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Biomedical subjects

G Flati

Publications and source records attributed to G Flati.

At least 37 records · Page 2Linked to original sources
PubMed1984

Portal stump pressure monitorization in the conscious rat after porta-caval shunt and total liver arterialization with the left gastric artery.

A method for portal stump pressure monitorization following arterialization is presented. Both intra and postoperative pressure determinations were performed and a significant difference between intra and postoperative values was observed. The pressure of the arterialized portal stump either using the left gastric artery or one of its branches, when compared to the free portal pressure did not reveal significant differences. According to these data, the proposed method of arterialization seems to create a "physiologic" arterialized stump pressure. This information while contributing to a better understanding of the complex hemodynamics of the arterialized liver represents essential guidelines for further studies on liver trophism and experimental portal hypertension.

Animals↗
PubMed1984

Occult gallbladder microlithiasis causing acute recurrent pancreatitis. A report of three cases.

Gallbladder microlithiasis may be a cause of acute recurrent pancreatitis. When this process cannot be detected with routine investigative procedures, a precise etiologic diagnosis cannot be formulated. In such circumstances, endoscopic collection of bile followed by microscopic examination for presence of cholesterol crystals constitutes a valid diagnostic tool. Three cases of acute recurrent pancreatitis are presented in which cholesterol crystals were found in the bile. The technique and advantages of the method are described and a useful diagnostic approach is proposed.

Acute Disease↗
PubMed1984

Role of cholesterol and calcium bilirubinate crystals in acute postoperative acalculous cholecystitis.

Acute acalculous cholecystitis is rather unusual, but it is considered an increasing entity. Particularly interesting are the post-traumatic or post-operative forms of acute acalculous cholecystitis. Ischemia of the gallbladder and biliary stasis are the most likely pathogenetic factors. A case of acute acalculous cholecystitis after total gastrectomy for cancer is presented. Particular emphasis is put on the significance of cholesterol and calcium bilirubinate crystals findings in the bile of the gallbladder. The pathogenetic role of this microscopic form of lithiasis in post-operative acalculous cholecystitis is discussed. It is concluded that all surgeons should be aware of this pathology since it is becoming much more common to be faced with elderly patients having life-threatening post-operative gallbladder complications unrelated to macroscopic lithiasis.

Acute Disease↗
PubMed1984

[Surgical risk of the Oddi sphincterotomy. Results of an international survey (25541 cases)].

Operative risks of transduodenal sphincterotomy (T.D.S.) are the principal subject of discussion between those surgeons who practice the operation and those that condemn it. An international survey of 25, 541 cases treated by 130 surgeons showed that the incidence of specific complications such as acute pancreatitis (0.6 p. 100), hemorrhage (0,65 p. 100), and early cholangitis (0,5 p. 100), and relative mortality were lower than those usually reported by surgeons attributing an excessive operative risk to the procedure. Data was also obtained indicating that certain "risk factors" due to teh surgical technique were statistically significant (X2 test) and that knowledge of these enabled complications to be avoided. Morbidity and mortality of TDS could then be reduced to the level of those common to biliary tract surgery.

Acute Disease↗
PubMed1983

A simplified method for total arterialization of the liver in rats.

Total arterialization of the liver appears to be a promising clinical method in preventing or reducing encephalopathy after shunting. A new technique for achieving total arterialization of the liver in rats in described and illustrated. This method is fast, simple, and associated with a high patency rate, even in the hands of relatively inexperienced microsurgeons. It can be recommended as an experimental model for additional studies in rats.

Animals↗
PubMedDate not supplied

Angiographic studies of the totally arterialized rat liver.

Twenty-three angiographies were performed in 20 rats with a totally arterialized liver. The arterialization was obtained by the construction of an end-to-side portacaval shunt (PCS) and an arteriovenous (AV) fistula between the left gastric artery and the portal stump. Microsurgical technique was necessary because of the small diameter of the AV fistula (0.5 mm). The angiographic examinations showed an AV fistula patency rate of 70% and a PCS rate of 100%. A successively increasing diameter of the fistula with dilation of the intrahepatic portal vessels was demonstrated in the rats with a patent arterioportal fistula. Tortuous and irregular vessels were also observed. All these signs suggest an overarterialization which developed despite the use of a very small AV fistula. None of the three rats examined histologically had cirrhosis of the liver. Further research is needed to attempt to avoid or minimize the deleterious effects of overarterialization of the portal tree, while utilizing the advantages of a dual liver blood supply in patients with decompressive PCS.

Angiography↗
PubMedDate not supplied

[Benign thyroid disease: 20-year experience in surgical therapy].

