Chirurgia italiana最新文献_第5页

Leiomyosarcoma of the inferior vena cava: a case report and review of the literature. 下腔静脉平滑肌肉瘤1例报告及文献复习。

Chirurgia italiana Pub Date : 2009-07-01

Alberto Sartori, Silvia Vigna, Aldo Dal Pozzo, Maurizio Balduino, Carlo Augusto Sartori

引用次数: 0

Cryptogenetic intestinal angiodysplasia and elderly aortic stenosis: Heyde's syndrome? A case report. 隐源性肠血管发育不良和老年主动脉瓣狭窄:Heyde综合征?一份病例报告。

Chirurgia italiana Pub Date : 2009-07-01

Walter Testi, Francesco Coratti, Carmen Staffieri, Riccardo Malatesti, Giulia Baldoni, Vanessa Borgogni, Bruno Lorenzi, Andrea Coratti, Francesco Tani

{"title":"Cryptogenetic intestinal angiodysplasia and elderly aortic stenosis: Heyde's syndrome? A case report.","authors":"Walter Testi, Francesco Coratti, Carmen Staffieri, Riccardo Malatesti, Giulia Baldoni, Vanessa Borgogni, Bruno Lorenzi, Andrea Coratti, Francesco Tani","doi":"","DOIUrl":"","url":null,"abstract":"Gastrointestinal haemorrhage is extremely frequent, but in some cases the aetiology may remain unknown. Haemorrhage from the small bowel especially can create important diagnostic problems. We report the case of a patient admitted to hospital with intestinal bleeding in an ileal site in association with aortic stenosis. Enteric angiodysplasia is a frequent pathology in the surgery of the gastrointestinal tract. Recognizing bleeding lesions in the small intestine can be really difficult. Concerning the case reported here, the most probable diagnostic hypothesis is Heyde's syndrome, which is characterised by valvular aortic stenosis together with gastrointestinal bleeding due to cryptogenetic angiodysplasias. The choice to be made in the therapeutic management of angiodysplasia is still a debatable issue and should be suited to the patient's clinical state and the site and extent of the bleeding. In the literature the link between aortic valvular stenosis and intestinal angiodysplasia is unclear. The physiopathological relationship between the two entities is still mysterious.","PeriodicalId":75700,"journal":{"name":"Chirurgia italiana","volume":"61 4","pages":"497-501"},"PeriodicalIF":0.0,"publicationDate":"2009-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28452002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

[Prognostic significance of the Mandard TRG classification after induction therapy in carcinoma of the oesophagus and cardia]. [食管癌、贲门癌诱导治疗后标准TRG分型的预后意义]。

Chirurgia italiana Pub Date : 2009-07-01

Andrea Zanoni, Giuseppe Verlatoa, Annamaria Minicozzi, Anna Tomezzoli, Simone Giacopuzzi, Mapriantonietta Di Cosmo, Ilaria Franceschetti, Edoardo Saladino, Giovanni De Manzoni

{"title":"[Prognostic significance of the Mandard TRG classification after induction therapy in carcinoma of the oesophagus and cardia].","authors":"Andrea Zanoni, Giuseppe Verlatoa, Annamaria Minicozzi, Anna Tomezzoli, Simone Giacopuzzi, Mapriantonietta Di Cosmo, Ilaria Franceschetti, Edoardo Saladino, Giovanni De Manzoni","doi":"","DOIUrl":"","url":null,"abstract":"Mandard's tumor regression grade (TRG) is widely used to evaluate the pathological response to induction therapy with concurrent chemoradiotherapy in cancer of the oesophagus or gastro-oesophageal junction. The aim of this study was to evaluate the prognostic significance and clinical applicability of TRG. From 2000 to 2007, 108 patients with squamous cell carcinoma of the oesophagus (57 cases) or Siewert type I and II adenocarcinoma of the cardia (51 cases) were treated with induction chemoradiotherapy followed by surgery in the 1st Division of General Surgery of the University of Verona. The treatment was identical for all patients and consisted of cisplatin, 5 FU and docetaxel together with 50 Gy of concurrent radiotherapy. The treatment-induced response was evaluated by TRG. Fifty-one, 24, 17, 9 and 7 patients were classified, respectively, as TRG1, 2, 3 4 and 5. Fifty-two patients died of the disease. Disease-related survival decreased with the increase in TRG class in node-negative patients (p < 0.001), while in N+ patients it was poor, irrespective of TRG class (p = 0.241). Mandard TRG is therefore useful for staging patients undergoing preoperative chemoradiotherapy, because it displays high prognostic significance. In our study, however, N was the main prognostic factor and for this reason it is mandatory to consider nodal status along with TRG. Moreover, among N negative patients, the prognosis of each different TRG class is statistically different and for this reason different TRG classes cannot be grouped together.","PeriodicalId":75700,"journal":{"name":"Chirurgia italiana","volume":"61 4","pages":"419-25"},"PeriodicalIF":0.0,"publicationDate":"2009-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28451053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

