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1.
Minerva Chir ; 58(3): 341-4, 2003 Jun.
Artigo em Italiano | MEDLINE | ID: mdl-12955053

RESUMO

BACKGROUND: The availability of drugs which can effectively inhibit gastric secretion allowed the control of the peptic disease in almost all the patients, but the incidence of complications is substantially unchanged. METHODS: In the present study, we performed a retrospective evaluation of 153 patients treated for complicated peptic ulcer (hemorrhage and perforation) in the last 6 years. Hemor-rhage is a common onset of the peptic disease and it rarely requires a surgical treatment, because medical and endoscopic therapies are successful in a high number of patients. RESULTS: Surgery was necessary in 17.2% of the cases in the group of patients studied. CONCLUSIONS: Our experience confirms the high operative mortality in the patients who underwent surgery for hemorrhage related to complicated peptic ulcer because of the frequent presence of several risk factors. Surgical therapy is the main procedure of treatment of perforated peptic ulcer and in the group of patient examined all the cases of perforation underwent surgical operation. In conclusion, despite the progress of pharmacological and endoscopic therapies, surgical treatment is the best therapy of complicated peptic ulcer.


Assuntos
Úlcera Péptica/complicações , Úlcera Péptica/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
2.
Ann Ital Chir ; 73(2): 173-7; discussion 178-80, 2002.
Artigo em Italiano | MEDLINE | ID: mdl-12197291

RESUMO

AIM: In elderly people colorectal cancer has an high incidence of emergency presentation. In this article we report our experience on colorectal emergency surgery for cancers in patients older than 80 yrs. METHODS: From October 1995 to December 2000 323 patients were submitted to emergency surgical procedure for colorectal cancer at the Dpt of Emergency Surgery of University of Bologna. 37 (11%) subjects were over 80 years of age. A retrospective analysis was performed: the data collected included the mode of presentation of the patients, the location and Dukes' classification of the tumors, the incidence of radical and palliative operations, the causes of death and 30-day mortality. RESULTS: The most common emergency presentation was an intestinal occlusion (21 cases); the other different presentations were peritonitis (7 cases) and hemorrhage (9 cases). 22 patients underwent resection of the primary growth and anastomosis and 11 subjects had palliative intervention by creating a stoma only or bypass anastomosis without resection, 2 patients had an explorative laparotomy and 2 were inoperable. Our overall postoperative mortality was 14.2% and we registered 1 anastomotic leakage. DISCUSSION AND CONCLUSIONS: Emergency surgery for colorectal cancer in patients over 80 years of age can be performed safely without restrictions related to the age.


Assuntos
Idoso , Neoplasias Colorretais/cirurgia , Fatores Etários , Idoso de 80 Anos ou mais , Causas de Morte , Neoplasias Colorretais/complicações , Neoplasias Colorretais/mortalidade , Emergências , Feminino , Humanos , Masculino , Cuidados Paliativos , Estudos Retrospectivos , Fatores Sexuais , Fatores de Tempo
3.
Minerva Chir ; 57(3): 363-9, 2002 Jun.
Artigo em Inglês, Italiano | MEDLINE | ID: mdl-12029232

RESUMO

BACKGROUND: Incisional hernia (IH) repair with conventional techniques is associated with high recurrence rate. Surgical repair using prosthetic biomaterials is becoming increasingly popular. On the basis of the good results an increasing number of surgeons have begun to use this technique. However prosthesis use in contaminated fields is still debated. In complicated IH contaminating surgical procedure are often performed and the use of meshes can be hazardous. The aim of this study was to report our experience about the treatment of complicated IH with prosthetic materials in an emergency surgery setting. METHODS: From November 1995 to November 2001 55 patients were submitted to emergency surgical treatment for complicated IH. Eleven patients were treated using a prosthetic device. Patients mean age was 71.3 (range 38-91). About 70% of patients had concomitant major cardiac or pulmonary diseases. RESULTS: Thirty-two IH were strangulated, 23 were incarcerated. In all patients a viscerolysis was carried out. In 6 patients a small bowel resection was done and in 4 subjects a large bowel resection was performed. Eight patients were submitted to omental resection. There were not differences in morbidity and mortality between the studied group. Recurrence rate was significantly lower in prosthetic treated group. CONCLUSIONS: We concluded that prosthetic repair of complicated IH is feasible in selected cases allowing abdominal wall anatomy re-establishment.


