Biomedical subjects
Publications and source records attributed to D De Anna.
One case of extracranial carotid artery aneurysm observed is reported. This uncommon and interesting vascular disorder is still under discussion even if the present tendency is to treat it actively by reconstructive surgical procedures that make it possible to avoid the natural aneurysm complications with a low risk of postoperative neurological lesions.
Local recurrence is the most serious complication of anterior resection for rectal cancer, usually occurring during the first two years after surgery. Over a five-year period, from 1981 to 1986, 183 patients underwent anterior resection for rectal carcinoma at the Surgery Ward of the University of Ferrara. Patients were followed for two years postoperatively. All operations were performed with staplers and classified according to Dukes, with 43 cases of Dukes' A; 83 cases of Dukes' B; and 57 cases of Dukes' C. In the first 24 months after surgery, the tumor recurred locally in 44 of the 183 patients (24 percent). Dukes' stage, grading distal resection margin, and histopathologic differentiation of the distal rectal ring left in the stapler after anastomosis were assessed to determine a prognostic indicator for the recurrence of the tumor. The stage:recurrence ratio was as follows: A, 1 (2 percent); B, 21 (25 percent); and C, 22 (39 percent). The grading:recurrence ratio was: G1, 13:51 (25 percent); G2, 24:110 (22 percent); and G3, 7:22 (32 percent). The ratio between distal rectal resection margin and recurrence was: 0 to 2 cm, 15:27 (56 percent); 2 to 4 cm, 16:74 (22 percent); and over 4 cm, 13:82 (15 percent). Histopathologic examination of the distal rectal ring was negative for all patients. These data confirm the direct relationship between class and local recurrence and indicate histologic grade and distal resection margin as significant prognostic parameters only when interpreted in the light of staging.
A rare case of haemoperitoneum due to gallbladder rupture with intraluminal bleeding is reported. The importance of a coagulopathy in the etiology of the disease is pointed out: in the present case it was related to cirrhosis and anticoagulant treatment during dialysis sessions.
Esophago-jejunal reconstruction, after total gastrectomy, is best performed by one of the following three operations: interposed jejunal loop, Roux-en-Y loop and "omega" loop with Braun anastomosis. To assess the effects of the three mentioned techniques three groups of 15 patients each were examined after total gastrectomy for I, II or III stage cancer. Four to ten months after surgery all patients underwent the following tests: a) esophago-jejunal transit with labeled solid meal; b) cholangio-scintigraphy and c) absorption test of biliary acids. A group of 10 patients, without gastrointestinal pathology, was selected for comparison. The data obtained from the comparative study, in agreement with the opinions held by many Authors and our previous research, demonstrate that the interposition of jejunal loop (Mouchet) is the reconstructive technique closest to the unoperated stomach and, for this reason, is to be preferred after total gastrectomy.
Following a short introduction on the physiopathology of the phlebo-lymphatic system, the results of a study carried out on 114 patients suffering from chronic venous insufficiency (CVI) treated at the Department of General Clinical Surgery and Surgical Therapy of the University of Ferrara are reported. These patients were subdivided into two random groups and treated with common phlebotonic drugs and aminaftone, respectively. Both groups were also subjected to those physical and medical measures that are usually adopted for the treatment of such patients. The therapeutic effects were assessed by comparing symptomatology before and after 90 days of treatment, both subjectively (patient's assessment of the symptoms by means of a scoring system) and with objective methods (measurements and echo-Doppler examinations). The differences between the two groups were statistically very significant in favour of patients who had taken aminaftone. Excellent results were obtained in the treatment of CVI as well as in lymphatic-related pathology (lymphedema).
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The anti-oedema activity of an injectable drug (HR; active principle: 0-(beta-hydroxyethyl)-rutoside) was assessed in 60 gastric extrahepatic bile duct, and large intestine surgery patients (30 being used as controls). Gastroscopy (with biopsy), gastroduodenoscopy, colonoscopy (with biopsy) and radiological examination were usually performed on the 5th and 10th post-operative days. The drug showed significant therapeutic effects: rapid resolution of oedema, especially at the sutures, leading to early cicatrisation, canalisation and the prevention of dehiscence. Finally, duration of hospitalisation was less than in the untreated cases. The gastroscopic, radiographic and biopsy findings are considered to have shown clear evidence of the drug's action against oedema formation.
The authors review the indications of their 146 cases of supraduodenal choledochoduodenostomy (SDC) from 1970 to 1977. The conditions for which the procedure was carried out were dilatation of the choledochus (100%), multiple calculosis (83%), and primitive or secondary stenosing odditis (17%). After a detailed discussion of these indications, the authors report their immediate and long-term results, which were good in 96% of the patients. In the matter of surgical technic the authors give preference to laterolateral SDC, stressing that effective anastomosis requires a choledochal diameter of at least 10 or 12 mm. In good accord with data published from other sources, the authors' data suggest further restriction of direct procedures (in view of the associated risk of acute pancreatitis) in favor of SDC. The authors also review the objections to, and complications of, this surgical procedure, and conclude that these are never so important as to discourage the procedure when definitely indicated.
After outlining and discussing the etiology and pathophysiology of the postcholecystectomy syndrome, the authors describe their own series of 35 cases, therapeutic policies, and results obtained. In the discussion they suggest that the so-called cystic stump syndrome has probably been overplayed, since in the authors' own series of cases there was a high incidence of associated pathology.
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The authors describe one case of agenesis of the gallbladder associated with papillary stenosis, dyskinesia of the extrahepatic bile ducts, and chronic appendicitis. They devote particular attention to the composition of hepatic bile and choledochal bile, which was investigated in detail after surgical exploration of the extrahepatic bile passages, transduodenal papillosphincterotomy, and appendectomy. They conclude that this rare congenital failure of organ development, in the long run, even a slight alteration of bile composition in the hepatic and/or choledochal segment of the biliary tract (the latter somewhat serving the purpose of the missing gallbladder) may invite calculosis of the common bile duct.
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70 peripheral amputations of the lower extremities in arteriosclerotic and diabetic vasculopathics have been examined. In a number of cases, the postoperative period was complicated by dehiscence of the suture on the stump, with lengthening of hospitalization time, risk of infection in the underlying bone and thus further amputation. To solve this problem, dehiscence was treated with dermo-epidermal autografts to cover the missing tissue area. The dehiscence was cleaned with compresses of 2% amuchina associated with topical instillations of Lincomycin hydrochloride. The cure percentage after grafting was about 80%.
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30 patients were examined: 17 males and 13 females aged between 53 and 83 years (average age 66 years), candidates for large intestine surgery. For 5 days before the operation, they were treated at random, in a balanced way, with cefotaxime (3 g/day intravenously), either alone or associated with rifaximin (1200 mg/day P.O.). Rifaximin, an antibiotic drug endowed with a topical intestinal action, substantially increased the antibacterial activity of the well known and traditional third-generation cephalosporins therapy in the prevention of bacterial infections after major colic surgery. Intestinal bacterial load and pathogenic micro-organisms reduction was substantially increased. Furthermore, a more limited onset of post- surgical complications was observed, together with a better post-surgical clinical course, and a more rapid recovery of normal intestinal functions. The possibility of carrying out an effective chemoprophylaxis by means of an oral drug, such as rifaximin, must be encouraged as, among other things, it substantially reduces the intolerance risk at systemic level, which is nevertheless possible with parenteral antibiotic treatments.