Biomedical subjects
Publications and source records attributed to S Chiarini.
Of unknown etiology, mainly located on the upper limbs, the nodular fasciitis nowadays is considered as a reactive inflammatory lesion more than a neoplastic one. With very few symptoms, it can be diagnosed through histology and the extent of the excision is related to the report of the pathological examination.
By clinical observation and surgical treatment of a patient with a primitive lymphoma of the breast, the authors describe the nosological approach, the correct diagnosis and the relative surgical treatment in that disease.
In the microsurgical therapy of facial nerve palsy, the muscles most frequently utilized have been gracilis, latissimus dorsi, and pectoralis minor, this depending upon surgeons' personal experience. However, at the moment no satisfactory comparison studies are available; this work is a comparative study of the three most often used cadaver-derived muscles in surgical therapy of facial nerve palsy. The potential use of gracilis, latissimus dorsi, and pectoralis minor as free flaps has been assessed by analyzing their microsurgical, anatomical and functional parameters. Suitability has been evaluated by scoring each parameter from 0 to 3 (unsatisfactory, satisfactory, good, and excellent respectively). The results may provide the surgeon who undertakes this kind of technique with a useful data comparison.
Three cases of gastrointestinal bezoar are described. Two were submitted to conventional surgery and one to endoscopic fragmentation. The natural and postoperative pathophysiologic mechanisms responsible for the formation of bezoars were studied. The condition is generally asymptomatic, the clinical presentation being similar to that of gastritis and/or duodenitis. Endoscopy is the non-invasive technique of choice in the diagnosis of gastric bezoars. Treatment of these lesions in day-endoscopy consists in removal of the bezoar if less than 3 cm in diameter and fragmentation if larger in diameter followed by extraction of any fragments over 1 cm to prevent the risk of intestinal obstruction. Long term maintenance therapy with cisapride or metoclopramide is then immediately administered for preventive purposes, and it is also used in patients submitted to traditional gastric and/or duodenal surgery.
The authors intend to contribute to the knowledge of this complex and in part not fully defined subject of apudomas, in particular with regard to classification criteria and physiopathological aspects. After having examined the characteristics of these neoplasias (probably common embryonal origin, similar radioimmunological, immunohistochemical and ultrastructural characteristics, the capacity to convert amine precursors into amines), the authors focus on the most significant aspect of these carcinoids which, in the light of current knowledge, possess varying but undisputed degrees of biological aggressiveness. They also highlight the importance of the gastroenteric tract as an organ with an endocrine function and lastly affirm the value of the classification which, using the pancreas as the reference organ, distinguishes endocrine neoplasias in this tract into entopic and ectotopic examples.
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The impulse given to vascular surgery by new technologies has facilitated the use of the bypass technique in a number of arterial pathologies with better and better results over time. At the moment, however, we haven't a "sure prosthesis" in venous surgery. Our intention has been to examine the most significant developments, studying all the available material dating from the beginnings of the art up to the present. After a careful examination of the venous pathophysiology as well as the most valid surgical approaches, we tried to evaluate on laboratory animals the results of experimental graft replacement of the inferior vena cava. In this study we analysed prostheses in PTFE, biological prostheses, spiral composite vein grafts, arterial autologous grafts. For the experimental study we used 55 rabbits (New Zealand and Fiandra). Results have been rather successful with respect to biological prostheses (62.5% patency) and PTFE (66.6%). As for spiral composite vein graft prosthesis patency over time was very low (16.6%); this was affected by the different venous graft (heterologous graft) and caval wall thicknesses. Arterial autologous graft was carried out only once because rabbit experimented on did not stand up to surgical stress.
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The commonly used gamma probes are easy to use but also give rough information when employed in radioisotope-guided surgery. When images are required for exact localization, a gamma camera as well as a probe have to be used. Position-sensitive photomultipliers have contemporaneously allowed high-resolution scintigraphy and miniaturization of gamma cameras. We have assembled a miniature gamma camera with a 1-square-inch field of view and an intrinsic resolution of about 1 mm. When the minicamera is collimated with a large-holed, highly sensitive collimator, it acquires a spatial resolution of 3 mm. This prototype has been tested in the detection of difficult-to-image breast cancer sentinel nodes. Five nodes that had not been found with the usual technique of an Anger camera plus conventional probe were checked with the miniature camera that we named imaging probe: it actually is small enough to be used as a probe and large enough to give an image. One of the five nodes was found and imaged. It was small, disease-free, close to the tumor and probably hidden by the Compton halo around the peritumoral injection site. Our pilot study shows that the imaging probe, although still a prototype, has certain advantages over conventional methods when lymph node localization is required during surgery.
AIMS AND BACKGROUND: When removal of osteoid osteoma is performed with open biopsy, the surgeon can be guided by radioactivity of 99mTc-MDP (methylene D- phosphonate) acquired by a probe. MATERIAL AND METHODS: We compared the performance of a commercially available ZnCdTe probe (Neoprobe 2000) and a one-square-inch-field-of-view imaging probe (IP) on two patients undergoing open biopsy for osteoid osteoma. Triphasic bone scintigraphy was performed before operation and Neoprobe as well as IP were used in the operating room by two nuclear physicians. When the surgeon asked for guidance, each nuclear physician had to indicate a precise direction. RESULTS: The surgeon asked for guidance once in the first operation, on a patient with osteoid osteoma of the femur, and four times in the second operation, for osteoid osteoma of the acetabulum. The indications provided by IP were correct 5/5 times, whereas the commercial probe was correct 3/5 times. Both devices were able to assess the surgical radicality. After biopsy, bone samples were divided into high-count and low-count samples. Pathological examination confirmed the presence of osteoid osteoma in high-count samples. CONCLUSIONS: IP has already been used to guide biopsy, but only in breast disease. The present work confirmed its good performance also in orthopedics as a portable mini gamma camera that can be used in the operating room.
BACKGROUND/AIMS: Surgery remains the first choice for achalasia of the esophagus with good results in 90% of cases. METHODOLOGY: We studied the cause of failure for surgical treatment and the results of a second operation in 20 patients that were followed up for at least three years. RESULTS: The results were good in 70% of the cases. CONCLUSIONS: To improve this procedure, according to the authors, it is essential for a careful presurgery evaluation, an early reoperation in case of failure and a careful surgical technique in order to avoid periesophageal sclerosis.
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The authors report their experience of microsurgical reconstructive techniques using musculo-cutaneous free flaps after radical operations for head and neck neoplasms.
The Authors analyze the role of microsurgery in the treatment of chronic obstructive arteriopathies. In accordance with their results, they stress the usefulness of the microtechniques in the rescue of ischaemic limbs due to distal occlusion, and how these procedures are less dangerous than amputation, even though results are not long lasting.
The Authors present a case of hypopharyngeal tumor in which digestive continuity was assured by a jejunal autotransplant. Tumoral exeresis and jejunal preparation were carried out at the same time by two surgical teams. The use of microsurgical techniques assures the revascularization of the neck transplant by implementing the superior thyroid artery and the internal jugular vein. Digestive anastomoses complete the operation.
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