85 results on '"Spina GP"'
Search Results
2. Liver transplantation in Italy: Preliminary 10-year report
- Author
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Fagiuoli, S., Leandro, G., Bellati, G., Gasbarrini, A., Rapaccini, Gl, Pompili, M., Rendina, M., Denotariis, S., Francavilla, A., Gasbarrini, G., Ideo, G., Naccarato, R., Agnes, S., Castagneto, M., Angeli, P., Angelico, M., Ascione, A., Calise, F., Bertocchi, M., Dardano, G., Borzio, M., Budillon, G., Burra, F., Farinati, F., Cadeo, Gp, Camisasca, M., Podda, M., Paolo, S., Cavallari, A., Mazziotti, A., Casciani, Cu, Tisone, G., Cillo, U., Damico, D., Colombo, M., Donato, F., Conoscitore, P., Coppolecchia, P., Dessanti, A., Fassati, Lr, Lucianetti, A., Rossi, G., Forti, D., Belli, L., Rondinara, Gf, Gaeta, G., Piccinino, F., Gerunda, G., Faccioli, Am, Gridelli, B., Guariso, G., Zancan, L., Gullini, F., Boccia, S., Jemmolo, Rm, Marcellini, M., Marzano, Ma, Marzio, L., Mazzaferro, V., Regalia, E., Morelli, Mc, Pagliaro, L., Palazzo, U., Piras, MR, Ricci, Gl, Salmi, A., Sama, C., Sangiovanni, A., Salizzoni, M., Marzano, A., Smedile, A., Rizzetto, M., Solinas, A., Spina, Gp, Stefanini, Gf, PIETRO ANDREONE, Villa, E., and Zignego, L.
- Subjects
Settore MED/12 - Gastroenterologia ,liver transplantation ,liver disease ,rejection - Published
- 1996
3. RICANALIZZAZIONE DI DUE VENE SOVRAEPATICHE MEDIANTE STENT METALLICI PER VIA PERCUTANEA TRANSEPATICA IN UN CASO DI SINDROME DI BUDD-CHIARI
- Author
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Castrucci, M, Camalori, M, Angeli, E, Salvioni, M, Venturini, M, Ghio, D, Ongari, B, Spina, Gp, and Del Maschio, A
- Published
- 1996
4. Fine-Needle Endoscopic Percutaneous Gastrostomy
- Author
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Giampiero Negri, Spina Gp, Cosentino F, Negri, Giampiero, Cosentino, F, and Spina, Gp
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Foley catheter ,Balloon ,Catheterization ,Enteral Nutrition ,Percutaneous gastrostomy ,Percutaneous endoscopic gastrostomy ,Gastroscopy ,medicine ,Humans ,Aged ,Gastrostomy ,Wound Healing ,Foley ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,Middle Aged ,Surgery ,Endoscopy ,Catheter ,Needles ,Female ,business ,Gastroscopes - Abstract
A procedure for percutaneous endoscopic gastrostomy is described. Under direct endoscopic control, the surgeon introduces, percutaneously, into the inflated stomach a 9 French Foley catheter through a special needle, which may then be opened for removal. After positioning, the terminal balloon of the Foley is inflated with 7-8 ml of air and the catheter is placed under slight traction to appose the gastric and abdominal walls. Such a method has been used in 5 patients with cancer of the cardia requiring enteral feeding prior to surgery. No complications due to the positioning of the gastrostomy catheter have been observed. We believe that this simple, reliable and inexpensive method constitutes an improvement on the previously described endoscopic percutaneous gastrostomy techniques.
- Published
- 1984
5. Current management of pancreatic pseudocysts
- Author
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Maruotti RA, Spina GP, ZANNINI , PIERO, Montorsi M, NEGRI , GIAMPIERO, ROSATI , RICCARDO, Voci C. e. Pezzuoli G., Maruotti, Ra, Spina, Gp, Zannini, Piero, Montorsi, M, Negri, Giampiero, Rosati, Riccardo, and Voci, C. e. Pezzuoli G.
- Published
- 1982
6. GLI INTERVENTI DI DENERVAZIONE NEL TRATTAMENTO DEL DOLORE PANCREATICO
- Author
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Spina GP, Maruotti RA, Montorsi M, Voci CP, Ramella G, Ceccopieri M., ROSATI , RICCARDO, Spina, Gp, Maruotti, Ra, Montorsi, M, Rosati, Riccardo, Voci, Cp, Ramella, G, and Ceccopieri, M.
- Published
- 1982
7. LE SUTURATRICI MECCANICHE CIRCOLARI IN CHIRURGIA DIGESTIVA
- Author
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Rebuffat C, Montorsi M, Zago M, Spina GP, ROSATI , RICCARDO, Rebuffat, C, Rosati, Riccardo, Montorsi, M, Zago, M, and Spina, Gp
- Published
- 1983
8. ENCEFALOPATIA E DERIVAZIONI PORTO SISTEMICHE
- Author
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Spina GP, Galeotti F, Battaglia G, Opocher E, Santambrogio R, Pezzuoli G., ROSATI , RICCARDO, Spina, Gp, Galeotti, F, Battaglia, G, Opocher, E, Rosati, Riccardo, Santambrogio, R, and Pezzuoli, G.
- Published
- 1986
9. Tumori maligni della regione oddiana: risultati del trattamento chirurgico
- Author
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Spina GP, Montorsi M, Maruotti RA, Opocher E, ROSATI , RICCARDO, Pezzuoli G., Spina, Gp, Montorsi, M, Maruotti, Ra, Opocher, E, Rosati, Riccardo, and Pezzuoli, G.
- Published
- 1984
10. CONCENTRAZIONE CEREBRALE DI COLECISTOCHININA 8 IN RATTI CON INSUFFICIENZA EPATICA ACUTA
- Author
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Bonato C, Malesci A, Abbiati R, Santambrogio R, Spina GP, Montorsi M, Salerno F., ROSATI , RICCARDO, Bonato, C, Malesci, A, Abbiati, R, Rosati, Riccardo, Santambrogio, R, Spina, Gp, Montorsi, M, and Salerno, F.
- Published
- 1986
11. NUOVO ENTEROSTATO A BRANCHE CURVE PER IL CONFEZIONAMENTO AUTOMATICO DELLA SUTURA A BORSA DI TABACCO SUL MONCONE RETTALE
- Author
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Rebuffat C, Poccobelli M, Montorsi M, Spina GP, ROSATI , RICCARDO, Rebuffat, C, Rosati, Riccardo, Poccobelli, M, Montorsi, M, and Spina, Gp
- Published
- 1984
12. Alimentation enterale precoce par jejunostomie en chirurgie digestive lourde;analyse de 75 cas
- Author
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NEGRI , GIAMPIERO, Spina GP, Zannini P, Galeotti F, Maruotti RA, Voci C, Pezzuoli G., Negri, Giampiero, Spina, Gp, Zannini, P, Galeotti, F, Maruotti, Ra, Voci, C, and Pezzuoli, G.
