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Biomedical subjects

U Fumagalli

Publications and source records attributed to U Fumagalli.

34 records · Page 2Linked to original sources
PubMed1991

Effects of intraperitoneal chemotherapy on anastomotic healing in the rat.

The effect of perioperative intraperitoneal (ip) (2 mg/kg) vs intravenous (iv) (1.5 mg/kg) mitomycin-C on healing of intestinal anastomoses was studied in rats after jejunal section and anastomosis. When the animals were killed 7 days after surgery 52.8% in the ip group had an anastomotic leak (41.2% causing death of the animals), compared to 20% in the iv group and none in the control group. Mean anastomotic bursting pressure was 156 mm Hg in the ip group, 178 mm Hg in the iv group, and 203 mm Hg in controls (P less than 0.01). Hydroxyproline content of the intestinal segment containing the anastomosis was 2.26 micrograms/mg in the ip group, 3.49 in the iv, and 4.91 in controls (ip vs controls, P less than 0.01). Histological examination of the anastomoses in rats given ip mitomycin showed significantly "slower" anastomotic healing than in iv rats and controls. Electron microscopy showed that the mean diameter of collagen fibers was significantly smaller (P less than 0.05) in ip rats (34 nm) than iv (51 nm) and controls (79 nm). An intraoperative bolus of mitomycin thus significantly impaired the healing of a jejunal anastomosis in the rat, more so after ip than iv injection. Thus in clinical practice ip adjuvant chemotherapy after surgery should perhaps be delayed until wound repair has reached an advanced stage.

Anastomosis, Surgical↗
PubMed1991

[Aneurysms in various segments of the hepatic artery. Treatment by resection].

The authors report two cases of aneurysms of the hepatic artery, one of which, with a intrahepatic localisation, was complicated by rupture and infection. The etiology was atherosclerotic in the case involving the main trunk of the hepatic artery, and polyarteritis nodosa in the case with intrahepatic involvement. Both were resected; the extrahepatic aneurysm was excised and a venous graft inserted, whereas in the one with intrahepatic involvement, right lobectomy was performed. On the basis of these cases, the authors discuss the various etiologies and the problems related to the indications and surgical techniques for aneurysms of the main trunk of the hepatic artery and those of its intrahepatic branches.

Aged↗
PubMed1990

Clinical application of a new compression anastomotic device for colorectal surgery.

Fifty-six patients underwent large bowel anastomosis by the compression anastomotic device developed by the authors from May 1986 through December 1988. Operations performed were 40 left hemicolectomies or anterior resections of the sigmoid and rectum, 7 left colon resections, 7 right hemicolectomies, and 2 total colectomies. Twenty-one anastomoses were done on the extraperitoneal rectum, in 7 cases less than 4 cm from the anal verge and in 9 cases between 4.5 and 8 cm. Five intraoperative diverting colostomies were done (9%). The rings of the device were evacuated postoperatively after a mean of 11 days with little or no discomfort. Operative mortality was 1.8% (one patient died of myocardial infarction). Anastomotic complications were one (1.8%) clinical and one (1.8%) subclinical leak. Mean postoperative hospital stay was 14 days. This initial clinical experience shows that the anastomotic device is reliable.

Adult↗
PubMed1989

[Segmental splenectomy. Usefulness of linear surgical staplers].

As the high risk of sepsis after splenectomy is well recognized, reliable conservative surgical techniques in splenic surgery are widely advocated. Among these, segmental splenectomy carries specific and increasing indications. The use of linear staplers makes this operation quicker and safer. On the basis of a personal observation, Authors examine the anatomical features on which this operation is based, the surgical technique and the technical details to be followed using these devices. The advantages offered by staplers in this surgery allow to widen the indications to partial splenectomy, so as to yield a true primary prophylaxis of the post-splenectomy sepsis.

Adolescent↗
PubMedDate not supplied

Thoracoscopic esophagectomy: are there benefits?

Between 1991 and 1995, 18 patients affected by a resectable intramural tumor of the esophagus underwent esophagectomy with thoracoscopic dissection of the esophagus. All patients had a relative contraindication to transthoracic esophagectomy with radical lymphadenectomy. All esophagectomies were completed thoracoscopically and reconstruction of the digestive tract was performed in 17 cases through cervical gastroplasty, and in 1 case, through cervical coloplasty. One cirrhotic patient died in the postoperative period due to a cervical anastomotic leak. Six other patients experienced a postoperative complication (mortality rate, 5.5%; morbidity rate, 33.3%). After a median follow-up of 17 months, 14 patients are alive without evidence of disease. One patient, who had excision of a cutaneous metastasis at a trocar insertion site 6 months postoperatively, eventually died with locoregional recurrence 14 months postoperatively. Another patient died 20 months after surgery with mediastinal recurrence. One patient died 28 months postoperatively after massive hematemesis with a suspect abdominal recurrence. The results of the present series, and those reported by other authors, do not seem to indicate evident advantages at present for the minimally invasive procedure during resection of the esophagus for cancer. Currently, there is no indication that this procedure should be used for standard clinical use. Wider randomized trials, performed in selected centers only, and longer follow-up are needed to further evaluate the procedure.

