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Biomedical subjects

P Tenchini

Publications and source records attributed to P Tenchini.

At least 19 recordsLinked to original sources
PubMed1989

Surgical strategy in primary retroperitoneal tumours.

Sixty-nine patients with primary retroperitoneal tumours (17 benign, 52 malignant including 4 malignant tumours of uncertain origin) were reviewed to determine the best form of surgical strategy. Total resection was performed in 88 per cent of benign cases and in 65 per cent of malignant cases. In 62 per cent of the total resections for malignant tumours, en bloc excision included adjacent organs or anatomical structures. Operative mortality rate (in terms of the total number of operations performed) was 5 per cent. Postoperative complications occurred in 14 per cent and recurrences in 35 per cent. The overall 5-year survival rate was 67 per cent in patients with totally resected tumours and zero in patients whose tumours were treated by partial resection or biopsy. An aggressive surgical approach aimed at total excision of the tumour is the best form of therapy currently available. In the totally resected retroperitoneal tumour, the use of adjuvant radiotherapy and/or chemotherapy depends on the grade of the malignancy and clearance as assessed histologically. Careful follow-up based on the use of computerized axial tomography and ultrasound allows early identification of recurrence at a stage when the recurrence is amenable to total resection.

Adolescent↗
PubMed1989

[Biomechanico-clinical interpretation of firearm wounds. General problems (III). A propedeutic ABC on terminal ballistics].

The surgeon should have a comprehensive knowledge of firearms as thermochemico-ballistic machines in order to come to grips in an adequate manner with the wounds they inflict on the human body. The traces left on the body to all intents and purposes embrace a cultural "cul de sac" which risks being defrauded of most of its content by a lack of those propedeutics elements which painstaking reflection is capable of affording us. Only the interpretation of each individual ballistic phase, both as a complete phenomenon in itself and as a component in a single articulated complex, can offer such elements: credit is due at least for a wholehearted commitment in this direction, while never losing sight at any time of the clinical perspective of such wounds.

Forensic Medicine↗
PubMed1989

Emergency surgical management of retrosternal goiter causing tracheal compression.

Acute tracheal compression caused by mediastinal masses is a rare event. Dyspnea is the most frequent symptom and the treatment of choice is intubation followed by surgical operation. Four cases of acute tracheal compression due to retrosternal goiter are described. All of them underwent emergency surgical treatment. Clinical findings and problems of surgical technique are discussed.

Aged↗
PubMed1988

[Biomechanico-clinical study of gunshot wounds (general problems--II)].

Whenever the surgeon finds himself face to face with a wound (probably this is the only opportunity for a meeting between physician and pathology which seems to be able to leave the "illness" on one side, almost forgotten, as it were), even when immersed in routine, he can hardly help making a number of considerations of a general nature, to which the sentence above in brackets is not entirely extraneous. In practice, we cannot help asking ourselves an apparently simple, almost banal, question: what exactly is trauma? This triggers off a whole series of secondary queries, such as, for instance, what the relationship is between trauma and classical pathology? In the first place, it should be pointed out that "traumatic" pathology is undoubtedly the only instance of pathology in which, as a rule, at least at the outset, one can justifiably talk about the "isolated" role of what can certainly be regarded as an out-of-body factor. If, then, we consider the specifically morphological and pathophysiological aspects of the period subsequent to the traumatic insult, we find ourselves in an even more embarrassing position: we are faced with irreparably devastated organ and body structures, or with a situation which is already on the way to convalescence. One last alternative is that the traumatic insult is merely a memory, a key finding in the case history, a past reality which to all intent and purposes has ceased to exist, and we are faced with extremely complex clinical pictures which we tend to label as complications. A few examples by way of explanation: shock, adult respiratory distress syndrome (ARDS), stress ulcer, acute post-traumatic cholecystitis, haemorrhagic pancreatitis, and problems caused by resolving the hypovolaemia-ischaemia situation and by implementing reperfusion (oxygen radicals). Trauma favours - and surgeons concerned with organ transplants are well aware of this - the only possibility of death which, perhaps with a grain of excessive optimism, we may even accept as fruitful, in that it occurs without all the destructive deterioration involved in the process of dying. The above consideration probably plays a major role in our attitudes of almost fatalistic resignation towards the youthful victims of trauma.(ABSTRACT TRUNCATED AT 400 WORDS)

Physical Phenomena↗
PubMed1988

[Biomechanical and clinical study of gunshot wounds (general problems). I].

