Biomedical subjects
Publications and source records attributed to F Carolo.
The Authors face the problems involved in the colonic familial polyposis, with particular attention to the surgical treatment of subjects bearing neoplastic degeneration. They, moreover, report their clinical experience, and compare it with the experience of other centres.
The Authors face the diagnostic and therapeutical problems involved in the tardy recognition of diaphragmatic breakages. On the basis of two clinical cases observed, they emphasize the relative frequency of this lesion, the variability of the clinical pictures, the limits of the clinical and radiological diagnostics, the utmost seriousness of the complications. They face the problem of the choice of the surgical way of approach and the techniques for repairing the diaphragmatic lacerations.
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 long-term fate of patients treated surgically for carcinoma of the lung is not well known. In a careful review of the literature the authors found only nine papers with a postoperative followup of at least 10 years; the mean survival was 16,3% of patients so treated. Factors making for a good long-term prognosis include small initial tumor size, absence of mediastinal lymph node invasion, a favorable histologica type, and the type of surgery performed (partial exeresis). Translated into TNM code, this means that the best candidates for prolonged survival are patients with lung carcinoma of the squamous cell type, stage I, treated by limited lung exeresis.
The AA. describe the indications, the technique and the complications of application of oesophageal endoprosthesis (Celestin or Haring) for palliative treatment of oesophageal cancer and they value the results of 34 applications of these prosthesis that were executed about Surgical Clinic in Verona with satisfactory results during the period 1974-77. They show the improvement of survival conditions in these patients, the rareness of complications, the absence of absolute contra-indications.
The Authors report their experience regarding two primitive tumours of the confluent and one tumour of the gall bladder involving the biliary confluent, all treated by major hepatic demolitions--one left hemihepatectomy and two extended right hemihepatectomies--with removal of the biliary tree en bloc and appropriate reconstruction. These highly demolitionary operations were performed with the aim of achieving greater radicality. The indications for such type of operation, dictated by notions of tumoral biology and reasons of surgical technique, are discussed. The Authors make a comparison of their experience with the data obtained from literature, which up to now reports only twenty-two; no statistical judgment on the effectiveness of the method is therefore possible, even if the results obtained and the theoretical presuppositions would seem to confirm its validity.
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.
The Authors describe one case of pulmonary oncocytoma successfully treated by ablative surgery. The patient was a man aged 38 with an asymptomatic nodule, about the size of a walnut, in his right lower lobe. The whole right lower lobe was removes surgically, and histological examination resulted i na diagnosis of pulmonary oncocytoma. In the discussion, the authors point out that this type of malignancy is extremely rare, with only 7 cases reported in the more recent literature to the best of their knowledge.
The authors describe one case of lipoid granuloma of the lung in a patient with PARKINSON'S disease. The cause of this pulmonary sequel is probably to be found in the alteration of the mechanism of deglutition, typical of PARKINSON'S disease, with aspiration bronchopneumonia and subsequent evolution to granuloma formation. In the case presented (a man of 64) the X-ray picture resembled the irregular mass opacities and bronchial amputations characteristically associated with cancer of the lung. As the actual anatomical extent of the process exceeded the limits indicated by radiological examination, the whole left lung was removed at surgery; histological studies, however, revealed the essentially benign nature of the lesion. The patient was discharged in due course of time as surgically cured. There was no major deterioration of his neurological status either at discharge time or at later rechecks.
The paper considers a clinical case of multiple bronchogenic cysts associated with a pneumonitic process of TB character, operated successfully by means of an upper right and middle bilobectomy. No similar case was found in literature. The malformations were of congenital origin, characterised histologically by a cavity, the walls of which contain elements proper to the bronchus: cartilage and ciliate columnar epithelium. The squamous metaplasia is rare, and the neoplastic transformation very rare. From the clinical point of view a distinction is made between asymptomatic cysts, in which the clinical picture is dominated by compressive phenomena affecting the surrounding structures, or sometimes by infection due to supervening bacterial, mycotic or--as in our case--tubercular contamination. The therapeutic indication is exclusively surgical, with methods of exeresis varying according to the extent and location of the morbid process.
Pulmonary tuberculosis--although appreciable reduced as regards number of cases--is still far from being wiped out and even today constitutes a real problem in the field of thoracico-pulmonary surgical pathology. Infection with Koch's bacillus can from this point of view arise basically according to two procedures: a) as superimposed element--unexpected guest--on a pulmonary disease of surgical interest, sometimes being mistaken for it (e.g. a tubercular inflammation of slow evolution mistaken for a cancer of the lung) or b) taking the form of pulmonary relics of an earlier and apparently extinguished Kochian infection, the starting point of an always possible revival of the infection during the postoperative period. In the former case the so-called attack therapy must be adopted without delay in accordance with well tested doses and schedules; in the latter case by means of a chemoprophylaxis, carried out in with rifampicin (600/1200 mg/day) in the cases reported and also continued in the postoperative period.