Aged↗
PubMedDate not supplied

Anastomotic healing in dogs under cortisone treatment. A pilot study comparing compression and stapled anastomosis.

Colonic anastomoses made both by a new Compression Anastomotic Device (CAD) and by a traditional stapler (Autosuture CDEEA) were evaluated in impaired anastomotic healing induced by systemic cortisone in the dog. Twenty dogs were given daily i.m. hydrocortisone (25 mg/kg) starting one month before surgery and then until sacrifice. Eight untreated dogs served as controls. Surgery consisted of colonic transection and anastomosis done with CAD-25 in half the cases and with CDEEA-25 in the remaining half. The dogs were sacrificed six and 13 days after surgery. Macroscopic assessment, bursting pressure test, and histology were performed on the anastomosis. One dog died from peritonitis due to anastomotic dehiscence. No other clinical complications were observed. Although the number of observations was too small to attain statistical significance, CAD anastomoses appeared better than stapled ones as regards peri-anastomotic adhesions, anastomotic index, and histology. This preliminary study suggests that compression is as reliable as the stapler in the construction of colon anastomosis even in such situations of delayed anastomotic healing. Further experience is required to substantiate this conclusion.

Anastomosis, Surgical↗
PubMedDate not supplied

Laparoscopic treatment of functional diseases of the esophagus.

The possibilities of laparoscopic surgery in the treatment of functional esophageal diseases (gastroesophageal reflux, achalasia and epiphrenic diverticula) are illustrated with special emphasis on the technical aspects, including intraoperative complications and postoperative care. Results are discussed on the ground of the following experience. Thirty-seven laparoscopic fundoplications were performed with 13% conversion rate, 2.7% postoperative morbidity (1 slipped Nissen requiring redo laparoscopic surgery). Median operative time was 140 min. One patient complained of dysphagia relieved by endoscopic dilation (2.7%). All patients are not asymptomatic after a median follow-up of 16 months although one has gastroesophageal reflux (GER) at 24-hrs pH monitoring. forty laparoscopic Heller-Dor procedures: 7% conversions, 5% postoperative morbidity. Median duration 120 min. One patient complained of persistent dysphagia requiring endoscopic dilation (2.5%) and asymptomatic GER was detected in 8% of patients. Finally, 2 patients underwent laparoscopic diverticulectomy, esophagomyotomy and Dor fundoplication without morbidity and excellent postoperative result. Laparoscopic treatment of functional diseases of the esophagus is safe and effective, provided it is performed by an experienced surgeon with respect for some important technical details. Further follow-up is needed to evaluate long-term results.

Adolescent↗
PubMedDate not supplied

Thoracoscopic dissection of the esophagus for cancer.

Eighteen patients affected by a resectable intramural tumor of the esophagus have undergone esophagectomy with thoracoscopic dissection of the esophagus in the last 4 years. All patients had a relative contraindication to transthoracic esophagectomy with radical lymphadenectomy. All esophagectomies were completed thoracoscopically and reconstruction of the digestive tract was performed in 17 cases through cervical gastroplasty and in 1 case through cervical coloplasty. One cirrhotic patient died in the postoperative period due to cervical anastomotic leak. Six other patients experienced a postoperative complication (mortality rate 5.5%; morbidity rate 33.3%). After a median follow up of 17 months, 14 patients are alive without evidence of disease. One patient, who had excision of a cutaneous metastasis at a trocar insertion site 6 months postoperatively, eventually died with locoregional recurrence 14 months postoperatively. Another patient died 20 months after surgery with mediastinal recurrence. One patient died 28 months postoperatively after massive hematemesis with a suspect abdominal recurrence. The results of the present series and those reported by other authors do not seem to indicate presently evident advantages from the minimally invasive procedure during resection of the esophagus for cancer. At the present time, no indication to this procedure exists for standard clinical use; wider randomized trials and longer follow-up to be performed only in selected centers are needed to further evaluate the procedure.

Adenocarcinoma↗