[Endoscopic sclerosis of esophageal varices. Analysis of results obtained after 2 years' experience].
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Biomedical subjects
Publications and source records attributed to A Peracchia.
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In the light of previous personal research indicative of immunodepression in patients with cancer of the oesophagus, the effect of aspecific immunostimulation with Levamisol was assessed on 70 patients with inoperable forms. All patients were treated by positioning of a Celestin endoesophageal prosthesis for the palliation of dysphagia, and submitted to a randomised protocol involving aspecific immunostimulation with 150 mg Levamisol per os twice a week on nonconsecutive days for an indefinite period. The mean survival of the treated group was not significantly better than that of the controls, nor was any real advantage detected on dividing the series in terms of age, tumour histology and degree of differentiation, extension, or the clinical stage.
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Brief periods of fasting or moderate trauma were previously shown to give rise to malnutrition characterized by negative nitrogen balance, reduction of lean body mass and relative increase of body water. The present study aimed to assess the possibility that brief low-calorie, low-protein parenteral fluid regimen after relatively moderate surgical trauma can modify the muscle metabolism and alter the water, electrolyte and protein composition. Well-nourished patients undergoing elective cholecystectomy were studied. During the first four postoperative days, seven patients (group I) received parenteral nutrition adequate as regards water, sodium and potassium but deficient in carbohydrates and without amino acids, while six patients (group II) had adequate parenteral supply of calories and nitrogen. The extracellular balance in regard to water, sodium, potassium, calcium, phosphorus, magnesium and urea was assessed in all 13 patients. Needle biopsy of muscle was performed during surgery and at the end of the observation period in six patients from group I and five from group II, in order to assess the total and the intracellular and extracellular water content and also sodium, chloride, potassium, magnesium, phosphorus and alkali-soluble protein nitrogen. In group I, but not in group II, there was weight loss and negative extracellular balance of all parameters, in particular potassium and nitrogen, and reduction of muscle potassium. The analyses of balance and of muscle cell composition showed considerable loss of lean body mass and indicated 'true' electrolyte disturbance, although clinical symptoms were absent and serum parameters remained normal.
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The results of an epidemiological study using the case-control method on 150 oesophageal cancer cases, observed at the IIIrd Surgical Department in Padua and on 150 controls are presented. The results show that alcohol an maize flour (corn meal) are two aetiopathogenetic factors of verified statistical significance in oesophageal carcinoma in the Veneto population. This confirms other studies among populations with a high risk of oesophageal cancer.
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Starting from a discussion of the controversial views on the indications and correct execution of papillosphincteroplasty (PSP), the Authors report their own experience with the procedure and their first-hand evaluation of its merits, based on a series of 77 patients treated by PSP over the last 3 years (out of a total of 650 patients treated surgically for nonneoplastic pathology of the biliary tract). Their followup to date (up to 3 years after surgery), based on clinical, biohumoral and radiological findings, shows that the long-term results were excellent in 85%, good in 13%, and poor in 2% of the cases.
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Motor disturbances of the oesophagus are attributable to hypermotility or hypomotility, or to peristaltic uncoordination of the upper or lower sphincter, or of the corpus. Endoesophageal manometry has enabled considerable progress to be made in the study of oesophageal dysfunction by allowing the spasm to be quantified. Treatment is poorly effective and its results are uncertain, save in the very few cases where surgery leads to resolution. For this reason, the efficacy of a new drug with marked antispastic properties, prifinium bromide, was investigated in 12 cases of megaoesophagus, of hiatal hernia, 6 of diverticulum, and 4 of dyskinesia in the light of the manometric values observed before and after its administration. The drug relieved spasm of the sphincters and corpus.
The AA. describe a method of gradual occlusion of the portal vein in the rat to induce a hepatic encephalopaty. This method allows to realise a condition of hepatic ischemia and a portal hypertensive state accompanied by spontaneous portal-systemic shunts. These two factors produce a hepatic encephalopaty like in cirrhotic state or in patients after portal systemic anastomosis. A part from similar behavior at the beginning of the encephalopaty it is possible to define two classes of animals: one showing a slow recovery and one showing a transient and slight improvement followed at the end by the death of the animal. The AA. found a definite correlation amoung the clinica, EEG's, serum aminoacids and biochemical data. Probably the different anatomical and phisiological aspects of the induced portal systemic shunts and the different ways of hepatic rivascularization may determine the two different evolutions of the animals.
The Authors present and discuss clinical and therapeutic aspects of several cases of chronic portal thrombosis, troncular and radicular, either isolated or variously associated. Splenoportography and selective arteriography do not always provide a clear-cut picture of the vascular situation, particularly in the presence of mural thrombi. Surgery may be needed as an emergency measure in cases of hemorrhage, but the best results are obtained if it can be done electively. Indications, however, must be evaluated very carefully in each individual case, especially for thrombosis not associated with cirrhosis of the liver, in which the tendency to a more favorable natural evolution may invite a more conservative approach. The choice of surgical procedures is dictated essentially by the site of obstruction in the portal system. After discussing the indications for various methods, the authors present some cases of thrombosis involving only the superior mesenteric vein, managed successfully by disobliteration and mesenterocaval anastomosis.
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This paper analyses the prognostic factors in cancer of the oesophagus in relation to site, histological type, age, and the patient's immunitary reactivity evaluated histologically in the lymphonodes and the tumoral tissue itself, and the invasion or otherwise of the loco-regional lymphonodes. The survival curves are calculated by the actuarial method. In particular, it was seen that patients with absence of peritumoral lymphocytic infiltrate and depletion of the loco-regional lymphonodes present a survival curve stopping at the second year after the operation, whereas reactive patients survive beyond that date in 29% of cases. It may therefore be asserted that the presence of lymphocytic infiltrate in the tumour and of lymphonodal reactivity are a pointer to an attitude of defence of the organism, and the importance of the study of these factors as prognostic criterion in patients subjected to resection of the oesophageal tumour clearly emerges.
Fourteen cases of primary cancer of the gastric stump as a long-term sequel to resection for ulcer are presented. Surgery was undertaken in all cases, though radical intervention was only possible in 6. Questions of diagnosis and surgical tactics associated with this type of neoplasia are discussed. It is felt that early ascertainment could be aided by fibrogastroscopic controls carried out on a large scale at the time of the symptomatological overture. The possibility of preventive examination is also mooted.