Biomedical subjects
Publications and source records attributed to C Redaelli.
Postsurgical or spontaneous iris cyst is a rare finding. Unfortunately, all treatments are complicated and the results may be disappointing. We report a case of postsurgical iris cyst treated by sector iridectomy with satisfactory recovery of visual acuity.
BACKGROUND: Leakage of oesophagogastric anastomosis has been associated with poor perfusion of the gastric tube. The authors recently developed a new form of gastroplasty, preserving not only the arterial arcade along the greater curvature, but also the lesser curvature. In this study their first clinical experience with that gastric tube is reported. METHODS: Thirty-five patients undergoing either oesophagectomy or laryngopharyngo-oesophagectomy for malignant lesions and substitution of the oesophagus with a funds rotation gastroplasty were included. Patient outcome, including anastomotic leak, hospital mortality and morbidity rates, were studied prospectively. RESULTS: Hospital mortality rate was one of 35 and anastomotic leak (one minor, one moderate) was found in two patients with no subsequent mortality. Further major morbidity included pulmonary dysfunction in the form of acute respiratory distress syndrome (ARDS) in seven patients. Mean (s.e.m.) hospital stay was 27(19) days, and 21(9) days in patients who did not develop ARDS. CONCLUSION: Fundus rotation is a new method of gastroplasty that allows safe anastomosis of the tube with the remaining oesophagus or pharynx and is associated with a low leak rate even at high cervical levels.
BACKGROUND: Splanchnic macrocirculatory changes during high-pressure CO2 pneumoperitoneum include a decrease in mesenteric arterial blood flow, and decreased gastric perfusion with a drop in gastric pH in experimental studies. Microcirculatory changes in abdominal organs under clinical conditions with a low pressure CO2 pneumoperitoneum are unknown. STUDY DESIGN: In 18 patients undergoing routine laparoscopy with a CO2 pneumoperitoneum (7 symptomatic cholecystolithiasis, 3 acute cholecystitis, and 8 acute appendicitis) gastric, duodenal, jejunal, colonic, hepatic, and peritoneal blood flow was measured with a custom-made laser Doppler flow probe at an intra-abdominal pressure of 0, 10, and 15 mm Hg. RESULTS: Intra-abdominal pressure elevation from 10 mm Hg to 15 mm Hg significantly decreased the blood flow in the stomach by 40 percent to 54 percent, the jejunum by 32 percent, the colon by 44 percent, the liver by 39 percent, the parietal peritoneum by 60 percent, and the duodenum by 11 percent. Splanchnic blood flow decreased with operative time at a constant intra-arterial pressure (r = 0.88, p < 0.0001). CONCLUSIONS: From our study, we concluded that laparoscopic procedures with a CO2 pneumoperitoneum should be performed at a pressure of 10 mm Hg or lower to avoid splanchnic microcirculatory disturbances.
Poor perfusion of the gastric substitute in esophageal replacement frequently causes anastomotic break down. In this in vivo study we assessed gastric microperfusion before, during, and after gastric tube formation by means of laser Doppler flowmetry in 11 patients undergoing esophagectomy for esophageal cancer. Baseline blood flux along the greater curvature was 323 +/- 57, 167 +/- 28, and 190 +/- 44 perfusion units (PU) and along the lesser curvature 222 +/- 44 and 227 +/- 46 PU. Blood flux was significantly higher in close proximity to tumor-infiltrated areas (819 +/- 172 and 879 +/- 119 PU, P < 0.03 and P < 0.008 compared to normal stomach). Dissection of the gastrocolic ligament and the left gastric artery reduced gastric blood flux along the greater curvature to 69 +/- 21, 79 +/- 19, and 155 +/- 61 PU. Elongation and transformation of the stomach to a gastric tube further reduced blood flux in the stomach especially at the fundus. In this study laser Doppler flowmetry was a valuable tool to assess microcirculatory changes during gastric tube formation as well as pathological blood flow in tumor bearing areas of the stomach in vivo. Quantification of the perfusion of gastric tubes in esophageal replacement might help prevent ischemia-induced anastomotic breakdown.