- Published
- 1985
13. L'alimentazione parenterale in chirurgia digestiva Analisi di 37 casi trattati con AP protratta
- Author
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Gritti, G, Chiaranda, Maurizio, Corner, P, Bertoni, Gc, DAL GRANDE, G, Lieta, E, Capuzzo, M, and Spina, Gp
- Published
- 1977
14. [Acid-base metabolism in patients with hepatic cirrhosis treated with portacaval anastomosis at various intervals after the operation]
- Author
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Conte, G, Semplicini, Andrea, CAREGARO NEGRIN, Lorenza, Lauro, S, Macca, F, Galeotti, F, and Spina, Gp
- Subjects
Acid-Base Equilibrium ,Liver Cirrhosis ,Postoperative Complications ,Portacaval Shunt, Surgical ,Hyperaldosteronism ,Hypertension, Portal ,Humans ,Alkalosis ,Acidosis ,Gastrointestinal Hemorrhage ,Potassium Deficiency ,Alkalosis, Respiratory - Abstract
In a series of 68 cirrhotics subjected to portacaval anastomosis for digestive haemorrhage, alterations in the acid base balance, 3, 6, 12, 24 and 48 weeks after anastomosis, were examined. Following operation, an increase in the incidence of the usual acid base disturbances of liver cirrhosis is observed. Respiratory alkalosis increases with no direct relationship to teh postoperative increase in ammoniemia, the main stimulating agent of the resporatory centres. This is probably because the active fraction on the nerve cells is the non-ionized one only, freely diffusible through the haematoencephalic barrier, the plasma concentration of which is a function of blood pH. Postoperative metabolic alkalosis is secondary to the potassium and chloride depletion consequent on operative trauma, on the malnutrition syndrome and, in the case of potassium, on secondary hyperaldosteronism which, unlike what is observed in the other groups of cirrhotics, is uncorrected by anastomosis. After the shunt, metabolic acidosis may be the expression of an increase in lactates and pyruvates following on further liver function deterioration, and of a functional renal insufficiency which anastomosis makes more manifest.
- Published
- 1978
15. Liver transplantation in Italy: Preliminary 10-year report
- Author
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Fagiuoli, S., Leandro, G., Bellati, G., Gasbarrini, A., Rapaccini, Gl, Pompili, M., Rendina, M., Denotariis, S., Francavilla, A., Gasbarrini, G., Ideo, G., Naccarato, R., Castagneto M, Agnes S., Paolo Angeli, Angelico, M., Ascione, A., Calise, F., Bertocchi, M., Dardano, G., Borzio, M., Budillon, G., Burra, F., FABIO FARINATI, Cadeo, Gp, Camisasca, M., Podda, M., Paolo, S., Cavallar, A., Mazziotti, A., Casciani, Cu, Tisone, G., Umberto Cillo, Damico, D., Colombo, M., Donato, F., Conoscitore, P., Coppolecchia, P., Dessanti, A., Fassati, Lr, Lucianetti, A., Rossi, G., Forti, D., Belli, L., Rondinara, Gf, Gaeta, G., Piccinino, F., Gerunda, G., Faccioli, Am, Gridelli, B., Guariso, Graziella, Zancan, L., Gullini, F., Boccia, S., Jemmolo, Rm, Marcellini, M., Marzano, Ma, Marzio, L., Mazzaferro, V., Regalia, E., Morelli, Mc, Pagliaro, L., Palazzo, U., Piras, Mr, Ricci, Gl, Salmi, A., Sama, C., Sangiovanni, A., Salizzoni, M., Marzano, A., Smedile, A., Rizzetto, M., Solinas, A., Spina, Gp, Stefanini, Gf, Andreone, P., Villa, E., and Zignego, L.
- Subjects
liver transplantation ,liver transplantation, liver disease, rejection ,rejection ,liver disease
16. Recanalization of 2 suprahepatic veins with metal stents via a percutaneous transhepatic approach in a case of the Budd-Chiari syndrome
- Author
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M, Castrucci, M, Camalori, E, Angeli, M, Salvioni, M, Venturini, D, Ghio, B, Ongari, G P, Spina, A, Del Maschio, Castrucci, M, Camalori, M, Angeli, E, Salvioni, M, Venturini, M, Ghio, D, Ongari, B, Spina, Gp, and DEL MASCHIO, Alessandro
- Subjects
Radiography ,Catheterization, Peripheral ,Humans ,Female ,Stents ,Vena Cava, Inferior ,Budd-Chiari Syndrome ,Hepatic Veins ,Middle Aged ,Angioplasty, Balloon ,Magnetic Resonance Angiography ,Ultrasonography - Published
- 1996
17. Natural history of a randomized trial comparing distal spleno-renal shunt with endoscopic sclerotherapy in the prevention of variceal rebleeding: a lesson from the past.
- Author
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Santambrogio R, Opocher E, Costa M, Bruno S, Ceretti AP, and Spina GP
- Subjects
- Adult, Esophageal and Gastric Varices complications, Esophageal and Gastric Varices etiology, Esophageal and Gastric Varices mortality, Female, Follow-Up Studies, Gastrointestinal Hemorrhage etiology, Gastrointestinal Hemorrhage mortality, Humans, Hypertension, Portal complications, Hypertension, Portal physiopathology, Liver Cirrhosis physiopathology, Longitudinal Studies, Male, Middle Aged, Randomized Controlled Trials as Topic, Secondary Prevention, Survival Rate, Endoscopy, Gastrointestinal methods, Esophageal and Gastric Varices prevention & control, Gastrointestinal Hemorrhage prevention & control, Liver Cirrhosis complications, Sclerotherapy methods, Splenorenal Shunt, Surgical methods
- Abstract
Aim: To compare endoscopic sclerotherapy (ES) with distal splenorenal shunt (DSRS) in the prevention of recurrent variceal bleeding in cirrhotic patients during a long-term follow-up period., Methods: In 1984 we started a prospective, controlled study of patients with liver cirrhosis. Long-term follow-up presents a natural history of liver cirrhosis complicated by advanced portal hypertension. In this study the effects of 2 types of treatment, DSRS or ES, were evaluated. The study population included 80 patients with cirrhosis and portal hypertension referred to our department from October 1984 to March 1991. These patients were drawn from a pool of 282 patients who underwent either elective surgery or ES during the same period of time. Patients were assigned to one of the 2 groups according to a random number table: 40 to DSRS and 40 to ES using polidocanol., Results: During the postoperative period, no DSRS patient died, while one ES patient died of uncontrolled hemorrhage. One DSRS patient had mild recurrent variceal hemorrhage despite an angiographically patent DSRS and another patient suffered duodenal ulcer rebleeding. Eight ES patients suffered at least one episode of gastrointestinal bleeding: 4 from varices and 4 from esophageal ulcerations. Eight ES patients developed transitory dysphagia. Long-term follow-up was completed in all patients except for 5 cases (2 DSRS and 3 ES patients). Five-year survival rates for shunt (73%) and ES (56%) groups were statistically different: in this follow-up period and in subsequent follow-ups this difference decreased and ceased to be of statistical relevance. The primary cause of death became hepatocellular carcinoma (HCC). Four DSRS patients rebled due to duodenal ulcer, while eleven ES patients had recurrent bleeding from esophago-gastric sources (seven from varices, three from hypertensive gastropathy, one from esophageal ulcerations) and two from unknown sources. Nine DSRS and 2 ES patients developed a chronic encephalopathy; 13 DSRS and 5 ES patients suffered at least one episode of acute encephalopathy. Five ES patients had esophageal stenoses, which were successfully dilated., Conclusion: In a subgroup of patients with good liver function, DSRS with a correct portal-azygos disconnection more effectively prevents variceal rebleeding than ES. However, this positive effect did not influence the long-term survival because other factors (e.g. HCC) were more important in deciding the fate of the cirrhotic patients with portal hypertension.