[Iatrogenic lesion of the hepatic artery in the course of pancreatic surgery]. [胰腺手术过程中肝动脉的医源性病变]。

Chirurgia italiana Pub Date : 2009-07-01

Fausto Rosa, Fabio Pacelli, Valerio Papa, Antonio Pio Tortorelli, Maurizio Bossola, Giovanni Battista Doglietto

{"title":"[Iatrogenic lesion of the hepatic artery in the course of pancreatic surgery].","authors":"Fausto Rosa, Fabio Pacelli, Valerio Papa, Antonio Pio Tortorelli, Maurizio Bossola, Giovanni Battista Doglietto","doi":"","DOIUrl":"","url":null,"abstract":"The authors report a case of operative injury of the hepatic artery during a total spleno-pancreasectomy procedure for a mixed-type intraductal papillary mucinous neoplasm. During the preparation of the structures of the hepatic pedicle, a \"true\" hepatic artery was not identified, but only a small arterial vessel measuring about 2 mm in diameter, just in front of the portal vein, apparently emerging from the parenchyma of the pancreatic head. To obtain complete mobilisation of the duodeno-pancreatic block from the portal vein, it was necessary to cut this small arterial vessel. In the postoperative period, the patient developed extensive liver ischaemia, which was gradually resolved, but resulted in multiple stenosis of the intra- and extra-hepatic biliary tree. At follow-up at three years, the patient was in fairly good condition, with a permanent percutaneous biliary drainage, but with no clinical or radiological signs of local or distant disease. Although interruption of hepatic arterial flow is usually well tolerated, this is not always the case. It is important to predict in what circumstances complications are likely to occur. The main determinants that should guide the surgeon faced with this problem are whether the portal circulation is normal, whether structures carrying collateral blood supply have been interrupted, and whether some form of biliary reconstruction is needed.","PeriodicalId":75700,"journal":{"name":"Chirurgia italiana","volume":"61 4","pages":"485-92"},"PeriodicalIF":0.0,"publicationDate":"2009-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28452000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

[Emergency laparoscopic cholecystectomy in the treatment of acute cholecystitis: when and how?]. 急诊腹腔镜胆囊切除术治疗急性胆囊炎:何时及如何?

Chirurgia italiana Pub Date : 2009-07-01

Marco Catani, Ritanna De Milito, Francesco Romagnoli, Giovanni Luciani, Luigi Simonelli, Valentina Carocci, Valentina Usai, Vania Silvestri, Claudio Modini

{"title":"[Emergency laparoscopic cholecystectomy in the treatment of acute cholecystitis: when and how?].","authors":"Marco Catani, Ritanna De Milito, Francesco Romagnoli, Giovanni Luciani, Luigi Simonelli, Valentina Carocci, Valentina Usai, Vania Silvestri, Claudio Modini","doi":"","DOIUrl":"","url":null,"abstract":"Optimal surgical timing and operative technique in the treatment of acute cholecystitis are of major importance and are still debatable issues. We report the results of our study on the timing of surgery in a consecutive series of 163 patients treated in the emergency setting for acute cholecystitis over the period from 1998 to 2008. Early surgery and the partially downwards laparoscopic cholecystectomy technique provide a safe and effective way of treating these patients and preventing major complications. The mean time period between onset of symptoms and surgery was 69.2 hrs, with a median value of 53 hrs. The mean operative time was 63.9 min, with a conversion rate of 0.6% and a specific complication rate of 1.22%. The mean postoperative hospital stay was 3.2 days. The timing of surgery (measured in hours) and operative time (measured in minutes) were recorded and analysed to verify whether or not there was a statistically significant relationship between these two variables and establish the best timing for surgery. Our results show a linear relationship between operative time and the timing of surgery. Moreover, at the cut-off point of 57 hrs, the later subgroup (over 57 hrs) had a two-fold increase in operative time compared to the earlier subgroup. At more than 60 hrs approximately from the onset of symptoms, the pathological changes in the surgical target begin, with increasing rapidity, to present a troublesome challenge to the surgeon, making laparoscopic cholecystectomy for acute cholecystitis more difficult and less safe than when performed earlier.","PeriodicalId":75700,"journal":{"name":"Chirurgia italiana","volume":"61 4","pages":"435-47"},"PeriodicalIF":0.0,"publicationDate":"2009-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28451055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