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Damage to the spinal cord in course of the treatment of diseases of the infrarenal aorta is a rare but calamitous complication. The reported incidence is about 0.2%. The neurological loss is usually complete flaccid paraplegia with high mortality and rare full or partial recovery. Between 1980 and 1991, 1070 reconstructive procedures of the infrarenal aorta were performed: 821 due to aneurysm (316 elective procedures [mortality 1.6%] and 505 emergency procedures [mortality 24.5%]) and 249 due to aorto-iliac occlusive disease. Damage to the spinal cord occurred in 2 patients (2/1070, 0.19%). One patient had incomplete paraparesis following repair of an unruptured abdominal aortic aneurysm with gradual return of all neurological symptoms to normal. The second patient developed complete paraplegia following repair of a ruptured infrarenal aneurysm. There war no recovery of the symptoms. The patient died from septicaemia 4 months later.
BACKGROUND: Urgent operation for ruptured aneurysm is still associated with a high operative mortality rate. The purpose of the study was to determine the risk factors that truly influence early complications and death. METHODS: Between 1979 and 1991, 314 consecutive patients with a mean age of 69 years were treated surgically for a ruptured infrarenal abdominal aortic aneurysm. Twenty-two preoperative, perioperative, and intraoperative variables were subjected to a multivariate analysis to identify the independent predictors. RESULTS: Early death occurred in 92 (29%) of 340 patients. Significant primary predictors for early death were duration of cross-clamp (p < 0.0001), preoperative shock (p = 0.0005), suprarenal cross clamp (p = 0.002), and a history of coronary artery disease (CAD) (p = 0.004). The following postoperative complications were risk factors for death: myocardial failure (p < 0.0001), renal failure (p < 0.0001), sepsis (p = 0.01), and colon ischemia (p = 0.03). Predictors for postoperative myocardial insufficiency were a history of CAD (p < 0.0001), amount of intraoperative volume substitution (p < 0.0001), suprarenal cross clamp (p = 0.0007), and preoperative shock (p = 0.05). CONCLUSIONS: Preoperative and perioperative risk factors that result in fatal postoperative complications can be partially influenced by the surgeon. Short clamping time and infrarenal position of aortic clamp may lower overall early mortality rates. A history of CAD is a highly significant predictor for postoperative complications and early death.
Successful total removal of a renal cell carcinoma extending through the tricuspid valve into the right ventricle is reported. The rarity of this case prompted a review of the literature in which only right atrium involvement in this type of tumor was found.
Rotator cuff tear is an extremely common and important disease. An extensive rotator cuff tear is an incapacitating event and remains a major problem which forces to respect to the management. The late outcome of majors ruptures of such tears are often a defect-arthropathy with a complete destroy of the shoulder and a loss of flexibility caused by pain. The deltoid muscle plasty, as the logical reconstruction method and relatively easy to perform, lead to better results in compare to all the variety of surgical treatments of restoring the anatomical continuity. This article reviews the clinical manifestations, operative technique and the results associated with the treatment by deltoid muscle plasty. Based on the results. Based on the results of flexibility, and postoperative pain in shoulder we conclude that the early results in our group of the first 20 patients are excellent. 84% of the patients were subjectively very satisfied and free of pain.
The rise of recreational sports activities and the incidence of ruptures of the Achilles tendons has increased simultaneously. Recently the use of fibrin sealing for surgical therapy of ruptured Achilles tendons has emerged as an alternative technique. Between 1982 and 1989 62 consecutive patients were operated for unilateral Achilles tendon rupture. Following causes for ruptures are known: 36 indirect traumas in sport (74%), 9 direct blunt injuries at occupational work (18%), 3 traffic-accidents (11%) and 1 rupture after operation of a Haglund exostosis. 25 patients (56%) were treated by suture technique and 20 patients (44%) with fibrin sealant. The mean long term follow-up of 49 months is known of 49 patients. There were 3 (12%) postoperative infections in the suture group and none in the fibrin group. After suturing the Achilles tendon 3 (12%) reruptures occurred 8-10 weeks after tendon repair and 1 (5%) rerupture after fibrin sealing. All reruptures are caused by a new adequate trauma. The time of return to social and recreational activities was 9 months in the suture group and 7 months in the fibrin group. The functional and cosmetic results after use of fibrin was significant better, and the long-term results were very satisfactory. We prefer fibrin sealing for the treatment of acute ruptures of Achilles tendons.