- Published
- 2006
- Full Text
- View/download PDF
18. [Surgery in the cirrhotic patient. Prognosis and risk factors].
- Author
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Pisani Ceretti A, Cordovana A, Pinto A, and Spina GP
- Subjects
- Blood Coagulation, Humans, Laparoscopy, Liver Cirrhosis classification, Liver Cirrhosis metabolism, Liver Cirrhosis mortality, Liver Failure physiopathology, Pharmacokinetics, Postoperative Complications physiopathology, Prognosis, Risk Factors, Liver Cirrhosis surgery
- Abstract
Patients with cirrhosis have reduced life expectancy. Surgery is often associated with clinical decompensation in this group of patients. The purpose of this paper is to study the surgical risk in cirrhotic patients undergoing nonderivative operations. Unfortunately, most of the studies in the literature about this problem are retrospective reviews with limitations. The conditions increasing surgical risk in cirrhotic patients are analysed. These include changes in the pharmacokinetics and pharmacodynamics of various drugs, altered hemostasis, poor resistance to infections, water retention, suture line insufficiency, chronic renal failure and congestive heart failure. Assessment of the disease stage in cirrhosis is very important, because the severity of hepatic abnormalities influences the prognosis. The Child-Pugh classification has been used extensively to risk-stratify patients with cirrhosis. However, the disregard for cardiorespiratory, renal, electrolyte balance and acid-base status limits its predictive accuracy. Recently a new scoring system, the Acute Physiology and Chronic Health Evaluation (APACHE III), has been introduced and seems to be superior to Child-Pugh for prognosticating short term survival of cirrhotic patients. In conclusion, surgery can be done safely only in cirrhotic patients with a good hepatic function. On the contrary, in patients with advanced cirrhosis, surgery causes a very high mortality. Finally, the patients with moderate hepatic failure can be operated only after a careful study of the disease and an adequate correction of the reversible risk factors.
- Published
- 2000
19. Complications of subcutaneous infusion port in the general oncology population.
- Author
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Ballarini C, Intra M, Pisani Ceretti A, Cordovana A, Pagani M, Farina G, Perrone S, Tomirotti M, Scanni A, and Spina GP
- Subjects
- Humans, Neoplasms drug therapy, Antineoplastic Agents administration & dosage, Catheterization, Central Venous adverse effects, Catheterization, Central Venous methods
- Abstract
Subcutaneous infusion ports (SIPs) represent a valid method for long-term chemotherapy. The SIPs have several advantages over other methods of venous access: they are easy to implant under local anaesthesia, have less discomfort for the patients, allow low costs, can be implanted in day hospital, and can be managed ambulatorily. However, SIPs have delayed complications, frequently related to clinical conditions of the neoplastic patients, and immediate complications, often due to the placement technique. From March 1992 to March 1997 we placed, under local anaesthesia and under fluoroscopic control, 102 SIPs in 99 general oncology patients for long-term chemotherapy (88% solid, 12% haematological tumours). The percutaneous venous access devices were in the subclavian vein in 96% of the cases and in the internal jugular vein in 4% of them. Immediate complications were: 1 haemopneumothorax, which required thoracic aspirations and two blood transfusions, 1 loop of the tunneled part of the catheter without alterations in SIP function, and 1 left jugular thrombosis in a patient with subclavian veins already thrombosed. The venous access was in the subclavian vein in the first 2 cases, and it was not necessary to suspend the therapeutic program. In the third instance, implanted in jugular vein, it was necessary to remove the SIP. Delayed complications were: 1 necrosis of the skin over the port, 1 infection of subcutaneous pocket, 2 infections of the system, 1 catheter deconnection, and 3 catheter ruptures with embolization of the catheter tip. The SIPs were removed in all cases but 1 in whom infection was successfully treated by appropriate antibiotic therapy. Embolization of the catheter required removal from the pulmonary artery under fluoroscopic guidance in the cardiac catheterization laboratory. In conclusion, infection and thrombosis are the two major complications of SIP in general oncology patients. In these cases it is not necessary to remove systematically the system, but a correct therapy (antibiotic, fibrinolytic agents) can be utilized with good results. The catheter rupture is often due to the wear over the costoclavicular angle. The interventional radiology is the method of choice in the treatment of the catheter embolization by rupture or dislocation. The experience of the surgical and nursing staff is probably the most important factor in decreasing the total rate of complications.
- Published
- 1999
- Full Text
- View/download PDF
20. [Prophylactic cholecystectomy for gallbladder calculosis].
- Author
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Spina GP and Pagani M
- Subjects
- Cholecystectomy, Laparoscopic economics, Cholecystectomy, Laparoscopic mortality, Cholelithiasis diagnosis, Cholelithiasis economics, Cholelithiasis prevention & control, Costs and Cost Analysis, Humans, Postcholecystectomy Syndrome prevention & control, Cholecystectomy economics, Cholecystectomy mortality, Cholelithiasis surgery
- Abstract
Asymptomatic gallstones are defined as stones that have not caused biliary colics or other biliary symptoms. Some cross-sectional epidemiological screening studies have shown that as many as 66% to 77% of patients with gallstones are asymptomatic. Studies of natural history suggest that the cumulative probability of developing biliary colics after ten years ranges from 15% to 25%. None of the variables considered as possible modifiers of natural history, were found to be associated with an increased risk of incidence of biliary colics. Cholecystectomy is a vary safe treatment and is being performed with near zero mortality. Two are the possible strategies compared: prophylactic cholecystectomy with expectant management for silent gallstone disease. Consideration of survival and monetary costs disfavors prophylactic cholecystectomy. The results of laparoscopic cholecystectomy compare favorably with those of open cholecystectomy with respect to mortality, complications, length of hospital stay, cosmetically satisfactory and financial benefits. Patients with asymptomatic stones in the gallbladder require neither surgical nor medical treatment. Consideration of monetary costs disfavors prophylactic cholecystectomy: a waiting attitude has the advantage of lowering the sanitary costs also for the high incidence of silent gallstones in our population.
