Biomedical subjects
Publications and source records attributed to A Milazzo.
Following a brief review of the various types of local anesthesia, including a recent method using EMLA cream, the paper focuses on the different complications which arise in relation to the technique used. Treatment protocols are also analysed in relation to the toxic stage.
The influence of prostaglandins on renal function changes induced by furosemide was analyzed in 21 non-azotemic cirrhotic patients with ascites. Patients were studied in two periods of 120 min immediately before and after furosemide infusion (20 mg, ev). Furosemide caused an increase in creatinine clearance in 15 patients (group A: 99 +/- 7 vs. 129 +/- 5 ml/min; mean +/- S.E.) and a reduction in the remaining six (group B: 102 +/- 13 vs. 71 +/- 9 ml/min). Parallel changes were observed in the urinary excretion of 6-Keto-prostaglandin-F1 alpha (metabolite of renal prostacyclin) which augmented after furosemide in 14 of the 15 patients from group A (478 +/- 107 vs. 1034 +/- 159 pg/min, p less than 0.001) and decreased in all patients from group B (1032 +/- 240 vs. 548 +/- 136 pg/min, p less than 0.05). In contrast, the urinary excretion of prostaglandin E2 was stimulated by furosemide in all patients (group A, 92 +/- 19 vs. 448 +/- 60 pg/min, p less than 0.001; and group B, 209 +/- 63 vs. 361 +/- 25 pg/min, p less than 0.05). In all of the patients furosemide-induced changes (post- minus pre-furosemide values) in creatinine clearance were closely correlated in a direct and linear fashion with those in 6-Keto-prostaglandin-F1 alpha (r = 0.74; p less than 0.001). These changes were associated with a higher furosemide-induced natriuresis in group A than in group B (641 +/- 68 vs. 302 +/- 46 mumol/min, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
We present a series of 76 patients operated over a period of nine years, diagnosed as gastric cancer (CG), in whom radical oncologic total gastrectomy (GT) with esophago-jejunal anastomosis (EY) on a Roux-en-Y loop (Y-R) was performed. The tumor was located in the cardias in 27 patients, body in 37, fornix in 3, gastric stump in 7 and over plastic linitis in 2. We performed total gastrectomy enlarged to the spleen in 63 patients, to the pancreas in 28, to the colon in 5 and to the liver in 4. We describe the most salient technical details of the surgical intervention. Twenty-six percent of the patients presented postoperative complications, which we divided into two groups: anastomosis failures, among which are emphasized 4 severe esophagojejunal fistulas, a fistula of the duodenal stump (MD) and respiratory complications. The mortality was 7.8%, corresponding to 4 esophago-jejunal fistulas, 1 fistula of the duodenal stump and 1 bilateral bronchopneumonia. We analyzed various parameters that we consider important prognostic indicators of postoperative morbi-mortality. Applying the Fischer test, we attempted to assign statistical significance to these parameters. Age over 60 years increased postoperative mortality. Super-radical surgery did not increase mortality. On the other hand, patients in stages IIIb and IV have a worse prognosis, with a mortality in the first 30 days of 28.5%. Esophago-jejunal anastomosis on a Roux-en-Y loop is the procedure of choice used by our center after total gastrectomy for gastric cancer, yielding the most acceptable morbi-mortality figures.
We present 7 personal cases of Boerhaave syndrome, 6 treated surgically and one managed with conservative measures. Boerhaave's syndrome is one of the most serious gastro-intestinal perforation pictures. Although its frequency is scant, because of its seriousness it is important to be aware of it for early diagnosis. While a prompt diagnosis is important in any pathology, it is even more so in this syndrome since there is a clear relationship between the time lapse from perforation to the onset of treatment and the rate of survival. Although we present one case cured medically, this is exceptional and treatment is eminently surgical and should be as early as possible. The technique that provides the best results and an excellent morbimortality rate in relation to efficacy is primary suture followed by a fundal patch. In delayed cases with patients in deteriorated condition, other techniques can be considered. Due to its initial severity and a tendency to postoperative complications, the patient should be closely controlled, and correct antibiotic therapy and complete parenteral support nutrition are very important in treatment.
The effect of spironolactone on the urinary excretion of prostaglandins was studied in patients with liver cirrhosis and ascites. Patients were kept in bed and given a sodium-restricted diet for at least 4 days before spironolactone treatment was considered. Starting from the 5th day of protocol, patients were treated with this diuretic if their spontaneous weight loss had been less than 600 g during the 2 previous days. Patients were distributed in groups according to weight loss during the first 4 days on diuretic therapy: Group I (high responders), II (medium responders) and III (low responders). Group I patients showed higher basal values (4th day of protocol) of urinary sodium (P less than 0.02) and urinary 6-keto-PGF1 alpha (P less than 0.02) than the other patients, but there were no significant differences in the basal excretion rates of PGE2 nor TXB2 among the groups. The therapeutic requirement for spironolactone treatment in patients from Group I was delayed as compared with the other two groups (P less than 0.001) due to the fact that their spontaneous weight loss took place over a long period. For all patients, spironolactone administration produced a significant increase in 6-keto-PGF1 alpha excretion (P less than 0.01) without affecting significantly urinary elimination of PGE2 nor TXB2. A close relationship was found between the spironolactone-induced increments in urinary sodium and urinary 6-keto-PGF1 alpha excretion (r = 0.74, P less than 0.001). It is suggested that the ability of the kidney to synthetize prostacyclin can influence the natriuretic response to spironolactone therapy in patients with liver cirrhosis.
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