Biomedical subjects
Publications and source records attributed to F Cabano.
The authors describe two cases of malignant non-Hodgkin's lymphoma in a mammary site observed at IRCCS Policlinico San Matteo (Pavia). Histologic, immunohistochemical and clinical features are illustrated. Correct diagnosis is essential so that appropriate multidisciplinary treatment may be applied.
The authors report a retrospective study of four patients treated for sigmoid volvulus at the Clinica Chirurgica II of IRCCS Policlinico S. Matteo of Pavia between April 1974 and June 1989. They are collected from a series of 74 consecutive operations for colonic obstruction not related to hernias of the inguinal-crural region (incidence 5.4%). One patient died. The authors review the incidence, epidemiology, etiopathogenetic hypothesis, clinical patterns, nonoperative and operative therapeutic options of the affection. They emphasize the poor prognosis because the sigmoid volvulus usually occurs in elderly ill patients.
Four patients operated on at the Clinica Chirurgica II of IRCCS--Policlinico San Matteo of Pavia for trauma involving the colon were reviewed. All were males and their ages ranged from 14 to 84 years (mean 43.5 years). Injuries of the colon were found on 9 per cent of all patients operated on for abdominal penetrating injuries and on 6 per cent of patients with blunt injuries. The authors recall the pathogenetic mechanisms, clinical patterns, some grading systems proposed for quantifying the severity of the lesion. Our experience has shown that in blunt trauma the prognosis is worse because there were many associated organ injuries. These condition the early mortality for shock and exsanguination.
The author suggest a computerized program for filing clinical records of surgical institution. The proposed file is written in DB III plus (Ashton-Tate) and consists of one file .dbf and 4 files .prg. The database file contains anagraphic and clinical data of the patients. The program files make it possible to attribute a personal code to patients, print records of single patients, calculate the time of operation and assist in codifying diagnostic related groups (DRGs). The author stresses the utility of a medical computerized records system containing only few but important clinical data. It makes it possible to perform the most analysis of surgical series without the aid of a professional programmer.
DRGs system allows the grouping in a single grad-bag code of a number of similar surgical procedures carried out in patients homogeneous for age, physical status, complication and so on with similar costs. Therefore this grouping method is useful for payment to hospitals. The Authors have coded with DRGs the surgical activity of a general surgery staff during a year to verify the image that DRGs bears. Seven hundred diagnoses of dismission were related to operated on patients while one hundred twenty seven were related to patients treated with medical therapy. The DRGs more numerous were 290, 258, 198, 162, related with thyroidectomy, mastectomy, cholecystectomy and herniorrhaphy.
The Authors report a case of epithelial cyst of the spleen-observed in a 25 years old woman. After remembering the nomenclature and pathogenetic hypothesis, they consider clinical patterns of this rare disease of the spleen which is usually found in children and young adults. The Authors discuss pathological findings, diagnostic aids, especially non-invasive imaging. They also suggest considering the cysts in diagnosis of the diseases of the spleen and splenectomy as a treatment of choice.
A retrospective review of all the traumatic splenic ruptures from 1974 to 1988 was performed. Thirty-five patients were treated with splenectomy: 24 were males and 11 women. Teenagers and young adults were the most affected age groups. The mechanisms of injuries were: road accidents (78.8%), falls (12.1%), aggression, autoaggression and iatrogenic mishap (3%). Eighty per cent of the patients had associated injuries. Authors suggest a decisional algorithm to precise preoperative diagnosis and to treat the patients correctly. Mortality was 11.4% and primarily due to associated injuries.
The clinical records and pathologic patterns of all the cases of primary small bowel malignancies, treated in the last 15 years, were reviewed. There were 12 patients: 8 men and 4 women ranged from 41 to 86 years old. Carcinoma was the most common (82%) followed by carcinoid and lymphoma (9%). The distribution of the malignancies showed preponderance in the proximal jejunum and duodenum. Multiple primary malignancies were found in 17% of enteric cancers. The most common presentation was pain (75%) followed by weight loss (58%), palpable mass, anemia and gastrointestinal bleeding (25%), obstruction (17%). Barium studies of the duodenum and of the small bowel, duodenal endoscopy were the most useful diagnostic tools but a correct preoperative diagnosis was made in only 42% of the patients. Curative resection was attempted in 67% of the cases. The prognosis is poor.
A comparative experimental study was conducted on three different suture techniques for end-to-end colonic anastomoses. The development of stenosis, perivisceral adhesions and resistance to endoluminal pressure were assessed. The results show that the one layer all-coat interrupted stitch anastomosis displays less resistance to endoluminal pressure during the first seven days but is followed by fewer complications.
