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Biomedical subjects

N Pandolfo

Publications and source records attributed to N Pandolfo.

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

Diagnosis of superior sagittal sinus thrombosis by computerized tomography. Report of two cases.

Superior sagittal sinus thrombosis was diagnosed on computerized tomography (CT) scanning and was subsequently confirmed by angiography in two patients. Small ventricles and filling defects occurring within the sinus (the empty triangle sign) appeared to be highly suggestive of superior sagittal sinus thrombosis, and the association was confirmed angiographically. Potential pitfalls in the CT diagnosis of local obstruction of cerebral venous outflow are described and correlated with the natural history of the disease. The need for improved awareness of the CT appearance of occlusive disease of the dural venous sinuses is stressed.

Adult↗
PubMed1981

[Effects of extramucosal duodenal myotomy in dogs (author's transl)].

Numerous experimental and clinical observations have established the role of hypertonic duodenal dyskinesia in the etiology of duodenogastric reflux and delayed emptying of the stomach. The original procedure proposed, section of the duodenal muscle fibres, demonstrated a relative hypotonia of the viscera and maintenance of antropyloroduodenal coordination. The present study confirms the effects of extramucosal duodenal myotomy after short- and long-term follow-up in dogs: reduction in gastric emptying time, absence of duodenal stagnation, and lack of morphological changes in the viscera. Unfavorable in duodenogastric reflux, it has favorable effects, on the contrary, on gastric emptying and antral function.

Animals↗
PubMed1981

Modifications in gastroduodenal motility induced by the extramucosal section of circular duodenal musculature in dogs.

The effect induced on the gastroduodenal motility by the extramucosal section of the circular layer of the first two parts of the duodenum, excluding the pylorus, was studied in a series of 5 dogs. The myoelectric and manometric activities of the antrum, pylorus, and duodenum were recorded by using special devices surgically implanted in the gut wall. The recordings were made 3 mo after operation, both during basal conditions and after stimulation with neostigmine. The results were statistically compared with those obtained in a control group of 4 dogs in which the electromanometric devices had been implanted 3 mo before. The gastric emptying time of a food-barium meal was determined radiologically before the operations, and 3 and 9 mo after. The results demonstrate that extramucosal duodenal myotomy: (a) significantly decreases the basal and stimulated motor activity of the duodenum, without noteworthy alterations of the gastroduodenal myoelectrical activity and coordination of motor waves; and (b) significantly shortens the gastric emptying time.

Action Potentials↗
PubMed1979

Prolonged manometric study of the gastroduodenal junction in man.

A study of the motor activity of the gastroduodenal (GD) junction has been carried out on 8 subjects by using an original probe provided with a suction cup, that allows not only a duodenogastric (DG) pull-though, but also a prolonged recording of the pyloric, antral and duodenal motor activity, in basal condition and after intraduodenal instillation of HCl 0.1 N and intravenous infusion of cerulein. The position of the probe was controlled with fluoroscopy and transmural potential difference. The DG pull-through did not show a zone of high pressure at the GD junction, but the prolonged study showed, during HC1 and cerulein administrations, a significant increase of the pyloric tonus.

Adult↗
PubMed1979

Pyloric reflux: a duodenal functional problem?

A manometric study of duodenal motor activity was performed in 8 duodeno-gastric (D.G.) reflux patients and in 5 healthy volunteers. The examination was done by an open-tip probe containing three catheters which was positioned in the descending portion of the duodenum. The evaluation of manometric data evidenced in D.G. reflux patients a Motility Index (M.I.) significantly higher than that of control subjects in all the three duodenal recording points both in basal conditions and after prostigmine stimulation. Evaluation of the percentage of coordinated waves showed that in D.G. reflex patients the waves had a frequency lower than that in normals. On the basis of these results we can conclude that the duodenum of patients with D.G. reflux exhibits hyperkinetic-dyskinetic disturbances suggesting an important role of the duodenum in determing D.G. reflux.

Adult↗
PubMed1979

Prolonged endoscopic and manometric observations of the pylorus.

Functional aspects of the antral-pyloric segment were evaluated in 30 patients without gastroduodenal disorders by means of prolonged endoscopic observations. Patients were examined in standardized conditions. Pressure measurements of the antrum, pylorus and duodenal bulb were assessed by means of water-perfused polyvinyl tubes in 7 patients of the same group a few days after the endoscopy. The pylorus appeared open in above 80% of the total endoscopic observation time. Pyloric closure was observed only for few seconds at the end of 30-40% of antral peristaltic waves. The antrum and pylorus appeared to contract in sequence. Antral peristaltic waves moved at a mean rate of 2.4 per minute and duodenal reflux was observed at a mean rate of 0.96 per minute usually in the form of bubbles. The manometric measurements by means of pull through in 7 patients and immediately after by means of prolonged registration carried out in a fixed position in 4 patients failed to show a high pressure zone in the gastroduodenal junction. In some cases it was possible to observe a peculiar phasic activity in the pyloric tract. The endoscopic and manometric observations suggest that human pylorus does not act as a true physiological sphincter. These findings confirm the functional aspects described by radiology and manometry in other studies. In this way, endoscopy appears to be a useful procedure to evaluate some functional aspect of the gastroduodenal tract.

Adult↗
PubMedDate not supplied

Manometric assessment of Heller-Dor operation for esophageal achalasia.

