Browsing by Author "Rossi, RL"

Now showing 1 - 6 of 6
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    Malignant obstructive jaundice - Evaluation and management
    (1996) Rossi, RL; Traverso, LW; Pimentel, F
    A large number of laboratory tests, radiologic studies, and endoscopic techniques are available for the evaluation of the jaundiced patient. Similarly, the therapeutic options have increased with the development and improvement of endoscopic, percutaneous, and laparoscopic procedures, and the morbidity and mortality rates associated with open surgery have decreased. The challenge is to select, on an individual basis, the most efficient and cost-effective evaluation as well as the management with the lowest morbidity and mortality rates and the best short- and long-term goals.
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    Multidisciplinary considerations for patients with cancer of the pancreas or biliary tract
    (2000) Martin, RF; Rossi, RL
    In the past century, operative management has remained the mainstay of therapy for patients with pancreatic and biliary neoplasms. Currently, operative extirpation with clear surgical margins represents the only hope for long-term survival without evidence of disease in patients with these types of tumors. Advances in diagnostic imaging, noninvasive and minimally invasive procedures, anesthetic techniques, and palliative or adjuvant chemotherapy and radiation therapy all have improved the ability to care for patients with these maladies. This article reviews the advances made in these areas.
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    Options and strategies for the management of choledocholithiasis
    (1998) Rosenthal, RJ; Rossi, RL; Martin, RF
    The introduction of laparoscopic techniques for the management of biliary stone disease has expanded the therapeutic choices for surgeons confronted with choledocholithiasis. As new strategies emerge, the treatment of cholelithiasis and choledocholithiasis remains controversial, This paper discusses the options available for the treatment of common bile duct stones, Diagnostic and therapeutic algorithms are proposed, The treatment of these patients must be individualized, taking into consideration the condition of the patient, associated diseases, secondary complications of the gallstones, and the surgical expertise and resources of the institution.
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    Pancreatic autotransplantation in chronic pancreatitis
    (2003) Watkins, JG; Krebs, A; Rossi, RL
    The apancreatic state secondary to resective surgery for chronic pancreatitis is associated with a high rate of late morbidity and mortality that is due, in part, to endocrine insufficiency. Resective procedures should, therefore, be used very selectively. Over the last 2 decades we have seen a shift from extensive distal resections to limited proximal resections. This is because of the lowering of the operative mortality of pancreatic head resection and its better results in pain relief, while preserving in situ the body and tail of the gland with its metabolic functions. Islet autotransplantation and segmental pancreatic autotransplantation were introduced in 1977 and 1978, respectively. Over 150 and 25 cases of these operations have been reported, respectively. Both techniques are evolving with a goal to improve results. Procedures placing the graft in the iliac fossa and anastomosing the pancreatic duct to the jejunum are now favored over groin placement and duct occlusion. Islet autotransplants achieve a higher yield of islet cells and decrease the exocrine impurity of the preparation. Both methods can prevent or delay the onset of diabetes mellitus, and when diabetes mellitus does occur, it is frequently easier to manage. The long-term function of the grafts appears to be dependent on the beta-cell mass available in the diseased pancreas, the loss of cells related to the transplant procedure, and the characteristics of gradual loss of function from the type of transplant used. Although extensive pancreatic resections are occasionally required, the possibility of autotransplantation should be considered in those patients.
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    The acute abdomen - An overview and algorithms
    (1997) Martin, RF; Rossi, RL
    The diagnosis and management of the patient with an acute abdomen remains one of the most difficult challenges for the surgeon. A thorough understanding of the anatomy and physiology of the abdomen are essential to properly generate a differential diagnosis and to formulate a treatment plan. While recent advances in technology can be extremely helpful in certain situations, they cannot replace a physician's clinical judgment based upon a good history and physical examination. This article provides a general overview of the evaluation of the patient with an acute abdomen. It will also suggest algorithms to consider in the diagnosis and treatment of these patients.
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    Thyroid cancer
    (2000) Rossi, RL; Majlis, S; Rossi, RM
    This article presents basic principles and controversies in the management of thyroid cancer, a disease that is increasing worldwide. To treat patients best, a multidisciplinary management protocol provided by experts is favored. Specific management and treatment strategies presented include the use of needle biopsy to evaluate thyroid nodules and the use of radioactive iodine and various prognostic factors to guide surgical therapy.