Biomedical subjects
Publications and source records attributed to A Carditello.
The authors reviewed their series of thyroid cancers and analyzed possible factors of the low incidence of these neoplasms in their experience. They outline the importance of total thyroidectomy which must be performed as soon as possible. Cervical lymphadenectomy must be reserved only to papillary cancers in which intraoperative histologic examination give the evidence of multiple metastasis of cervical nodes.
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Since january 1970-december 1982, 58 patients underwent emergently appendectomy for acute appendicitis. 31 (53,4 percent) where males; the average age was 21 +/- 2,3 years (M +/- SEM). The duration of symptoms ranged from 1-6 hours (10,3 percent of cases) to over 48 hours, before the hospital admission (15,4 percent of cases). 27 patients (46,5 percent) had a clinical examination at home by a physician. 21 patients (36,4 percent) came to hospital emergency unit without previous physical examination; 10 (17,2 percent) were transferred from other departments. In 6,9 percent of cases was present a perforated appendicitis with peritonitis. During operation, in 50 percent of patients was performed a therapeutic peritoneal lavage. In 63,7 percent of cases multiple drains were placed in peritoneal cavity. In all patients was effected postoperative antibiotic profilaxis. The mortality rate was 3,4 percent. General complications were observed more in patients with perforated appendicitis. This review suggests the following remarcable data: morbidity of this disease is still high; the physical examination is more important than laboratory work (especially in the elderly patients, which are often immunodepressed and in children, with leucocitosis-lack at hospital admission); early surgery is the most important factor to the improvement of prognosis in these cases and the results of surgical treatment are improved by large vertical incisions, peritoneal lavage and application of multiple intracavitary drains.
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Out of 116 cases of abdominal trauma observed, 6 (23%) consisted of hepatic lesions. In 2 cases (33.3%) the hepatic lesion was isolated. In the other cases, it was associated with lesions to the diaphragm, duodenum, pancreas or thorax. After emphasis on the gravity of such lesions and the high mortality rate (33.3% in the cases observed) the factors contributing to the extremely gloomy prognosis are discussed and the basic therapeutic approach to injuries of varying gravity is outlined.
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Results are reported from a study on the presence and concentration of nitrites and nitroso-compounds in the gastric juice of 53 patients operated on for duodenal ulcer and in 15 controls. The investigations were made after various postoperative intervals. In the patients who had undergone Billroth II operation, the concentrations of nitrites and of nitroso-compounds were higher than in those with Billroth I operation and in the controls. It is concluded that patients with Billroth II operation may be particularly susceptible to subsequent primary neoplasm of the gastric stump, as a result of the carcinogenic action of these substances.
From 1971 to 1982, 126 blunt thoraco-abdominal trauma were seen: in 9 cases (7,1%), diaphragmatic rupture was present. Automobile accidents were the most frequent cause of diaphragmatic rupture and, in only one case, the injury was single. Diaphragmatic rupture was suspected preoperatively in two patients, who had positive physical and radiologic chest findings. The lesion was seen intraoperatively in the other patients, who underwent surgical operation because of severe intra-abdominal injuries. In the author's experience, roentgenologic examinations and adjuntive studies were not important for diagnosis of diaphragmatic injuries. Surgical treatment depended on entity of associated intra-abdominal and intrathoracic injuries, especially in patients observed during immediate post-traumatic period. Authors conclude that single diaphragmatic injury, generally, give no surgical or prognostic problems. High mortality rate seen in these patients is due to multiple organ involvement.
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A recently observed personal case of spontaneous cholecystospontaneous fistula is reported. Factors leading to the relative infrequency of this form in recent years are described, and its rarity is demonstrated by the fact that the case reported was the first to be noted in about 1000 operations on the bile ducts. A brief account of the genesis, diagnosis and treatment of the condition is given. The interest of the case lay in the unusual site of the orifice (epigastrium).
In veiw of the interest represented by the possible development of cholelithiasis after peptic ulcer surgery, the authors report their results in 848 patients undergoing surgery for peptic ulcer, 521 were followed up in order to determine whether the biliary complication developed and in how many cases. They conclude that their results showed nothing which might support the possibility of the development of cholelithiasis after any from of surgery for peptic ulcer.
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From 1990 to 1997, 12 patients with Zenker's diverticulum underwent TA 30-stapler diverticulectomy and cricopharyngeal myotomy. All patients were operated on under local anaesthesia. No death was observed. In two cases subcutaneous infection was drained with recovery. No post-operative fistulas were observed with radiologic control. At 6 months follow-up all patients were well. Advantages of both stapler diverticulectomy and local anesthesia are outlined.