[Surgical approach in the management of oesophageal tumours: considerations based on therapeutic results]. [食道肿瘤的手术治疗:基于治疗结果的考虑]。

Chirurgia italiana Pub Date : 2009-07-01

Alessandro Longhini, Francesco Della Nave, Alessandro Grechi, Amir Reza Kazemian, Gianluca Munarini, Giuseppe Marcolli

{"title":"[Surgical approach in the management of oesophageal tumours: considerations based on therapeutic results].","authors":"Alessandro Longhini, Francesco Della Nave, Alessandro Grechi, Amir Reza Kazemian, Gianluca Munarini, Giuseppe Marcolli","doi":"","DOIUrl":"","url":null,"abstract":"Over the last two decades, oesophageal cancers, although considered among the most malignant visceral tumours, have witnessed a gradual increase in survival rates at a distance after surgery. The aims of the study were to present the results of our surgical approach and, on this basis, to discuss a number of considerations regarding the type of intervention to be adopted. In a retrospective study we recruited 105 patients with oesophageal cancer treated with various types of oesophageal resection, with or without thoracotomy, in the Division of General Surgery of the Civic Hospital of Sondrio. The postoperative mortality rate was 12%, with 40.2% of non-lethal complications. The average overall survival, whether in patients R0 or not, was 31.2 months (range: 1-167), with actuarial survival rates of 63.2% at one year, 30.3% at three years and 22.1% at five years. This was not significantly influenced by the type of surgery or by the location or histology of the cancer, while TNM stage, degree of parietal infiltration and the presence or absence of lymph-node metastases were significant factors. Although we limited the lymphadenectomy to \"standard or extended two-field\" operations, our overall survival at five years was similar to that of surgeons advocating much more extensive lymphadenectomy. In our case most of the relapses occurred at the systemic level and in the short term, on average after 12.7 months, meaning that micrometastases were probably already present at the time of intervention (82.4% of these patients, in fact, had stage N1 cancers). We prefer cervical anastomosis owing to the possibility it affords of greater oesophageal resection and to its relative safety in case of dehiscence. We always perform a right cervicotomy, which allows us to avoid having to move the patient on the operating table and to have fewer injuries to the recurrent nerve.","PeriodicalId":75700,"journal":{"name":"Chirurgia italiana","volume":"61 4","pages":"449-60"},"PeriodicalIF":0.0,"publicationDate":"2009-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28451995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

[Laparoscopic lavage and drainage in the surgical treatment of diverticular disease complicated by peritonitis]. 腹腔镜灌洗引流在憩室病并发腹膜炎手术治疗中的应用

Chirurgia italiana Pub Date : 2009-07-01

Carlo Ettore Lippi, Luca Beatini, Silvio Cervia, Alaido Fabbricotti, Piero Antonio Miaruelli, Elisabetta Spessa, Ivarco Sturlese, Andrea Braini

{"title":"[Laparoscopic lavage and drainage in the surgical treatment of diverticular disease complicated by peritonitis].","authors":"Carlo Ettore Lippi, Luca Beatini, Silvio Cervia, Alaido Fabbricotti, Piero Antonio Miaruelli, Elisabetta Spessa, Ivarco Sturlese, Andrea Braini","doi":"","DOIUrl":"","url":null,"abstract":"The treatment of peritonitis complicating diverticular disease of the colon is yet to be universally regarded as established practice and major differences in management are to be noted in the various surgical institutions. In the emergency setting, the minimally invasive approach is used by few surgeons and the most frequent therapeutic options are sigmoid resection with primary anastomosis (with or without a diverting stoma) and Hartmann's procedure. The Authors report their preliminary experience (13 cases) with laparoscopic lavage and drainage without colonic resection in diverticulitis complicated by peritonitis and describe the technical details of the surgical procedure. They conduct a systematic review of the literature and, on the basis of their latest experience, compare the results of the traditional resective operations (resection with primary anastomosis and Hartmann's procedure) with those of laparoscopic conservative and non-resective treatment. Laparoscopic non-resective procedures reduce the frequency and severity of the surgical complications, as well as the hospital stay and costs of treatment. In conclusion, laparoscopic lavage and drainage can be used in the majority of patients, with excellent prospects of recovery, without disabling stomas, in a single operative stage.","PeriodicalId":75700,"journal":{"name":"Chirurgia italiana","volume":"61 4","pages":"467-74"},"PeriodicalIF":0.0,"publicationDate":"2009-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28451997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

