Biomedical subjects
Publications and source records attributed to V Pugliese.
Leiomyosarcoma of the inferior vena cava is a rare tumor. The authors report a case and discuss the clinical features, diagnosis and treatment of this disease. With recent advances in radiologic and surgical procedures an early diagnosis and radical resection might be possible, leading to a better prognosis or even to the cure of the condition.
Eight patients with splenic abscess are reported. Etiological factors were sepsis, mainly due to endocarditis. Diagnosis was made by ultrasonography and computed tomography scans. Splenectomy was performed in four cases, transcutaneous drainage in three and abscess puncture in one case. Mortality was 12.5% (1/8). Since the introduction of US and CT scans early diagnosis and treatment was possible by which the mortality decreased.
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The authors present three cases of splenic artery aneurysm in a group of 96 patients with portal hypertension due to Schistosomiasis mansoni. Etiology, diagnosis and treatment are discussed.
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.
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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.
Solitary hepatic cysts an uncommon disease in the past, which incidental diagnosis is increasing with the advent of ultrasound and computed tomography, are nowadays very frequent. Cysts that reach massive proportions often become symptomatic and necessitate surgical intervention. Surgical wide unroofing technique is a simple procedure advocated for the treatment of symptomatic patients. Ten patients with solitary liver cysts were submitted to wide unroofing with good immediate and late results.
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.
BACKGROUND/AIMS: The ideal treatment for patients with advanced rectal cancer and who cannot undergo a radical therapy is still undefined. The association between lasertherapy (LT) and internal radiotherapy (IRT) could affect both technical results and quality of life. This study was aimed at evaluating the association of LT and IRT in the palliative treatment of rectal cancer. MATERIAL AND METHODS: Between January and April 1994, 9 patients (2 males, 7 females) with rectal cancer underwent a combined treatment modality in order to control their symptoms. All patients were unfit for surgery and EUS showed an invasion of the whole muscular layer. After laser recanalization, brachytherapy was applied at a one week interval from last laser session. Two fractions of 10 Gy were administered at one week intervals. RESULTS: The mean number of laser sessions to obtain a complete recanalization was 3 (range:2-5) and no complications occurred. After IRT, we obtained a good result in 7/9 patients (79%) and 2 patients required further LT. The mean follow-up was 146 days (range:74-240): during this period no laser treatment was performed. Four patients complained of acute perineal pain and tenesmus after brachytherapy: in one patient, a colostomy was performed. CONCLUSION: We deem that the administration of two fractions of 10 Gy is not advisable, particularly for the treatment of non-circumferential lesions, due to the severe side effects we observed.
Angiomyolipoma, a form of mixed mesenchymal tumor, a not uncommon tumor of the kidney, is rarely found in the liver. We report a case of angiomyolipoma of the liver in a 34-year-old woman, in whom diagnosis was made by computed tomography (CT), magnetic resonance imaging, superior mesenteric and celiac trunk angiography and histological examination. The treatment of choice was a successful extended right hepatectomy.
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.
Twenty two patients having indication for surgical treatment of portal hypertension due to hepatoesplenic schistosomiasis were prospectively studied. Each patient was submitted to preoperative monitoring with pulmonary artery catheterization. The results showed hemodynamic alterations characterized by an increase of cardiac index (4.50 +/- 0.96 l/min/m2) associated to a decrease of systemic vascular resistance index (1638.60 +/- 441.86 dyn.s/cm5.m2). The stroke index and all right and left cardiac work indeces were increased. The pulmonary artery mean pressure was increased (17.23 +/- 8.63 mmHg) and the pulmonary vascular resistance index was decreased (147.95 +/- 126.21 dinas.seg/cm5.m2). We concluded that hepatoesplenic schistosomiasis determines hyperdynamic systemic circulation, probably correlated with portosystemic shunt, and pulmonary hypertension.