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Biomedical subjects

G Mangiante

Publications and source records attributed to G Mangiante.

At least 55 records · Page 3Linked to original sources

[Perforation of the esophagus during pneumatic dilatation in achalasia].

Esophageal perforation is a serious complication of pneumatic dilatation. We studied the cases of 4 patients (2 men and 2 women, mean age 58 years, range 56-62) who had surgical treatment for achalasia, two of which had had previous dilatation. The main symptoms were pain and dyspnea. Pneumomediastinum was present in all patients, pleural effusion in 2 and cervical emphysema in 1. Esophagographic results showed evidence of perforation in all four cases and gastric patches were surgically placed on the esophageal tear within 12 hours. Three patients received enteral nutrition for an average of 13 days. Mean hospital stay was 14 days. No post-operative complications were exhibited although one patient did develop gastroesophageal reflux 3 months later and underwent surgery to repair a hernia in the thorax 5 years later. Early and aggressive treatment is considered the best therapy and the gastric patch, in our opinion, is an effective and reliable technique for esophageal perforation repair in achalasia patients.

Dilatation↗

[Butterfly mesh for the treatment of hernia].

Incisional hernias (IH) occur with an incidence of 2 to 11% after laparotomy and represent a huge social and economical problem. Polypropylene meshes remarkably decreased the incidence of recurrence after first repair. This paper reports a personal method that allows a strong, safe and quick replacement of the abdominal wall with a double layer of polypropylene mesh. This method is reliable for IHs bigger than 4 cm. The sac and the surrounding fascia are cleaned from fat and scarred tissue: peritoneum is dissected up to at least 3 cm all around the edges of the hernial sac and under the fascia, as far as possible. Two sheets of PM, 3 cm larger than the defect, are sutured together with non-absorbable running suture (polypropylene 2-0) from the center to 2 cm from the extremities at the bank. The inferior mesh is extended and fixed under the fascia with polypropylene mattress stitches. When the peritoneum is not present, the edges of the mesh are refolded and sutured to the fascia in order to avoid trauma to the loops. The superior mesh is sutured directly onto the fascia. Closed aspiration drainage is positioned. We performed this method on 20 IHs (from 5 to 25 cm long). At 24 months follow-up we never observed recurrence. This method is similar to abdominal wall suture, and permits tension free repair.

Adult↗

[A probiotic as an antagonist of bacterial translocation in experimental pancreatitis].

Infection is the most common cause of death in acute pancreatitis. Earlier studies have demonstrated that early enteral nutrition decreases microbial translocation, upregulates the immune function and reduces septic complications and mortality. Lactobacillus plantarum (Lp) has been shown to be effective in reducing egress of endotoxin and microbial strain that showed very high adherence power to gut mucosa. We adopted a model of acute pancreatitis induced by isolation and ligation of biliopancreatic duct in adult Lewis rats. Three groups were studied: A. control group (sham operation); B. induced pancreatitis, no further treatment; C. Induced pancreatitis + gavage with 5 ml/day of a suspension of Lp 299 v in a dose of 0.5-1.0 x 10(9)/ml during 4 days before and 4 days after induction of pancreatitis. All animals were sacrificed after 96 hours. Histological studies and microbiological analyses were performed. Forty out of 55 animals showed signs of severe pancreatitis on sacrifice after 96 hours. Only these animals were further studied. In group A, we found only 1/20 bacteria in mesenteric nodes (MN). Pathogenic microrganisms were found in the non-treated group in MN in 14/20 and in the pancreatic tissue in 10/20. In contrast, when kept on an umbrella of Lp 299 v, only 4/20 animals demonstrated growth of enteric bacteria in MN and 3/20 in pancreatic tissue. All of these results showed a significant reduction of infection in the treated groups. In our model, Lp 299 v is effective in preventing microbial translocation in experimental pancreatitis. Treatment with probiotic bacteria, such as Lactobacillus spp, seems to be a promising alternative as problems with antibiotic-resistant bacteria seem to accumulate.

Acute Disease↗

Intraoperative and percutaneous radiofrequency thermal ablation in the treatment of hepatocellular carcinoma.

