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Biomedical subjects

G D Tebala

Publications and source records attributed to G D Tebala.

9 recordsLinked to original sources
PubMed1998

The human gallbladder increases cholesterol solubility in bile by differential lipid absorption: a study using a new in vitro model of isolated intra-arterially perfused gallbladder.

In this study, we first developed and validated a new in vitro isolated, intra-arterially perfused, gallbladder model and then applied the method to investigate the absorption of biliary lipids by the gallbladder wall and the effect of this process on the composition of human bile. Oxygenated and glucose-added buffer was perfused through the cystic artery to maintain organ viability. A standard pooled natural bile, radiolabeled with H3-cholesterol and C14-palmitoyl-linoleoyl-phosphatidylcholine, was instilled in the lumen via a cystic duct catheter. Changes in bile volume and lipid concentrations were monitored at time intervals to evaluate the disappearance of lipids from bile caused by gallbladder absorptive function. Organ viability was demonstrated by stable lactate dehydrogenase (LDH) organ release and oxygen consumption throughout the experiments. In the pig, disappearance rates of lipids from bile were similar in vitro and in vivo, demonstrating the validity of the isolated in vitro model for functional studies. By applying our in vitro isolated preparation to the human gallbladder, we found that 23% of cholesterol and 32% of phosphatidylcholine, but only 9% of bile salts, disappeared from bile in 5 hours. As a consequence, at the end of the experiments, cholesterol (P < .05) and phospholipid (P < .05) molar percentages were significantly reduced, while the bile salt (P < .05) molar percentage was significantly increased with respect to values at the beginning of the studies. Our findings are of pathophysiological relevance and support the concept that the human gallbladder modifies the relative composition of biliary lipids in such a way as to increase cholesterol solubility in bile.

Absorption↗
PubMed1997

Routine use of open technique in laparoscopic operations.

BACKGROUND: The "blind" insertion of the Veress needle for insufflation of the peritoneal cavity with subsequent closed placement of the first trocar during laparoscopic abdominal procedures can result in severe major vascular and visceral injuries. An open technique was proposed as an alternative method for insufflation in patients with abdominal scars to reduce the possibility of such complications. The aim of this article is to report the results of our experience with the routine use of open technique in laparoscopic surgery. STUDY DESIGN: Open technique was routinely used and prospectively evaluated in 330 patients who underwent laparoscopic procedures. RESULTS: Laparoscopic conversion was necessary in 25 out of 330 cases (7.6 percent): in 20 cases for unclear biliary anatomy during laparoscopic cholecystectomy, and in 5 cases for minor hemorrhage that could not be managed by laparoscopy. In the 305 procedures completed by laparoscopy, 11 patients (3.6 percent) had 13 postoperative complications. These complications were all of minor importance and were always unrelated to trocar insertion; in particular, no major vascular or visceral injuries were observed. CONCLUSIONS: Routine use of open technique for pneumoperitoneum represents the best prevention of most of the severe trocar-related complications that are potentially avoidable.

Adolescent↗
PubMed1996

Hepatic resections in normothermic ischemia.

BACKGROUND: Reduction of operative blood transfusions is a primary goal in resective surgery of the liver. Temporary vascular inflow occlusion is an effective method to decrease hemorrhage during hepatic resection. This study was performed to assess the impact of normothermic ischemia on intraoperative bleeding and outcome after hepatic resection. METHODS: Sixty-one hepatic resections were performed by using pedicle clamping alone or associated with total vascular exclusion of the liver. The mean duration of normothermic ischemia was 40 +/- 18 minutes (range, 7 to 98 minutes). Major resections were performed in 32 cases (52.5%). RESULTS: Operative mortality was nil. Major complications occurred in 11.5% of cases. Twenty-five patients (41%) received intraoperative blood transfusions; mean +/- SD of transfused blood units was 2.4 +/- 1.3. Twelve major resections (37.5%) did not require any transfusion. Postoperative changes in liver function test results were moderate and transient. CONCLUSIONS: The results of this study confirm the benefit of vascular occlusion techniques in reducing intraoperative bleeding and postoperative complications. The routine use of these techniques during hepatic resections, if applied properly and with the necessary precautions, is not associated with severe adverse effects on liver function.

