A randomized controlled trial aimed at comparing the individual efficacy of cephalothin, cefoxitin, and metronidazole in the prevention of postoperative wound infection was performed among 74 colorectal surgical patients. Of 28 patients on cephalothin, seven (25 per cent) developed a postoperative infection, but among 23 patients in each of the other two groups, only one (4 per cent) in each group became infected. These results confirm the primary importance of anaerobes in the causation of postoperative sepsis after colorectal surgery.

Adult↗

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[The diagnosis and therapy of dysphagic disorders of the LES].

Primary motor disorders of LES causing dysphagia consist in cardial achalasia and intermedius motor disorder (IMD), the last one different from achalasia because of normal motor pattern of the esophageal body. In this paper diagnostic and therapeutic procedures are examined according to an experience of 94 surgically treated cases (22 rioperations for surgical failures). Cardial dilatation as treatment of choice is recognized only for IMD in which a normal peristaltic behaviour of the esophagus can avoid the high danger of GER. Surgical procedure, now laparoscopically performed, consisting in Heller's myotomy + Dor partial fundoplication is to be preferred in cases of true achalasia.

Cardia↗

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Management and survival of patients affected with obstructive colorectal cancer.

Between 1978 and 1984 a consecutive series of 571 patients with colorectal cancer were admitted to the First Department of Surgery of the University of Rome. Patients were divided into a group of 82 patients affected with obstructive cancer and a control group of 489 patients with non-obstructive tumors. In the obstructed group there was a significantly higher incidence of lesions localized in the left colon. Depending on the advancement of lesions a significantly higher incidence of Dukes D tumor, nodal involvement, hepatic metastases and peritoneal dissemination and a significantly lower incidence of Dukes A tumors, were found in the obstructed patients. No significant differences were found in the two groups according to age distribution, duration of symptoms and degree of differentiation of neoplasms. The mortality and morbidity rate were 9.7% and 12.2% respectively in the obstructed patients, and 3.5% and 8.3% respectively in the non-obstructed patients. The rate of complications was greater in the two groups when serum albumin values were under 3 g/l, being 40% vs. 3.3 and 20% vs. 5.2% in obstructed and nonobstructed groups respectively. When Hb levels were under 10 g/l the incidence of complications was 16.7% and 14.4% for the two groups, while when it was higher than 10 mg% the morbidity rate was 8.7% and 6.3% in obstructed and non-obstructed patients respectively. The execution of surgical treatment within 24 hours was related to a morbidity and mortality rate of 50% and 22.2% in obstructed patients, and 40% and 20% in the non-obstructed group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗

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[Physiopathological changes after interventions for rectal cancer].

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Anal Canal↗

PubMedDate not supplied

Patient selection and factors affecting results following resection for hepatic metastases from colorectal carcinoma.

Personal experience is reported of 47 consecutive liver resections for metastatic colorectal carcinoma treated in the I Clinica Chirurgica of the University of Rome for the purpose of contributing to treatment and evaluating the clinical factors and possible determinants of prognosis that could be potentially predictive of outcome and length of survival after liver resection: Duke's stage of primary colorectal cancer, synchronous or metachronous disease, number of hepatic lesions. Patients were classified according to the proposed staging system of the "Istituto Nazionale Tumori" in Milan. For Stage I and II patients the median survival time was 15 months, while in Stage III patients survival time was reduced to only 4.5 months. The 3- and 5-year survival rate was 20% and 12% respectively for Stage I patients; no patients at stage II or III survived more than 3 years.

Adenocarcinoma↗

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Colorectal cancer in young patients.

Colorectal cancer is rare in patients under 40 years of age. We reviewed all colorectal cancer patients treated at the First Department of Surgery of the University of Rome, to determine the true incidence of large bowel cancer in young patients. During the period 1978-1984 a total of 571 patients were indexed. Out of these 44 were 39 years of age or less. A group of 527 patients 40 years of age or over served as a control. Neoplasms were localized in the right colon in 19 cases and in the left colon in 25 patients, in the young group. In the control group 178 patients presented neoplasms localized in the right colon, while 349 presented tumors localized in the left colon. According to tumor advancement in the young group tumor classification from A stage tumor through D stage was: 4, 6, 14, 5, 9, 6. In the control group 22 patients presented A stage tumors, 106 B1, 139 B2, 50 C1, 118 C2, 92 D tumors. The operability rate was 93.2% in the young group, and 92% in the old one. The operative mortality rate was 0% in the young group, and 2.5% in the old one. Four complications occurred in the young patients, and 57 in the old patients. The five years survival rate was 56.7% and 52.1% in young and old patients respectively. The results of our study indicate that there are no significant differences in prognosis and five years survival in young patients with colorectal cancer.

Adenocarcinoma↗

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Surgical treatment of metachronous colorectal cancers.

Thirty-four patients with metachronous colorectal cancer who underwent surgical procedures at the First and Fourth Department of Surgery of the University of Rome were reviewed. 55.9% of the patients developed a second carcinoma within five years after the first operation, and the time interval for the entire group ranged from 13 to 228 months. Adenomatous polyps occurred in 14 patients. Two patients developed a third metachronous cancer. We followed up eight patients using colonoscopy regularly. In this group we found two early cancers, five submucosal cancers and only one advanced tumor. In the other group we found 16 advanced cancers and ten submucosal cancer. The curability rate at second operation was 88.2%, and at the third 50%. The management of metachronous tumors should imply total colonoscopy, at a mean interval of 12-18 months.

Adult↗

PubMedDate not supplied

Operative morbidity after shunt surgery for portal hypertension.

The operative morbidity observed in a consecutive series of 286 patients who underwent shunt surgery for portal hypertension is reported. 149 patients out of 286 (52.1%) had a postoperative complication, which required reoperation in 11 cases (5 intestinal perforations, 2 bleeding peptic ulcers, 1 eventratio, 1 cholestasis, 1 acute pancreatitis, 1 strangulated hernia). 42 patients out of the 149 with complications died of the complication (operative mortality 14.6%). Operative morbidity and mortality appeared higher in patients operated as emergencies. Whereas elective shunts gave better results. The problem involved in preventing and treating the serious complications following shunt surgery for portal hypertension are discussed.

Female↗

PubMedDate not supplied