Thirteen cases of congenital anomalies of the bile passages are described, as observed in the Verona Surgical Clinic during the period 1970-75, out of a total of 908 operations on the biliary passages and hence with a frequency of about 1.6%. They consisted of one case each of agenesis of the gall-bladder, septal gall-bladder, clepsydra gall-bladder, Hartmann's sac, diverticulum of the gall-bladder, outlet of the right hepatic in gall-bladder, outlet of cystic duct in third duodenal portion, accessory cholecystobiliary ducts, three cases of outlet of cystic duct in right hepatic duct, and two cases of common choledocho-wirsunghian canal. After a brief description of the individual types of anomaly, the main data in the relevant literature are considered, with a review of the semeiological and therapeutic aspects of the most frequent anomalies.
Modern portable firearms, whether for military or civilian use, present substantially different features as instruments for striking, wounding and killing compared to those used in the past on account both of their intrinsic characteristics as thermo-chemico-ballistic machines, guaranteeing extra, more easily achievable performance and of the characteristics of the bullets used. The factors responsible for this difference, which consists essentially in an unprecedented wounding capability, are, in the military field, the enormous amount of research which only now is beginning to yield a bare minimum of concrete results in terms of futuristic forms and devastating performance, amongst other things because it is easier to achieve, and, in the "civilian" field, the maniacal search for an unlikely definitive wound, based on the unusual nature of the cartridge and on sophisticated training.
A 44-year-old male affected by mesenchymoma of the mediastinum was treated surgically. The neoplasm, localized in the postero-inferior mediastinum with prevalent development to the left, was found to consist of adipose, leiomuscular and myxoid tissue. The patient was asymptomatic. Complete removal of the neoplasm proved possible, and one year after surgery no signs of recurrence were present. Few cases of mediastinal mesenchymoma have been reported.
If we want to enunciate the damaging potential of a bullet fired from a gun we have to express ourselves right from the outset in terms of destructive work, that is to say not only destruction of the structures the bullet passes through, but also, above all, destruction of the homeostatic condition. In modern terms, this is particularly true of the abdomen, which, in perspective, above and beyond any direct involvement, is a candidate for an interesting role. As regards the translation of this destructive force in mathematical language, formulae are proposed in kilogram-meters, feet per second and Joules. A basic factor in external ballistics, quite apart from the actual forces involved, is the trajectory in space, the hyperbola, though we should also reflect on the problem of resistance, which has such a considerable effect on the behaviour of the "ideal" bullet in the atmosphere (the smallest calibre for a given mass, with the attempt to rid itself of its forced subordination to the calibre of the barrel). This leads us on to the subsequent concept of the "ballistic coefficient" and, in itself definitively established the basic assumptions of terminal ballistics.
The authors report on a study population of extended operations for locally spread colon-rectum cancer in the Verona Surgical Clinic over the period from 1971 to 1987 (114 surgical demolitions for colon-rectum cancer out of a total of 1294 operations). They report an overall 5-year survival rate of 41% and a 3-year survival rate of 59% with a perioperative mortality rate of 1.75%. A number of aspects of such extended operations are discussed, and, in accord with most other reports in the literature, the authors confirm the validity of the choice of this type of surgery.
The parallelism breaks down, and the bullet, which is now the subject, speeds towards the object, the body, its target. The ideal vantage point for capturing the moment of impact is the nose. We set up our station here, imaging that were are a kind of TV camera recording with cold objectivity, in slow motion, instant by instant, the marks and the impact made by the hard body on its soft target.
The Authors, consistent with their aim to compare and contrast the two protagonists of bullet wounds, namely the bullet and its soft human target, delineating their respective profiles, strengths and weaknesses, feel obliged to dwell at some length on the most frequently pathogenetic regulation firearms. Up until the early twentieth century bullet wounds could be generically classified among the forms of open traumatism, but with the advent of high-speed bullets they have come to take on a unique profile of their own, setting against the old permanent cavity due to mechanical insult a new type of transitory ghost, the definition of which as a cavity would merely be an oversimplification in theoretical terms. Can we really attribute this somewhat privileged dimension to bullet wounds today or must we relegate them once again to the sphere of mechanical traumatisms, albeit with a new inflammatory key to their interpretation, making the most in this sense of the contribution provided by the speed of the bullet? The literature is abundant, but uncertain; we intend to attempt an answer to this tricky question in the following pages, devoted more properly to terminal ballistics. Undoubtedly, the new speeds have had a substantial impact on the wounds inflicted upon the soft target, but the streamlining of the jacket has modified and even offset the results, giving rise to the unexpectedly humanitarian bullet, later subject to reappraisal in military quarters as tactically more efficient, because it obliges the enemy to employ greater resources for recovering, assisting and healing the wounded. We can safely claim that ballistic science in the field of light or portable firearms is experiencing a contradiction between the speed of the bullet and the streamlining of the jacket which makes this speed possible, but which undermines the efficacy of the often unconfessable results. Short-barrelled firearms, which on account of their defensive role, the alibi of their problematic access to speed, and their characteristic use as "last-chance" weapons, are less subject to international constraints and enjoy an extensive civilian market with specific claims to stopping power, thus become the true witnesses to a reality no different to the one Dum-Dum interpreted: the field of modern regulation firearms is shrouded in similar doubts, strengthened by the increasingly short barrels of the weapons, remedies and temptations, with, in addition, the increasingly precarious nature of the human element behind the firearm.(ABSTRACT TRUNCATED AT 400 WORDS)