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Biomedical subjects

E Forni

Publications and source records attributed to E Forni.

At least 37 records · Page 2Linked to original sources
PubMed1987

Cytogenetic findings in a case of anaplastic carcinoma of the pancreas.

A cytogenetic study was performed on a short-term culture of a biopsy from a primary anaplastic carcinoma of the pancreas. The modal chromosome number was 60. Six numerical clonal anomalies involving chromosomes #2, #6, #7, #10, #15, and #16 were found, and marker chromosomes involving #1, #3, #5, #8, #11, #12, #13, #15, #16, #18, #20, #22, and X. Premature chromosome condensation (PCC) was observed with a high frequency. The results are discussed with reference to the scarce literature on chromosome changes in pancreatic cancer.

Carcinoma↗
PubMed1985

Diaphragmatic hernias due to blunt thoracoabdominal trauma.

This nineteen-year retrospective review was designed to evaluate diaphragmatic hernias due to blunt thoracoabdominal trauma in a series of 50 patients. Motor-vehicle accidents were the most frequent cause. The diagnosis was made immediately after injury in 34 patients (acute hernias), but delayed from two months to 30 years in 16 (chronic hernias). Two patients, with multiple associated injuries, died soon after admission and diagnosis was made at necropsy. The nature of injury, the physical findings and the plain chest roentgenograms suggested a traumatic diaphragmatic hernia in most of the remaining acutely injured patients. All patients with chronic hernias had suggestive or suspicious abnormalities on chest roentgenograms; however, appropriate upper gastrointestinal tract and barium enema studies were of utmost importance for the correct diagnosis. Reduction of herniated viscera and repair of diaphragmatic defect were generally accomplished through a laparotomy in acute hernias, whereas thoracotomy was the preferred approach in delayed instances. There were four postoperative deaths, three with severe multiple associated injuries and one with respiratory failure.

Abdominal Injuries↗
PubMed1984

[Results of the treatment of carcinoma of the thoracic esophagus with one-stage resection and esophagogastrostomy].

Between november 1964 and december 1982, 102 patients were operated upon for the treatment of carcinoma thoracic esophagus. The philosophic objectives were to restore promptly the ability to swallow and to achieve a worthwhile survival period. To fulfill these requirements wide excision of the growth and immediate esophagogastrostomy were performed through a combined abdominal and right thoracic approach. In higher thoracic growths the Authors added a cervical phase. The resectability rate was 74% and the overall hospital mortality rate was 19,6%. Anastomotic leaks occurred in 10 patients (9,8%) with fatal outcome in 6. Pre- and postoperative care (particularly hyperalimentation and intensive respiratory therapy) and use of mechanical devices reduced the operative mortality rate to 8,1% between 1976 and 1982 without deaths in the last 16 patients. Very satisfactory palliation was achieved in 80% of the patients who survived the standard esophagogastrectomy. These patients enjoyed uncomplicated oral alimentation for the remainder of their lives. Despite there has been considerable improvement in operability and resectability rates and in survival of resection as compared to past years, long term results of treatment of carcinoma of the esophagus continue to remain disappointingly low. Overall survival rate at 5 years was 10,2% in this report. The stage of the disease influenced significantly survival: curative as opposed to palliative resections demonstrated a marked difference in 5-year survival (28,2% vs 2,8%). Long-term survival of patients with carcinoma of the esophagus will probably not improve until early diagnosis is possible. Therefore esophagogastrectomy should be the treatment of choice until other forms of therapy prove superior to it both in terms of palliation and long-term survival rate.

Adult↗
PubMed1984

[Retrosternal gastric bypass in the palliative treatment of advanced carcinoma of the thoracic esophagus].

