Biomedical subjects
Publications and source records attributed to F Ferrero.
The present report is based on a review of literature and shows that violence is a rare manifestation, which results from the intrications of numerous factors and which is difficult to predict even in the short term. Preventive work should be based on the knowledge of some personal as well as relational risk factors.
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Personal experience in the postoperative treatment of patients with liver traumas is reported, and a comparison is made between those treated in ordinary wards and those admitted to intensive care units. The latter had shorter stays (24 days as opposed to 40) and fewer postoperative complications, assuming a comparable picture of preoperative shock and associated lesions. The difference is attributed to the possibility offered by such units of providing closer surveillance and more rational management.
In the healthy subject, glucose tolerance tends to decrease with age due to impaired insulin secretion and/or decreased peripheral insulin activity. An oral glucose (100 g) tolerance test was performed on 12 aged (70 +/- 4 yr) and 8 young (32 +/- 7 yr) subjects; these subjects underwent laparatomy for cholecystectomy or the management of abdominal diseases. Subcutaneous adipose tissue was removed during surgery and fat cells, prepared according to a personal modification of Rodbell's method, were incubated in a medium containing monoiodo- and cold insulin to evaluate insulin binding and affinity constants. The results of the tolerance test pointed to an insulin resistant state i.e., impaired glucose tolerance coupled with normal plasma insulin, as previously shown also by us using other methods in the aged subject. The binding study demonstrates a distinct insulin receptor decrease in fat cells from the older subjects (185,000 +/- 19,200 as opposed to 310,000 +/- 12,000), without any change in affinity constants. The result indicates that insulin resistance in the aged may be attributed at least in part to a reduction in the number of insulin receptors on the target cells. This could be a consequence of aging itself, as proposed by other workers in the case of old fat rats.
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Authors report a four month old patient, admitted to hospital because of blood in stools. Diagnosis of congenital deficiency of factor VII was established because such factor was practically absent; on the contrary, other coagulation factors were normal. His parents and sister presented a mild deficit of factor VII without clinical manifestations. An up-to date review of the problem is presented.
Central venous catheterisation via the supraclavicular and subclavicular route was performed in 61 and 44 cases respectively at the department's intensive therapy unit. A statistical assessment was made of the modalities of application, complications, time of indwelling, and reasons for removal. A large number of more serious complications (pneumothorax, haemothorax, arterial puncture) were noted with the supraclavicular technique, whereas subclavian catheterisation permitted longer residence times and was rarely responsible for serious disturbances, even though there were more instances of poor positioning. A preference is expressed for the second method. Mention is also made of employment of the internal jugular in recent cases, though these are not yet sufficiently numerous to enable any conclusions to be drawn.
An examination is made of a series of emergency operations carried out in the period 1974-78 to arrest haemorrhage due to the rupture of oesophageal varices. An account is given of the personal criteria employed in the choice of candidates and the type of surgical management. Stress is laid on the need for greater aggressivity. In addition, support is expressed for the porto-systemic shunts, especially shunts of the porto-cava and meso-cava type. These are superior to other forms on account of their easy and rapid execution.
Six cases of delayed rupture of the spleen in two stages are described. One case of occult rupture is also presented. A picture of acute anaemia was observed in the five two-stage cases, whereas the occult rupture was diagnosed as organised splenic haematoma following computerised scintiscanning, arteriography and tomography. Splenectomy was performed in all cases, under emergency conditions in the first five, and of choice in the sixth. No post-operative complications were noted.
Three typical cases of segmental portal hypertension due to occlusion of the splenic vein are reported. This syndrome may be asymptomatic for a very long time and then present suddenly in the form of a serious picture of high digestive haemorrhage due to rupture of the varices of the fundus of the stomach as a result of hypertrophized submucous collateral drainage circulation. Useful for diagnosis are oesophagogastroduodenoscopy, which points to stomach varices, and splenoportography or superselective arteriography of the splenic artery with venous phase, which highlight pathognomonic dilatation and tortuosity of the gastroepiploic veins. Surgical exploration typically shows: presence of large epipolic vessels, splenomegaly, absence of changes in the liver and in the portal and mesenteric circulation. Resolutive treatment of choice is splenectomy.