This retrospective study compares recurrence and postoperative complication rates after isthmo-lobectomy and subtotal thyroidectomy (group I) vs near-total and total thyroidectomy (group II) for benign thyroid disease. Seven hundred and forty-three patients were operated on for thyroid diseases over the period from 1977 to 1998. We considered 202 patients operated on for benign thyroid disease from 1988 to 1998. The follow-up ranged from 1 to 10 years (mean: 3.4 yrs). One hundred and thirty-two patients (65.3%) were operated on for bilateral nodular goitre, 35 (17.3%) for unilateral nodular goitre, 14 (6.9%) for toxic goitre and 21 (10.4%) for thyroiditis. Over the period 1988-1992, 19 patients underwent isthmo-lobectomy and 71 subtotal thyroidectomy (group I). From 1993 to 1998, 39 patients underwent near-total thyroidectomy and 61 total thyroidectomy (group II). The relapse rate was 14.4% in group I, while there were no recurrences in group II (p = 0.000064). Temporary hypocalcaemia was significantly higher (p = 0.000001) in group II (29%) than in group I (2.2%). Within group II, the rate was significantly higher (p = 0.0013) after total thyroidectomy (37.7%) than after near-total thyroidectomy (15.4%). In our experience, near-total and total thyroidectomy are an appropriate approach for preventing recurrence in patients with benign thyroid disease despite the fact that the risk of temporary hypocalcaemia is higher than after less radical surgery. Near-total thyroidectomy and the exercise of all due care in the surgical technique may help to reduce its incidence.

Adult↗
PubMedDate not supplied

Surgical management of substernal goitres. When is sternotomy inevitable?

PURPOSE: Aim of this retrospective study is to report personal experience in the surgical management of substernal goitres emphasizing the guidelines for preoperative planning of sternotomy in selected cases. PATIENTS AND METHODS: Medical records of all patients (n=355) submitted to thyroidectomy for struma in our Operative Unit, between 1993-2003, were analysed. A substernal goitre was defined as a goitre having a significant retrosternal extension (>50%) requiring mediastinal dissection. RESULTS: A total of 18 out of 355 patients undergoing thyroidectomy for struma in our Operative Unit had substernal goitres. The most common symptoms, at presentation, were the presence of neck mass and respiratory disorders. Standard cervical incision was adequate to achieve total thyroidectomy in 17 cases while, in one patient with computed tomography images showing the presence of a huge goitre extending below the aortic arch, a sternotomic approach was inevitable to ensure safe removal. No major morbidity or perioperative deaths occurred. One patient with scleroderma experienced bilateral paralysis of laryngeal nerves for two months, with full recovery thereafter. CONCLUSIONS: While removal of the majority of substernal goitres can be achieved by means of cervical incision, this approach is not always safe. In a selected number of cases with an iceberg shaped substernal goiter and with >70% of the volume lying below the thoracic outlet, a sternotomic approach is inevitable. Preoperative diagnostic work-up should, thus, include chest X-ray and computed tomography. Overall results in the present patient population, have been excellent since morbidity has been minimal and mortality absent, and all patients are symptom free.

Adult↗
PubMedDate not supplied

[Nerve sparing total mesorectal excision for rectal cancer. Technical notes and results].

OBJECTIVE: To evaluate the quality of life after nerve sparing total mesorectal excision for rectal cancer. PATIENTS AND METHODS: Crucial technical aspects of the procedure such as the preservation of genitourinary innervation and the achievement of optimal local control of the disease have been emphasized. It is known that local recurrences, sexual and urinary dysfunctions may have a significant impact on postoperative quality of life of the patients. Postoperative evaluation of functional outcomes of nerve sparing total mesorectal excision has been carried out utilizing the QLQ C30 (version 3) (All CR38). RESULTS: At one year follow-up 27.2% of the patients presented sexual activity related dysfunctions, 6.1% complained of urinary dysfunction and 21% of the patients complained of some significant psychologic disturbances. CONCLUSIONS: A correct surgical dissection with preservation of inferior hypogastric plexus and all genitourinary nerve supply yield the best results either in terms of quality of life and of oncologic control of the disease.

Adult↗
PubMedDate not supplied

[Incidental diagnosis of caecum adenocarcinoma due to retention of endoscopic videocapsule: a clinical case].

Capsule endoscopy is a new technique for the study of small intestine particularly in cases of obscure gastro-intestinal bleeding or chronic iron-deficiency anemia. In our study we present a case of 62 years-old man with a chronic iron-deficiency anaemia developed at least six months before and refractory to iron therapy. The patient was submitted to upper gastro-intestinal endoscopy and to partial colonscopy due to abdominal adhesions for previous abdominal surgery. A capsule endoscopy was indicated to achieve a definitive diagnosis. Wich discosed an intestinal obstruction. So far a surgical resolution was indicated. The surgery revealed a stricturing neoplasia of the cecum in which the capsule endoscopy was retained.

Adenocarcinoma↗
PubMedDate not supplied

Colonic involvement in pancreatitis. Six cases more.

Lesions of the colon are generally considered to be sequelae of pancreatitis. They include: localized paralytic ileus (colon cutoff sign), necrosis, fistulae, stenosis and varices. On the basis of an extensive review of the literature (332 cases), it is suggested that the real incidence of these lesions is significant. The anatomic relationship of the large bowel to the pancreas is an important factor in the genesis and localization of the lesions. Enzymatic-inflammatory and ischemic processes are involved in the most highly supported theories. Each complication shows different diagnostic and clinical patterns. In this paper, six cases of such lesions are presented, including 2 cases of necrosis, 2 of stenosis, 1 of fistula and 1 case of localized paralytic ileus.

Acute Disease↗
PubMedDate not supplied

[Occlusion caused by colo-rectal carcinoma: personal experience].

In the last 12 years 25 patients affected with obstruction from colorectal carcinoma were treated. Mortality following simple colostomy was not different from that of surgical resections (25% vs. 14% in Authors' experience). Major surgery (subtotal colectomy) registered a reasonable mortality rate (5-6%).

Aged↗