[Abdomino-visceral neuralgia and false surgical abdomen].
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Biomedical subjects
Publications and source records attributed to E Trabucchi.
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In the last few years, several drugs have been proposed for the healing of peptic ulcers H2 receptor antagonists are probably the reference-drugs for their efficacy and safety. Acute treatment of peptic ulcer with cimetidine, ranitidine or famotidine gives a high healing rate: from 60% to 90%, depending on the location of the ulcer and the drug used. However, relapse after short-term treatment still remains frequent, and prophylaxis of recurrence must be decided. Long-term treatment with antisecretory drugs could be dangerous for changes of the gastric system, with nitrites and nitro-compounds occurrence, and for the risk of frequent relapses. Therefore, the role of mucus-barrier drugs and surgery must be reconsidered.
One case of pouch ileitis after restorative proctocolectomy for ulcerative colitis is described. Diagnosis was made by endoscopy, histology and electron microscopy. The most prominent feature was intense inflammation of the mucosa and submucosa, with atrophy of the villi, and colonic metaplasia, occurring before closure of the loop ileostomy. The patient improved after a course of metronidazole therapy, but ileostomy closure was postponed. It appears that the ileum mucosa of patients with ulcerative colitis is highly prone to the development of inflammation and careful, regular follow-up is recommended.
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Three successful technical procedures for the correction of complex defects of the urinary excretory pathway and the renal vessels are described. The authors emphasize their original technique which allowed kidney preservation and yielded good long-term results. They suggest that this conservative approach be used in more patients to avoid unnecessary nephrectomies.
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In the Italian population the risk of gastric stump cancer after surgery for peptic ulcer is increased after 20-30 years. Bearing in mind that further surgery has little curative chances, we examined the series seen at the Institute of General Surgery of the University of Milan (1983-1992) to investigate whether or not patients followed-up endoscopically have a better chance of cure after surgery. Although only 10 patients were available for evaluation, it was evident that patients found at endoscopic screening in stage 0 and I (UICC classification) had a good survival after surgery. Our results support the need of strict endoscopic follow-up of resected patients 20 or more years after surgery and the need of further investigations to establish whether or not resection is useful and safe for early lesions.
The ulcus cruris is an ulcerative lesions caused by chronic venous stasis and chronic venous hypertension. Every pathologic obstacle to venous return can cause ulcus cruris. Ulcus could be brought back to 3 situations: postphlebitic syndrome, chronic venous insufficiency and primitive varicosities. The common denominator is always the increase in venous pressure, the appearance of reflux and venous stasis. Venous ulcers are possibly characterized by tissue degeneration and by bacterial superinfection. A particular bacterial flora is found in these injuries, it is qualitatively different from that of healthy skin. The therapy of ulcus cruris cannot leave out by its etiopathogenesis: the first treatment always consists in the stasis suppression to arrive quickly to a complete cicatricial would repair. In it three moments are recognizable: ulcus abstersion, disinfection and cicatrization. The venous ulcer is not cured when it is closed, but when it has no recurrency: the cicatrization is obtainable treating the principal causes, eliminating the venous stasis and anticipating the relapses.