[Bile duct calculi. Comparison of surgical and endoscopic therapy].
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Biomedical subjects
Publications and source records attributed to R Rossoni.
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Thin-caliber (4.9 and 6.3 mm) flexible bronchoscopes already provided with a suction button have been modified by adding an air/water button for the control of air insufflation and water irrigation; the channel used is the biopsy-suction one. With the aid of this instrument, several pathologies can be studied and treated, under adverse conditions such as esophageal or recto-sigmoidal stenosis, hematuria in polytraumatic patients, residual stones in patients carrying a T-tube, acute respiratory obstructions, etc.
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A mechanical lithotripter producing a percussion action on biliary stones is described. This device seems to be robust and flexible at the same time. Every biliary stone is easily crushed by this lithotripter. Sixty-seven patients have been endoscopically treated with the aid of this probe.
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Recently a medical treatment with propranolol has been proposed in order to decrease portal pressure and lessen the risk of recurrent gastrointestinal bleeding in cirrhotic patients. No data are available about another beta-blocker, nadolol, which, unlike propranolol, has a low hepatic metabolism, a low lipid solubility, a long serum half-life and does not reduce renal blood flow in patients with arterial hypertension. In 18 cirrhotics with portal hypertension, the effects of nadolol were studied on systemic and hepatic haemodynamics and liver function, at a dosage which reduced the heart rate by 25%. After one month of treatment, a significant decrease in cardiac output, portohepatic gradient and estimated hepatic blood flow were found. The degree of oesophageal varices was reduced in 11 patients, unchanged in the other seven. Hepatic function, evaluated by galactose eliminating capacity, did not change significantly. Although the small number of treated patients does not allow definitive conclusions, nadolol seems to have the features needed to be used in the medical treatment of portal hypertension in patients with liver cirrhosis.
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Oesophageal dilatation were performed 24 times in 10 patients aged 12 months to 78 years presenting with acquired strictures of non-neoplastic origin. Tre conjunction of EDER PUESTOW'S metallic olives system with systematic use of fiberendoscopy enhances considerably the safety of the procedure and permits better functional results.
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