BACKGROUND/AIMS: The aim of this study was to evaluate changes occurring in esophageal motility through a systematic manometric study performed before, during and after Heller-Dor operation (8) and to correlate the possible post-operative symptoms to the manometric and pH-recording patterns detected, in order to provide useful elements that may optimize surgical therapy for esophageal achalasia. MATERIALS AND METHODS: Between January 1981 and January 1991, 27 patients affected by esophageal achalasia underwent Heller's operation with Dor's anti-reflux procedure. Assessment involved clinical, radiological and manometric investigations. RESULTS: Intra-operative manometry was performed on 11 patients, in whom LES pressure reached values lower than 5 mmHg. Post-operative control, performed 2 years after operation on 25 patients, showed the complete absence of dysphagia in 22 (88%) and occasional dysphagia in 3 (12%). Post-operative manometry in all the patients showed a decreased LES resting pressure (from 32.6 to 7.2 mmHg, p < 0.001), LES residual pressure (from 16.4 to 5.0 mmHg, p < 0.001) and esophageal tone (from 4.8 to -3.5 mmHg, p < 0.001). Patients free of dysphagia presented LES basal and residual pressures lower than the other patients (6.2 and 4.6 vs 15.1 and 7.7 mmHg respectively, p < 0.01 and p < 0.05). 24-hour-esophageal pH-metry showed pathologic reflux in 3 patients with reflux symptoms and in 1 without symptoms. All had LES basal and residual pressures equivalent to non refluxing patients (5.7 and 5.0 vs 7.5 and respectively 4.9 mmHg, p = n.s. and p = n.s.). On the contrary, a difference was found in abdominal LES length between the two groups (0.5 vs 1.6 cm, p < 0.01). Patients with intra-operative manometry presented a lower incidence of residual dysphagia than patients without it (0% vs 21.5%), but a higher incidence of reflux (18.2% vs 7.3%). CONCLUSION: Heller-Dor operation induces a definitive disappearance of dysphagia when it is complete in depth and length. Prevention of gastro-esophageal reflux requires the preservation of a sufficiently long portion of esophagus in the abdomen.

Adolescent↗
PubMedDate not supplied

[Heller's intervention for esophageal achalasia].

From 1962 to 1992 sixtythree patients with esophageal achalasia underwent primary surgical treatment. The intervention performed was a cardiomiotomy according to Heller in 20 patients (Group A), a cardiomiotomy according to Heller with anti-reflux procedure according to Lortat-Jacob in 12 patients (Group B), a cardiomiotomy according to Heller with fundoplicatio according to Dor in 31 patients (Group C). Preoperative study was performed by radiological evaluation in patients of Group A, while patients of Group B and Group C were submitted also to endoscopy and esophageal manometry. Postoperative evaluation in Group A was performed by clinical and endoscopical controls, while in Groups B and C by clinical and radiological studies 6 months after the intervention and by clinical and endoscopical studies every two years. During the early two years after operation a functional study (esophageal manometry and esophagogastric pH-monitoring) was performed. The follow-up was complete for 13 patients of Group A, 10 patients of Group B and 28 patients of Group C. Good results (complete absence or slight dysphagia) have been obtained in 70% of Group A, in 90% of Group B and 90% of Group C. Esophageal manometry found a decrease of both resting pressure and length in every patient in Groups B and C. Gastro-esophageal reflux symptoms were found in 15% of Group A, 20% of Group B and 11% of Group C. A various degree of esophagitis was found by endoscopy in 40% of Group A, 50% of Group B and 18% of Group C. Esophago-gastric pH-monitoring, performed in Group C patients, showed pathologic refluxes in 22% of the subjects. The clinical and functional study demonstrates that Heller's cardiomiotomy, in the way it is performed nowadays (complete miotomy over 7 cm of the esophagus and 3-4 cm of the stomach), allows the complete disappearance of dysphagia. On the other side the anti-reflux procedures till now performed (including the 180 degrees fundoplicatio according to Dor) are not effective enough to avoid post-operative gastro-esophageal reflux.

Adolescent↗
PubMedDate not supplied

[Rationale of the surgical treatment of duodenogastroesophageal reflux].

Patients with "intact stomach" but more frequently patients operated on the esophago-gastric junction, vagus, stomach, can develope a duodeno-gastro-esophageal reflux syndrome. We propose a rationale of the surgical treatment based upon our experiences during these last 15 years in functional studies, mainly manometric, of the entire esophago-gastro-duodeno-jejunal tract. Patients with an intect stomach: a non-demolitive ("functional") technique may be proposed each time a correctable alteration of the gastro-duodenal motility is found during the manometric study. Such interventions are the association between a fundoplicatio and Extramucose Duodenal Myotomy, Duodenal Switch, Pylorectomy. On the other side when the motor alteration is too severe and uncorrectable (Prostigmine-Test) or in presence of morphological, nearly always pre-cancerous, alterations we can perform only demolitive procedures. The intervention preferred by the AA is Total Duodenal Diversion. Patients with operated stomach: the different possible surgical procedures and their results are strictly related to the intervention preceding the onset of the reflux syndrome. In fact the better results are related to bad management and to post-operative complications during the previous intervention, rather than to an ignored pre-existing motor disorder. The Total Duodenal Diversion seems to be the must reliable also in this case, both initially and in the operated patients (conversion from Billroth II to Roux). Between 1978 and 1993 we observed 604 refluxers at 24-hour pH-recording, 209 of them with alkaline or mixed gastro-esophageal reflux. On the basis of the morphologic and functional diagnostic evaluation 64 patients underwent surgery, 36 with intact stomach and 28 with operated stomach. Good results (disappearance of esophageal symptoms and improving in gastric symptoms) were obtained in 30 (83.3%) patients with intact stomach and in 25 (89.3%) with operated stomach.

Duodenogastric Reflux↗