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1.
Tech Coloproctol ; 12(2): 103-10, 2008 Jun.
Article in English | MEDLINE | ID: mdl-18545882

ABSTRACT

BACKGROUND: The aim of the survey was to assess the incidence of anastomotic leaks (AL) and to identify risk factors predicting incidence and gravity of AL after low anterior resection (LAR) for rectal cancer performed by colorectal surgeons of the Italian Society of Colorectal Surgery (SICCR). METHODS: Information about patients with rectal cancers less than 12 cm from the anal verge who underwent LAR during 2005 was collected retrospectively. AL was classified as grade I to IV according to gravity. Fifteen clinical variables were examined by univariate and multivariate analyses. Further analysis was conducted on patients with AL to identify factors correlated with gravity. RESULTS: There were 520 patients representing 64% of LAR for rectal cancer performed by SICCR members. The overall rate of AL was 15.2%. Mortality was 2.7% including 0.6% from AL. The incidence of AL was correlated with higher age (p<0.05), lower (<20 per year) centre case volume (p<0.05), obesity (p<0.05), malnutrition (p<0.01) and intraoperative contamination (p<0.05), and was lower in patients with a colonic J-pouch reservoir (p<0.05). In the multivariate analysis age, malnutrition and intraoperative contamination were independent predictors. The only predictor of severe (grade III/IV) AL was alcohol/smoking habits (p<0.05) while the absence of a diverting stoma was borderline significant (p<0.07). CONCLUSION: Our retrospective survey identified several risk factors for AL. This survey was a necessary step to construct prospective interventional studies and to establish benchmark standards for outcome studies.


Subject(s)
Postoperative Complications/epidemiology , Rectal Neoplasms/surgery , Aged , Anastomosis, Surgical , Chi-Square Distribution , Female , Humans , Incidence , Italy/epidemiology , Logistic Models , Male , Middle Aged , Retrospective Studies , Risk Factors , Treatment Outcome
2.
Surg Endosc ; 15(9): 1038-41, 2001 Sep.
Article in English | MEDLINE | ID: mdl-11443421

ABSTRACT

BACKGROUND: Cholecystoenteric fistula (CF) is a rare complication of cholelithiasis. The aim of this study was to evaluate the safety and risk of complications when the laparoscopic approach is applied in patients with CF. METHODS: A questionnaire was mailed to all surgeons with experience of >100 cholecystectomies working in Naples, Italy, and the neighboring area. RESULTS: Between February 1990 and May 1999, 34 patients presented with cholecystoenteric fistula (0.2% of >15,000 laparoscopic cholecystectomies performed in the same period). These patients were allocated into two groups: the LT group (those who underwent laparotomic conversion after the diagnosis of CF), which consisted of 20 patients, four men and 16 women, with a mean age of 66.5 +/- 9.3 years (range, 46-85) and the LS group (laparoscopically treated patients), which consisted of 14 patients, three men and 11 women, with a mean age of 65.6 +/- 8.8 years (range, 51-74). They types of CF observed were as follows: in the former group of patients, cholecystoduodenal fistulas (n = 11, 55%), cholecystocolic fistulas (n = 5, 25%), cholecystojejunal fistulas (n = 3, 15%), and cholecystogastric fistulas (n = 1, 5%); in the latter group, cholecystoduodenal fistulas (n = 8, 5.1%), and cholecystocolic fistulas (n = 4, 28.6) and cholecystojejunal fistulas (n = 2, 14.3%). Stapler closure of CF was done in four LT patients and three LS patients with cholecystoduodenal fistula; it was also done in three LT patients and three LS patients with cholecystocolic fistula. Hand-sutured fistulectomy was performed in six LT patients and three LS patients with cholecystoduodenal fistula, in two LT patients with cholecystocolic fistula, and in all patients with cholecystojejunal or cholecystogastric fistula. There were no deaths or intraoperative complications in either group. One patient in the LT group developed a bronchopneumonia postoperatively. Postoperative hospital stay was significantly longer in LT patients-17 +/- 4 vs 3+/-1 days (p < 0.001). CONCLUSION: Cholecystoenteric fistula is an occasional intraoperative finding during laparoscopic cholecystectomy. The results of this study, which are based on the collective experiences of 19 surgeons, illustrate the growing success of the laparoscopic approach to this condition, including a decreasing rate of conversion to open surgery over the last 3 years.


Subject(s)
Cholecystectomy, Laparoscopic/methods , Cholelithiasis/surgery , Fistula/epidemiology , Fistula/surgery , Gallbladder Diseases/epidemiology , Gallbladder Diseases/surgery , Intestinal Fistula/epidemiology , Intestinal Fistula/surgery , Aged , Cholangiopancreatography, Endoscopic Retrograde , Cholecystectomy, Laparoscopic/statistics & numerical data , Cholelithiasis/diagnosis , Cholelithiasis/epidemiology , Comorbidity , Contraindications , Duodenal Diseases/epidemiology , Duodenal Diseases/surgery , Feasibility Studies , Female , Fistula/diagnosis , Gallbladder Diseases/diagnosis , Gastric Fistula/epidemiology , Gastric Fistula/surgery , Humans , Italy/epidemiology , Male , Middle Aged , Treatment Outcome
3.
J Laparoendosc Adv Surg Tech A ; 7(4): 213-20, 1997 Aug.
Article in English | MEDLINE | ID: mdl-9448115