- Published
- 1998
21. Surgical and radiologic treatment of primary Budd-Chiari syndrome.
- Author
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Pisani-Ceretti A, Intra M, Prestipino F, Ballarini C, Cordovana A, Santambrogio R, and Spina GP
- Subjects
- Adult, Female, Humans, Male, Middle Aged, Portacaval Shunt, Surgical, Portasystemic Shunt, Surgical, Radiography, Interventional, Stents, Budd-Chiari Syndrome diagnostic imaging, Budd-Chiari Syndrome surgery
- Abstract
Budd-Chiari syndrome (BCS) is an uncommon form of portal hypertension caused by obstruction of the hepatic venous outflow. From 1969 to 1997 we treated 19 patients (7 men, 12 women; mean age 37.6 years) affected by primary BCS. In most of the cases no etiologic factors were identified; in the remaining cases the etiology was associated with polycythemia vera, use of oral contraceptives, presence of endoluminal membranes, and repeated episodes of sepsis. Three patients with membranous occlusion of the major hepatic veins were treated by percutaneous placement of a self-expanding metallic stent inserted via a transjugular or transhepatic approach. The remaining 16 patients underwent a side-to-side portacaval shunt, which required interposition of a graft in five cases. In two patients with a significant caval obstruction, a metallic vascular stent was placed in the narrowed tract of the inferior vena cava, before shunting, by means of a transfemoral venous approach. One patient died within the first 30 postoperative days. The 18 survivors were followed for a mean of 66.7 months. The 5-year survival was 83%. Primary BCS requires different therapies depending on the stage of the disease. The fulminant or chronic forms with irreversible hepatic damage require definitive treatment, such as orthotopic liver transplantation. For the acute or subacute forms, characterized by reversible hepatic injury, a portasystemic shunt represents the most effective treatment. The patients at poor hepatic risk can be treated by interventional radiology. In both cases preliminary caval stenting is necessary if the syndrome is complicated by significant obstruction of the inferior vena cava.
- Published
- 1998
- Full Text
- View/download PDF
22. Application of self-expandable metallic stents in the inferior vena cava followed by portosystemic shunt in the treatment of primary Budd-Chiari syndrome complicated by caval obstruction.
- Author
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Ceretti AP, Intra M, Opocher E, Santambrogio R, Castrucci M, and Spina GP
- Subjects
- Adult, Budd-Chiari Syndrome complications, Budd-Chiari Syndrome diagnostic imaging, Equipment Design, Female, Humans, Male, Radiography, Vascular Diseases complications, Vascular Diseases diagnostic imaging, Budd-Chiari Syndrome surgery, Portasystemic Shunt, Surgical, Stents, Vascular Diseases surgery, Vena Cava, Inferior surgery
- Published
- 1997
- Full Text
- View/download PDF
23. [Role of surgical therapy in the treatment of refractory ascites].
- Author
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Pisani Ceretti A, Intra M, Borzio M, Santambrogio R, Opocher E, Ballarini C, Cordovana A, Motta R, and Spina GP
- Subjects
- Ascites mortality, Humans, Liver Cirrhosis complications, Ascites surgery, Liver Transplantation, Peritoneovenous Shunt, Portasystemic Shunt, Transjugular Intrahepatic mortality
- Abstract
In 5-10% of cases ascites is not controlled by medical therapy and is defined refractory. These patients may be submitted to one of the four following surgical options: portal-systemic shunt, peritoneo-venous shunt, transjugular intrahepatic portal-systemic shunt, orthotopic liver transplantation. Although the portal-systemic shunt is efficient in clearing ascites, it does not improve the survival, which depends on liver function, and it is complicated by an important incidence of encephalopathy. Since the patients with refractory ascites and good hepatic risk are not usually many, it is possible to understand why derivative surgery has been disappointing with this indication. Although the peritoneo-venous shunt is associated with a significant rate of valve obstruction, it is an easy, effective and not expensive treatment. So, till now, it has been considered the first choice procedure of refractory ascites, if any situations, determinating the onset of postoperative complications, are not present. Recently a new method has been introduced in the therapy of portal hypertension, the transjugular intrahepatic portal-systemic shunt. This is a bloodless portal-systemic derivation and so it has caused great enthusiasm even if the available data are insufficient to give a definitive opinion on its role in management of ascites. Certainly the liver transplantation, which presents the great advantage to treat both the cirrhosis and its complications, seems to be the most rational therapy for these patients. However, at least for this moment, the well-known absence of organ donors makes still actual the palliative surgical measures.
- Published
- 1997
24. Gasless laparoscopic resection of hepatocellular carcinoma (HCC) in cirrhosis.
- Author
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Intra M, Viani MP, Ballarini C, Pisani Ceretti A, Ongari B, Croce AM, De Murtas G, Marraro G, and Spina GP
- Subjects
- Aged, Carcinoma, Hepatocellular diagnosis, Carcinoma, Hepatocellular pathology, Female, Humans, Liver Neoplasms diagnosis, Liver Neoplasms pathology, Carcinoma, Hepatocellular surgery, Laparoscopy methods, Liver Cirrhosis complications, Liver Neoplasms complications, Liver Neoplasms surgery
- Abstract
Liver resection by open surgery remains the method of choice for treatment of hepatocellular carcinoma (HCC) in cirrhotic patients with compensated liver function. Laparoscopy for surgical treatment of hepatic diseases is at an early stage. Laparoscopy has been often proposed for diagnosis, staging of hepatic malignancy, treatment of hepatic cyst or benign tumors, but very few laparoscopic treatments of hepatic malignancies have been reported at present and always using conventional CO2 laparoscopy. We describe herein the operative treatment of a single subglissonian HCC of segment III in a child, HCV (hepatitis C virus)-related cirrhosis. A nonanatomical wedge resection was performed by gasless laparoscopic technique using a mechanical retractor obviating the creation of the pneumoperitoneum and of the sealed environment. The technique, in selected cases, is a simple, safe, and effective surgical method. The gasless technique guarantees a clear vision, it makes possible the continuous suction of smoke and fluids, it allows the use of conventional instruments for classic maneuvers of the liver surgery (Pringle maneuver), and the easy management of suturing. The present case has proved to be another abdominal procedure that can be carried out with all the advantages of gasless minimally invasive surgery.
- Published
- 1996
- Full Text
- View/download PDF
25. Intraoperative ultrasonography (IOUS) during laparoscopic cholecystectomy.
- Author
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Santambrogio R, Bianchi P, Opocher E, Mantovani A, Schubert L, Ghelma F, Panzera M, Verga M, and Spina GP
- Subjects
- Adult, Aged, Aged, 80 and over, Cholecystectomy, Laparoscopic, Cholelithiasis diagnostic imaging, Common Bile Duct surgery, Female, Follow-Up Studies, Humans, Intraoperative Period, Male, Middle Aged, Retrospective Studies, Cholelithiasis surgery, Common Bile Duct diagnostic imaging, Ultrasonography methods
- Abstract
Background: The purpose of this study was to evaluate the usefulness of intraoperative ultrasonography (IOUS), a new method of imaging the biliary tree and related structures, during laparoscopic cholecystectomy., Method: An IOUS probe (Aloka, Tokyo, Japan) with a 7.5-MHz linear-array transducer was used during cholecystectomy in 124 patients with symptomatic cholelithiasis (45 men, 79 women; mean age, 48 +/- 14 years)., Results: The examination of the common bile duct (CBD) was excellent in 117 patients but unsatisfactory in 7 cases (5.6%) at the level of the head of the pancreas. In 5 patients, IOUS showed unsuspected choledocholithiasis: a subsequent intraoperational cholangiogram confirmed this. In five cases IOUS was able to help the surgeon to localize a Calot area obscured by inflammation. Postoperatively, one patient had an injury of the cystic duct stump: a nasobiliary tube resolved the bile leakage after 7 days. Another patient was submitted to postoperative endoscopic retrograde cholangiopancreatography (ERCP) for a choledocholithiasis recognized by a trans-cystic-tube cholangiography: the stone was suspected but not demonstrated either by laparoscopic IOUS or by intraoperative cholangiography. During the follow-up period, one patient had an episode of acute pancreatitis. ERCP showed a small stone wedged in the sphincter of Oddi., Conclusions: IOUS may be a real alternative to cholangiography during laparoscopic cholecystectomy since it is safer and offers a complete examination of the biliary tree. It has some disadvantages which can solved by additional experience.
