Biomedical subjects
Publications and source records attributed to A Fianchini.
We describe a variation of the technique of transthoracic forequarter amputation, consisting of a completely anterior approach, removal of the left forequarter en bloc with the chest wall and lung, and sparing of the scapula. This latter bone is mobilized and is used, along with the transposition of the lower ribs, to stabilize the chest wall.
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Restorative proctocolectomy with various types of reservoir is widely used in the elective surgery of ulcerative colitis and familial adenomatous polyposis. Both, advantages and disadvantages of this procedure are well known and documented. Straight ileo-anal anastomosis (IAA) yields unsatisfactory clinical results due to the lack of storage capacity of the distal ileum and the frequency of bowel movements related to high pressure ileal waves. In an attempt to create an alternative to the above procedures, we have performed a straight ileo-anal anastomosis with two rectangular (10 cm x 1 cm) myectomies down to 2 cm, above the anastomotic line. The two myectomies are spaced at 120 degrees to each other and to the mesenteric border of the ileal loop. The rationale of this approach is to reduce the peristaltic drive of the ileum by weakening the muscular wall. This study presents the results in three patients operated on with this new method in the last year.
Congenital cysts of the choledochus and of the glandulae mucosae biliosae are rare anomalies generally observed in pediatric age: it is in fact exceptional to detect them in adults. There seems also to be a difference in the occurrence among the various races since the disease is more frequently seen in the Japanese and in women. In the Western world the incidence of this pathology has rated to be 1 out of 26,000 hospitalizations, consequently the personal experience and familiarity of every surgeon with this disease will be naturally limited. The authors describe the case of a women, aged 21, under observation as carrier of cystoduodenostomy after congenital cyst of the choledochus. A calculosis of the common hepatic duct as well as the stenosis of the previous cystoduodenostomy are also discovered. The abscission of the cyst and the confection of a Roux's en Y loop hepaticojejunostomy with the separation of the previous gastrojejunostomy are then performed. According to the authors, the complete abscission of the cyst and the Roux hepaticojejunostomy should be considered the surgery of choice when the local situation and the patient's general condition allow it because this treatment reduces the occurrence of late postoperative accidents such as lithiasis and cholangitis and the possibility of malignant degeneration of the cyst. Two years after the operation, the patient is in excellent health conditions.
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The present study compared the outcome of a small series of patients (7 cases) who underwent total proctocolectomy without mucosal proctectomy and stapled ileal pouch-anal anastomosis made at the apex of the anal transitional zone, with our previous experience (17 cases) in which the ileal pouch was anastomosed at the dentate line after mucosectomy. Though not statistically significant, our limited experience showed excellent clinical results with better continence and discriminating ability of flatus from faeces in the former group. The resting anal pressure profile was not changed postoperatively. The operation time was significantly reduced compared with our previous approach which was a time-consuming procedure. There was an indication that risk of complications (pelvic sepsis and haemorrhage) was less.
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The authors illustrate the cases of spontaneous pneumothorax observed in their institute along with the diagnostic and therapeutic aspects. In accord with the experience of others as reported in the literature, they stress the importance of a precise, immediate diagnosis for the purposes of adopting the treatment of choice: in the presence of closed, partial forms a conservative approach is to be preferred, whereas in open and/or hypertensive cases an aspirative thoracic drainage must be provided without delay. Aggressive surgical treatment, with resection of the bullous lesions responsible for bronchopleural fistulas, will resolve the condition and should be implemented after a reasonable waiting period with aspirative drainage, or even, electively, in the first instance, in the presence of multiple relapses. In any event, the authors stress the need to avoid uncertainty and delay in view of the youthful age of most of the subjects affected and the potential danger of the complications of this apparently banal disease.
The authors considered a series of 13 patients undergone surgical operation for primary malignant lymphoma of digestive system, with gastric, gastro-jejunal, jejunal, ileal and colic localization. They examined diagnostic and therapeutic features and the follow-up data. According to literature, the authors remark the importance of roentgenology and endoscopy, that together with bioptic data may reach a definite and early diagnosis; an elective and wide surgical exeresis seems useful in early stages, showing a better prognosis and epithelial malignancies. IV stage patients, however, had a very poor survival; a quick management appears today the only factor affecting long-term results in these patients.
The culture technique used proved to be more simple and economical than the different culture methods described in literature. This process permits the in vitro growth of parasites for a period long enough (10 days) to determine the possible activity of drugs. On the 10th day the cultures are infectious.
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The Authors report their experience concerning 10 cases operated on for non-parasitic cysts of liver, among which a case of multicystic liver and a biliary pseudocyst. They emphasize the necessity, in symptomatic patients, for a selective treatment, but, where possible, with complete removal of cystic wall. The interventions performed also include six typical hepatic resections (two right hepatectomies, one of which extended to the fourth segment, and four minor resections), which revealed to be an effective therapeutical means, exempt from significant postoperative complications.
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The indications for transverse taeniamyotomy, and the results obtained on a group of 11 patients, were analyzed. Intraluminal pressure recordings carried out before and one year after operation showed a significant decrease of the mean motility index after both natural and pharmacologic stimuli. The use of such a procedure, even in an early stage of the disease, should be considered.
After a short synthesis of the elements characterising intrahepatic calculosis, and evaluation of the five cases considered, the value of cholangiography (both intravenous and instrumental) and of radio-scintiscanning with Bengal Rose marked with I131 in pre-operative diagnosis is stressed. The intra-operative use of choledochoscopy in conjunction with cholangiography is recommended. With regard to treatment, it must ensure removal of the calculi and create an ample biliodigestive communication (papillectomy or, even better, hepaticojejunostomy on excluded Roux loop) in order to prevent recurrences. In order to visualise the intrahepatic branches of the bile ducts, the removal of the hilar plaque is advised, possibly combined with sagittal scissurectomy or mobilisation of the 4th segment. In conclusion it is asserted that correctly performed surgical treatment is the only means of offering permanent cure.
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In a group of patients with arterial pulmonary hypertension of various origin, the relationship between the relative magnitude of the "a" wave of the right apex-cardiogram (ACG) to the total deflection of the ACG ("a/H ratio") to both the right atrial "a" wave and the right ventricular end-diastolic pressure was studied. Both correlations were statistically significant. The results obtained confirm the ACG value in the non invasive study of the right ventricular function.