Biomedical subjects
Publications and source records attributed to C Bassi.
The authors report three cases of endobronchial lipoma, and study the etiopathogenesis and the main clinical and therapeutical aspects of such neoplasiae. Both diagnosis and treatment should be timely, in order to prevent irreversible damages to lung parenchyma, compelling surgeons to mutilating operations making the function of the apparatus heavier.
The authors show a casuistry of 125 operations of SPV, and comment on the clinical and physiopathologic presuppositions justifying the indications to SPV in the field of gastroduodenal peptic pathology. They report the results of the gastric probings, both basal and after stimulation with pentagastrin in the pre- and postoperative phase, and after a year. They face the problem of pyloroplastics, and appraise the elements indicating and contra-indicating it in association to SPV.
The analgesic effect of two doses (1.8 and 3.6 g) of acetylsalicylate of lysine and two doses (30 and 60 mg) of pentazocine was studied after random administration to 40 patients who had undergone cholecystectomy. The experimental pattern was a four-point bio-assay and pain intensity was assessed on a 0 to 100 algesimetric scale by the patients themselves upon administration of the analgesic and after 30, 60 and 120 minutes. The analgesic of acetylsalicylate of lysine proved dose-dependent with a power ratio with respect to pentazocine of between 43 and 65.
A new case for mosaicism for an extra small ring chromosome is described in a 13-year-old girl with minimal phenotype anomalies and moderate mental retardation. The origin of the extra chromosome could not be determined either cytogenetically or clinically. The present case is compared with six similar cases in the literature.
The AA. report one case of "choleretroperitoneum". They discuss the techniques of diagnosis that they have used, outlining the importance of A.C.T. (Axial Computerizing Tomography) and of Transduodenoscopic Cliolangiography, that have permitted a preoperative diagnosis and an exact surgical treatment of this case.
On the basis of angiographic documentations the Authors report on 4 observations (3 men and 1 woman) of extrinsic compression of the coeliac trunk symptomatologically evidenced through abdominal pain attacks. All the patients were treated surgically by resection of the median arcuate ligament of the diaphragm. In one case distal pancreatic resection was also performed on account of accompanying chronic pancreatitis. The long-term results were excellent in 3 cases, and good in 1. The diagnosis and surgical indication were made possible after repeated biochemical and instrumental investigations in order to exclude different pathologies (vascular, biliary, pancreatic, gastrointestinal) which might account for the reported symptoms. There is still discussion on the unresolved problem of the pathogenesis of the pain, as well as on surgical tactic and the advisability of completing resection of the arcuate ligament by sympathicectomy or coeliac ganglionectomy.
The use of recently introduced methods such as computerised axial tomography (CAT), in addition to endoscopic retrograde cholangiopancreatography (ERCP), has in recent years led to attainment of new targets in the diagnosis of pancreatic diseases. The Authors present a clinical case of massive and recurring left pleural effusion in a patient with a pseudocyst at the level of the cauda pancreatis. They report the clinico-diagnostico-instrumental factors leading to pre-operative diagnosis of pseudocystic-pleural fistula.
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In this paper the Authors describe two cases of carcinoma of the lung with cavitary aspects that came under their observation. There are various hypotheses on the formation of such cavities: it is possible that the neoplastic cells may have a growth trend in a centrifugal direction, or that the cavity is due to a necroic-colliquaive process of the mass itself or to extensive phenomena of autophagism. In other cases the neoplastic cells carpet already existing air cysts, giving the appearance of thin wall cavitation. It is precisely this type of cavitation that poses problems of differential diagnosis. In fact, when other instrumental investigations such as bronchoscopy or needle biopsy, always combined with cytology of the sputum, are not decisive, a relatively certain diagnosis can be obtained only by observing the evolution of the picture for some time, as was the case in the patients referred to above.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
This is a report on 108 cases collected from 1970 to 1987, in the same department, of surgically-detected pancreatic abscesses or pus-harboring collections. The purulent areas were either of a spreading pattern or represented a clearly localized mass. To the spreading pattern belong 47 cases of necrotizing pancreatitis, without discontinuity in the clinical course from the early toxic to the late septic phase, 4 cases of acute pancreatitis, initially in remission and later complicated by septic collections, and 4 cases which developed after an acute attack of chronic pancreatitis. The abscess pattern was made up of 19 each of pseudocysts and predisposing pancreatitis, 10 cases of chronic pancreatitis, and only 5 necrotizing "nonstop" pancreatitis. The surgical treatment in all cases consisted of multiple drainages and postoperative irrigation. We exclude 3 cases of associated open packing. The etiological, clinical, and biochemical features of each group of patients are reported and discussed. Computed tomography availability seems to be the most important improvement reported as regards diagnosis and surgical tactics. The overall mortality rate was 15.7% with a significant difference between the 2 patterns (23.6% for the spreading pattern versus 7.5% for the abscess pattern). On the basis of this experience, it is possible to establish a relationship between the gross appearance of the collection and the underlying pancreatic disease with differences in terms of prognosis, morbidity, and mortality. Finally, a simple nomenclature can be chosen which is capable of distinguishing between the diverse pancreatic purulent collections. While the presence of pus may characterize the course of severe acute pancreatitis in many cases, the low incidence of "true" pancreatic abscess is emphasized.
