Biomedical subjects
Publications and source records attributed to A Quiroli.
A case of diffuse rectocolonic melanosis in association with severely dysplasic recurring multiple adenomas is reported. The rarity of the condition gives rise to remarks based on a review of recent literature on the subject.
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A clinical and statistical comparison a is made of the surgical frequency of cases of varicothrombophlebitis in 1972-1976 (10.8%), as reported in 1977, and 1977-1978 (38,3%). An objective assessment is made of this increase and its current interest. The degree of understanding reached by the general practitioner and patients of their district is held to be responsible for the increase. Stress is laid on the advantages of early surgery and some of its techniques. Medical management, on the other hand, not only delays surgical resolution, but also encourages the onset of complications that may convert an apparently benign disease into a crippling, or even mortal form (extension of the thrombophlebitic process to the deep circulation, followed by post-thrombotic syndromes, pulmonary embolism, ecc.). Two benefits to society are confered by surgical management: 1) rapid and final cure with a short hospital stay, low cost of theraputic aids, ecc.; 2) early and completion re-insertion of the patient into his social and working surroundings, free of the sense of psychological frustration brought about by the mistaken and general conviction that an unattainable, final cure has in fact been achieved.
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A case of enterogenous cyst of the mesosigmoid, exceptional for its abrupt onset and rapid course is reported in a woman of 65. Preoperative diagnosis at this age in practically impossible, but the operation and refined histological development is always unpredictable and never negligible. Although there was no presence of aetiopathogenetic originality, presentation and study of the clinical case had the purpose of informing the surgeon that surprises must always be notified, just as must any exceptionally rare anatomopathological finding.
After reviewing the modifications that have been made to the gastroduodenal resection technique according to Billroth II, a comparatively original solution is put forward. This involves subtotal resection of the stomach with simultaneous removal of the large omentum, followed by gastro-jejunal anstomosis "oralis inferior minima" and suspension of the afferent ansa at the oesophago-cardial angle. Original diagrams illustrate the practical impossibility of reflow into the afferent ansa, demonstrated in practice by short- and long-term postoperative radiography. The other advantages of the technique lie in the absolute lack of postcibal and nutritional syndromes, in the increase in body weight and in a number of sero-haematic parameters and, finally, in the complete recovery of the patients.
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The methods of treatment used in the cure of simple and complicated lower extremity varices are described. These conditions are found in about 10% of the population throughout the civilised world and their social and economic repercussions are by no means negligible. The lines of surgical management dictated by the latest view of the pathogenesis and physio-pathology of these varices are explained. Treatment is by no means simples or of secondary importance with respect to the surgery of other vascular sectors. Emphasis is placed on the high percentage of recurrences. These are the result of mistakes in surgical technique or inadequate sclerosing management, as shown in the literature. Postoperative cure and the absence of local inflammation or infection come from the employment of non-reabsorbable, inert and very thin threads, rational in addition to the methodical use of widely diffusible antibiotics, fibrinolytics, and modern platelect anti-clumping agents.
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The aetiopathogenesis of varicothrombophlebitis and its frequency in terms of age and sex are examined in the light of the leading discussions in the literature. The prevention and treatment of its main complications are also discussed. Clinical and statistical data drawn from a personal series collected over a period of about 8 yr are presented. A personal opinion is expressed on the question of treatment. It is felt that the steps taken in any given situation will depend on the extent of the process. Immediate surgery (extended preventive crossectomy, or radical management of thrombotic varices) must be accompanied by suitable general and local medical management.
The literature data concerning the incidence of Meckel's diverticulum in the adult and the frequency of its complications are examined and problems associated with the preoperative diagnosis of this form are discussed. Reference is made to the limitations of abdominal scintiscanning and the encouraging results obtained with superior mesenteric arteriography in diverticular bleeding. Five cases of Meckel's diverticulum in the adult are presented. Stress is placed on the need to explore the ileum during appendicectomy to enable diverticula to be detected and removed, since they are often the cause or the site of complications, even in the adult.
A surgical therapy model for dermohypodermic sclerosis and varicose ulcer of the lower extremities is presented. This consists of extending the method described by Martorell in 1955 to cases of inveterate ulcer. The pre-, intra- and post-operative colour diagrams and figures presented show the validity of the method without superseding lengthier and more complex methods.
The latest findings in varicose relapses of the lower extremities are described, and the most significant bibliographic data discussed. The most frequent causes, the anatomo-topographical distribution and the causal therapy are examined. It is also point out that recurrent varices occur much less frequently than some years ago, the reason being knowledge of the disease's aetiology and hence of the most rational, radical treatment for it. In presenting 25 operations, 15 of them for post-operative recurrence and 10 for recurrences following sclerosing therapy, it is pointed out that out of 518 cases of varicose veins operated on in the Department since 1971, no case of varicose recurrence has ever been encountered. This is attributed to the eclecticism and rigour of the surgical technique. Stress is laid on the words of Martinet and Tubiana in 1950 "...treatment of varicose veins is far from being as simple as many believe...". Treatment must in fact be chosen case by case.
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