Above and beyond their effective epidemiological incidence, which is perhaps somewhat greater than is commonly imagined even outside the war context, gunshot wounds constitute a unique cultural opportunity for the traumatologist and for surgeons in general. The actual morphological and clinical features of such wounds, which bear precise, localized witness to, and reflect in a virtually mathematical manner, a programmed, and thus readily quantifiable, dimension of kinetic energy (rich in experimental implications), stand out against the backcloth of an extremely extensive involvement of the body in which, amongst other things, the intervention of a whole host of mediators may be seen to play a decisive role. Lastly, it should not be forgotten that it is precisely in field hospitals or their equivalents that surgery has found a precious opportunity to escape the environmental or "cultural" conditioning of the moment and play a leading role not only in terms of technological solutions but also in terms of reflection on the main leitmotive of pathophysiology, from shock to ARDS.

Biomechanical Phenomena↗
PubMed1987

[Hypothesis of the pathology of mediation in surgery (2)].

There are clearly numerous examples of mediation pathology in surgery. They go far beyond what may be defined as severe forms, in which the entire body is involved in the precipitating disease process and in which the mediation appears more easily recognizable, in that it evokes a resonance which wipes out all specificity and becomes the true protagonist of the critical situation. Forms which can be traced to a well defined pathogenesis, and others to a more debatable pathogenesis, afford great scope for mediation. May one, for instance, be justified in suggesting a mediation hypothesis for a classic surgical disease such as duodenal ulcer?

Disease↗
PubMed1987

[Hypothesis of the pathology of mediation in surgery (3)].

There are three aspects to mediation: the first of these is purely physiological, or rather is concerned with performance of service functions such as ovulation, sexual activity, sleep, etc.; the second, strictly speaking, may be defined as pathophysiological, as its starting point is considered to be an aggressive event, even when a routine occurrence (in the stomach, for instance, aggression is a constant feature, even when of only slight intensity, as produced by the physical characteristics of the enormous quantities of food transiting the stomach and by particular environmental conditions; the third aspect is distinctly pathological, in that it constitutes the basis for the aggravation of a pathological situation already in progress, sometimes according to the logic of plain addition, but more often according to a more catastrophic process of multiplication (less frequently it takes the form of induction of a prevalent or independent disease condition). This break-down of mediation into distinct types, though necessary from the point of view of academic classification, proves extremely difficult to apply in practice. The validity of this latter consideration obviously depends on the specific area we are tackling. As regards the sex glands and male genital organ, the service role is unquestionable; elsewhere, we can be equally sure that we faced with pathophysiological aspects. In the stomach, for example, the difference between "normality" and "disease" does not lie so much in the absence, as opposed to the presence, of lesions, but rather in their extent and duration. This makes it extremely difficult to draw the line between physiology and pathology, and at the same time suggests that the state of health may be an unstable equilibrium phase somewhere midway between divergent forces belonging to the same mechanism. This latter mechanism may therefore be the key factor both in vital performance and in disease processes, whereas the "classic" aetiological factor may actually be relegated to a secondary role, at least in most cases.

Homeostasis↗
PubMed1987

[Hypothesis of mediation pathology in surgery (4)].

The mediation pathology concept takes account to a large extent, though by no means exhaustively, of that horizontal language between peripheral cells, based on locally produced hormone-like substances and aimed at covering extremely short distances. This brings us well and truly into the paracrine domain of intercellular communication, whereby an exchange of messages takes place between adjacent cells via the interstitial spaces. Alongside this short-range communication network, there also exists a long-range network, involving above all the blood stream both as an intermediary and as mediation terrain. To the mediatory processes partakes the neuro-endocrine system, albeit it is not the predominant one as it was classically thought. There are other actors on the mediation stage: oxygen radical plays an important role.

Cell Communication↗
PubMed1986

[Nd-YAG laser disobstruction of esophageal endoprostheses occluded by neoplastic development in the palliative treatment of esophageal cancer].