Between January 1983 and October 1990, 20 patients age 80 years or older (mean 82 +/- 1.5 year, range 80 to 87 years) underwent valvular surgery at Clinic for Cardiovascular Surgery Zurich. The indication for operation was aortic stenosis in 19 patients, and mitral insufficiency after previous mitral valve replacement with a bioprosthesis in one. There were 15 elective operations, 2 urgent, and 3 emergency operations. Four of these patients had aortic valve replacement plus coronary artery bypass grafting. The operative mortality rate was 15% (3 patients). All patients were preoperative in NYHA classes III and IV. All survivors remained in NYHA classes I or II. The survivors have been followed from 6 to 70 months (mean 20 +/- 8 months). The actuarial survival rate at 1 and 5 years was 78.5% and 67%, respectively. Valvular replacement can be performed with increased but acceptable mortality and morbidity. Long-term results are encouraging.
A series of esters and ethers of N-alkylmorpholin-2-ols, and their methiodides, which can be considered cyclic analogues of acetylcholine, were synthesized. The amines were obtained by acylation or etherification of morpholinols with the appropriate acyl chlorides and alcohols. All compounds were tested for their ability to interact with the muscarinic receptor M2 (guinea-pig atria) or M3 (rat ileum and urinary bladder) subtype. Some compounds, although endowed with relatively low potency, proved interesting for their organ selectivity. Some considerations on the structure-activity relationship are made and the results obtained with reference agonists and antagonists are also shown.
To determine the amount of blood substitution required we evaluated in a retrospective analysis 68 consecutive patients that were operated on the infrarenal abdominal aorta 1990, 60 men with a mean age of 66 years (40-87) and 8 women, aged 73 years (62-85). Indications for treatment were: aneurysm (55) and occlusive disease (13). 21 aneurysms (45%) were ruptured and had to be operated as an emergency. Early lethality (less than 30 days) in this group was 19% (n = 4). In the other 47 patients there was no early mortality. Mean blood products transfusion requirements in patients with ruptured abdominal aortic aneurysm was: 18 (9-34) units of concentrated red cells, 16 (3-43) units of fresh frozen plasma (FFP) and 5 (0-19) units of concentrated red cells, 2 (0-7) units of FFP in the elective group. Main determinants of blood loss in the elective group were: the number of anastomoses and the preoperative status of the coagulant system. We conclude that in elective surgery of the infrarenal aorta homologous transfusion can be virtually eliminated if an entire autologous transfusion concepts is applied (predonation, intraoperative salvage, hemodilution and plasmapheresis).
This article reviews the clinical manifestations, operative techniques, results and complications associated with the treatment of 8 aneurysms of the extracranial carotid artery encountered over a 13-year period. The etiology was atherosclerosis in 4 cases, congenital in two, posttraumatic in one and mycotic in another case. All patients were operated on because of symptomatic disease. Six patients had resection and reconstruction with end-to-end anastomosis, one with a patch of the saphenous vein. One patient had aneurysmorrhaphy and the last one had reconstruction with Gore Tex graft interposition. Two patients had a hemiparesis prior to the operation; this manifestation disappeared slowly in both patients but residual neurological deficit is still present in one of them 9 months postoperatively. One patient developed transient neurological symptomatology after the operation. We conclude that accessible aneurysms of the extracranial carotid artery can be operated with acceptable morbidity and mortality. Operative management is the treatment of choice because these lesions are attended by a high incidence of neurological complications if left untreated.
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Eighty-nine unrelated patients with ocular inflammation (uveitis) were investigated for the HLA class I and class II genetic markers, We subdivided our patients according to: 1. the anatomical location of the lesion; 2. the temporal course of the disease; 3. the aetiology. We eliminated from our sample of patients the individuals with other systemic diseases. We could not find an association with B27, as previously described, but we did note statistically significant differences between the class II antigen distribution in the different anatomical subgroups. HLA-DR3 seems a marker of the intermediate form of uveitis (p, uncorrected 0.03); the absence of DR1 in the patient group with posterior uveitis may be a protecting factor (p. uncorrected less than 0.01); the presence of DR4 in all cases of panuveitis is statistically significant (p, uncorrected = 0.0006).
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