[Focal liver lesions: clinical usefulness of contrast-enhanced ultrasound in the selection of surgical patients]. [局灶性肝脏病变:超声造影在手术患者选择中的临床应用]。

Chirurgia italiana Pub Date : 2009-05-01

Tommaso Vincenzo Bartolotta, Luigi Sandonato, Adele Taibbi, Stefania Latteri, Maurizio Soresi, Giuseppina Lombardo, Claudio Genova, Mario Adelfio Latteri

{"title":"[Focal liver lesions: clinical usefulness of contrast-enhanced ultrasound in the selection of surgical patients].","authors":"Tommaso Vincenzo Bartolotta, Luigi Sandonato, Adele Taibbi, Stefania Latteri, Maurizio Soresi, Giuseppina Lombardo, Claudio Genova, Mario Adelfio Latteri","doi":"","DOIUrl":"","url":null,"abstract":"The aim of the study was to evaluate the role of contrast-enhanced ultrasound (CEUS) in the characterisation of focal liver lesions and for the selection of surgical patients. One hundred and thirty-five consecutive patients (71 women, 64 men) with 165 focal liver lesions (mean size: 3.1 cm)--89 benign (10 simple cysts, 26 haemangiomas, 29 focal nodular hyperplasia, 2 hepatocellular adenomas, 11 focal fatty sparing, 3 focal fatty areas, 5 regenerative nodules, 2 hydatid cysts, 1 abscess) and 76 malignant (47 metastases, 26 hepatocellular carcinomas and 3 peripheral cholangiocarcinomas)--underwent CEUS after the administration of SonoVue. Two radiologists reviewed baseline US and CEUS scans obtained 25-30 sec (arterial phase), 55-80 sec (portal-venous phase), and 235-260 sec (late phase) after initiating SonoVue injection, respectively. The radiologists classified each lesion as malignant or benign on the basis of clearly defined diagnostic criteria. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were calculated. CEUS correctly characterised 156/165 focal liver lesions (94.5%), 85 benign and 71 malignant. Five focal liver lesions (3%; 3 haemangiomas and 2 hepatocellular carcinomas) remained undetermined after CEUS and 4 focal liver lesions (2.4%; 3 hepatocellular carcinomas and 1 abscess) were misdiagnosed. CEUS presented sensitivity, specificity, and diagnostic accuracy values of 93.4%, 95.5% and 94.7% respectively. Positive and negative predictive values were 94.7% and 94.4%, respectively. CEUS is a useful tool in the characterisation of focal liver lesions and for selecting surgical patients.","PeriodicalId":75700,"journal":{"name":"Chirurgia italiana","volume":"61 3","pages":"295-307"},"PeriodicalIF":0.0,"publicationDate":"2009-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28350532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Giant nodular pseudoangiomatous stromal hyperplasia (PASH) of the breast presenting as a rapidly growing tumour. 乳腺巨大结节性假性血管瘤间质增生(PASH)表现为快速生长的肿瘤。

Chirurgia italiana Pub Date : 2009-05-01

Maurizio Mezzabotta, Silvia Riccardi, Simona Bonvini, Paolo Declich, Enrico Tavani, Eugenio Morandi

引用次数: 0

Parastomal hernia repair with the use of Parietex composite mesh: a technical note. 使用Parietex复合补片修复造口旁疝:技术说明。

Chirurgia italiana Pub Date : 2009-05-01

Lino Succi, Nnawuihe Luca Ohazuruike, Conchita Emanuela Oliveri, Antonino Carlo Privitera, Serafina Prumeri, Antonino Politi, Giuseppe Randazzo

引用次数: 0