Palliative substernal gastric bypass was performed in 20 patients with far-advanced, obstructing carcinoma of the thoracic esophagus between the years 1978 and 1982. In 18 patients the thoracic esophagus was bypassed using the stomach brought to the neck by substernal route for anastomosis to the proximal end of the divided cervical esophagus. The thoracic esophagus was completely excluded in 10 patients; the tumor-bearing segment of the esophagus excluded formed a small and asymptomatic mucocele with time. The Kirschner-Ong technique with the additional step of Roux-en-Y jejunal anastomosis to the intra-abdominal esophagus was used to provide drainage of esophageal secretions in 8 patients with tracheoesophageal invasion or impingement, for fear of imminent esophagorespiratory fistula; in three of these patients a radiation therapy was subsequently administered. In two patients an isoperistaltic gastric tube formed from the greater curvature and brought to the neck substernally was used for esophageal bypass. Anastomotic leakage occurred in 3 patients (15%). The thirty day operative mortality was 10 per cent (2/20) and the mean survival time was 10 months. The palliation afforded was excellent in all survivors with restoration of the ability to swallow a normal diet until the time of death. The authors believe that a simple one-stage bypass of the esophagus using the stomach substernally is an effective alternative to esophageal intubation, prolonged radiation therapy or colon bypass in achieving palliation with an acceptable morbidity and mortality in a high risk patient group.

Aged↗
PubMed1984

[Adenocarcinoma of the proximal stomach and cardia: problems of surgical strategy and technics].

In a total of 142 patients with adenocarcinoma of the proximal third of the stomach and cardia, curative resection was carried out in 88 during the period 1960-1980. The patients were divided in two groups. I group included 32 patients with tumor distal to the esophagogastric junction. In II group (54 patients) the tumor involved the esophagogastric junction (adenocarcinoma of the gastric cardia). In I group, when the proximal border of the cancer was well defined and sufficient length was maintained between the proximal tumor border and esophagogastric junction, the abdominal approach was preferred and the operation performed was generally a total gastrectomy combined with splenectomy and celiac node dissection. Distal pancreatectomy was performed as necessary. In most patients of the II group, the operation was performed using separate abdominal and right-sided thoracic incisions. Two principally types of operation were used: extended total gastrectomy and extended proximal subtotal gastrectomy, depending on degree of gastric wall involvement, combined with extensive esophagectomy, splenectomy and regional nodes dissection in both cases. Distal pancreatectomy was not performed routinely but only as necessary. In this group of patients there was no significant difference in the overall cure rate between the extended total gastrectomy and the extended proximal subtotal gastrectomy. Operative morbidity and mortality rates were also comparable.

Adenocarcinoma↗
PubMed1984

[Treatment of esophagotracheal and esophagobronchial fistulas secondary to carcinoma of the esophagus].

An experience with 16 patients with respiratory tract fistula (RTF) related to carcinoma of the esophagus is presented. The malignant fistula was present at the time of initial presentation and/or before any therapeutic intervention in 11 patients, and developed either during or following a course of radiation therapy in 5 patients. Bronchoscopy examination in 8 patients prior to RTF development showed tracheobronchial invasion or impingement in all. The patients were divided in five groups according to the treatment received. One patient received no specific therapy although was fed via nasogastric tube. Three patients had a feeding gastrostomy. Four patients underwent insertion of a Celestin tube. Three patients were submitted to esophageal exclusion with combinations of cervical esophagostomy, feeding gastrostomy and ligation or complete division of the gastroesophageal junction; drainage of the excluded esophagus was provided by a red rubber catheter. Five patients received by-pass operation: four had Kirschner-Ong operation with gastric by-pass placed substernally and distal esophagus anastomosed to a Roux-en-Y jejunal loop; in one patient an isoperistaltic gastric tube brought to the neck substernally was used for esophageal by-pass. These patients had, by far, the best palliative results with complete relief of their respiratory tract symptoms and restoration of the ability to eat and drink. Substernal gastric by-pass of the RTF is therefore advocated if the general conditions of the patient are improved with the institution of parenteral hyperalimentation and antibiotic therapy.

Aged↗
PubMed1984

[Current role of surgery in the treatment of pulmonary metastasis].

During the period between november 1964 and december 1982, 48 patients were operated upon for metastatic lesions of lung from previous or actual carcinomas and sarcomas elsewhere in the body. The most frequent sites of origin of the primary malignancy were colon, testis and breast. The usual approach was through a thoracotomy; bilateral lung metastases were removed with one-stage procedure through a median sternotomy in two patients. The operative mortality was 2%. Overall five-year survival was 26%, which was not influenced by tumor histology, disease-free interval, or extent of pulmonary excision. In view of these findings, conservative pulmonary resection of metastatic lesions is advocated, regardless of the tumor histology or the disease-free interval, when the following criteria are adhered to: primary site controlled or controllable; no extrapulmonary metastases demonstrable; good operative risk; no other effective means of treatment available.