AIMS AND BACKGROUND: The aim of the study was to evaluate feasibility, survival rate, complications and length of hospital stay in 47 patients with hepatocellular carcinoma (HCC) treated by radiofrequency thermal ablation (RFTA). Though the treatment of choice for HCC is surgical resection, the strong association of this disease with cirrhosis often rules out this procedure. Many investigations have been conducted in order to identify alternative therapies. Preliminary studies of radiofrequency thermal ablation have shown that the technique is effective and safe, achieving a predictable area of tumor tissue coagulative necrosis and sparing the surrounding cirrhotic parenchyma, without any significant side effects. In addition, this technique, which can be performed percutaneously, allows very short hospital stays. PATIENTS AND METHODS: We report the results of a series of 47 cirrhotic patients with 52 HCC nodules (mean diameter 2.9 cm, range 1-6 cm) treated in our Institute between May 1997 and June 1999 by RFTA using an expandable needle with four hooks at its tip. All patients had hepatic cirrhosis (32 Child A, 13 Child B and two Child C). We treated patients with both unifocal (35 patients) and multifocal HCC (12 patients); 33 patients underwent percutaneous RFTA (54 passes), while in 14 cases RFTA was performed during laparotomy (22 passes). RESULTS: The mean number of passes to achieve complete necrosis was 1.43 in 28 patients with unifocal HCC treated by percutaneous RFTA, 1.7 in 7 patients with unifocal HCC treated by intraoperative RFTA, 2.8 in 5 patients with multifocal HCC treated by percutaneous RFTA and 1.43 in 7 patients with multifocal HCC treated by intraoperative RFTA. No deaths related to the procedure or major complications occurred. Post-treatment dynamic CT was performed in all patients. All patients but one were followed-up for a mean period of 11.8 months (1-25 months). Six patients died during the follow-up (three Child A, two Child B and one Child C. The actuarial survival, computed by the Kaplan-Meier method, was 83% at 24 months. The mean hospital stay was 3.4 days in patients treated by percutaneous RFTA and 11.2 days in those treated by intraoperative RFTA. CONCLUSIONS: In our opinion RFTA is an effective, safe technique capable of achieving good results in the conservative therapy of small HCC. We believe that curative ablation is possible for HCC nodules measuring up to 3 cm in diameter. Further studies of longer duration are necessary.

Aged↗

[The Bengmark tube in surgical practice and in the critically ill patient].

Enteral nutrition (EN) is increasingly used to minimize the rate of septic complications related to bacterial translocation, due to its effectiveness and low cost. Bengmark's self-propelling auto-positioning feeding tube (SPT) absorbs and uses gut motility for rapid transport to the upper small intestine, thereby allowing uninterrupted EN both in surgical and critically ill patients. We report on our experience with 175 SPTs applied over the period from December 1996 to February 2000, and analyse the safety, compliance, and indications of SPT in surgical and ICU practice. Open study: feasibility of insertion, time and rate of placement, compliance and complications related to the tube or to EN were studied. SPTs were successfully placed in 40 patients before liver resection, in 32 patients before extensive maxillo-facial surgery MFS and prior to colon resections in 10 cases. SPTs were also applied in 56 patients with acute vascular neurological diseases, 22 in pancreatic diseases and in another 15 critically ill patients. 92.5% of SPT's crossed the pylorus, while only 7.5% stopped in the stomach and 3.4% in the duodenum; 89.14% reached the first jejunal loop. The tip of the tube reached its final position within a mean period of 5.2 hours, 8% instantly and all within 24 hours. Enteral nutrition was started immediately after introduction of the tube into the stomach. The compliance was excellent, even in maxillo-facial surgery patients: only 2/76 patients (2.6%) showed poor compliance. There were no cases of aspiration pneumonia or other complications related to SPT. Polymeric nutrition was usually supplied at a starting flow rate of 45 ml/hour and rapidly increasing over the following 48 h. Eleven patients experienced diarrhoea and 6 abdominal distension, leading to a temporary reduction of the EN flow rate. Clogging of the SPT occurred in 13 patients: 7/13 were cleansed with pancreatic enzymes, but 6 had to be replaced. SPT is ideal for intensive EN and is characterised by minimal complications and excellent patient compliance.

Critical Illness↗

[Effect of probiotic administration on colic anastomosis healing].

