1,720,979 research outputs found
CORSO DI ALTA FORMAZIONE IN Accessi venosi centrali totalmente impiantabili
No full textIl corso di Alta Formazione in Accessi venosi Centrali totalmente impiantabili, ha lo scopo di consentire un perfezionamento delle conoscenze nel campo della indicazione, dell’impianto e della gestione degli accessi venosi centrali a medio e lungo termine, in tutte le loro implicazioni cliniche e assistenziali.
Gli accessi venosi centrali (o cateteri venosi centrali o sistemi venosi centrali) sono presidi – posizionati soprattutto in ambiente ospedaliero – che consentono a tempo indeterminato la somministrazione di farmaci o infusioni endovenose in condizioni di tranquillità e sicurezza. Per renderci contro della importanza del loro impiego, basti pensare che si stima che ogni anno, solo in Italia, vengono impiantati circa 100.000 accessi venosi centrali e che almeno 25-30.000 di essi siano programmati per sostenere le necessità cliniche dei malati per tempi prolungati (più di 3-6 mesi).
Tramite questi accessi venosi centrali viene facilitata la somministrazione di svariati trattamenti endovenosi: terapie endovenose (farmaci vasoattivi, antibiotici, nutrizione parenterale, ecc.) in svariate categorie di malati ospedalizzati, come ad esempio i pazienti acuti gravi in terapia intensiva o i pazienti chirurgici nel decorso postoperatorio; chemioterapici per la cura dei tumori, in malati seguiti ambulatorialmente o in day hospital; nutrizione parenterale domiciliare, per garantire la sopravvivenza di soggetti affetti da malattie gastrointestinali gravi o malnutriti; somministrazione di antidolorifici nella maniera più efficace per i malati con dolore da cancro; e così via.
E’ evidente come questo tipo di presidi interessi una grande varietà di situazioni cliniche e coinvolga una notevole eterogeneità di operatori sanitari, appartenenti a discipline e competenze assai diverse (chirurghi, anestesisti, radiologi, oncologi, pediatri, nutrizionisti, nefrologi), la cui preparazione culturale nell’ambito degli accessi venosi è spesso di tipo empirico e autodidattico.
Lo scopo del corso di Alta Formazione in Accessi venosi Centrali totalmente impiantabili è di consentire agli operatori sanitari coinvolti in questo campo un approfondimento organico, completo, teorico e pratico delle proprie conoscenze, in modo da poter affrontare in prima persona, su basi oggettive e basate sulla evidenza, i multiformi problemi clinici (di indicazione, di impianto, di gestione) posti da questi presidi
[Electrohydraulic intracorporeal lithotripsy in the treatment of "difficult" calculi of the common bile duct. Report of a caseload].
No full textThe Authors report their experience in 38 cases (January 1990-Septembre 1994) of "difficult" gallstone disease of the main bile duct treated with electrohydraulic intracorporeal lithotripsy. Nineteen patients were affected with giant stones of the biliary tree, 6 with multiple stones of the main bile duct, 13 with stones of one or both hepatic ducts. The approach to the biliary tree was peroral transpapillary in 16 patients and transhepatic in the remaining 22. Twenty-five patients were previously submitted to surgery of the biliary tree (13 hepaticojejunostomy, 8 choledochoduodenostony, 4 papillostomy), while 5 had required a cholecystectomy, and 6 a gastroresection according to Billroth II. In 80\% of the cases two lithotripsy sessions were enough to achieve the complete clearing of the bile duct. There was no mortality and morbidity was 5.3\%. Total clearing was obtained in 97.4\% of the cases. 6-48 months after treatment 37 patients still do not show clinical, laboratory or echographic signs of gallstone stasis or disease relapse
Gastric cancer precursor lesions and helicobacter pylori infection in patients with partial gastrectomy for peptic ulcer
No full textThe mucosa of the gastric stump is considered at greater risk of dysplastic and neoplastic changes than that of the intact stomach. The combination of enteric reflux and Helicobacter pylori infection may have a synergistic damaging effect on the mucosa of the gastric remnant, both producing and increasing mucosal proliferation. The aim of this study was to assess whether the occurrence of H. pylori infection in the remnant mucosa of partially gastrectomized subjects for peptic ulcer disease is associated with an increase of the mucosal precursor lesions of malignancy. A series of 151 subjects who underwent partial gastrectomy for peptic ulcer disease were submitted to upper digestive endoscopy for long-term surveillance. Biopsy specimens of the gastric stump were tested for the occurrence of H. pylori infection and for the presence of precancerous mucosal lesions. The prevalence of H. pylori colonization in the remnant stomach was less than 30% and similar in subjects with different time intervals between gastrectomy and endoscopy. Age at surgery (x(2): p = 0.03) and H. pylori infection (x(2): p = 0.002) were significantly associated with the grading of mucosal lesions. The prevalence of normal mucosa was 10 times higher in H. pylori-negative patients as in H. pylori-positive ones (22.0% vs. 2.4%), and the prevalence of intestinal metaplasia was four times higher in H. pylori-positive patients than in H. pylori-negative ones (19.6% vs. 4.6%). We concluded that H. pylori infection may play a causal role in the development of gastric lesions in the operated stomach
Anastomotic leakage and septic complications: impact on local recurrence in surgery of low rectal cancer
No full textPURPOSE: We thought to determine the influence of anastomotic leakages (AL) and septic complications (SC) on the incidence of local recurrence (LR) in patients undergoing curative surgery for rectal cancer. METHODS: The records of 479 patients (286 male, 193 female; median age 67 years) who received, between 1966 and 1975 (Group A) and 1976 and 1985 (Group B), curative surgery for middle to low rectal cancer were retrospectively reviewed. All patients received meso rectal excision in the course of abdominoperineal excision (Group A) and of anterior resection with colorectal anastomosis (Group B). The outcome of SC in both groups and that of AL in Group B were investigated. AL were divided into clinical leaks (CL) and radiological leaks (RL). All patients surviving surgery were followed up for a mean period of 71 months. The development of pelvic recurrence was registered. The effect of SC and AL on LR was statistically analyzed. RESULTS: LR was diagnosed in 24 (9.3%) patients of Group A. No difference was detected between patients with SC (9.3%) and those without (9.3%). In Group B, LR occurred in 28 (12.7%) patients: 12.5% without SC and 12.7% with SC. A significant difference in the prevalence of LR was found between patients with CL (14.2%) and those with RL (30.0%). When CL were excluded, RL resulted as an independent predictor of LR. DISCUSSION: Many factors have been shown to affect the rate of LR, including operative technique and surgeon expertise as well as margins of clearance and tumor stage. In our study, overall LR rate of Group B was 13.2%. The incidence of this event in patients with AL (24%) was significantly higher than that in the nonleakage group (11.1%). Correspondent results have been reported by some authors who evidenced RL as a negative prognostic factor for higher rates of LR. The mechanism by which AL affects LR remains to be elucidated. CONCLUSIONS: All were found to be associated with higher rates of LR, especially if associated with prolonged inflammatory local reaction
La chirurgia degli ipersurrenalismi primitivi. Parte I: cenni di anatomia chirurgica e valutazione critica delle vie di accesso.
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