Adolescent↗
PubMed1983

[Carcinoma of the common bile duct].

The clinical courses of 18 patients with extrahepatic bile duct carcinoma operated on between 1960 and 1979 are reviewed retrospectively. The preoperative and intraoperative diagnostic difficulties due to marked peritumor sclerosis are pointed out. The location of the lesion appeared to bear the most important relationship to prognosis: the lesions located in the upper and middle thirds of the extrahepatic biliary system are often invasive of adjacent vascular structures and, hence, unresectable, necessitating a proximal biliary-enteric anastomosis or intubation to alleviate jaundice and pruritus. A more aggressive operative approach, however, will result in a higher survival rate, as shown in personal experience for lower third lesions resected by Whipple's procedure.

Adult↗
PubMed1983

[Pancreatic injuries].

Twenty patients were operated on for pancreatic trauma from 1960 to 1980. 8 (40%), without ductal lesions, were treated by drainage alone; 4 (20%) by distal resection; 3 (15%) by duodenal diversion; 1 by pancreatoduodenectomy and 1 by an anterior Roux-en-Y pancreatojejunostomy. Penrose and sump drains was used in all patients. Mortality rate was 20% (4 p.). Pancreas related complications occurred in 7 p. (35%). Particular emphasis is placed on general principles of management of pancreatic injuries to decrease mortality and morbidity.

Adolescent↗
PubMed1982

[Treatment of bleeding esophageal varices by esophago-gastric devascularization and esophageal transection with EEA stapler].

The authors report their experience in the urgency surgery of oesophageal varices on a range of 24 patients operated in the years 1979 and 1980. In consideration of the utter seriousness of this pathology, they consider the direct operations of resection-anastomosis and devascularization of thoracic oesophagus and gastric bottom the most suitable to face the problem. Such operations, burdened by a relatively low mortality (12.5%), get the immediate step of hemorrhage and, 3 years after the first operations performed, gave good remote results. Such assertion expects a further confirmation from a longer follow-up.

Adult↗
PubMed1982

[Comparative analysis of manual and mechanical sutures in the surgery of neoplasms of the esophagus and the cardia].

The authors analyse 50 sutures by hand and 50 by stapling device in oesophagocardial surgery, and compare them as to time of performance, number and quality of complications and influence on the protraction of stay in hospital after operation. The conclusions indicate the sutures by device as the most reliable and safe, susceptible to supplant, although not totally, the techniques by hand.

Cardia↗
PubMed1982

[The surgical consequences of topographical variations of the implantation of the papilla in the duodenum].

The Authors underline the importance of anatomical variations concerning the location of the duodenal papilla. In roughly 75% of cases this structure pierces the duodenal mucosa at D2 and at the level of the lower flexure, in 20% at D3 and in about 6% at D1. Intraoperative cholangiography is most useful to spot the papilla, its position is fundamental from an anatomo-surgical point of view both when this structure is placed at a high level (when performing a gastro-duodenal resection), and when located at D3 level, if sphincterotomy is required. In this latter case the usual incision at 12 hours should be carried out at 9 hours instead in order to avoid surgical damage to the canal of Wirsung running vertically and along the common bile duct.

Ampulla of Vater↗
PubMed1982

[Our experience in the preservation of the rectum in the surgical treatment of ulcerative rectocolitis].

The Authors report a personal series of 42 cases of Ulcerative colitis seen over a 12 year period. (1969-1980). These patients underwent total colectomy with preservation of the rectum. Intestinal canalization was restored by means of an ileo-rectal anastomosis performed either with colectomy or at a later stage. Results are satisfactory as an improvement of general conditions occurred. Normalization of the intestinal function was observed in 85% of cases. Rectal lesions, periodically kept under control with endoscopy and hystologic examination, improved noticeably. In a few cases a total recovery was attained with an adequate, postsurgical, topic therapy. No cancer onset in the rectal stump had been recorded thus far among these patients. In the light of the Author's experience, total colectomy with rectal preservation represents a sensible solution for the surgical treatment of Ulcerative colitis.

Adolescent↗