- Published
- 1996
- Full Text
- View/download PDF
26. [Recanalization of 2 suprahepatic veins with metal stents via a percutaneous transhepatic approach in a case of the Budd-Chiari syndrome].
- Author
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Castrucci M, Camalori M, Angeli E, Salvioni M, Venturini M, Ghio D, Ongari B, Spina GP, and Del Maschio A
- Subjects
- Angioplasty, Balloon instrumentation, Angioplasty, Balloon methods, Budd-Chiari Syndrome diagnosis, Catheterization, Peripheral instrumentation, Catheterization, Peripheral methods, Female, Humans, Magnetic Resonance Angiography, Middle Aged, Radiography, Ultrasonography, Budd-Chiari Syndrome therapy, Hepatic Veins diagnostic imaging, Hepatic Veins pathology, Stents, Vena Cava, Inferior diagnostic imaging, Vena Cava, Inferior pathology
- Published
- 1996
27. Gastric endoscopic features in portal hypertension: final report of a consensus conference, Milan, Italy, September 19, 1992.
- Author
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Spina GP, Arcidiacono R, Bosch J, Pagliaro L, Burroughs AK, Santambrogio R, and Rossi A
- Subjects
- Canada, Esophageal and Gastric Varices classification, Esophageal and Gastric Varices pathology, Europe, Gastroscopy methods, Humans, India, Italy, Japan, Multicenter Studies as Topic, Surveys and Questionnaires, United States, Gastric Mucosa pathology, Hypertension, Portal pathology
- Published
- 1994
- Full Text
- View/download PDF
28. Factors predicting chronic hepatic encephalopathy after distal splenorenal shunt: a multivariate analysis of clinical and hemodynamic variables.
- Author
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Spina GP, Santambrogio R, Opocher E, Pisani-Ceretti A, Ongari B, Rashidi B, Garancini P, and Gallus G
- Subjects
- Actuarial Analysis, Adolescent, Adult, Aged, Analysis of Variance, Female, Hepatic Encephalopathy mortality, Humans, Liver Cirrhosis pathology, Liver Cirrhosis, Alcoholic pathology, Male, Middle Aged, Multivariate Analysis, Probability, Prognosis, Hemodynamics, Hepatic Encephalopathy etiology, Hepatic Encephalopathy physiopathology, Liver Cirrhosis surgery, Liver Cirrhosis, Alcoholic surgery, Splenorenal Shunt, Surgical
- Abstract
Background: This study was aimed at evaluating several factors that promote chronic hepatic encephalopathy by multivariate analysis of data for patients with cirrhosis with good or moderate liver function submitted to distal splenorenal shunts., Methods: The study group comprised 131 patients: 55 had alcoholic and 76 nonalcoholic cirrhosis. Seventy patients were in Child's class A and 61 in class B. Cerebral function was assessed by a complete neurologic examination. Angiography with venous phase was performed before and within 1 month after the shunt operation. In 84 cases the original Warren technique was used and in 20 cases a Britton's modified procedure was used. Twenty-seven patients had distal splenorenal shunts with a splenopancreatic disconnection. Statistical analysis was performed by two multivariate analyses based on stepwise selection., Results: Thirty-nine patients died during a follow-up period of 51 +/- 32 months. Chronic encephalopathy occurred in 18 patients (14%). According to the multivariate analysis of the preoperative prognostic factors, only age (p = 0.0001) and albumin values (p = 0.0002) were independent predictive risk factors for chronic encephalopathy. In the multivariate analysis concerning the hemodynamic consequences of the selective shunts, independent risk factors promoting chronic encephalopathy were postoperative portal perfusion (p = 0.0001), postshunt portal pressure (p = 0.001), and surgical disconnection (p = 0.0064)., Conclusions: Our study has shown that chronic encephalopathy after selective shunt surgery is promoted by both clinical and hemodynamic factors. A better selection of the candidates for shunt surgery and prevention of the development of portal malcirculation by accurate surgical disconnection should further decrease the risk of chronic encephalopathy.
- Published
- 1993
29. Distal spleno-renal shunt versus endoscopic sclerotherapy in the prevention of variceal rebleeding. A meta-analysis of 4 randomized clinical trials.
- Author
-
Spina GP, Henderson JM, Rikkers LF, Teres J, Burroughs AK, Conn HO, Pagliaro L, and Santambrogio R
- Subjects
- Brain Diseases etiology, Chronic Disease, Endoscopy, Digestive System, Humans, Recurrence, Risk Factors, Esophageal and Gastric Varices therapy, Gastrointestinal Hemorrhage prevention & control, Sclerotherapy, Splenorenal Shunt, Surgical adverse effects, Splenorenal Shunt, Surgical mortality
- Abstract
Meta-analysis was used to evaluate 4 clinical trials comparing distal spleno-renal shunt (DSRS) with endoscopic sclerotherapy (EVS) in the prevention of variceal rebleeding: the interval between bleeding and therapy ranges from < 14 days to > 100 days. A questionnaire was sent to each author of the published trials concerning methods, definitions and results of the trials in order to obtain more detailed and up-to-date information. The selected end-points for the meta-analysis were: rebleeding, mortality and chronic encephalopathy. Analysis of the results in the questionnaires was made using the method proposed by Collins. The pooled relative risk (i.e. the combined Odds ratio of each trial as an estimate of overall efficacy) of rebleeding was statistically reduced by DSRS (0.16; 95% confidence interval 0.10-0.27). Despite this, the overall risk of death following DSRS was only marginally decreased (0.78; 95% confidence interval 0.47-1.29); the lack of homogeneity in the results does not permit any significant conclusions on this end-point. However, in non-alcoholic patients, the decrease in risk of death was greater, and this without heterogeneity, following DSRS than EVS (0.59; 95% confidence interval 0.23-1.50). The overall risk of chronic encephalopathy was slightly increased after DSRS (1.86; 95% confidence interval 0.90-3.86). In conclusion, DSRS significantly reduced the risk of rebleeding compared to EVS without increasing the risk of chronic hepatic encephalopathy. However, DSRS did not significantly affect the overall death risk. Only in non-alcoholic disease did it seem to show an advantage over EVS.
- Published
- 1992
- Full Text
- View/download PDF
30. [Clinical results of selective distal splenorenal and latero-lateral portacaval anastomoses. Comparative prospective study of 93 patients].
