Abstract: The preservation of livers to be transplanted is currently obtained by static cold storage at 4 C degrees and flushing with UW solution. New methods of preservation are being studied that take advantage of machines for continuous hypothermic perfusion of the organ. Such machines have permitted a lengthening of preservation times and the use of livers from non-beating-heart donors. In an attempt to eliminate the damage due to hypothermia, to lengthen preservation times, and to extend the availability of livers to be transplanted, also using those subjected to short periods of warm ischaemia, we have constructed a transportable machine that produces a hyperbaric atmosphere and allows continuous perfusion of the liver. Ten pig livers from beating-heart donors were perfused with Ringer solution in hyperbaric conditions with oxygen at temperatures ranging from 10 to 25 degrees C for periods of up to 24 hours and studied by means of histopathological analysis and tests of mitochondrial activity (FAU) in order to verify cell viability. The group of livers perfused up to 15 hours yielded an FAU value of 169.40 +/- 5.5 compared to the value of the non-perfused livers (controls) established as 100 and those perfused up to 24 hours had a FAU value of 139.18 +/- 10.7 compared to the controls established as 100, thus demonstrating cell viability. The viability of the organs after preservation with our procedure in the hyperbaric oxygenation perfusion machine gives us good reason to believe that, after appropriate further confirmation of the results, it will be possible to use the machine for the transplantation both of livers subjected to warm ischaemia and of livers preserved for longer periods than is currently the case.
Abstract: Right-sided colon cancer therapy is based upon right hemicolectomy, which is a well established surgical technique. Considering the possibility of biological diversity in cancer arising from the caecum, ascending colon and transverse colon, this retrospective study analysed age, sex, grading, T, N, M and mortality to evaluate the biological characteristics of the cancers and their level of local and general diffusion with a view to establishing any correlation between these characteristics and the advisability of employing different surgical procedures for the different sites. Cancer arising from the sites considered does not seem to present different biological aspects and therefore a different surgical procedure is not authorized. Our data show that a significant majority of cancers are diagnosed at an advanced stage as compared to earlier stages (P < 0.05) and that early detection of these cancers is the best way of improving the prognosis.
Abstract: The authors report the results of a multicentre trial to evaluate the characteristics of a new bag for ostomised patients (Coloplast Alterna). While affirming that a correct technique is essential to avoid complications and to achieve good stoma function, the authors emphasise that the bag also pays an important role in giving confidence to patients and enabling them to enjoy a social life which is as similar as possible to that before surgery. In the search for the ideal bag the trial evaluated adhesive, filter and the bag and a whole. 85% of the 92 patients who tested the new bag for four weeks considered it good or excellent. Although it cannot yet be considered ideal, Alterna represents a further step towards this aim.
Abstract: The presence of proteins (albumin and globulins) in lymphedematous tissue not only gives rise to colloidosmotic pressure but also produces an electrostatic charge endowing the proteins with individual features and different migration rates. The working hypothesis of the experimental study is to transfer lymph proteins from the upper fascia accumulation area to a subfascial drainage area by subjecting them to an adequate difference in potential. A double chamber, variable volume system with separation wall able to contain a 1 cm square of muscle fascia, was designed and built; the aim of the apparatus was to reproduce the subcutaneus zone separated by the fascia interposition, from the muscle-vascular zone. At the system was applied a variable electric field in six different experiments: 4 using porous synthetic membranes and 2 using human muscle fascia.
Abstract: More than 60% of patients who are submitted to Hartmann's procedure refuse to undergo reversal. This procedure is in fact a major undertaking associated with significantly mortality and morbidity rates. The authors suggest a minimally invasive approach without pneumoperitoneum. A consecutive series of four male patients, average age 64 years, underwent laparoscopic assisted reversal of Hartmann's procedure in our department. The procedure was performed for intestinal malignant occlusion in two cases and for perforated diverticulitis in the other two. Mobilization was nearly immediate and incisional pain almost absent; peristalsis restarted after 36-48 h. Finally, the patients were discharged on day 6. Neither mortality nor morbidity occurred in the 8-month follow-up period. The authors conclude that this new laparoscopic procedure may lead to shorter hospital stays and increased acceptance by patients, while maintaining the same safety of the traditional open procedure.