Since August 1984 18 patients suffering from inoperable esophageal cancer have been treated by Nd. Yag Laser therapy under endoscopic control in the Verona University Institute of Clinical Surgery. Three patients, all males ranging in age from 68 to 80 years, had endo-esophageal prostheses which were occluded as a result of the neoplasms. Occlusion of the prostheses had been ascertained by both x-rays and endoscopy. The symptoms consisted of severe dysphagia of solid foods in 2 cases and of solids and liquids in 1 case. The original sites of the tumors were the lower 3rd in two cases and the mid 3rd in 1 case. Histologically, the tumors were identified as 2 squamous-cell carcinomas and 1 adenocarcinoma. Laser treatment was given on average once every 7 days. Patients were admitted to the day hospital, thus avoiding negative repercussions in terms of quality of life or length of hospital stay. In 2 cases there was an improvement in symptoms with the possibility of semi-solid nutrition after a single treatment with 6000-5032 Joules. In the third case, to obtain the same result, 2 treatments were necessary at an interval of 7 days with a total of 9396 J. One patient died of cardiorespiratory failure 24 days after the first treatment. A second patient was treated a further 3 times with a total of 12356 J and is now on a liquid and solid diet 5 months after the first treatment. The third patient was treated 4 times with a total of 15769 J; this patient was on a liquid and solid diet, but died of cardiorespiratory failure 3 months after the first treatment. In the light of our experience, Nd. Yag Laser disocclusion of endo-esophageal prostheses occluded by neoplasms presented no complications and was an appropriate indication in these cases with satisfactory long-term results.

Adenocarcinoma↗
PubMed1986

[Hypothesis of the pathology of mediation in surgery (1)].

The mediation pathology hypothesis is not new. As early as 1955, Laborit hinted at something of the kind in his phrase "N'est malade que l'organisme qui le vent bien". Today, however, in the light of free oxygen radicals, which together with other mediators may possibly represent only the tip of an enormous iceberg, we may venture a number of admittedly cautious theoretical considerations. This would appear to be particularly relevant today, in that surgery at this precise moment, I would venture to say, is at a turning point. On the one hand, surgery is pushing to extremes its classic restrictive morpho-mechanistic approach to disease, while on the other, together with cardiology, it is quick to perceive new biological horizons, which until very recently were unimaginable and, as such, constitute its elective target of interest. Paradoxically, to all intent and purposes at least, the biological rite appears to have found the most natural place for its celebration precisely on the site where the morpho-mechanistic ritual seems to have reached its zenith and, at the same time, its moment of glory.

Animals↗
PubMed1986

[Biology and surgery: a bound pair or merely a couple of disciplines? (2)].

Carcinoma of the breast, to our way of thinking, appears to be capable of providing what is virtually a master key to the interpretation of surgical oncological pathology. In the wake of the acquisitions made in this field--not always as a result of the initiative of the surgeon - a definite process of revision of the age-old concept of surgical radicality is underway, albeit in a somewhat surreptitious manner. Oncological surgery is clearly passing through a difficult phase, almost a crisis of identity, and, in the authors' opinion, may to some extent come back into its own, albeit only after a great deal of painstaking effort, by adopting a "biological" approach with greater respect for the morpho-functional integrity of the patient, who must no longer be viewed as merely the victim of disease, but rather as the prime mover of the disease itself.

Cocarcinogenesis↗
PubMed1986

[Biology and surgery: a bound pair or merely a couple of disciplines? (3)].

In the following reports two main problems are questioned by the Authors. To start with, a sharp distinction is made between the so-called "theoretical physiology" and the "actual" use of the physiological functions adopted by the single man and woman. The second question is concerned with the biological consistency of the different surgical approaches. In the neoplastic treatments, surgeon can draw a conclusion that goes behind the single therapeutic event casting over other different areas of the surgery itself. To answer this second question by no means represents the solution of the aimed goal, on the contrary it is the starting-line towards a surgery, which, having left behind his old, obsolete, but pompous garments, does wear those, which, apparently shabby, are, on the other hand, enriched of many lapels, such as those naturally offered by the self-healing behaviour.

Humans↗
PubMed1985

[The ND-Yag laser in the treatment of non-resectable esophageal neoplasms: evaluation and results].

