight patients (54.9%) had leukocytosis; 45% hyperbilirrubinemia and 35.3% a high serum level of alkaline phosphatase. The most common cause of abscesses was biliary tract disease (66%). Thirty-three (64.7%) were surgically treated and thirteen underwent percutaneous drainage with 90.4% and 69.2% of good results, respectively. Mortality was 9.6% in the surgical group and 0% in the percutaneously drained group. A review of literature of this condition and a discussion about the diagnosis, treatment and etiopathogenesis are presented.

Adolescent↗
PubMedDate not supplied

[Cystic neoplasm diagnosed as pancreatic pseudocyst: report of 5 cases and review of the literature].

The majority of cystic lesions of the pancreas are pseudocysts. Nine to thirteen per cent of pancreatic cyst are neoplastic, benign or malignant. Failure to recognize neoplastic nature of a cyst leads to an improper management. The authors present five cases of cystic tumors mistaken for pancreatic pseudocysts, including three mucinous cystadenomas and two mucinous cystadenocarcinomas. Four were drained by cystojejunostomy and one cystogastrostomy. One patient with no metastases at first operation had metastatic spread at reoperation. In the other four cases, subsequent resection was possible and probably curative. Review of the literature and guidelines are given for the purpose of differential diagnosis between theses entities.

Adult↗
PubMedDate not supplied

[Cystic neoplasm of the pancreas: analysis of 24 cases].

Cystic neoplasms are an uncommon group among pancreatic tumors. These lesions are seen more frequently in recent surgical practice, probably because of advances in diagnostic and surgical techniques. We report 24 patients with cystic tumors of the pancreas, including twelve patients with serous cystadenoma, ten with mucinous cystadenoma and two patients with mucinous cystadenocarcinoma. Twenty-two patients were women and two were man. The median age of patients was 53.5 years (range, 21 to 80 years). Mild abdominal pain was the main symptom; in 71% of patients and weight loss in 29% of patients. The lesions were incidental findings 8% of patients. The mean size of the cysts was 7.8 cm (range, 2.3 to 15cm). Eleven cystic neoplasms were located in the head, three in the neck, five in the body, two in the tail of pancreas and three in the body and tail. All patients underwent surgical exploration. There was no perioperative mortality. Total tumor resection provides the best chance of cure and may remove the risk of malignant transformation of the cystadenomas, particularly of the mucinous type.

Adult↗
PubMedDate not supplied

[Duodenal ulcer clinically simulating pancreatic neoplasm].

A small fraction of solid mass in the head of the pancreas are inflammatory rather neoplastic in origin. The failure to recognize the true nature of a solid tumor in the head of pancreas may lead to an incorrect treatment strategy. This is a report of a patient with clinical history of pancreatic cancer which computed tomography showed a mass in the head of the pancreas with radiologic characteristics of malignancy. The patient underwent exploratory laparotomy with the finding of a mass in the head of the pancreas. The inflammatory palpable characteristic of the mass led to a intraoperative biopsy to confirm the preoperative diagnosis. With the benign result of the biopsy, the final diagnosis was duodenal ulcer which penetrates in the pancreatic parenchyma.

Diagnosis, Differential↗
PubMedDate not supplied

[Transformation of hepatic adenoma into hepatocellular carcinoma in patients with prolonged use of oral contraceptives].

Liver cell adenomas were relatively rare until the use of oral contraceptives. Most of these tumors have occurred in otherwise healthy young women who have been exposed to oral contraceptives. The treatment of this condition remained controversial for a long time. However, bleeding is still a frequent complication and can lead to a significant mortality rate. The better surgical results in hepatic resection, due to technological advances, has contributed to the indication of surgical management as therapeutic option in hepatic cell adenoma. Some authors believe that liver cell adenomas were potentially premalignant and could degenerate into hepatocellular carcinoma but there is very few well documented reports of this transformation. We report our experience in the management of liver cell adenoma.