Abstract: The goals of non-invasive duplex vascular diagnosis of the venous system of the lower limbs are: 1) To make evaluation of the venous system during deambulation feasible under physiological, pathological and post-surgical or elastocompressive conditions. Moreover, any such evaluation must be achieved using a standardized, easy, highly reproducibly method which is inexpensive and utilizes the diagnostic instruments available. 2) To achieve detailed, selective localization of the valvular and parietal dysfunctions at the basis of any reflux pathology. 3) To identify and quantify venous flux and reflux during deambulation. The present work gives the results achieved over the period of one year after a new method simulating deambulation (Walk System 1 patented) was set up for several utilizations, principally correlated to the use of conventional duplex scanning in studying the venous system. The main purpose of the Walk System 1 is step simulation to uncover the location and extent of venous disease. This application test of: a pneumatic pump which compresses the calf to 100-120 mmHg in 0.3 sec thus simulating muscolar pumping during deambulation; standard 40 mmHg compression of the foot in order to rule out any hemodynamic involvement of the foot pump venous system. We can use this pump in the hemodynamic component, a part, during the step simulation, with synchronism with calf pump in TVP prophylaxis or in vascular therapy; an easy-to-use application software able to quickly pulsed Doppler data of flux and reflux by means of the flux and reflux orthodynamic indices or with measures in ml/sec. The study was performed on 80 lower limbs in normal subjects in order to define the normality range and in 380 lower pathologic limbs. The study has yielded a clinical-instrumental correlation between the hemodynamic data observed during inflation-deflation of the calf cuff, positioning the pulsed Doppler sample volume in the saphenous vein in the saphenous-femoral ostium zone and the underlying venous morphology. The results have made it possible to determine physiological S-F reflux and to establish 4 pathological classes of orthodynamic S-F reflux, each class corresponding to a specific range in the orthodynamic reflux index (class 0 = 0 < RI < 0.25; class 1 = 0.25 < RI < 2; class 2 = 2 < RI < 3.5; class 3 = 3.5 < RI < 6; class 4 = RI > 5) and to a particular morphological conditions.(ABSTRACT TRUNCATED AT 250 WORDS)
Abstract: The authors in explaining their limited clinical experience relative to one single case, describe the peculiarity of Takayasu's disease and its rare incidence in western populations. The case under observation because of its peculiar rarity had been underestimated and treated in a completely inappropriate manner. Important instrument in its diagnosis is the High Resolution echography which in determining the diagnosis favors and speeds up the diagnostic therapeutic iter.
Abstract: Modern technology has recently provided us with new resorbable suture material for use also in vascular surgery. Clinical use of these sutures has been impeded however by not little mistrust and by old dogmas without a rational experimental basis. We have therefore begun studies of two slowly resorbable materials, polyglactin 910 and polyglycolic acid, in comparison with two classic nonreabsorbable materials, nylon and polypropylene, used in experimental model of end-to-end anastomosis rats'infrarenal aorta, following up the healing process and its evolution after an interval. The results are discussed in relation to data collected from current literature.
Abstract: The Authors report on the use of non-invasive techniques in the preliminary evaluation of revascularization of the femoral-popliteal axis. The study of this pathology, for which surgery has become less and less frequent, being limited to the more serious cases, has greatly benefited by the use of H/R echography and of Doppler. These techniques, which remain complementary to angiography, have proved very important and reliable for their capacity to visualize the arterial lumen, an important element for the pre- and post surgical evaluation of vascular recanalization and of the relationship of continuity and continuity with the nearby structures.
Abstract: Local recurrence is the most serious complication of anterior resection for rectal cancer, usually occurring during the first two years after surgery. Over a five-year period, from 1981 to 1986, 183 patients underwent anterior resection for rectal carcinoma at the Surgery Ward of the University of Ferrara. Patients were followed for two years postoperatively. All operations were performed with staplers and classified according to Dukes, with 43 cases of Dukes' A; 83 cases of Dukes' B; and 57 cases of Dukes' C. In the first 24 months after surgery, the tumor recurred locally in 44 of the 183 patients (24 percent). Dukes' stage, grading distal resection margin, and histopathologic differentiation of the distal rectal ring left in the stapler after anastomosis were assessed to determine a prognostic indicator for the recurrence of the tumor. The stage:recurrence ratio was as follows: A, 1 (2 percent); B, 21 (25 percent); and C, 22 (39 percent). The grading:recurrence ratio was: G1, 13:51 (25 percent); G2, 24:110 (22 percent); and G3, 7:22 (32 percent). The ratio between distal rectal resection margin and recurrence was: 0 to 2 cm, 15:27 (56 percent); 2 to 4 cm, 16:74 (22 percent); and over 4 cm, 13:82 (15 percent). Histopathologic examination of the distal rectal ring was negative for all patients. These data confirm the direct relationship between class and local recurrence and indicate histologic grade and distal resection margin as significant prognostic parameters only when interpreted in the light of staging.
Abstract: Immunostaining with monoclonal antibody Ki-67 (MAb Ki-67) has been employed to determine the growth fractions in a series of 139 primary adenocarcinomas of the large bowel. A wide range (18.9-71.4%; mean 39.4%; median 37.2%) in the percentage of Ki-67 reacting cells (Ki-67 index) was observed. The Ki-67 index was found to be unrelated to tumour stage, lymph node involvement, and presence of synchronous distant metastases. Mucinous carcinomas showed higher levels of Ki-67 reactivity than non-mucinous adenocarcinomas (P = 0.0003). Among non-mucinous adenocarcinomas a significant inverse correlation was demonstrated between the percentage of Ki-67 stained cells and the degree of differentiation (P = 0.002), and preservation of nuclear polarity (P less than 0.001). Moreover, tumours of patients younger than 45 years were generally characterized by high numbers of proliferating cells. There was no correlation between Ki-67 index and the other clinical and pathological variables examined. In most cases small differences in Ki-67 reactivity were observed in different samples from the same tumour. These results demonstrate that immunohistochemical assay with MAb Ki-67 represents a simple and reliable method for the assessment of proliferative activity in colorectal adenocarcinomas and suggest that Ki-67 labeling may provide information of clinical relevance in the management of patients with large bowel cancer.