- Author
-
Pezzuoli G, Spina GP, Galeotti F, Opocher E, Santambrogio R, Gagliano G, and Strinna M
- Subjects
- Esophageal and Gastric Varices prevention & control, Female, Gastrointestinal Hemorrhage prevention & control, Hepatic Encephalopathy etiology, Humans, Liver Cirrhosis mortality, Male, Middle Aged, Prospective Studies, Liver Cirrhosis surgery, Portacaval Shunt, Surgical mortality, Splenorenal Shunt, Surgical mortality
- Abstract
The distal splenorenal shunt (DSRS) was compared with the side-t-side portacaval shunt (PCS) in 93 prospectively matched cirrhotic patients with portal hypertension. After a mean follow-up of 38 months, no differences were observed in operative mortality, long term survival and variceal rebleeding between the two groups. There was no significant difference in terms of acute encephalopathy (22% in PCS group and 33% in DSRS group) and chronic encephalopathy (35% in PCS and 17% in DSRS). However, the only cases of severe and disabling chronic encephalopathy (CE) arose after PCS (p = 0.049). Actuarial curves of CE showed that the maximum rate of this complication (18%) in the DSRS group was reached 27 months after shunt surgery, whereas this value was reached and passed in PCS group only 4 months after shunt. CE occurred for a total duration of 20.1 months after PCS and only 11.1 months after DSRS (p = 0.003) and occupied 46.3% of the follow-up of PCS patients in contrast to 18.7% of the follow-up of DSRS patients (p = 0.001). DSRS is associated with a lower global incidence of CE without severe forms and provides a better quality of life than does a nonselective shunt.
- Published
- 1991
31. Emergency portosystemic shunt in patients with variceal bleeding.
- Author
-
Spina GP, Santambrogio R, Opocher E, Gagliano G, Cucchiaro G, Pisani A, and Macri M
- Subjects
- Cause of Death, Female, Follow-Up Studies, Gastrointestinal Hemorrhage diagnostic imaging, Gastrointestinal Hemorrhage etiology, Hepatic Encephalopathy diagnosis, Hepatic Encephalopathy epidemiology, Humans, Incidence, Male, Middle Aged, Portasystemic Shunt, Surgical mortality, Postoperative Complications diagnosis, Postoperative Complications epidemiology, Radiography, Risk Factors, Survival Rate, Emergencies, Esophageal and Gastric Varices complications, Gastrointestinal Hemorrhage surgery, Portasystemic Shunt, Surgical standards
- Abstract
Thirty-five patients for whom emergency sclerotherapy or conservative treatment, or both, failed to arrest variceal bleeding, or who had early rebleeding and required emergency portosystemic shunts (EPSS) were studied. EPSS permanently controlled the variceal bleeding in all but one patient. In this patient, the shunt was patent as demonstrated by angiography. Esophageal varices disappeared in 18 patients and were reduced in 14. Three patients died before the endoscopic examination could be performed. The causes of death were hepatic failure in two and bleeding ulcerations of the gastric fundus in the other patient. One patient was classified in Child's category B and two in Child's category C. Thirty-two patients submitted to EPSS and were discharged alive. Twelve of these patients subsequently died, at an average of 11.2 months after undergoing the shunt procedure. Four of 12 patients died of hepatic failure; two patients died of hepatomas; two, other neoplasia; three, hemorrhaging duodenal ulcers, and one patient, renal failure. Analysis of actuarial survival rates showed that the five year survival rate was 43 per cent. The long term survival rates were fewer for patients with Child's category C than for those with combined Child's categories A and B (five year survival rates were 21 versus 55 per cent; p less than 0.05). During the follow-up period, none of the patients had variceal bleeding. Chronic encephalopathy developed in six, which was mild in three, moderate in one instance and severe in two. It developed soon after EPSS, with onset in the first month after discharge in three. Thus, when conservative treatment fails to arrest variceal bleeding, EPSS should be performed to guarantee definitive control of hemorrhage and prolong the survival period.
- Published
- 1990
32. Distal splenorenal shunt versus endoscopic sclerotherapy in the prevention of variceal rebleeding. First stage of a randomized, controlled trial.
- Author
-
Spina GP, Santambrogio R, Opocher E, Cosentino F, Zambelli A, Passoni GR, Cucchiaro G, Macrì M, Morandi E, and Bruno S
- Subjects
- Adult, Aged, Data Interpretation, Statistical, Electroencephalography, Esophageal and Gastric Varices complications, Esophageal and Gastric Varices surgery, Female, Gastrointestinal Hemorrhage etiology, Gastrointestinal Hemorrhage surgery, Humans, Hypertension, Portal therapy, Male, Middle Aged, Neuropsychological Tests, Prospective Studies, Randomized Controlled Trials as Topic, Esophageal and Gastric Varices therapy, Gastrointestinal Hemorrhage prevention & control, Sclerotherapy, Splenorenal Shunt, Surgical
- Abstract
In 1984 we started a prospective controlled trial comparing endoscopic sclerotherapy (ES) with the distal splenorenal shunt (DSRS) in the elective treatment of variceal hemorrhage in cirrhotic patients. The study population included 40 patients with cirrhosis and portal hypertension referred to our department from October 1984 to March 1988. These patients were drawn from a pool of 173 patients who underwent either elective surgery or endoscopic sclerotherapy during this time. Patients were assigned to one of the two groups according to a random-number table: 20 to DSRS and 20 to ES. During the postoperative period, no DSRS patient died, while one ES patient died of uncontrolled hemorrhage. One DSRS patient had mild recurrent variceal hemorrhage despite an angiographically patent DSRS. Four ES patients suffered at least one episode of gastrointestinal bleeding: two from varices and two from esophageal ulcerations. Five ES patients developed transitory dysphagia. Long-term follow-up was complete in all patients. Two-year survival rates for shunt (95%) and ES (90%) groups were similar. One DSRS patient rebled from duodenal ulcer, while three ES patients had recurrent bleeding from esophagogastric sources (two from varices and one from hypertensive gastropathy). One DSRS and two ES patients have evolved a mild chronic encephalopathy; four DSRS and two ES patients suffered at least one episode of acute encephalopathy. Two ES patients had esophageal stenoses, which were successfully dilated. Preliminary data from this trial seem to indicate that DSRS, in a subgroup of patients with good liver function and a correct portal-azygos disconnection, more effectively prevents variceal rebleeding than ES. However no significant difference in the survival of the two treatment groups was noted.
- Published
- 1990
- Full Text
- View/download PDF
33. Early hemodynamic changes following selective distal splenorenal shunt for portal hypertension: comparison of surgical techniques.
- Author
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Spina GP, Santambrogio R, Opocher E, Gattoni F, Baldini U, Cucchiaro G, Uslenghi C, and Pezzuoli G
- Subjects
- Adult, Aged, Female, Hemodynamics, Hepatic Encephalopathy etiology, Humans, Hypertension, Portal complications, Hypertension, Portal physiopathology, Male, Middle Aged, Hypertension, Portal surgery, Splenorenal Shunt, Surgical
- Abstract
Ninety patients with cirrhosis undergoing elective distal splenorenal shunt (DSRS) for variceal bleeding between January, 1977 and September, 1988 comprised the study group. In 63 cases, the original technique of Warren was used and, in 15, the modified Britton procedure was employed. Twelve patients had a DSRS plus splenopancreatic disconnection. Thirty-four had alcoholic cirrhosis and 56 had nonalcoholic cirrhosis. Intraoperative portal pressure remained high after the shunt (29.4 cm H2O) even if its initial value was probably decreased by the loss of the splenic flow. Splenic pressure was reduced to 21 cm H2O. The hepatic artery diameter enlarged even after selective shunt (from 6.5 to 7.1 mm). The persistence of a high portal pressure allowed for the preservation of hepatopedal portal flow in 87% of cases. Disconnection between the high-pressure mesenteric area and the low-pressure splenic area seemed to be ideal in only 17% of cases. Fifty-five percent of cases had the early development of minimal or moderate portomesenteric gastrosplenic (PM-GS) collateral pathways. In 33%, the PM-GS collaterals were generally abundant and often allowed visualization of the splenic and caval veins during the venous phase of the superior mesenteric arteriograms. In this group, portal flow was generally highly reduced and even abolished. The incidence of portal thrombosis was 11%. Early angiographic checks after DSRS did not show a different hemodynamic behavior between alcoholics and nonalcoholics. Splenopancreatic disconnection seems to prevent the development of collaterals and the loss of portal perfusion after shunt surgery.
