Biomedical subjects
Publications and source records attributed to M Pozzi.
Embolization of very vascular intracranial meningiomas prior to operation will reduce the loss of blood during the operation. The indications and the technique of preoperative embolization are discussed and 20 cases are presented.
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The AA. reviewed our experience concerning 64 patients operated on for discrete subaortic stenosis due to a fibrous membrane, between 1975 and 1981 at the Department on Cardiac Surgery "A. De Gasperis" in Milan. The clinical and hemodynamic features, the indication for operation, the surgical management and the immediate and long-term results are described. No patients died at surgery or afterwards. Only in three cases complications were noted (2 atrioventricular block, 1 pleural empyema). Of all the patients 95% were asymptomatic after operation; only three cases presented symptoms correlated with the cardiac malformation, but still they were greatly improved, compared to their preoperative status. As discrete subaortic stenosis is a progressive disorder, the operative risk is poor and the results are good, surgical treatment is recommended in symptomatic patients and if the haemodynamic gradient is 50 mmHg or greater.
Since 1970, forty patients with ventricular septal defect (VSD) and aortic insufficiency (AI) have undergone surgical treatment in our institution. In the majority of the patients (60%) the VSD was subcristal. In sixteen cases the aortic valve was replaced, whereas in 9 patients the valve was repaired and in 15 subjects simple closure of the VSD was deemed to be sufficient to correct the AI. There have been 2 hospital and 4 late deaths. The A.I. seems to be due to two different pathogenetic mechanisms in supra- and subcristal V.S.D., with the faster progression in the supracristal ones. With simple patch closure of the V.S.D. we had the best late results, good results were obtained with the plasty of the aortic leaflets while the worst late results were found in the group which had undergone aortic valve replacement. For this reason the Authors recommend surgical intervention as soon as AI shows up.
A cranioplastic technique is described that is easy to do by making a series of molds and an acrylic prosthesis identical to the bone segment.
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The authors have inserted Mc Kee prostheses in 1,000 hips between 1967 and 1977. 616 were reviewed with a follow-up of more than three years. There was an overall infection rate of 2.4 p. cent and of 4.3 p. cent in cases which had previously had operations. The results were satisfactory with 84.7 p. cent giving no pain, using no sticks and with good mobility. 83 cases were reviewed with more than ten years follow-up. 3 out of 4 still have a satisfactory result. Only 14 cases had to be operated on for a second time for loosening with 11 satisfactory results. It is concluded that this type of prosthesis is valuable when compared with other types. Very little wear and no fracture of the stem was seen.
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Retrospective analysis was undertaken of 24 patients with atrial myxomas surgically treated. There were 19 males and 5 females, ranging in age from 10 to 69 years (mean 44.6 years). 22 myxomata were located in the left atrium and 2 in the right atrium. Clinical manifestations and cardiac catheterization findings are described. All tumors were resected with the aid of extracorporeal circulation. The operation consisted of removal of the tumor, with a generous excision of septal attachment in 17 cases; patch reconstruction of the atrial septum was required in most patients. One patient had a concomitant correction of atrial septum defect, another required mitral annuloplasty, and third had a concomitant aorto-coronary bypass. There were 3 hospital deaths (operative mortality 12.5%) and 2 patients (one died) had intraoperative tumor emboli. In a follow-up extending to 11 years (mean 38 months), there were not late deaths and functional results were generally excellent (15 surviving patients are in N.Y.H.A. class I). No patient had evidence of recurrence of the tumor.
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The aim of our study was to evaluate in 18 diabetic patients (11 with and 7 without evidence of autonomic neuropathy as revealed by common cardiovascular tests) alterations indicative of autonomic nervous involvement of the gastrointestinal tract, independently of the presence of suggestive symptoms. All patients, without evidence of obstructive or mucosal pathology of the upper gastrointestinal tract, underwent the following: 1) study of gastric emptying time of nonabsorbable radiopaque markers (90, 120, 150 and 210 min); 2) study of gastric acid secretion: basal (BAO) and peak (PAO) acid output after sham-feeding (PAOSF) and peak acid output after pentagastrin (PAOPENT).PAOSF/PAOPENT ratio is an index of vagal integrity; 3) esophageal manometry. Our data confirm that a delayed gastric emptying of undigestible solids is a frequent finding in diabetic subjects. This was highly significant (p less than 0.01) at 150 min after a standard meal, in patients with signs of autonomic neuropathy and was often associated with asymptomatic esophageal motor abnormalities. No correlation was found with index of vagal integrity, hormonal pattern and degree of glycemic control. Autonomic neuropathy cannot be considered the only explanation for gastric and esophageal abnormalities in decompensated diabetes.
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Serum levels of the immunosuppressive acidic protein (IAP) and CA-125 were measured in 45 patients with ovarian tumors (30 malignant and 15 benign) before surgery. Concentrations of both markers were slightly increased in benign forms but still within the upper limit for controls. The sensitivity of IAP in detecting ovarian cancer was higher than CA-125 (83.4% versus 76.7%). Five false negatives were observed in IAP assay and seven for CA-125. Parallel determination of both markers, however, improved the diagnostic accuracy up to 90.0% of the total malignant cases. Combined measurements of circulating IAP and CA-125 are therefore recommended in the detection of ovarian cancers.