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Biomedical subjects

F Galeotti

Publications and source records attributed to F Galeotti.

54 records · Page 3Linked to original sources
PubMed1985

Portacaval shunt in the treatment of primary Budd-Chiari syndrome.

We have performed a side-to-side portacaval shunt as the treatment of choice in six cases of primary Budd-Chiari syndrome. All the patients (three men and three women, mean age 33 years) had marked hepatomegaly and massive ascites. Four patients had endoscopically proved esophageal varices with no episodes of bleeding. Preoperative angiographic studies, caval pressure measurement, laparoscopy, liver biopsy specimens, liver scanning, and liver function tests confirmed the diagnosis. A possible etiologic factor was evident in only two cases. A plain side-to-side portacaval shunt was performed in four patients, while two required the interposition of a graft. One patient died after surgery of hepatorenal syndrome. Four of the surviving patients are free of ascites and doing well at 29, 27, 25, and 6 months. The remaining patient subsequently developed cirrhosis and died 76 months after surgery. None of the patients who survived developed encephalopathy. Shunt patency was confirmed endoscopically by variceal decompression in the four patients with esophageal varices. We believe the side-to-side portacaval shunt is a reliable and effective procedure for the definitive management of primary budd-Chiari syndrome.

Adult↗
PubMed1983

Prophylactic portosystemic shunt: a special indication.

Generally, when a splenectomy is performed to treat either a severe hypersplenism or another splenic affection in a cirrhotic patient with uncomplicated esophageal varices, the question arises whether to associate or not a prophylactic shunt. In fact, splenectomy alone does not lower the portal pressure and does not affect positively the esophageal varices. Because of this, 36% of these patients will eventually undergo a bleeding episode from varices. Furthermore, in the patients surviving the first bleeding, the occurrence of splenoportal thrombosis following splenectomy does prevent a therapeutic shunt to be performed. For this reason splenectomy with a complementary prophylactic shunt was performed in 24 patients. This operation, which showed 16% mortality rate, significantly prevented bleeding (0%). Furthermore in the treated patients, splenectomy has lowered the portal pressure. Encephalopathy occurred in 30% of cases, however the accuracy in the selection of patients together with a proper diet and medical treatment have avoided severe complications. The 5 year survival rate was 60%. Nevertheless, the indication to a prophylactic shunt must be limited to these particular cases.

Adolescent↗
PubMed1983

[Variations in the hepatic artery in the surgery of portal hypertension].

The effect of anatomical variations of the hepatic artery on the performance of the anastomosis was assessed during 390 portacaval shunt operations as well as the degree to which technical difficulties could be anticipated from preoperative arteriography. Variations were detected in 25 p. cent of 130 patients examined by angiography but were confirmed during portal vein dissection in only 11 p. cent of cases. Technical difficulties due to hepatic artery variations were encountered in only 2 p. cent of the 390 anastomosis. Accidental section of a right hepatic artery occurred once only, and this before the routine use of angiography. Treatment was by aortohepatic by-pass using a saphenous graft. Portacaval anastomosis can be conducted in the presence of an hepatic artery variation bat technical difficulties cannot be predicted by preoperative digestive angiography.

Adolescent↗
PubMed1982

[Diagnosis of secondary tumors of the pancreas. Analysis of 13 cases].

The Authors report their experience of 13 cases of metastatic carcinoma of the pancreas, diagnosed over 350 pancreatic cancers examined by digestive angiography (4%). The rarity of this localization is emphasized and is affirmed that any organ may cause pancreatic metastasis (liver, bile ducts, oesofagus) although the kidney and the lung are more frequently the original sites. The pancreatic metastases were of different types but the multilocalized or the total forms don't prevail over the single ones. The angiographic modifications induced by these secondary lesions are evident but not characteristic and diagnosis only of pancreatic tumor can be evocated. Therefore digestive angiography is of high diagnostic value in this cases, although histologic examination is necessary to define the metastatic nature of these lesions.

Angiography↗
PubMed1980

[Sulfobromophthalein clearance and survival of cirrhotics after an elective porto-systemic shunt].

Preoperative clearance of a single dose of BSP was assessed in 72 candidates for porto-systemic shunt in cirrhosis of the liver. Comparison between those who had died (24) and those who had survived (48) several years later showed statistically significant differences with regard to equivalent liver volume, first uncorrected exponential (Ki), absolute clearance, and 45' retention. A certain degree of differentiation could be made out among the survivors, whereas those who had died could not be distinguished from the series as a whole, nor could correlations be established with the length of survival. No practical advantage was displayed by the more complex, computer-processed parameters as opposed to those that were more immediately available.