Colic anastomoses are still affected by a high incidence of leakage. We speculate that a supply of fibres and probiotic bacteria improves the healing of colic anastomoses due to a higher production of short-chain fatty acids. These are known to improve the anastomotic healing of colic sutures. Sixty Lewis rats, weighing from 250 g to 350 g, were divided into 6 groups. Groups A + A1 were fed with a low-fibre diet (less than 0.1%), Groups B + B1 with normal rat chow and groups C + C1 with normal rat chow + Lactobacillus plantarum 299v. Transections and re-anastomosis of the distal colon were performed. Groups A1, B1 and C1 were sacrificed after 3 days, and groups A, B, and C after 7 days. The bursting pressure of colic anastomoses was measured. All data are expressed as mean (+/- S.D.). The pH of the colon contents was evaluated by means of a fine needle plastic electrode only in groups A1, B1 and C1. The results were studied by analysis of variance followed by the Student Newman Keuls test for multiple comparisons (significance level P < 0.05). Three days postoperatively, the pH of the colic lumen was lower in animals fed with a normal diet (pH 7.1 +/- 0.3 without Lp supplementation, 6.5 +/- 0.2 with Lp supplementation) than in animals fed with a low-fibre diet (pH 8.0 +/- 0.3). Bursting pressures were significantly higher in the groups fed with fibre and fibre + Lactobacilli than in animals on a low-fibre diet, both on day 3 and day 7. On the basis of these data there seems to be no support for the belief that a supply of fibre-rich food might impair healing and promote development of anastomotic leakage. On the contrary, short-chain fatty acids and fibres would seem to facilitate the healing of colic anastomoses.

Anastomosis, Surgical↗

[The analgesic treatment of the surgical patient].

An effective treatment of postoperative pain can achieve a better postop course especially in high risk patients. Pain is unacceptable when it can be relieved and, beside all it causes vasoconstriction, hypertension, tachycardia, fluid retention and pulmonary hypoventilation. A correct use of both narcotic drugs and NSAIDs are sufficient in most cases. In high risk patients, mainly after thoracic and upper abdominal procedures, insertion of a peridural catheter for drug administration can be very useful. The authors discuss the therapeutic possibilities according mainly to their experience.

Analgesia↗

Necrosectomy by lavage in the surgical treatment of severe necrotizing pancreatitis. Results in 263 patients.

A conservative surgical technique for treatment of necrotizing pancreatitis is described. Standardized since 1976, the technique is based on washout mechanical necrosectomy accomplished by lavages via intraoperatively placed wide-bore drainage tubes. The overall mortality rate from necrotizing pancreatitis was thereby reduced from 61% (with resective technique) to 18%, and in 106 cases observed from the onset of the disease the mortality fell to only 6.6%. The series included also patients with fulminant acute pancreatitis and multiorgan failure.

Acute Disease↗

[Biliary cystadenoma and cystadenocarcinoma].

The authors present their experience with 5 biliary cystadenomas (BCA) and 1 cystadenocarcinoma (BCAC). BCA are rare but intriguing lesions of the liver for the possibility of the former to evolve into malignant lesion. Preoperative diagnosis is often difficult also at ultrasound and CT scan. The possibility of BCA and BCAC should be always ruled out in every cystic lesion of the liver. In every doubt lesion surgical exploration is indicated and at least a biopsy should be performed. The procedure of choice for BCA is radical resection, while palliative procedures may be justified only in poor risk patients.

Adult↗

[Major hepatectomies in liver neoplasms].

The development of major hepatic resective surgery during the last 50 years is due to a better knowledge of both hepatic regenerative capacity and intraparenchymal vascular and biliary anatomy. Two approaches of major hepatic resection have been described: 1) primary hilar approach; 2) primary transparenchymal approach. The authors review the indications of major hepatic resections in the treatment of hepatic tumors and discuss the advantages and the disadvantages of primary hilar and primary transparenchymal approaches, reviewing the data from the literature and the experience gained at the Clinica Chirurgica of the University of Verona from 1970 to 1989 of 289 major hepatic resections.

Hepatectomy↗

[Hepatocellular adenoma and focal nodular hyperplasia].

The diagnostic findings of hepatocellular adenoma and focal nodular hyperplasia became more frequent in the last years in our as in western experience. The improvement in diagnostic technique, a correct pathological identification and the diffusion of oral contraceptives explain this increase of incidence. In our series were present 11 hepatocellular adenomas and 19 focal nodular hyperplasias: all the HCA cases were radically resected, while only 15 FNH were resected, only two biopsied and two submitted to periodical follow-up. The tendency to spontaneous bleeding and the presence of diagnostic uncertainty versus well-differentiated hepatocellular carcinoma are mandatory indications for radical resections in all the HCA cases. FNH resection is reserved to symptomatic cases and wide wedge biopsy is at least required in presence of diagnostic doubts: the asymptomatic FNH ("hot spot" on Tc99m-HIDA scintigraphy) may be followed-up only.