Assuntos
Tratamento de Emergência , Hérnia Ventral/complicações , Hérnia Ventral/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Perfuração Intestinal/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Telas Cirúrgicas , Resultado do Tratamento
4.
Dig Surg ; 17(5): 503-7, 2000.
Artigo em Inglês | MEDLINE | ID: mdl-11124556

RESUMO

BACKGROUND/AIMS: Gastrointestinal stromal tumors (GISTs) are a rare group of neoplasias of the gastrointestinal tract that have not yet been fully investigated. In this article the authors present the experience of an emergency surgery department in the diagnosis and treatment of patients with such neoplasms and discuss the approaches to these 'strange' tumors. METHODS: A review of our 4-year experience in emergency surgery was performed and 9 patients were found with the diagnosis of GIST. The median follow-up was 32.3 (range 18-45) months. RESULTS: 7 patients had evidence of gastrointestinal blood loss, 1 patient had abdominal pain, and the last patient had anorexia, vomiting and fever. Five tumors were located in the stomach and 4 in the small bowel. All the patients underwent complete resection. On histological examination 5 tumors were of myogenic origin, 1 was a gastrointestinal autonomic nerve tumor and 1 was a mixed neural-myoid tumor. The remaining 2 could not be differentiated. Of the 9 patients who underwent curative resections, 1 had a recurrence and died. CONCLUSION: GIST treatment mainly involves surgical resection with the goal of complete removal which can be curative. The histologic grade and tumor size are the most important prognostic factors.


Assuntos
Neoplasias do Íleo/cirurgia , Neoplasias do Jejuno/cirurgia , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Serviço Hospitalar de Emergência , Feminino , Humanos , Neoplasias do Íleo/diagnóstico , Neoplasias do Jejuno/diagnóstico , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Neoplasias Gástricas/diagnóstico
5.
Am J Gastroenterol ; 95(12): 3642-3, 2000 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-11151909

RESUMO

This report describes a patient with a type II Caroli' s disease who developed a gallstone ileus. Previous hepaticojejunostomy operations were thought to have facilitated the migration of stones into the bowel and consequent gallstone ileus. This complication, which was strongly suspected from the clinical history, was diagnosed by ultrasound examination despite the absence of aberrantly located stones on plain abdominal x-ray. Ultrasound is useful in the diagnostic workup of patients with bowel obstruction to confirm obstruction itself, to assess its level, and possibly to identify the cause.


Assuntos
Doença de Caroli/complicações , Colelitíase/complicações , Doenças do Íleo/etiologia , Obstrução Intestinal/etiologia , Feminino , Humanos , Doenças do Íleo/diagnóstico por imagem , Obstrução Intestinal/diagnóstico por imagem , Pessoa de Meia-Idade , Ultrassonografia
6.
Minerva Chir ; 53(9): 743-5, 1998 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-9866943

RESUMO

Meckel's diverticulum is the most common congenital abnormality of the intestinal tract, occurring in 2% of autoptic studies. The case of an 85-year-old man referred to the Emergency Surgery Unit for intestinal obstruction and lower gastrointestinal tract bleeding is reported. Surgical exploration revealed a complicated Meckel's diverticulum full of coproliths, immersed in pus and blood. Examination of the resected diverticulum showed necrotic diverticulitis in the absence of ectopic gastric or pancreatic tissues.


Assuntos
Divertículo Ileal/cirurgia , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Impacção Fecal/diagnóstico , Impacção Fecal/etiologia , Impacção Fecal/patologia , Impacção Fecal/cirurgia , Humanos , Masculino , Divertículo Ileal/complicações , Divertículo Ileal/diagnóstico , Divertículo Ileal/patologia
7.
Minerva Chir ; 53(4): 285-7, 1998 Apr.
Artigo em Italiano | MEDLINE | ID: mdl-9701983

RESUMO

The gallbladder volvulus is a very rare but extremely dangerous event. Described for the first time by Wendel in 1898, it affects more frequently the female sex, particularly in old age. The clinical case of a patient affected by this pathology, personally observed, is presented and the initial symptoms, diagnostic procedures and surgical intervention are described in detail. The anatomical and physiological backgrounds that permit the gallbladder to twist on its axis are analysed and finally the importance of an early diagnosis to avoid the complications of a bilious peritonitis is underlined. In any case the definite diagnosis is made more frequently during surgical intervention. An early intervention allows a rapid resolution of the clinical picture preventing the perforation of the viscus into the peritoneal cavity and the complication of a bilious peritonitis besides the spreading of the biliary stones into the abdominal cavity.