Adenoma, Liver Cell↗
PubMedDate not supplied

[Frantz's tumor (papillary epithelial and cystic neoplasms of the pancreas): report of 3 cases].

Three cases of Frantz tumor, a papillary and cystic tumor of the pancreas, are discussed and compared with other cases reported in the literature. The neoplasm behaved in these three cases as a benign tumor. Pancreaticoduodenectomy was performed in one patient and distal pancreatectomy in the other two. C T scan and ultrasonography are useful for the diagnosis of these tumors. Cut surfaces show mostly well encapsulated tumors with the characteristically solid and hemorrhagic-necrotic patterns. Usually they are of a very low-grade malignancy so the complete surgical removal is the treatment of choice.

Adolescent↗
PubMedDate not supplied

Surgical treatment of pancreatic ascites and pancreatic pleural effusions.

BACKGROUND/AIMS: Massive ascites and pleural effusions are uncommon but well-documented complications of chronic pancreatitis. The present study reviews the results of surgical management of pancreatic ascites and pleural effusions of pancreatic origin. PATIENTS AND MATERIALS: From forty-nine patients with chronic pancreatitis presenting with ascites and/or pleural effusion of pancreatic origin, 31 were surgically treated. RESULTS: Nineteen had ascites only, ten pleural effusions and two presented with both conditions. Diagnosis of the internal pancreatic fistula was based on the findings of high amylase levels and elevated albumin content of the peritoneal and pleural exudates. Failure of medical therapy was the indication of surgical treatment in all patients. Thirteen were submitted to internal pancreatic drainage, 17 to external drainage and one to distal pancreatic resection. Eight of 17 externally drained patients were reoperated for intraperitoneal abscesses (2), infected pseudocyst (1), pain recurrence (3) and pancreatic fistula (2); whereas reoperation occurred in only one of the 13 patients submitted to internal drainage (p < 0.05). CONCLUSIONS: Internal pancreatic drainage was the ideal surgical treatment for patients with pancreatic ascites and/or pleural effusion that did not respond to medical treatment. When this was not feasible external drainage was successfully used as an alternative to pancreatic resection.

Adult↗
PubMedDate not supplied

Resection of a fibrolamellar carcinoma of the liver originating in the caudate lobe.

Liver tumors rarely arise in the caudate lobe and resection of such tumors is even more rare. Spigel's lobe resection, first described by Ton Thac Tung, is a very unusual operation and the technique has not been clearly established. Recently, successful resections of the caudate lobe of the liver have been reported. Since Edmonson's first report in 1956, fibrolamellar carcinoma of the liver (FLC) has been recognized as a distinct variant of hepatocellular carcinoma. It occurs, without sexual preference, primarily in adolescents and young adults. Usually, FLC is found in noncirrhotic livers and rarely associated with hepatitis B virus. This tumor presents a high resectability rate (48-100%) with a good prognosis and a mean survival of 68 months. We report a case of fibrolamellar carcinoma arising in the caudate lobe of the liver. Resection of the caudate lobe of the liver was carried out with no morbidity.

Adult↗
PubMedDate not supplied

[Results of conventional cholecystectomy. Experience in a university hospital].

The experience with open cholecystectomy in an university affiliated hospital is documented in this report. We studied retrospectively 221 patients operated between 1987 and 1992, type of surgery, morbidity and mortality were analyzed. There were 171 (77.3%) cholecystectomy alone and 50 (22.7%) cholecystectomy with other biliary surgery (BS). Pulmonary, urinary and wound complications were the most common. Overall incidence of complications was 7.2%. For patients with cholecystectomy alone morbidity was 3.5% and for patients with BS morbidity was 20% (p < 0.002). There were no mortality in this group of patients.

Adolescent↗
PubMedDate not supplied

[Biliary fistula after elective conventional cholecystectomy].