- Published
- 1990
- Full Text
- View/download PDF
34. [Current aspects of the surgery of portal hypertension (PH)].
- Author
-
Pezzuoli G, Spina GP, and Vassanelli P
- Subjects
- Animals, Brain metabolism, Brain Diseases etiology, Catecholamines metabolism, Enzymes metabolism, Esophageal and Gastric Varices complications, Humans, Hypertension, Portal etiology, Liver metabolism, Liver Circulation, Liver Cirrhosis complications, Postoperative Complications, gamma-Aminobutyric Acid metabolism, Hypertension, Portal surgery, Portacaval Shunt, Surgical
- Published
- 1975
35. [Prevention of laparocele after portasystemic shunt. Randomized comparison of sutures with absorbable vs non-absorbable thread].
- Author
-
Galeotti F, Opocher E, Santambrogio R, Fumagalli U, Cucchiaro G, and Spina GP
- Subjects
- Absorption, Female, Humans, Male, Phthalic Acids, Polyglycolic Acid, Random Allocation, Hernia, Ventral prevention & control, Portasystemic Shunt, Surgical adverse effects, Sutures
- Published
- 1986
36. [A case of recurrent hemoperitoneum caused by hepatocarcinoma].
- Author
-
Roviaro GC, Binda R, and Spina GP
- Subjects
- Carcinoma, Hepatocellular pathology, Carcinoma, Hepatocellular surgery, Humans, Liver pathology, Liver Neoplasms pathology, Liver Neoplasms surgery, Male, Middle Aged, Recurrence, Carcinoma, Hepatocellular complications, Hemoperitoneum etiology, Liver Neoplasms complications
- Abstract
A case of recurring haemoperitoneum caused by liver cancer is presented. This neoplasia, rare itself in Italy, may have a variety of clinical pictures. Recurring haemoperitoneum is quite exceptional and mistaken diagnosis and aetiopathogenetic interpretation are the likely results. The symptomatology is illustrated and the problem of diagnosis is discussed.
- Published
- 1977
37. [Immediate and late results of 171 therapeutic portal systemic by pass operations (author's transl)].
- Author
-
Pezzuoli G, Spina GP, Galeotti F, and Battaglia G
- Subjects
- Esophageal and Gastric Varices complications, Esophageal and Gastric Varices surgery, Gastrointestinal Hemorrhage complications, Gastrointestinal Hemorrhage mortality, Humans, Liver Circulation, Retrospective Studies, Hypertension, Portal surgery, Portacaval Shunt, Surgical mortality
- Abstract
The authors reports the results of 171 cases of portal systemic by pass operations out of a total of 200 cases operated on between 1968 and 1974. These 171 patients all presented with a syndrome of portal hypertension with oesophageal varices and all had previously bled. Their age lay in 70 p. cent of cases between 40 and 60 years and the cause of hypertension was in 96 p. cent of cases an intra-hepatic block. 41 p. cent were included in the risk group A according to Child's classification, 51 p. cent in Group B and 8 p. cent in Group C. The routine operation was side-to-side portacaval anastomosis (75 p. cent). The operative mortality was 5.2 p. cent in all with 1 p. cent in cases with risk A, and 15 p. cent in cases with risk C. The fall in portal pressure was on average 15 cm of water, i.e. 41 p. cent of the initial pressure. The overall survival after 5 years was 65 p. cent, 70 p. cent for risk A and 26 p. cent for risk C. In 69 p. cent of cases the cause of death was liver failure. Encephalopathy, studied in 76 patients over an average period of 3 years, occurred in 39 p. cent of cases, and in 13 p. cent of the latter it was serious. In the 12 p. cent of survivors, we noted recurrent hemorrhage, but in only 2.5 p cent of cases did the bleeding definitely come from oesophageal varices. In the light of these results, the authors judge positively the surgical treatment of portal hypertension.
- Published
- 1977
38. [Effect of Warren's selective spleno-renal derivation on esophageal varices].
- Author
-
Galeotti F, Cosentino F, Opocher E, Santambrogio R, Cucchiaro G, and Spina GP
- Subjects
- Adolescent, Adult, Aged, Blood Pressure, Child, Esophageal and Gastric Varices physiopathology, Female, Gastrointestinal Hemorrhage prevention & control, Humans, Male, Middle Aged, Esophageal and Gastric Varices surgery, Portasystemic Shunt, Surgical methods, Splenorenal Shunt, Surgical methods
- Published
- 1983
39. [Evaluation of peripheral and CNS biochemical changes in models of acute and chronic experimental hepatic insufficiency in the rat].
- Author
-
Rosati R, Montorsi M, Beccaria G, Santambrogio R, Salerno F, Malesci A, Abbiati R, Bonato C, and Spina GP
- Subjects
- Amino Acids blood, Ammonia blood, Animals, Brain Chemistry, Cholecystokinin analysis, Peripheral Nervous System Diseases etiology, Rats, Rats, Inbred Strains, Hepatic Encephalopathy complications, Hepatic Encephalopathy etiology, Liver Diseases complications, Portacaval Shunt, Surgical adverse effects
- Published
- 1983
40. [Angiomas of the liver. Their diagnosis and surgical treatment].
- Author
-
Montorsi M, Bona S, Opocher E, Spiropoulos J, Fumagalli U, Rosati R, Varoli F, and Spina GP
- Subjects
- Adult, Aged, Female, Follow-Up Studies, Hemangioma, Cavernous surgery, Hepatectomy methods, Humans, Liver Neoplasms surgery, Male, Middle Aged, Postoperative Complications epidemiology, Hemangioma, Cavernous diagnosis, Liver Neoplasms diagnosis
- Published
- 1989
41. [Variations in the hepatic artery in the surgery of portal hypertension].
- Author
-
Spina GP, Galeotti F, Opocher E, Santambrogio R, and Pezzuoli G
- Subjects
- Adolescent, Adult, Aged, Angiography, Child, Hepatic Artery diagnostic imaging, Humans, Hypertension, Portal surgery, Middle Aged, Hepatic Artery anatomy & histology, Portacaval Shunt, Surgical methods
- Abstract
The effect of anatomical variations of the hepatic artery on the performance of the anastomosis was assessed during 390 portacaval shunt operations as well as the degree to which technical difficulties could be anticipated from preoperative arteriography. Variations were detected in 25 p. cent of 130 patients examined by angiography but were confirmed during portal vein dissection in only 11 p. cent of cases. Technical difficulties due to hepatic artery variations were encountered in only 2 p. cent of the 390 anastomosis. Accidental section of a right hepatic artery occurred once only, and this before the routine use of angiography. Treatment was by aortohepatic by-pass using a saphenous graft. Portacaval anastomosis can be conducted in the presence of an hepatic artery variation bat technical difficulties cannot be predicted by preoperative digestive angiography.