Assuntos
Colecistectomia , Doenças da Vesícula Biliar/cirurgia , Idoso , Idoso de 80 Anos ou mais , Colelitíase/complicações , Feminino , Vesícula Biliar/irrigação sanguínea , Vesícula Biliar/patologia , Gangrena , Humanos , Isquemia/etiologia , Isquemia/cirurgia , Necrose , Peritonite/prevenção & controle , Anormalidade Torcional/complicações , Anormalidade Torcional/cirurgia
10.
Arch Pathol Lab Med ; 119(3): 209-13, 1995 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-7887773

RESUMO

AIMS: The main clinicomorphologic findings from two new cases of intraductal papillary-mucinous neoplasm of the pancreas were analyzed and discussed. METHODS: Formalin-fixed pancreatic tissues from the more representative areas were routinely stained. An electron microscopic examination was performed in case 2 on glutaraldehyde-fixed tissue fragments. RESULTS: Both patients had a long history of symptoms that was suggestive of chronic pancreatitis. At endoscopic retrograde pancreatography a dilatation of the main duct was observed. Ultrasonography revealed cystic dilatations that were interpreted as pseudocysts. The patients underwent total pancreatectomy. The gross appearance showed no mass, but the pancreas was enlarged and diffusely hard. The cut surface showed micromacrocysts filled with soft friable tissue and mucus. Histological examination revealed diffuse neoplastic papillary proliferations within ectatic and cystically dilated ducts. The lesions exhibited varying grades of atypia and foci of in situ carcinoma. No clear evidence of invasion or lymph node metastases were observed. The nontumorous pancreas showed diffuse and multiple hyperplastic papillary changes in the ductal tree. CONCLUSION: The main clinicopathologic findings of intraductal papillary-mucinous neoplasm of the pancreas have been reported. Our study favors the hypothesis that chronic pancreatitis and/or ductal epithelial papillary hyperplasia may play a role in the pathogenesis of this tumor. We have emphasized the cystic appearance and mucinous features of this neoplasm, and so we suggest the use of the term intraductal papillary-mucinous neoplasm.


Assuntos
Cistadenoma Mucinoso/patologia , Neoplasias Pancreáticas/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Pâncreas/patologia
11.
Ital J Gastroenterol ; 27(2): 69-72, 1995 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-7579594

RESUMO

The prevalence and characteristics of alcoholic liver disease (ALD) in patients with alcohol-induced chronic pancreatitis (AICP) are not well defined. Fifty consecutive patients undergoing surgery for AICP were investigated for evidence of ALD. In addition to preoperative functional and imaging assessment of the liver, all had liver biopsy during surgery. Hepatic biopsy results were as follows: 12 patients had normal liver and 10 minimal aspecific changes; of the remaining 28 patients, 7 had liver cirrhosis, 11 showed features of alcoholic hepatitis, 2 had moderate steatosis, 6 extrahepatic cholestasis, and the remaining 2 had a combination of alcoholic hepatitis and cholestasis. Of the 7 patients with cirrhosis, 3 had oesophageal varices and 2 of these developed ascites in the postoperative period; in the remaining patients with ALD, this disease was subclinical. Patients with ALD consumed significantly (p < 0.005) more alcohol than those without ALD. In patients with cirrhosis, the duration of alcohol consumption (mean 27.6 years, range 18-42 years) was significantly longer (p < 0.05) than in patients without ALD (mean 19.7 years, range 8-36 years). The association of ALD with AICP is much more common than previously believed. The fact that AICP occurs earlier than liver cirrhosis and the fact that many patients stop alcohol consumption after the first attacks of pancreatic pain may explain, at least in part, the apparent rarity with which this association has been indicated by previous studies.