The Authors show a set of 9 cases of patients suffering from oesophagus flaky carcinoma, judged radically non-operable, and treated with endoscopic laser-therapy by N.D. Yag Laser. They illustrate the patients' main clinical data, method followed, complications observed and results obtained. What seems to emerge from the analysis of the data is: the effectiveness of laser-therapy in the control of disphagia, simplicity of the technique and its acceptability by the patient, as well as the rareness of complications. Three are the clinical parameters used for the checking of patients before and after the laser treatment: disphagia, odynophagia and thoracic ache. The intenseness of symptoms was classed from 0 up to 3. Before the treatment, six patients out of nine showed class 3 disphagia; after the treatment, two could assume fluids (class 2), two fed also on minced foods (class 1), and two fed normally; in the two cases with initial class 2 disphagia a normal feed could be adopted; in one case no initial disphagia was present. Odynophagia was initially present in one case only at class 3, in three cases at class 1, and in all the other cases it was absent (0). After the treatment, odynophagia disappeared totally, except in one class 1 case, which remained unchanged. The presence of thoracic ache before the treatment was class 1 in four cases, class 3 in one case, and absent in four cases. After the treatment, the class 3 ache turned into class 1: in one class 1 case it was not modified; in the remaining cases the ache, if present, disappeared. Some questions remain opened, concerning the effect on survival, even in relation to other palliative methods, to the duration of the palliation obtained and to the eventual associability of lasertherapy to radiotherapy.

Aged↗
PubMed1985

[The story of oxygen. (3)].

This last part of the oxygen story seems to stray from the line followed till now, and contradict itself, by electing ATP instead of oxygen as its protagonist. Yet, of course, this deviation is only apparent: in reality the hypoxanthine, which is at the basis of the production of superoxide, during the post-ischemic perfusion, is just a catabolic product of the intercellular reserves of ATP, pillaged by the ischemia itself. The attempts to resolve the ischemia and cellular anoxia through the supply, added to the volemic and respiratory reintegration, of performed packets of energy, such as ATP with MgCl2, FDP, etc., cannot be unimportant for traumatologist surgeon, accustomed to face the multiform physiopathologic facets of the shock. Although the flattering results tend to increase, some doubts remain about the effectiveness of such measures, especially ATP, and someone also suggests possible negative effects, partly framed in the well known and complex consequences of the "drug" on the cardiovascular dynamics, partly put forth by its not enough defined metabolic outline. Evidently, the way of the straight energetic supply, which, undoubtedly, represents the fulfillment of a "mirage" of release, at least partially, and in critical situations, from oxygen, although still long and burdened with problems, is also, decidedly, suggestive with promises. It seems surgeon, the true protagonist of such investigations, wants to seek a new dimension in them, being aware, and transplantations supplied an exemplary lesson in such sense, the biologic language is congenial to him, as it is high time.

Adenine Nucleotides↗
PubMed1985

[The other face of oxygen (1)].

The other face this two-faced Janus, the oxygen, allows us, by now, to see dimly is the bad, aggressive one shown by its free radicals, should they escape the respiratory machine, or, rather, should they follow the respiratory explosion of leucocytes and macrophage, or the same compromission of the cellular structure. The antioxidative mechanisms, although articulate and quibbled, appear inadequate, also because the oxygen radicals are formed on the outer side of the cellular membrane, and, just in the intercellular space, the defensive protections are extremely poor. If lung deserves a particular status, being the usual point of aggression by the oxygen radicals: here, these active metabolites are produced by its macrophage, but also by its endothelial cells, especially in conditions of hyperoxy; all organs and segments are their targets. Besides the immediate results, which are also caused by oxidizers having a long half-life, there are mediate results, essentially rotating around the arachidonic acid, a sort of multiplicating pin, with its products of the cyclooxygenase line (thromboxane A2, endoperoxides, prostacyclins) and the lipoxygenase line (the wide range of leukotrienes). But not even this "free body", in a position to escape, provided it wants so, the enzymatic control, seems inclined to free itself, what attenuates its bad face, from a basic rule in animal biology, that is, "negative feedback".

Arachidonic Acids↗
PubMed1985

[Biology and surgery: a team of disciplines or merely two disciplines? (1)].

The present work questions itself about the "ideal" relation between biology and surgery, the necessarily bloody arm of medicine, namely, of that science man has been preparing, parallel with his culture, to enrich the wideness of the defensive slope of his biologic curriculum. Does the instructiveness, we were accustomed to by the university route, give a satisfactory answer? Does not the preparation of a biologic basis seem nearly the arrangement of a compulsory stage, from which to subsequently deviate also in name of technology and by means of same? Surgery can draw advantages or disadvantages from such a way? In the oncologic field it represented the introduction to the anatomical and mechanistic principles which inspired Halsted's thought about radical intervention. At the same time, a sort of dam against the biologic questions was built. Yet, to-day the first leaks occurred, and through them biology prepares itself to flood into surgery, more and more massively.

Adaptation, Physiological↗