The majority of deaths in severe pancreatitis are the result of superinfection of necrotic tissue. The pathogen most commonly responsible for such infections is Escherichia coli. Antibiotic prophylaxis would appear a logical precaution. The antibacterial drugs of choice should possess two basic characteristics: they must be active against the flora responsible for the infections and must be capable of penetrating into the pancreas at adequate minimum inhibitory concentrations (MICs). Mezlocillin--which is active against E. coli--has been shown to possess the latter requisite, but achieving therapeutic concentrations requires administration at high doses. In the present study, pure human pancreatic fluid showed properties similar to those observed in the dog against E. coli (bacterial colony growth 100 times lower than in a control culture) and produced a 75% reduction in mezlocillin MICs against this organism. These enhancing characteristics might make the commonly used doses sufficient for prophylactic purposes.
AIM: To assess whether patients with misdiagnoses of chronic pancreatitis (CP), followed at an early stage by a diagnosis of pancreatic cancer (PCr), present different epidemiological characteristics from patients suffering either from CP alone or from CP with late degeneration to PCr. METHODS: We arbitrarily subdivided our patient series into three groups: (1) 12 CP who developed PCr within 4 years after onset of symptoms; (2) 12 CP developing PCr after the 4th year, and (3) 701 CP with no subsequent development of PCr. The variables studied were age, sex, drinking and smoking habits, tumor localization, and presence of intraductal calcifications and diabetes mellitus at the time of diagnosis of CP. RESULTS: There were no significant differences between CP and 'late' PCr in any of the study variables considered. As compared with the CP group, the 'early' PCr cases were older (58.7 vs. 40.7 years; p < 0.0001), with a lower proportion of males (58 vs. 88%; p < 0.01), smaller proportions of both smokers (42 vs. 88%; p < 0.0001) and subjects drinking more than 40 g of alcohol/day (42 vs. 86%; p < 0. 0001), and a greater incidence of non-insulin-dependent diabetics at the time of diagnosis of CP (25 vs. 3.7%; p < 0.012). As compared with the 'late' PCr group, the malignancies in the 'early' PCr cases were more often located in the head of the pancreas (100 vs. 50%; p < 0.01). Multivariate logistic regression analysis selected age over 50 (odds ratio OR 13.5, 95% confidence interval CI 2.79-65.5; p < 0. 001), smoking habits (OR 0.14, 95% CI 0.04-0.49; p < 0.002), and non-insulin-dependent diabetes (OR 5.91, 95% CI 1.20-29.1; p < 0. 028) as variables identifying subjects with 'early' PCr. CONCLUSIONS: A high suspicion of a pancreatic tumor is necessary when CP is diagnosed in a patient with atypical epidemiological characteristics for this condition, possibly female, aged over 50, who is not a smoker or drinker, and suffers from non-insulin-dependent diabetes.
Quality of life (Qol) assessment is a mandatory endpoint of cancer clinical trials. Little research has been conducted on pancreatic cancer (Pc) and no disease specific Qol questionnaire exists. We report on the development of the European Organization for Research and Treatment of Cancer (EORTC) Pc Qol module to supplement the core cancer module (QLQ-C30). Literature research and qualitative interviews with 6 specialists and 34 patients in the UK were followed by construction of a questionnaire, a peer review by international specialists and EORTC. Administration of the QLQ-C 30, a provisional Pc module and a qualitative debriefing interview was performed on 78 patients in 8 countries stratified into groups by disease stage and treatment intention. Pretesting identified that 23/26 questions had an adequate internal reliability (Cronbach's alpha > 0.7) and construct validity (Pearson's r 0.4-0.6). The median time of completion was 12 mins. Qualitative analysis indicates that the module is easy to complete and cross culturally applicable. The EORTC QLO-PAN 26 includes 26 items covering symptoms, body image, sexuality and the emotional and social consequences of Pc. It is intended for use in patients undergoing clinical trials for pancreatic cancer including surgery, chemotherapy and radiotherapy and will allow the detection of small but clinically meaningful differences in clinical trials for Pc.
Even in centers where the first choice in the surgical treatment of chronic pancreatitis is a derivative procedure some selected patients require resection. The most popular solution of gastrointestinal reconstruction still seems to be pancreaticojejunostomy but, the review of the reported experiences, suggests a general trend towards anastomosis with the stomach as a recent policy. A reliable comparison between pancreaticogastrostomy and pancreaticojejunostomy is difficult because the reported series are seldom related to chronic pancreatitis patients only, but are reporting mixed date concerning mainly periampullary cancer. Moreover with only one exception no prospective randomised clinical trails are available; unfortunately the positive trend in favour of pancreaticogastrostomy reported in uncontrolled studies is not confirmed in the randomized setting. Also the comparison between the experiences achieved by the present authors working in centers with different approach to the pancreatic anastomosis does not show statistical significant difference for both morbidity and mortality. In conclusion nowadays the best confidence and experience with any of the two methods represents the basis of choice.