Assuntos
Alcoolismo/complicações , Hepatopatias Alcoólicas/complicações , Pancreatite/complicações , Adolescente , Adulto , Idoso , Biópsia , Doença Crônica , Feminino , Humanos , Hepatopatias Alcoólicas/patologia , Masculino , Pessoa de Meia-Idade , Pancreatite/patologia , Estudos Prospectivos
13.
Ital J Gastroenterol ; 26(3): 137-40, 1994 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-8061340

RESUMO

Activated lymphocytes can release a soluble form of interleukin-2 receptor (sIL-2R) and abnormally high serum levels of sIL-2R have been reported in patients with advanced solid tumours and in those with chronic disease. We determined serum sIL-2R concentrations in 34 patients with chronic pancreatitis (8 in painful relapse), in 40 with pancreatic tumours in various stages, and in 40 healthy subjects as controls. Patients with pancreatic cancer and those with chronic pancreatitis had significantly higher serum concentrations of sIL-2R than healthy subjects (p < 0.001). In patients with Stage II pancreatic cancer, serum levels of soluble receptors were similar to those in patients with Stage III tumours, and these concentrations were significantly higher than in patients with resectable cancer (p < 0.01 and p < 0.05, respectively). In chronic pancreatitis patients, those studied during painful relapse of the disease had higher serum concentrations of sIL-2R than those studied during clinical remission (p < 0.05). The results of our study suggest an activation of the cellular immune system in pancreatic cancer and in chronic pancreatitis.


Assuntos
Neoplasias Pancreáticas/sangue , Pancreatite/sangue , Receptores de Interleucina-2/análise , Idoso , Doença Crônica , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Ativação Linfocitária/imunologia , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/imunologia , Pancreatite/imunologia , Recidiva , Linfócitos T/imunologia
14.
Ital J Gastroenterol ; 25(9): 487-9, 1993.
Artigo em Inglês | MEDLINE | ID: mdl-8123896

RESUMO

While the association between pancreatic cancer and diabetes is well recognized, little is known about glucose tolerance and insulin secretion in patients with this tumour. Thirty patients with pancreatic cancer not complicated by diabetes, 10 with nonpancreatic cancer, and 10 healthy subjects were studied for glucose tolerance and insulin secretion in response to an oral glucose load. Twenty of the 30 patients with pancreatic cancer (70%) had impaired glucose tolerance compared with none of the patients in the other two groups. In most of these 20 patients' insulin responses were higher than those of patients with non-pancreatic cancer or healthy subjects. The results indicate that about two-thirds of patients with pancreatic cancer have abnormal glucose tolerance; this intolerance is associated with elevated insulin secretion, suggesting that it may be due to a peripheral resistance to insulin.


Assuntos
Glicemia/metabolismo , Insulina/metabolismo , Neoplasias Pancreáticas/fisiopatologia , Idoso , Feminino , Intolerância à Glucose/etiologia , Teste de Tolerância a Glucose , Humanos , Secreção de Insulina , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/sangue , Neoplasias Pancreáticas/complicações
15.
Artigo em Inglês | MEDLINE | ID: mdl-1684256

RESUMO

A case of Zollinger-Ellison syndrome of multiple endocrine neoplasia type 1 (MEN 1) origin with hyperparathyroidism and with a rise in serum gastrin due to an unusual parathyroid "gastrinoma" has been investigated. The patient had multiple endocrine tumours (pituitary and parathyroid), but no evidence of pancreatic or duodenal gastrin-producing neoplasm. Radio-immunoassay, immunohistochemistry and electron microscopy showed gastrin in one parathyroid adenoma. These findings, together with a decrease of gastrinaemia after parathyroidectomy suggest that true gastrin was produced by parathyroid tumour cells and that they themselves may be the origin of the hypergastrinaemia. Our ultrastructural investigation extends these observations and the results are discussed.


Assuntos
Gastrinas/metabolismo , Neoplasia Endócrina Múltipla/complicações , Glândulas Paratireoides/metabolismo , Hormônio Paratireóideo/metabolismo , Síndrome de Zollinger-Ellison/metabolismo , Adenoma/metabolismo , Feminino , Humanos , Imuno-Histoquímica , Microscopia Eletrônica , Pessoa de Meia-Idade , Neoplasias das Paratireoides/metabolismo , Síndrome de Zollinger-Ellison/etiologia , Síndrome de Zollinger-Ellison/patologia
16.
J Clin Gastroenterol ; 12(2): 218-21, 1990 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-2157749

RESUMO

A 31-year-old man with recurrent attacks of hypoglycemia was hospitalized with the clinical suspicion of an insulinoma. Computed tomography and conventional (transabdominal) ultrasound were doubtful, showing a small solid low-density mass probably originating from the tail of the pancreas. Selective angiography and transhepatic venous sampling for pancreatic hormone assay were not discriminant. Finally, an endoscopic ultrasonographic examination, allowing a better visualization of the pancreas, established with certainty the origin of the lesion from the tail of the gland. This was subsequently confirmed at operation.


