[Iatrogenic hyperaldosteronism. Presentation of 3 cases].
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Biomedical subjects
Publications and source records attributed to F Cosentino.
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A procedure for percutaneous endoscopic gastrostomy is described. Under direct endoscopic control, the surgeon introduces, percutaneously, into the inflated stomach a 9 French Foley catheter through a special needle, which may then be opened for removal. After positioning, the terminal balloon of the Foley is inflated with 7-8 ml of air and the catheter is placed under slight traction to appose the gastric and abdominal walls. Such a method has been used in 5 patients with cancer of the cardia requiring enteral feeding prior to surgery. No complications due to the positioning of the gastrostomy catheter have been observed. We believe that this simple, reliable and inexpensive method constitutes an improvement on the previously described endoscopic percutaneous gastrostomy techniques.
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The Authors report a case of acalasic megaoesophagus operated through extramucous myotomy according to Heller 20 years before coming to their observation and with relapse of disphagic symptoms due to serious oesophagitis during the subsequent years, in spite of an interposition of jejunal ansa according to Merendino and an oesophago-gastrostomy after removal of the interposed ansa. As the patient showed a further relapse of the disphagic symptoms, he, at last, underwent a subtotal oesophagectomy with intrathoracic oesophago-colon-plasty. At examination of the operative specimen, as a report added and not evidenced through the preoperative ascertainments, a limited oesophageal neoplastic degeneration at level of the oesophagogastro-stomy was found. The patient died one year and eight months after operation for neoplastic cachexia. The Authors analyse the causes determining the disphagic syndrome after surgical treatment of acalasic megaoesophagus, the therapeutical solutions suggested and the relations between megaoesophagus and oesophageal cancer.
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The writers have reviewed thirteen cases of contusive trauma of the popliteal artery which came under their observation. The incidence of such lesions in arterial trauma is 22 per cent. The limb was saved in 76 per cent; but the result was only functionally good in only 46 per cent. The fundamental factors for successful revascularization are early diagnosis and precise technique. The operation of choice is a by-pass using the saphenous vein from the contralateral limb; this "jumps" right over the focus of arterial contusion.
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