ABSTRACT

Surgical literature around 1980 has emphasized the technical challenge and the risks of cholecystectomy in cirrhotic patients reporting discouraging results. The aim of this study is the retrospective analysis of laparoscopic cholecystectomy in cirrhotics. The collected laparoscopic experience of 3 surgical groups for the last 5 years is reported. Cirrhotics were classified according to Child-Pugh criteria. Postoperative complications were classified using Clavien's rules. Forty patients were recruited; 31 received successful laparoscopic cholecystectomy. Liver cirrhosis was preoperatively diagnosed in all Child-Pugh B (n = 11) and in 11/20 Child-Pugh A patients. Compared with 989 noncirrhotics undergoing laparoscopic cholecystectomy, cirrhotics were similar in terms of age (59.9+/-10.3 vs. 58.1+/-10.9) and sex (male: 51.6% vs. 50.1%). Acute cholecystitis has a similar frequence in cirrhotics and noncirrhotics (3.2% vs. 4.1%, respectively). Bile duct stones and acute pancreatitis were significantly more frequent in cirrhotic patients (6.4% vs. 3.7%, p < 0.001; and 6.4% vs. 0.3%, p < 0.001, respectively). Endoscopic papillotomy and stone extraction combined with laparoscopic cholecystectomy was performed in 2 patients. Intraoperatively, technical problems occurred in 5 (16.1%) patients: liver bed bleeding (n = 4) was significatively more frequent in cirrhotics vs. noncirrhotics (p < 0.001). Mean operative time was 90 min, range 50-180, and it was not significantly longer than in noncirrhotics (85 min, range 30-200). Conversion rate was also similar (3%). Seven patients presented 8 postoperative complications (Class II): right side lung effusion (n = 2), ascites (n = 2), temporary worsening of Child-Pugh status (n = 2), hyperosmotic coma (n = 1), and umbilical hernia (n = 1). Mean hospital stay in noncomplicated cases was the same for noncirrhotics (3+/-1). The authors suggest a more liberal use of laparoscopic cholecystectomy for symptomatic gallstones in selected Child-Pugh A and B patients.


Subject(s)
Cholecystectomy, Laparoscopic , Cholelithiasis/surgery , Liver Cirrhosis/complications , Case-Control Studies , Cholelithiasis/complications , Cholelithiasis/epidemiology , Contraindications , Female , Humans , Incidence , Italy/epidemiology , Liver Cirrhosis/epidemiology , Male , Middle Aged , Postoperative Complications/epidemiology , Retrospective Studies , Time Factors
4.
Minerva Urol Nefrol ; 49(3): 133-6, 1997 Sep.
Article in Italian | MEDLINE | ID: mdl-9432735

ABSTRACT

BACKGROUND: In the course of Continuous Veno-Venous Hemofiltration (CVVH), bicarbonate buffer instead of lactate is suitable for the treatment of combined renal and hepatic failure and for patients suffering from lactic acidosis, type A or B, joined with acute renal failure (ARF). METHODS: We applied the CVVH buffered with bicarbonate for the treatment of two patients affected by ARF and severe lactic acidosis type B (due to biguanide intoxication) and we evaluated its ability to correct the acid-base balance. RESULTS: Clinical and laboratory data show that this technique, performed in standard conditions (plasma flow: 70 ml/min, ultrafiltration: 25 ml/min, bicarbonate concentration in the infusion fluid: 30 mEq/L), was inadequate to compensate for the high requirement of bicarbonate (approximately 280 mEq/hr during the first 6 hours of observation) and the severe metabolic acidosis, thus additional bicarbonate infusion was needed. CONCLUSIONS: In particular, from ascertained data and theoretical considerations, in the course of lactic acidosis caused by biguanide, in order to correct acidosis a positive balance of bicarbonate could be obtained only by means of a bicarbonate-based replacement fluid and of a continuous high flow hemofiltration, such as to assure an ultrafiltrate volume exceeding 150 ml/min.


Subject(s)
Acidosis, Lactic/blood , Bicarbonates/blood , Bicarbonates/therapeutic use , Fluid Therapy , Hemofiltration/methods , Hypoglycemic Agents/adverse effects , Phenformin/adverse effects , Acidosis, Lactic/chemically induced , Acute Kidney Injury/blood , Acute Kidney Injury/therapy , Aged , Bicarbonates/administration & dosage , Buffers , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/drug therapy , Drug Therapy, Combination , Fatal Outcome , Female , Humans
5.
Minerva Med ; 78(18): 1399-403, 1987 Sep 30.
Article in Italian | MEDLINE | ID: mdl-3658214

ABSTRACT

The MMPI questionnaire was used as a personality test on 20 painfree cancer patients, otherwise in good health and undergoing outpatient chemotherapy. Analysis of the data shows that even in an early stage cancer can produce significant alterations in personality. 85% of the patients studied had emotional disorders with hypochondria and depression being the psychopathological profiles most commonly observed.


Subject(s)
Neoplasms/psychology , Personality , Ambulatory Care , Antineoplastic Agents/therapeutic use , Depression/etiology , Female , Humans , Hypochondriasis/etiology , MMPI , Male , Neoplasms/drug therapy , Sex Factors
7.
Minerva Chir ; 30(4): 179-85, 1975 Feb 28.
Article in Italian | MEDLINE | ID: mdl-131914

ABSTRACT

An ultrasound flow detector was employed to measure pressure values at the ankle at rest and after physical exercise in 91 limbs belonging to 61 patients with various degree of arteriosclerotic occlusion, and in 10 healthy subjects. Basal values and percent falls after effort, and recovery times were compared with the symptomatologies and the different degrees of occlusion. Statistically significant correlations were observed.


Subject(s)
Arteriosclerosis Obliterans/physiopathology , Rheology , Ultrasonography , Arteriosclerosis Obliterans/diagnosis , Blood Pressure , Humans , Intermittent Claudication/physiopathology , Leg/blood supply , Middle Aged , Physical Exertion , Preoperative Care
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