The use or not of drainage after elective cholecystectomy has been recently studied, and we will discuss the real incidence of the subhepatic biliary collection and its clinical significance. In this sense, we studied 20 patients with a mean age of 45 years (4 male and 16 female), submitted to elective cholecystectomy according to selective techniques patterned by our group, where we realized ligature of all vessels of the gallbladder bed, and subhepatic drainage. These patients receibed 99 mTc-DISIDA at the moment we closed the abdomen, and in a period of 24 and 48 hours we studied its presence in the subhepatic bed and in the drainage material. All the patients had not post-operative complications and none biliary drainage or subhepatic collection scanned. We concluded that using our preconized techniques, the subhepatic drainage is unnecessary after elective cholecystectomy.

Adult↗
PubMedDate not supplied

Pyogenic liver abscess: the role of surgical treatment.

MATERIALS AND METHODS: We present an analysis of 48 patients with pyogenic liver abscess (PLA) that were treated according to a protocol between 1975 and 1993. In this period, 35 patients with PLA were treated by surgical drainage (SD). The indication for surgical treatment of the abscess were patients in septic conditions, underlying intra-abdominal surgical disease and the failure/contraindication of other therapeutic methods. Thirty-one patients were submitted to surgical treatment as the initial procedure and four patients unsuccessfully treated by percutaneous drainage, underwent SD. RESULTS: The surgical approach was indicated in patients with severe disease and presented 91.5% of good results, and a mortality rate of 8.5%. CONCLUSIONS: These results suggest that surgical treatment is a good alternative as a first step not only for the treatment of the primary cause of the abscess but also in septic patients with severe disease where a delay in adequate drainage, frequent in percutaneous management, can lead to high morbidity and mortality rates.

Adolescent↗
PubMedDate not supplied

Surgical treatment of cicatricial biliary strictures.

BACKGROUND/AIMS: Cicatricial biliary strictures are usually associated with high morbidity and mortality rates, frequently related to technical difficulties of their surgical repair, mainly in hilar lesions. Interference with bile duct blood supply during surgical attempts for correction is a major factor for unsuccessful results. The aim of this study is to evaluate, after an extended follow-up period, the results obtained with a modified technique for surgical correction of cicatricial biliary strictures. METHODOLOGY: The medical records of 57 patients surgically treated for cicatricial biliary strictures between January 1984 and July 1995 were reviewed and the immediate and long term results retrospectively analyzed. Patients consisted of 46 females and 11 males. The average age was 43 years. The etiology of the biliary lesion was: cholecystectomy alone (23); cholecystectomy with duct exploration (8); T tube CBD drainage (6); Biliary-enteric anastomosis stricture (16); choledochoplasty (2) and trauma (2). In 28 cases (49.1%) the stricture was located in the upper third of the bile duct, in 28 (49.1%) in the middle third and in one case (1.7%) it was low. All patients were submitted to longitudinal Roux-en-Y hepaticojejunostomy with mucosa apposition after dissection of the anterior aspect of the biliary tract. No transanastomotic stents were used. RESULTS: Ten patients (17.5%) presented 11 postoperative complications: biliary fistula (4), duodenal fistula (1), wound infection (5), and acute pancreatitis (1). Average hospital stay was 11 days and there were no postoperative mortalities. The follow-up study was possible in 54 patients and ranged from one to ten years, with an average of 2.9 years. Four patients of 28 (14%) with hilar lesions developed stricture recurrence and cholangitis episodes, whereas no patients bearing lesions below the biliary junction had such complications. CONCLUSION: Roux-en-Y hepaticojejunostomy with mucosa apposition without transanastomotic stent performed after minimal dissection of the biliary duct, thus avoiding major interference with the bile duct blood supply, is a safe and efficient method for the surgical repair of cicatricial biliary strictures. Using this technique excellent results can be obtained in the lesions below the biliary junction and acceptable results may be achieved in patients with hilar lesions.

Adult↗