Abstract: The cost/benefit ratio of stapled anastomoses in colorectal surgery has been retrospectively evaluated on the basis of a 8 year experience taking into account the overall costs in surgery as well as short term and long term benefits. With this aim, our experience was divided in two periods: 1st period: November 1970-January 1981: 598 hand sutures; 2nd period: February 1981-December 1988: 787 stapled sutures. Mechanical suturing was found to be superior based on the following: a) the average postoperative hospital stay decreased from 20.2 days to 14.7 days; b) temporary stomas decreased from 62.2 to 25.1%; c) abdominoperineal resection for rectal cancer decreased from 60.7 to 41.6%.
Abstract: Primary gastric lymphoma (P.G.L.), though rare, is nevertheless the most frequent non-epithelial neoplasm of the stomach. The Authors report their experience based on 18 cases of lymphoma observed from 1975 throughout 1989. Diagnostic and therapeutic problems related to the disease are stressed, uncertain in the results the former, still discussed the latter. The crucial role of surgery, either diagnostic or therapeutic, even in advanced stages, is underlined.
Abstract: Esophago-jejunal reconstruction, after total gastrectomy, is best performed by one of the following three operations: interposed jejunal loop, Roux-en-Y loop and "omega" loop with Braun anastomosis. To assess the effects of the three mentioned techniques three groups of 15 patients each were examined after total gastrectomy for I, II or III stage cancer. Four to ten months after surgery all patients underwent the following tests: a) esophago-jejunal transit with labeled solid meal; b) cholangio-scintigraphy and c) absorption test of biliary acids. A group of 10 patients, without gastrointestinal pathology, was selected for comparison. The data obtained from the comparative study, in agreement with the opinions held by many Authors and our previous research, demonstrate that the interposition of jejunal loop (Mouchet) is the reconstructive technique closest to the unoperated stomach and, for this reason, is to be preferred after total gastrectomy.
Abstract: The authors relate their experience about Chronic Cystic Disease. They emphasize the frequency of relapses and the risks that such a pathology involves. They finally suggest a surgical treatment plan that, in their opinion, should be applied whenever the patient is a peri-menopausal aged woman who has undergone, at least twice, an operation for a Chronic Mastopathy with a histologically proved epiteliosis. The operation suggests is a total glandulectomy with simultaneous breast reconstruction by means of a prosthesis.
Abstract: AA. are reporting their experience on the subject of the surgical treatment of the rectal prolapse in all his clinical forms, during 12 years of activity that has taken place in the clinical surgery of the University of Ferrara. From their casuistry it is shown that usually this pathology is joined with other morbid forms of the small pelvis which vary according to the degree of the prolapse. They emphasize the excellent results obtained and support the surgical way of laparotomy adopted in the treatment of prolapse of II type (incomplete) and III type (complete).
Abstract: The authors report their experience concerning 26 cases of gastric stump carcinoma after gastric resection for benign pathology, observed in about 12 years. The incidence of such disease is 9,2% as regards the gastric neoplastic pathology and 5,2% as regards the benign ulcerous pathology, observed in the same period of time. The removal of the tumour was performed in 18 cases (69,2%), in spite of the stage, in most cases advanced, of the disease. In 7 cases (38,8%) the operation was extended to other organs. In 5 cases (27,7%) the removal was performed in spite of the presence of liver metastases. The survival amounts to 3 (16,6%) patients after 2, 4,5 and 5 years, one of whom suffers from liver metastases. In spite of the better knowledge of the histologic modifications and the phenomena caused by the biliopancreatic rebux and gastric hypochlorhydria, the etiopathogenesis of that disease is still unknown; the prognosis remains still unfavourable, due to the diagnostical delay and the particular aggressiveness of the neoplasm. Therefore, the Authors confirm the necessity for a precocious diagnosis, which only is suitable to improve the immediate and remote results.
Abstract: This paper presents a case of malignant fibrous histiocytoma localized in the sigmoid colon with multiple metastases in the right lobe of the liver and describes the pathological and microscopic aspects, clinical course and characteristics. The primary localization in the sigmoid colon is extremely rare, this being only the second case reported.
Abstract: The Authors, in the light of their experience, study some technical aspects in the use of circular stapling devices (SPTU-EEA). After paying attention to the risks involved in the employment of such instruments, they explain the precautions they consider necessary to prevent the most common complications. As a conclusion, they confirm the safety of stapling devices, provided they are used with skilfulness and caution.