The authors do a clinico-epidemiologic reviewing of 24 cases of neoplastic obstruction of large intestine, they had the opportunity to observe. Such patients represent 12.9% of all cases of mechanic intestinal obstruction. The obstructive complication, which in 70% of the observations involved sigma and rectosigmoid junction, was the clinical beginning of 9,6% of colonic and rectal carcinomata. Such disease arose preferably in old patients and in those suffering from one or more concomitant diseases. Some reflections about the surgical treatment, which, in this casuistry, determined a mortality of 25%, lead the Authors to think the requirements of the treatment of high risk patients and the rigid observance of the rules of colonic surgery should be put before the requirements of oncological radicalness.
A case of "simple ulcer" of the colon is reported. The lesion is uncommon and not well known. As far as pathogenesis is concerned, the Authors emphasize the role of peptic, neurogenic, circulatory, bacterial, toxic and mechanical factors. The following clinical picture was observed: sudden and acute abdominat pain due to colonic perforation with pneumoperitoneum. As already described by literature preoperative correct diagnosis was not possible; this is usually due to the fact that the ulcer tends to perforate before other symptoms arise. During surgery suture of the ulcer, temporary colostomy and Mikulicz's drainage were performed; after 4 months colostomy was closed.
Authors perform a retrospective review of all hepatic injuries operated on between 1974 and 1990 at Clinica Chirurgica II (ex Patologia Chirurgica II, ex Semeiotica Chirurgica) of Policlinico San Matteo (IRCCS) of Pavia. Thirteen patients were treated, 9 men and 4 women, with age ranged from 13 to 68 years and a mean age of 38 years. They were 21% of all patients operated on for abdominal trauma. Penetrating wounds were present in only two cases (15%), the other patients (85%) were affected by blunt trauma. The mechanisms of injuries were: road accidents (77%), fall at work (8%), gun shot wound (8%), stab wound (8%). All patients had associated injuries. The mortality was 31%: one patient died for haemorrhagic shock and the other three for craniocerebral injuries. After reviewing the several haemostatic techniques advocated for the various types of hepatic injuries, the authors stress that, although most lesions are minor and can be managed by simple technique of haemostasis, often the prognosis is severe for the associated injuries.
Authors refer about their experience on 12 cases of male breast carcinoma (MBC), studied in years 1975-1985 at the Semeiotica Chirurgica e Patologia Chirurgica II dell'I.R.C.C.S. Policlinico S. Matteo of Pavia. After a thorough discussion of the etiopathologic factors, there are cited the most common histotypes of MBC, as well as the typical clinical aspects, of basic importance for the compilation of the diagnostic inquiry, which, in uncertainty, makes use of the acuaspiration and of the excisional biopsy, there is referred on the present therapeutic trends, and results of their casuistry are exposed.
Authors report a case of Morgagni-Larrey obstructed hernia recently observed. After remembering pathogenetic hypothesis and pathological findings, they discuss clinical patterns, diagnostic tools and differential diagnosis. Authors suggest to consider surgical repair as a choice treatment, also for asymptomatic patients.
Colo-rectal endometriosis involving extensive intestinal wall may result in obstruction. This report is based on two patients having symptomatic intestinal endometriosis that required operative treatment. Diagnostic, pathologic and therapeutic findings were reviewed. Current treatment is the removal of the endometriomas, while removal of the reproductive organs should be made only after evaluation on the patient's menstrual status, age and future pregnancy desire.
The authors report a retrospective review of four cases of gallstone ileus seen at Semeiotica Chirurgica, at Patologia Chirurgica II and Clinica Chirurgica II of Policlinico San Matteo I.R.C.C.S. of Pavia between 1974 and 1989. Three patients were women and one male, with average age 69.4 years. All obstructions occurred in the distal ileum. Proceeding from available data in the literature and from their personal experience the Authors emphasize that gallstone ileus is a rare cause of mechanical obstruction of intestine (4% of the obstructions of the small bowel). This disease usually occurs in elderly women, with concomitant illness. Approximately 50 per cent of the patients have an history of gallbladder disease. The authors discuss the controversy on performing an enterolithotomy alone versus one stage procedure consisting of removal of the impacted stone, fistula repair and cholecystectomy. The prognosis is severe. High mortality and many postoperative complications are caused by the advanced age of the patients, concomitant illness and usually delayed diagnosis.
The authors describe a case of splenic cyst recently observed. After remembering the nomenclature and pathogenetic hypothesis, they consider clinical patterns and emphasize pathological findings, diagnostic aids, especially noninvasive imaging. Authors discuss why the cyst was probably hydatid one, although histologic examination did not show scolices, and believe that the treatment of choice is splenectomy.
The Authors carry out an experimental comparative study on four different suture materials (collagen cromic, polyglactin 910, PDS and nylon), used to perform end-to-end colonic anastomoses. They assess the resistence to the endoluminar pressure. The results show that during the first four days the anastomoses performed with PDS display a vere high resistence, while those with collagen cromic exhibit still lower value than Vicryl and nylon. After eleven days the anastomoses with the PDS show most resistence again, but the other three materials get similar value.