Biomedical subjects
Publications and source records attributed to G C Bruni.
The authors propose the conservative treatment of ischemic colitis using slow-release mesalazine and enema. The excellent tolerability of the treatment and the good level of therapeutic efficacy was confirmed in 13 cases treated without signs of recurrence of disease.
335 inguino-femoral hernias were repaired with polypropylene mesh from December 1991 through December 1995. Eleven patients underwent mesh reinforced Bassini, 167 modified Lichtenstein's technique and 108 Trabucco's repair. Forty-three patients were treated under regional anesthesia. Bilateral hernia was diagnosed in 33 patients and in 20 out of 33 the surgical procedure was entirely performed under regional anesthesia. Early complications referred were 32 scrotal hematomas which spontaneously healed. Two patients showed a recidive hernia and were retreated with and additional mesh; plug rejection (early experience) was referred in one patient who was reoperated on employing a mesh. The indications for the more suitable technique were directly deducted from Nyhus' hernia classification. The authors finally point out the: 1) importance of regional inguinal anesthesia; 2) correct cutting and application of the mesh in the inguinal canal; 3) internal inguinal ring repair; 4) bilateral hernia repair under regional anesthesia.
The authors examine 192 consecutive cases of upper gastrointestinal hemorrhage; the series included 133 males and 59 females with a mean age of 55.78 years (SD +/- 17.88) and range of 18-97. All patients underwent emergency esophagogastroduodenoscopy within 6-12 hours of hospitalisation. Adequate infusion and; when necessary, transfusion therapy associated with protection using anti H2 (ranitidine 200 mg/24 h) and octreotide (0.2 mg x 3/day sc), proportionately scaled over the following 72 hours, were used in all patients. Nasogastric aspiration (nasogastric probe or Sengstaken-Blakemore probe) were used for at most 48 h after endoscopy. Patients were then subdivided into 2 age groups: under (104 cases) and over (88 cases) 60 years. Statistical relations were studied (Chi-square test), assuming the reference value to be p = 5%, between age and diagnosis, sex, symptoms on presentation, hemotransfusion, Forrest's classification, the onset of renewed bleeding and lastly the evolution of each case. Hemorrhage was more frequent in males aged < 60 years and in females aged > 60 (p < 0.004), hemorrhagic shock, the presence of Forrest 1a and 1b and death were significant in elderly subjects (p < 0.004; p < 0.01; p < 0.01). The latter finding included patients with esophageal varices, group which was significantly correlated with mortality independent of age. The overlap of statistical results in hemorrhage not related to varices suggests, on the one hand, that appropriate early treatment has a greater influence on the prognosis rather than the type of pathology, and on the other that being aged over 60 does not correspond to an increased biological risk.
The authors report three cases of acute epiploitis diagnosed intraoperatively and discuss the etiopathogenetic hypotheses. They suggest a relationship between acute epiploitis and mesenteric lymphadenitis, as well as their common origin.
The authors examine eight cases of acute pseudo-obstruction of the colon and point out that these may be inserted in the wider context of intestinal pseudo-obstructions. These comments raise questions concerning Ogilvie's syndrome since the dilatations observed do not only affect the colon, according to the classic definition, but also the ileo-jejunal tract, in spite of the fact that the main target continues to be the colon. The term Ogilvie's syndrome is still significant in the clinical identification of colic dilatation, in particular the right colon in which possible complications are more severe. The authors identify colonoscopy as the best instrumental test owing to the possibilities its offers, including therapeutic, and also underline that there does not appear to be a real risk of iatrogenic lesions if an appropriate technique is used.
Acute intestinal ischemia is a pathology which is relatively often encountered in elderly patients where the concomitance of other diseases make its prognosis more severe, especially since diagnosis is usually late. Laboratory tests and imaging techniques are not of great value to diagnosis since they do not provide pathognomonic data, but together with a careful anamnesis they contribute a series of findings which, taken as a whole, lead to the diagnosis of intestinal ischemia. The sole therapy is surgery--when still possible and the best results are obtained when surgery is performed at an early stage. The authors report a series of 12 cases of acute intestinal ischemia and underline the difficulty of diagnosing this subtle pathology and the advantages of aggressive surgical techniques.
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Personal experience in the management of head injury in a General Surgery Department is reported and a series of 352 patients analysed with a view to identifying variations in the epidemiological profile of this pathology over the last decade and in order to establish indications for admission and the transfer of the patient to specialist departments.
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A case of intestinal occlusion is reported caused by volvulus of Meckel's diverticulum. The etiological and clinical aspects are discussed together with their implications in terms of suitable surgical therapy.
The paper illustrates a personal technique used in palliative surgery of extensive tumours of the head of the pancreas. An omega loop is prepared into which both the VBP and digestive tract are diverted, thus reducing the number of anastomoses to be performed and the length of the operation.
Perforated diverticulitis of the large bowel is a frequent observation in surgical practice. There is, however, no standard attitude to the procedures to be adopted: the only fixed point is the abandonment of straightforward colostomy and drainage. A series of 16 cases of perforated diverticulitis of the large bowel operated on in emergency and treated with various procedures, i.e. 8 Hartmann resections, 6 Paul-Mikulicz operations, 2 ideal colectomies, 2 colostomies and drainage. The observations made permit a number of considerations: 1) "ideal colectomy" is undoubtedly the best intervention providing the patient presents an early NPT and a temporary colostomy has been made to protect the anastomosis; 2) the rupture of a single diverticulum suggests the Paul-Mikulicz operation and it can be treated at a later stage by straightforward closure; 3) rupture of a diverticulum within the framework of extended diverticular involvement suggests Hartmann's resection; 4) colostomy and drainage should be abolished for its poor results and can be kept for patients in very serious condition.
Intraoperative cholangiography continues to be the principal investigation in the intraoperative diagnosis of biliary disease. Cholangiography and preoperative echography, the clinical aspect are not sufficient to exclude the possibility of choledochal lithiasis in operations carried out for straightforward cholelithiasis. Personal experience in a series of 248 bile lithiasis operations is examined: intraoperative diagnosis was based on 244 cholangiographies, 41 echographies and 22 choledochoscopies. Choledochoscopy proved decisive for evidencing residual choledochal calculi after seemingly accurate choledocholithotomy operations and also after trans-Kehr intraoperative cholangiography. Intraoperative echography, in the light of rather limited experience, would seem to add nothing to the two previous associated intraoperative instrumental investigations; it may prove useful in certain special cases.
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