Adolescent↗
PubMed1995

The use of cyanoacrylate tissue adhesive in high-risk intestinal anastomoses.

The success of every intestinal surgical procedure primarily depends on correct technical execution of the intestinal sutures. Despite the continuing improvements in intestinal synthesis techniques and the introduction of mechanical staplers, the risk of anastomotic dehiscence remains a major concern. For high-risk anastomoses, defined as those performed under critical conditions, n-butyl-2-cyanoacrylate tissue adhesive allows for quick sealing of the two stumps and supports the physiological wound-healing process. Furthermore, no experimental or clinical studies have shown that this glue has any carcinogenic or mutagenic properties. Thus, we believe that n-butyl-2-cyanoacrylate will be extremely useful for intestinal anastomoses with a high risk of dehiscence.

Anastomosis, Surgical↗
PubMed1994

[The surgical risk of liver resections for neoplasms in the elderly patient].

For patients who are candidates for surgical resection of the liver, advanced age has, for many years, been considered to be a limiting factor or has precluded intervention. More recently, improvements in diagnostic, surgical and anaesthetic techniques and the increase in the average age of the population have gradually broadened the indications for hepatic resection in elderly patients. The factors for reappraisal of the surgical risk of liver resection in elderly patients are discussed here. Comparative data are also presented on the mortality, morbidity and post-operative changes in blood chemistry parameters in 90 patients who underwent hepatic resection: 33 patients over 65 years of age (group A) and 57 under 65 years (group B). In group A, compared to group B, mortality (3% versus 5%) and the percentage of patients with post-operative complications (27% versus 37%) were not significantly different. The incidence of post-operative complications correlated more closely with specific risk factors (elevated pre-operative "ASA score" from associated disease) than with age itself. Analysis of the regressions did not reveal important relationships between age and changes in the blood chemistry parameters. These results help to support the idea that advanced age alone is not now an absolute contra-indication to major liver resection.

Age Distribution↗
PubMedDate not supplied

Polymeric glues in intestinal surgery.

Authors reports the results of an experimental study on the usefulness of n-butyl-2-cyanoacrylate in abdominal surgery. The research, performed on Wistar rats and Landrace pigs, is constituted by an early phase, to verify the tissue reaction to the n-butyl-2-cyano-acrylate and its adhesive properties, and a main phase, in which it was evaluated the efficacy of n-butyl-2-cyano-acrylate as the only support or as an adjunct to the usual methods in intestinal synthesis. histological and angiographic examination of the surgical specimens demonstrated the tissue autotoxicity and the good adhesive effect of the tissue glue. Because of these characteristic, authors propose its employment to reinforce intestinal sutures performed with the usual methods in high risk condition.

Animals↗
PubMedDate not supplied

Resection of hepatic metastases from colorectal cancer.

BACKGROUND/AIMS: Long term results of hepatic resection for metastases from colorectal cancer depend upon several factors which are related to both features of primary cancer and of metastases. The aim of this study was to evaluate prognostic factors that best correlate with long-term results. MATERIALS AND METHODS: Fifty-eight hepatic resections were performed for colorectal cancer metastases. Long-term results were evaluated in relation to age of patients, features of primary tumor, features of metastases, section margin, number of intra-operative blood transfusions and execution of adjuvant chemotherapy. RESULTS: Overall 5-year survival rate was 17%. 5-year survival rate in patients with stage B primary tumor was 63%, in patients with late metachronous metastases it was 28%, in patients with section margin > 1 cm it was 33% and in patients who did not receive intra-operative transfusions it was 45%. Patients with a solitary metastasis or with metastases sized less than 4 cm and those who received adjuvant chemotherapy also showed a better survival than the others. CONCLUSIONS: Better results were observed in patients without nodal involvement of the primary tumor. Patients with a small solitary metachronous metastasis that appeared more than one year after the colorectal resection and resected with a section margin of more than 1 cm, also showed good results.

Adult↗