- Published
- 1983
42. [Minimal jejunostomy for early postoperative enteral feeding: technic and results].
- Author
-
Negri G, Zannini P, Maruotti RA, Voci C, Baisi A, Viani M, and Spina GP
- Subjects
- Colon surgery, Duodenum surgery, Enteral Nutrition adverse effects, Esophagus surgery, Food, Formulated, Gastrectomy, Humans, Pancreatectomy, Postoperative Care, Time Factors, Catheterization methods, Enteral Nutrition instrumentation, Jejunum surgery
- Abstract
From March 1980 to December 1982, at the 2nd Surgical Clinic of the University of Milan, 47 jejunostomies were performed at the conclusion of a major gastrointestinal surgery to provide immediate post-operative enteral nutrition. A fine needle catheter jejunostomy technique according to Delaney (10) was employed in all cases, using a polythene catheter with an internal diameter of 2.5 mm. inserted into the proximal jejunum using a stainless-steel needle. An elemental diet (13) was adopted and fed through a volumetric infusion pump. Enteral nutrition was usually initiated on the second postoperative day and on average lasted 12 days. No complications connected to positioning, permanence or removal of the catheter were observed. The only inconvenience was represented by obstruction of the catheter with food concretion thus feeding was discontinued in 3 patients. Collateral effects were observed in 9 patients: diarrhoea (5 cases), hyperperistaltis (2 cases), abdominal distension and nausea (1 case). This method of nutritional intake allowed us to: maintain body weight at pre-operative values; obtain a positive nitrogen balance on average the sixth postoperative day; reduce the volume of parenteral support, early suspension and a significant reduction in complications connected with this method.
- Published
- 1983
43. [Diagnosis of pancreatic carcinoma. Preliminary results of a prospective study on the reliability of CA 19-9 in a group of selected patients].
- Author
-
Montorsi M, Spina GP, Malesci A, Santambrogio R, Opocher E, Bona S, Bonato C, Mariani C, Bissi O, and Wizemann G
- Subjects
- Female, Humans, Italy, Male, Middle Aged, Multicenter Studies as Topic, Pancreatic Neoplasms immunology, Predictive Value of Tests, Prospective Studies, Antigens, Tumor-Associated, Carbohydrate analysis, Pancreatic Neoplasms diagnosis
- Published
- 1989
44. [Role of beta blockers in preventing hemorrhages from esophageal varices. A hemodynamic study].
- Author
-
Santambrogio R, Galeotti F, Opocher E, Cucchiaro G, Cornalba GP, Rota L, Ferrario M, Fumagalli U, and Spina GP
- Subjects
- Adult, Drug Evaluation, Esophageal and Gastric Varices physiopathology, Female, Gastrointestinal Hemorrhage etiology, Gastrointestinal Hemorrhage physiopathology, Hemodynamics drug effects, Humans, Liver Cirrhosis complications, Liver Cirrhosis physiopathology, Male, Middle Aged, Phenoxypropanolamines, Propanolamines therapeutic use, Adrenergic beta-Antagonists therapeutic use, Esophageal and Gastric Varices complications, Gastrointestinal Hemorrhage prevention & control
- Published
- 1986
45. [Selective distal spleno-renal shunt vs. latero-lateral porta-caval shunt. Subsequent analysis of encephalopathy and survival].
- Author
-
Spina GP, Santambrogio R, Galeotti F, Opocher E, Lopez C, and Strinna M
- Subjects
- Adult, Chronic Disease, Female, Hepatic Encephalopathy etiology, Hepatic Encephalopathy mortality, Humans, Male, Middle Aged, Hepatic Encephalopathy prevention & control, Hypertension, Portal surgery, Portacaval Shunt, Surgical adverse effects, Portacaval Shunt, Surgical mortality, Splenorenal Shunt, Surgical adverse effects, Splenorenal Shunt, Surgical methods, Splenorenal Shunt, Surgical mortality
- Published
- 1989
46. [The role of circular mechanical suturing devices in digestive surgery].
- Author
-
Rebuffat C, Rosati R, Montorsi M, Varoli F, Zago M, and Spina GP
- Subjects
- Humans, Postoperative Complications, Digestive System Surgical Procedures, Esophagus surgery, Surgical Staplers
- Published
- 1983
47. Fine-needle endoscopic percutaneous gastrostomy.
- Author
-
Negri G, Cosentino F, and Spina GP
- Subjects
- Aged, Catheterization instrumentation, Enteral Nutrition instrumentation, Female, Gastroscopes, Gastrostomy instrumentation, Humans, Male, Middle Aged, Wound Healing, Enteral Nutrition methods, Gastroscopy methods, Gastrostomy methods, Needles
- Abstract
A procedure for percutaneous endoscopic gastrostomy is described. Under direct endoscopic control, the surgeon introduces, percutaneously, into the inflated stomach a 9 French Foley catheter through a special needle, which may then be opened for removal. After positioning, the terminal balloon of the Foley is inflated with 7-8 ml of air and the catheter is placed under slight traction to appose the gastric and abdominal walls. Such a method has been used in 5 patients with cancer of the cardia requiring enteral feeding prior to surgery. No complications due to the positioning of the gastrostomy catheter have been observed. We believe that this simple, reliable and inexpensive method constitutes an improvement on the previously described endoscopic percutaneous gastrostomy techniques.
- Published
- 1984
- Full Text
- View/download PDF
48. [The EEA circular mechanical stapler in digestive surgery. Analysis of 76 cases].
- Author
-
Spina GP, Rosati R, Rebuffat C, Montorsi M, and Zago M
- Subjects
- Adult, Aged, Female, Humans, Male, Middle Aged, Esophageal Diseases surgery, Esophagoplasty instrumentation, Gastrectomy instrumentation, Gastroenterostomy instrumentation, Gastrointestinal Diseases surgery, Surgical Staplers
- Published
- 1984
49. [Psammomatous somatostatinoma of Vater's papilla. A case report].
- Author
-
Opocher E, Viale G, Santambrogio R, Galeotti F, Dell'Orto P, Colombi R, and Spina GP
- Subjects
- Common Bile Duct Neoplasms diagnosis, Common Bile Duct Neoplasms surgery, Humans, Male, Middle Aged, Somatostatinoma diagnosis, Somatostatinoma surgery, Adenoma, Islet Cell pathology, Ampulla of Vater pathology, Ampulla of Vater surgery, Common Bile Duct Neoplasms pathology, Somatostatinoma pathology
- Published
- 1989
50. [Biliary pathology and portal hypertension. Analysis of 584 cases].
- Author
-
Opocher E, Galeotti F, Rosati R, Santambrogio R, Varoli F, and Spina GP
- Subjects
- Adolescent, Adult, Aged, Biliary Tract Diseases surgery, Child, Female, Humans, Liver Cirrhosis complications, Male, Middle Aged, Biliary Tract Diseases complications, Hypertension, Portal complications
- Published
- 1983
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