[Immunosuppression and postoperative infections: a rational approach to the problem].
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Biomedical subjects
Publications and source records attributed to M Garino.
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The rate of postoperative infections is significantly increased in anergic patients. The authors evaluated prospectively, in a controlled, randomized and stratified study, the efficiency of thymostimulin in reducing postoperative infections in 42 such patients. Excluded were those who were malnourished in whom preoperative alimentation corrected the anergy. The incidence of infections was significantly (p less than 0.05) reduced in thymostimulin-treated patients (4.8% versus 28.6%).
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The Authors describe a case of somatostatinoma in the pancreatic tail, characterized by the absence of a specific symptomatology, with the exception of a slight hyperglycaemia. The patient underwent a surgical operation of pancreatic resection and splenectomy, and now enjoys very good health. They have examined literature from 1977 to 1988, and overall the 30 cases of pancreatic localization, describing the symptomatology, the pathological anatomy, the therapy, and evaluating the malignity degree. Then the Authors could notice that the prognosis of these neoplasms is often fatal, both for the frequent tumor metastatization, and for the difficulties in making an early diagnosis. The therapy is essentially surgical.
We analyze a group of 64 laparoceles from which it emerges a per cent distribution in the different regions and a correlation between the dimensions of the lesion and the relative regions in agreement with the data usually given in the literature. Furthermore we point out a clear dependence on pathogenetic factors of general and local order. Is therefore recognized the necessity of preventing their insurgence and reducing the risk of relapses through appropriate laparotomy incisions, with adoption of a suitable surgical technique and the correction of systemic diseases. The voluminous laparoceles are responsible of cardiac, respiratory, coagulative diseases, that must be scrupulously judged for an appropriate therapeutical approach. The surgical treatment, as well as for the cases of bigger dimensions, has mostly availed itself of an elementary technique (simple approach, apposition "en paletot" splitting of the fasciae). In the necessity of strengthening weak parietal tissues or of replacing vast losses of matter, we have limitedly resorted to autologous grafts, while good results have been observed with the lyophilized dura mater.
Radiation enteropathy is a disease that seldom requires surgical treatment, in the chronic variety. We report the findings of four cases we operated in an attempt to identify the weak points of surgery involving a high percentage and morbidity of mortality. NPT (total parenteral nutrition) can favour a positive evolution with total rest of the bowel and with reinstatement of normal nutrition.
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