Biomedical subjects
Publications and source records attributed to S Scattone.
The Authors report two cases of sub-peritoneal rupture of the duodenum following blunt abdominal trauma. The diagnostic difficulties are explained in detail. Emphasis is placed on the importance of prompt recognition of the duodenal injury and early surgical treatment to ensure a successful outcome.
The Authors report their clinical experience in superior mesenteric artery embolism: 10 arterial embolisms (71%) collected from a series of 14 obstructions of the superior mesenteric artery. The main interval from the beginning of the symptomatology to hospital admission was 48 h. Laparotomy was performed in all ten patients; gangrenous bowel was resected in 2 and 2 had an embolectomy of the superior mesenteric artery without intestinal resection. The remaining 6 patients had laparotomy alone and died. The Authors emphasize the difficulty in recognizing the disease at an early stage and suggest to contemplate in patients at risk with a persistent abdominal pain, the possibility of a superior mesenteric artery embolism.
Clinical follow-up of 71 patients subjected to major amputation of the lower extremities for atherosclerotic arteriopathy has been analysed for the purpose of ascertaining real possibilities of functional recovery and quality of life. Research results show that only a small number of patients (38%) can achieve an acceptable quality of life. The reasons have been identified in the objective difficulty of adequate physical and psychotherapeutic rehabilitation owing to structural shortcomings or the presence of associated pathology or the advance in the basic condition which does not permit application or frustrates results.
The Authors report a 68% overall success rate in a three years follow-up study of 45 "complementary" profundoplasties. The key factors with a significant prognostic effect on the clinical surgical results are the early postoperative increase of the resting ankle pressure index (I.W.) and the angiographic preoperative patency of the tibial arteries. An early postoperative increase of I.W. has been always associated with good results whereas an unchanged postoperative I.W. has always been associated with poor results; an angiographic tibial run-off (one or two or three patient tibial arteries) has been associated with significant better clinical results (p less than 0.001).
The authors report a clinical experience on 37 internal carotid endarterectomies of 33 patients classified as: group A (asymptomatic patients); 4 patients (13%), group B (RIA); 9 patients (27%), group C (stabilized neurological lesions); 19 patients (56%), group D (acute cerebral ischemia): 1 patient (3%). Sixteen thromboendarterectomies (43%) were carried on for the prophylaxis of neurological lesions, 20 (54%) to increase and balance the cerebral blood flow in patients with stable neurological lesions, 1 (3%) for acute cerebral ischemia. The overall operative mortality was 6%, the operative morbidity was 22%. The clinical follow-up concerned 26 patients: the overall mortality was 19%: in survivors the late results were excellent. The rate of postoperative stenosis was 18%: 80% of these arteries had been treated without a patch angioplasty.
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A considerable number of patients having aorto-femoral surgery for chronic obliterative atherosclerosis show evidence of obstructed run-off vessels. In this condition poorer long-term results were documented in many series. The present study was aimed at investigating the state of 33 small muscular arteries of 8 limbs amputated for atherosclerotic gangrene. Histological studies showed that 11 muscular arteries were completely free from atheromatous lesions and that another 11 with minor abnormal features could be considered susceptible of revascularization. The conclusive data from this study in a small series suggest that in generalized atherosclerotic obstruction of lower limbs, nearly 70 per cent of the muscular vessels distal to the obstruction are potentially suitable for revascularization.
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Rupture of a hepatic artery aneurysm into the biliary tree is a rare cause of hemobilia. The dramatic nature of the disease and the difficulties in obtaining a preoperative diagnosis are the main causes of its high mortality rate. Progress in vascular radiology and surgery seems to be an important factor in improving the survival rates in patients with this type of hemobilia. A case of a patient with an aneurysm of the common hepatic artery ruptured into the common bile duct is reported. Preoperative arteriography revealed the aneurysm and the arteriobiliary fistula causing massive hemobilia. The patient was successfully treated by arterial ligation and is symptom free after 2 years.
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Rupture of the right hemidiaphragm is an unusual event and often misunderstood. Failure to diagnose this lesion in the acute stage, in addition to contributing to its high mortality, means that it frequently becomes apparent only months or even years after the event. Even at this late stage, diagnosis is not always easy, especially when the history is not correctly weighed and proper investigation is thus lacking. Pneumoperitoneum and liver scintiscanning are recommended in this respect. A recently observed case is presented as a more or less typical example of this rare disease.