Assuntos
Adenoma de Células das Ilhotas Pancreáticas/diagnóstico , Endoscopia , Neoplasias Pancreáticas/diagnóstico , Ultrassonografia/métodos , Adenoma de Células das Ilhotas Pancreáticas/complicações , Adenoma de Células das Ilhotas Pancreáticas/cirurgia , Adulto , Humanos , Hipoglicemia/complicações , Masculino , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/cirurgia
17.
Pathol Res Pract ; 183(6): 767-70, 1988 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-2851777

RESUMO

A histological and histochemical analysis of two new cases of mucinous cystic tumors of the pancreas is reported. Histochemical study revealed a predominantly sulphated acidic mucin secretion with some neutral mucins. Argyrophilic elements were also observed. The authors propose an origin from intestinal type epithelium through a metaplastic process.


Assuntos
Adenocarcinoma Mucinoso/patologia , Neoplasias Pancreáticas/patologia , Adenocarcinoma Mucinoso/diagnóstico , Histocitoquímica , Humanos , Neoplasias Pancreáticas/diagnóstico
18.
Ital J Surg Sci ; 15(2): 133-7, 1985.
Artigo em Inglês | MEDLINE | ID: mdl-2995275

RESUMO

The usefulness and the limits of the artificial endocrine pancreas in the surgical management of insulinoma has been evaluated in three male patients who underwent pancreatic resection because of previously detected adenoma. In particular, blood glucose and contemporary levels of insulin and C-peptide were continuously monitored before, during and after surgery, to record the temporal relationship between the removal of insulinomas and the variations of these parameters. In the pre-resection phase, only two cases revealed hypoglycemia and required dextrose infusion to correct hypoglycemia and reach euglycemic levels, whereas all the patients showed elevated insulin and C-peptide levels. After anesthesia and surgical incision, the pancreas was observed and manipulated in search of adenoma. In all patients this manoeuvre caused an increase of insulin and C-peptide levels and in two cases a slight decrease of blood glucose levels. After adenoma resection, a prompt increase of glycemia was observed only in one patient, in the other two the time which elapsed before significant blood glucose changes was more prolonged (55 and 80 min. respectively). On the contrary, a rapid fall in insulin and C-peptide levels was observed in all cases. We conclude that artificial endocrine pancreas has the advantage of maintaining the normoglycemia before and during surgery, preventing the risk of dangerous hypoglycemia in basal conditions and following manipulation of pancreas while localizing adenoma. However, the prolonged interval elapsed before significant blood glucose variations limits the usefulness of the artificial endocrine pancreas in localizing intraoperatively previously undetected adenomas.


Assuntos
Adenoma de Células das Ilhotas Pancreáticas/cirurgia , Sistemas de Infusão de Insulina , Insulinoma/cirurgia , Neoplasias Pancreáticas/cirurgia , Glicemia/análise , Peptídeo C/sangue , Humanos , Insulina/sangue , Masculino , Pessoa de Meia-Idade
19.
Surg Gynecol Obstet ; 158(4): 319-21, 1984 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-6710292

RESUMO

The response of serum immunoreactive trypsin (IRT) to the intravenous injection of secretin (75 clinical units) was evaluated in 14 patients with carcinoma of the pancreas and in 20 healthy control patients. A striking increase of serum IRT concentration after secretin, which was much more marked than in those in the control group, was found in patients with localized carcinoma of the pancreas, whereas no increase was observed in those with more diffuse carcinoma.


Assuntos
Neoplasias Pancreáticas/diagnóstico , Secretina , Tripsina/sangue , Adulto , Idoso , Avaliação de Medicamentos , Feminino , Humanos , Injeções Intravenosas , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/sangue , Radioimunoensaio , Secretina/administração & dosagem , Fatores de Tempo
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