Adolescent↗

[Zuckerkandl tubercle of the thyroid gland (anatomo-surgical study: preliminary considerations)].

The presence of tubercle of Zuckerkandl (TZ) of the thyroid gland has been investigated in 20 specimens obtained from patients died from diseases not concerned to the cervical area. The project mas undertaken to elucidate the presence and the role of TZ as normal anatomical landmark. Special attempt has been paid to the relationships of the TZ with parathyroid gland and recurrent laryngeal nerve and the branches of the inferior thyroid artery. The tubercle was constantly found on the postero-medial surface of the thyroid lobe which showed constant relations with the branches of the inferior thyroid artery, superior parathyroid gland and recurrent laryngeal nerve. The outcomes of this preliminary report prove that TZ is an useful anatomical landmark to detect both superior parathyroid gland and laryngeal nerve in thyroid surgery.

Aged↗

[Reinterpretation of the hepatic abscess, a new dimension in abdominal digestive surgery].

Pyogenic abscess of the liver is viewed here as a surgical disease, which appears to raise doubts as to its actual identity. Though located in a given abdominal organ, such abscesses find it hard to recognize this as their exclusive setting and attempt to shrug off these traditional confines. They aspire, rightly or wrongly perhaps, to symbolize a splanchnic context, though, in actual fact, the latter--at least for contingent, doctrinal reasons--is confined to the bipolar liver-bowel system. This context presents its candidacy as playing a leading role in a disease of such importance as to be regarded almost as the "Caudine Forks" of the very process of "surgical" dying. Liver abscess and multiorganic or multisystemic organ failure (MOF or MSOF) might thus be viewed as the two opposite poles (taxonomically definable) of a single clinical condition, which fans out over a broad area and for the most part is only barely known to us. Though is characterized by its abdominal location, it would be all too simple to define the condition as abdominal. In this case, in fact, the abdomen speaks an unusual language, not the habitual, traditional, "spatial" language of location, but the as yet uncertainly articulated "biological" or, why not, even "biosurgical" language of mediation. Is this then a turning point in the pathological field? No, if by that we mean a new concept of the problem. In effect, the concept dates back several centuries and, moreover, darries a heavy burden of responsibility, such as, for instance, having induced the Nobel Prize-winner Elie Metcknicoff (Metcknicoff E., The prolongation of life. London, Heinemann, 1907) to come up with theories appropriated and implemented surgically by Sir William Arbutnot Lane, gaining him nothing but sad notoriety (Gordon R., Great Medical Disasters, Hutchinson, London-Melbourne, 1983). "Concept" is a euphenism, and a more appropriate term might be simply "intuition". The real innovation lies in reviving this old intuition, reinterpreting it now, in fact, as a "concept". The code for this modern interpretation has barely been sketched out in its essentials, but is daily going from strength to strength.(ABSTRACT TRUNCATED AT 400 WORDS)

Endotoxins↗

[Biomechanical and clinical interpretation of firearm wounds. General problems. VII. Propedeutic ABC of terminal ballistics].

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.

Biomechanical Phenomena↗

[Biomechanical-clinical interpretation of firearm wounds. General problems. VIII. Propedeutic ABC of terminal ballistics].

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)

Biomechanical Phenomena↗

[Biomechanical-clinical interpretation of firearm wounds. General problems. IX. Propedeutic ABC of terminal ballistics].

In this chapter, the leading role is played by the mechanical-thermal-ballistic device, issued as a long-barrelled regulation firearm to modern armies. The most accurate description of this type of firearm and its present and possible future development seeks to be in line with the objective comparison between the biological matter and the mechanical material, which constitutes the essential basis for any optimal nosological, aetiological, or pathogenetic classification of bullet wounds. We should not forget that the advent of the M 16 A 1 has aroused great technical interest, particularly--though not only--as regards the hydroshock aspect, and that the technological developments in future can hardly fail to increasingly confirm the singular nature of bullet wounds, which refuse to be encompassed merely within the somewhat limited sphere of their strictly local effects, but carry a broader significance in a critical context open to further verification in the future. There can be no denying that this unique nature of modern bullet wounds makes them ideal candidates bearing witness to a new interpretation of traumatism, which at present is only in its infancy.

Biomechanical Phenomena↗