Biomedical subjects
Publications and source records attributed to B Albertino.
The authors report a case of perineal leiomyosarcoma treated using a combined surgical and radiotherapy protocol. Exeresis was performed through an incision in the left anterior perineum, beside the vagina. The patient then underwent TCT with excellent results.
The paper reports a case of ureteral [correction of urethral] stenosis with ureterorectal [correction of urethro-rectal] fistula due to diverticulitis of the sigmoid [correction of sigma] which resolved following reconstruction of the urinary tract by ureterocystostomy [correction of urethrocystotomy] using a modified version of Boari's technique, with satisfactory renal functional recovery. On the basis of an analysis of the literature, the authors comment on ureteral [correction of urethral] stenosis and its etiological diagnosis.
A case of pseudocyst of the suprarenal gland in a 32-years-old woman is reported. Stress is laid on the description of the clinical case and the diagnostic and therapeutic problems involved are reviewed.
The Authors report a case of Castleman's disease in a 45-year-old woman. She was admitted to hospital because of a thrombophlebitis of the left lower limb. An abdominal echotomography showed evidence of a mass with a diameter of about 6 cm at the pancreatic isthmus, and a cyst (diameter 25 mm) in the right ovary. An explorative laparotomy was performed and the masses were removed. Histological examination identified them respectively as a Castleman's disease of hyaline-vascular type and an endometrioid carcinoma of the ovary.
The Authors contribute their experience covering 228 cases of esophagoplasty after esophagectomy for cancer of the esophagus and of the esophagogastric junction, from 1980 to 1989. Thirty four of these patients (24 EGP, 8 EDP, 2 ECP) underwent accurate functional investigation by X-ray, manometry, pH-metry and scintigraphy. The investigation into esophagogastroplasty in particular revealed that the transposed organ is devoid of motor activity and that emptying is therefore achieved by gravity. It was also shown that the entity of the alkaline, acid and mixed-type reflux is linked to the site of the anastomosis: greater proximity of the anastomosis translates into lower involvement. An investigation into esophagojejunoplasty, instead, highlighted normal motor function: no cases presented reflux of the alkaline type. The two cases of colon plasty investigated presented efficient emptying even though manometry could not detect the presence of motor waves of the propulsive type. The authors conclude that, although the jejunum constitutes the best prosthetic element to transpose from the functional point of view, highly inconsistent and precarious vascularization limits the use of this organ to the higher anastomoses only. Therefore the Authors claim that the stomach, despite its tendency to behave as an inert tube, is still the best choice for transpositions following esophagectomy.
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A case of biliary cystadenoma is reported. The neoplasm was located at the left lobe of the liver and its diameter was 18 cm. It presented with abdominal swelling and palpable mass in epigastric region. A left hepatectomy was performed, to achieve a complete resection of the tumor.
At first, the authors mention indications and way of placement of the Angelchik prosthesis. Then after a wide review of the literature, they describe the complications and results. Finally a case of penetration into the stomach of an Angelchik prosthesis is reported. It was favourably resolved by an operation.
The paper reports the epidemiology and causal factors of esophageal carcinoma, and compares the authors' personal experience with already published data. The clinical importance of epidemiology is stressed as a means of identifying risk factors for esophageal carcinoma, thus aiding an early diagnosis. The authors underline the central role of surgery in the treatment of esophageal carcinoma.
The results obtained in the study of the pre- and postoperative immunological picture in 25 patients suffering from carcinoma of the pavement epithelium of the oesophagus are reported. From this study it emerges that in the preoperative period, the serum levels of immunoglobulin and complement as well as the lymphocyte subpopulations do not present significant changes, whereas 44% of the patients present cell-mediated immunity certified by the skin test. On the other hand, in the postoperative period there is a sharp reduction in the OKT4/8 ratio due in the main to a relative increase in suppressor lymphocytes. In conclusion, the value of skin tests in "in vivo" anergic patient research is underlined, evidencing the need for a programme of immunostimulation in the postoperative period.
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The search for early tumour markers has brought to light CA 19-9 and CA 50, glycoproteins recognised by monoclonal antibodies. Since these markers are mainly used on the digestive tract it was thought useful to investigate their value in the diagnosis of lung cancer which is only rarely identified by markers in its early stages. The two markers were compared with the better known CEA on 43 healthy volunteers, 42 patients with chronic lung conditions, 26 people with localised non-neoplastic lung shadows and 255 patients with staged and histologically identified lung tumours. The results obtained reveal the two markers to be of little use in lung cancer since though satisfactorily specific they are not at all sensitive even in the advanced stages of the disease. They could however be used to advise against surgery if positive.
Neurone-specific enolase, a serum marker of neuroendocrine tumours has been determined in small-cell anaplastic bronchial carcinomas, in typical and atypical carcinoid. The marker presents good sensitivity in small-cell tumours and in atypical carcinoids, while blood levels are within normal limits in cases of typical carcinoid. The low serum levels of neurone-specific enolase found in typical carcinoid suggest a failure of the enzyme to express itself in the circulation owing to the poor or lack of cellular necrosis.
In the context of major surgery the predictive significance of respiratory function tests in relation to postoperative pleuro-pulmonary complications is assessed. A statistical analysis is performed on a series of 85 oesophagectomy after thoracotomy and laparotomy. The most significant respiratory function indices are found to be those relating to volume restriction and the Mottley index.
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The paper reports the authors' ten-year experience of the surgical treatment of cancer of the esophagus. A total of 625 patients with esophageal carcinoma were observed during the period 1980-89 of whom 490 were admitted to hospital and, of the latter, 172 (35.1%) were operated with a sectile rate of 86% (148 patients). Data from this period were analysed both retrospectively and prospectively using a computerised system. There were 105 radical operations (70.9%) and 43 palliative operations (29.1%). The 3-year actuarial survival rate was 21.7% and the difference between radical and palliative resections was at the limit of significance (p less than 0.1).