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N de Manzini

Publications and source records attributed to N de Manzini.

33 records · Page 2Linked to original sources
PubMed1989

[Gastroduodenal ulcer. New therapy and new clinical practice?].

Duodenal, prepyloric, and gastric ulcers are based on different pathophysiological processes. The achievements obtained from therapeutic medication, using H2-blockers, have reduced indications for surgical treatment, primarily for duodenal ulcer. Surgery has continued to be required for failure of medicamentous therapy, recurrence, development of intercurrent diseases calling for corticoid or anti-coagulant treatment, patients above 55 years of age with haemorrhage, occurrence of severe side effects, and, occasionally, for economic reasons. Optional methods are left-side selective vagotomy for duodenal ulcer, antrectomy with bilateral subdiaphragmatic vagotomy for prepyloric ulcer, and hemigastrectomy with gastroduodenal anastomosis for gastric ulcer.

Gastrectomy↗
PubMed1989

[The development of surgical therapeutic concepts of acute severe pancreatitis].

The actual surgical concepts concerning the treatment of acute pancreatitis are described. Owing to sonography and above all to computed tomography, constantly compared with clinical data, the surgical decisions can be more easily conducted. In acute pancreatitis of biliary origin, endoscopic sphincterotomy is mandatory in a great number of cases, followed by complete de-obstruction of the common bile duct. That procedure has the advantage of reducing notably mortality and morbidity. In idiopathic pancreatitis, 4 therapeutic behaviours which correspond to 4 different clinical types, are to be faced: --or after 5 to 6 days, division of the left hypochondrium with performing of a meticulous cleaning, followed by a large drainage lavage, --if all reanimation measures have failed, earlier surgery, often of the last chance, consisting in necrosectomy as extended as necessary, --in right away appearing pancreatic phlegmon, a very large drainage, --or, a more expecting attitude in cases in which resorption of the necrotic spots appears to be very slow on CT-Scan, but without any clinical abnormality. Figures support these concepts and prove their warranty.

Acute Disease↗
PubMed1989

[What are the surgical indications for non-complicated duodenal and gastric ulcers?].

Taking into account recent medical progress and on the basis of their own experience, the authors define the up-to-date surgical management of non-complicated duodenal and gastric ulcers. Chronic duodenal ulcers still remain to be submitted to surgery in case of resistance to different types of medical drugs, in case of concomitant disease requiring a specific treatment contraindicated in ulcer disease, in case of patients refusing drugs or developing side-effects, and last, in posteriorly localized or bleeding ulcers. In these situations proximal gastric vagotomy (P.G.V.) still remains the best procedure owing to its low mortality (less than 0.5%) and morbidity rates, and its very satisfactory functional results. The recurrence risk, estimated between 10 to 15%, might burden the long-term results. But in a high percentage of cases it is related to technical inefficiencies. It has to be recalled that only 30% of these patients will undergo reoperation. But it should be emphasized that prepyloric ulcers are a poor indication for P.G.V. and should be submitted to truncular vagotomy with antrectomy. In gastric ulcers, the surgical treatment is mandated whenever endoscopic signs don't disappear under medical treatment or if biopsies remain suspicious. The most satisfying procedure is a gastric resection always involving the lesion and followed by a gastroduodenal anastomosis according to Péan-Billroth I.

Duodenal Ulcer↗
PubMed1988

[Surgery of the left colon].

Some basic technical principles make the left colon surgery as safe as possible. The authors recall the surgical anatomy and the vascularization of the left colon and describe the technic of a left hemicolectomy, of the Hartmann procedure with restoration of the intestinal continuity and the closure of a lateral colostomy. Mastering these technics should help to face and resolve any urgent or regular pathological pattern of the left colon.

Colectomy↗
PubMed1987

[Long-term recurrence and complications of 300 supra-selective vagotomies for simple chronic duodenal ulcer].

Three hundred H.S.V. for chronic duodenal ulcer, performed between 1972 and 1982, are reviewed. A thorough analysis of intra and post-operative complications points out that only ulcer recurrence still set problems. These concern their definition, frequency, diagnosis and treatment. The personal experience of the authors leads them, in case of failure of the medical treatment with and endoscopically proved ulcer--what happened in 6 patients of 17 (35,8%)--to prefer gastric resection to re-vagotomies, the performance of which is often difficult and the results uncertain.

Chronic Disease↗
PubMedDate not supplied

Reliable procedure for closing the duodenal stump for bleeding posterior duodenal ulcer.

Bleeding posterior duodenal ulcers is a critical problem especially in patients of advanced age. Surgical treatment should obtain efficient and stable hemostasis and avoid digestive fistulas due to leakage of the duodenal stump. The main difficulty lies in the closure of the duodenal stump. A procedure using intramural dissection of the duodenum and closure by means of a stapler is reported for a series of 40 patients without recurrent bleeding or duodenal fistula. Seven patients (17%) died from associated diseases, especially respiratory insufficiency (3 patients) and cirrhotic liver failure (2 patients).

Adult↗
PubMedDate not supplied

[The surgical therapy of liver trauma].

The different therapeutic patterns of liver trauma are presented; they should be chosen on the basis of both clinical assessment, particularly looking for hemodynamic impairment and associated bowel lesions, and CT scan data. Surgical abstention should be considered for a great number of blunt liver trauma; open or severe blunt trauma should be preferably treated by elective hemostasis and biliostasis, with only rare use of hepatic resection "à la demande", on partially sectioned or devitalized tissues. Cavo-suprahepatic wounds remain the most important technical problem and continue to worse the prognosis in liver trauma.

Embolization, Therapeutic↗
PubMedDate not supplied

Role of chemotherapy in acute breast cancer. Analysis of 41 cases.

Clinical and therapeutic results in a series of 41 patients treated for inflammatory cancer of the breast lend emphasis to the selection criteria to be included in a short (approximately two months) clinical history to complement Haagensen's criteria. Chemotherapy improved the previous very poor results obtained in this condition. Survival after surgery and radiotherapy were less than 5% at five years, and this is compared with the prognosis in the series study. However, these results are still only fair in absolute terms and there is still no currently available alternative solution to attempt to achieve a marked improvement in the course of the lesion.

Acute Disease↗
PubMedDate not supplied

[The musculocutaneous flap of the latissimus dorsi in the treatment of recurrences of breast cancer].

Breast cancers local recurrence treatment usually requires a large chirurgical resection. Latissimus dorsi myocutaneous flap was used after mastectomy in 27 patients. This technique was performed in 14 patients who had a recurrence after exclusive radiotherapy treatment. The follow-up of all the patients was more than 5 years. A 42% survival rate has been quoted in this group, after a 11 years period. Latissimus dorsi myocutaneous flap seems to be a satisfactory alternative when performing reconstruction after wall excision under 300 cm2, excepted for recurrence of fast kinetic cancers.

Adult↗
PubMedDate not supplied

[Cancer of the rectum: clinical and therapeutic aspects. What changes occurred during the last 2 decades?].

This retrospective study of 440 cases of cancer of rectum was done over a period of 2 decades (1970-1993) which was divided in 3 periods (1970-79, 1980-89, 1990-93) and a comparative analysis was done with respect to clinical features, histo-pathology, treatment and results. At least one predisposing lesion (polyp, villous tumour) was noted in 26.7%, 41.5% and 41.5% respectively. The topographic distribution was unchanged in all three periods. The Dukes staging showed increase in stage A with 1.9%, 9.8% and 10% respectively and decrease in stage D with 26.1%, 20.2% and 16% respectively. The operability rate was 92.3%, 94% and 96.5% respectively, resectability rate was 80%, 91.3%, 94% and 96.5% respectively, resectability rate was 80%, 91.3% and 95.9% and curative resection rate was 83.3%, 86% and 88.2% respectively. Amongst the operations done, abdomino-perineal resection was done in 55.8%, 39.5% and 7.2%; anterior resection was done in 5.5%, 36.6% and 81.4%; thus these two curves crossed in 1985. Hartmann's procedure was done in 11%, 8.7% and 4.1%. The radiotherapy was given in 6.9%, 23.9% and 75.8% respectively. Overall hospital mortality rate was 5.8% which showed progressive decrease in the 3 groups with 13.8%, 1.24% and 2% respectively. The principal factors influencing the mortality rate were the emergency presentation the type and the palliative type of operation. Overall early complication rate was 42% which showed progressive decrease in the 3 groups with 64.8%, 37% and 21% respectively. Rate of local recurrence was 17.2% which was related to the topography of the tumour, Dukes staging, type of operation, margin of resection and preoperative radiotherapy. 5 year survival rate was 43% which in relation to the curative or palliative nature of the operation and the Dukes staging. The expected progress in terms of survival depended on surgery in early stages of disease and use of radiotherapy and chemotherapy.

Adult↗