Adolescent↗
PubMed1978

[Acid-base metabolism in patients with hepatic cirrhosis treated with portacaval anastomosis at various intervals after the operation].

In a series of 68 cirrhotics subjected to portacaval anastomosis for digestive haemorrhage, alterations in the acid base balance, 3, 6, 12, 24 and 48 weeks after anastomosis, were examined. Following operation, an increase in the incidence of the usual acid base disturbances of liver cirrhosis is observed. Respiratory alkalosis increases with no direct relationship to teh postoperative increase in ammoniemia, the main stimulating agent of the resporatory centres. This is probably because the active fraction on the nerve cells is the non-ionized one only, freely diffusible through the haematoencephalic barrier, the plasma concentration of which is a function of blood pH. Postoperative metabolic alkalosis is secondary to the potassium and chloride depletion consequent on operative trauma, on the malnutrition syndrome and, in the case of potassium, on secondary hyperaldosteronism which, unlike what is observed in the other groups of cirrhotics, is uncorrected by anastomosis. After the shunt, metabolic acidosis may be the expression of an increase in lactates and pyruvates following on further liver function deterioration, and of a functional renal insufficiency which anastomosis makes more manifest.

Acid-Base Equilibrium↗
PubMed1977

[Immediate and late results of 171 therapeutic portal systemic by pass operations (author's transl)].

The authors reports the results of 171 cases of portal systemic by pass operations out of a total of 200 cases operated on between 1968 and 1974. These 171 patients all presented with a syndrome of portal hypertension with oesophageal varices and all had previously bled. Their age lay in 70 p. cent of cases between 40 and 60 years and the cause of hypertension was in 96 p. cent of cases an intra-hepatic block. 41 p. cent were included in the risk group A according to Child's classification, 51 p. cent in Group B and 8 p. cent in Group C. The routine operation was side-to-side portacaval anastomosis (75 p. cent). The operative mortality was 5.2 p. cent in all with 1 p. cent in cases with risk A, and 15 p. cent in cases with risk C. The fall in portal pressure was on average 15 cm of water, i.e. 41 p. cent of the initial pressure. The overall survival after 5 years was 65 p. cent, 70 p. cent for risk A and 26 p. cent for risk C. In 69 p. cent of cases the cause of death was liver failure. Encephalopathy, studied in 76 patients over an average period of 3 years, occurred in 39 p. cent of cases, and in 13 p. cent of the latter it was serious. In the 12 p. cent of survivors, we noted recurrent hemorrhage, but in only 2.5 p cent of cases did the bleeding definitely come from oesophageal varices. In the light of these results, the authors judge positively the surgical treatment of portal hypertension.

Esophageal and Gastric Varices↗
PubMedDate not supplied

[Ultrastructural relief of unaffected mucosa in recurrent oral ulcer patients. 2].

Electron microscopy was performed on clinically normal vestibular mucosa biopsies of two patients affected with recurrent oral ulcers. Apoptotic cells were absent from vestibular mucosa; this is in contrast with the pathogenetic theory proposed by Honma et al., 1985 (1). Only a few modifications in the keratinization process (intracytoplasmic desmosomes, electrondense granules in basal keratinocytes) and an unusually high number of dendritic cells were found; dendritic cells could be involved in local immunological iperreactivity, responsible for the ulcers of these subjects.

Dendritic Cells↗
PubMedDate not supplied

The distal splenorenal shunt: an update on experience of 106 cases.

This paper analyzes experience with 106 patients treated primarily with DSRS during a ten year period. Operative mortality was 5% of cases. Shunt patency was evaluated by postoperative angiography in 70 patients. A shunt thrombosis and a recanalization of the splenic vein were noted in a patient who had a Britton's operation resulting in a side-to-side shunt. In the other 31 cases, shunt patency was indirectly confirmed by the absence of varices at postoperative or long-term endoscopic examination. At postoperative check, esophageal varices had disappeared in only 19% of patients. However, this rose to 60% at long-term check-up. Ten patients bled from varices in the postoperative period (9%). During the follow-up period, no patient bled from varices, while five patients bled from gastroduodenal lesions (5%). During the postoperative period, 52% of cases had ascites. In the long-term, ascites developed in only 15% of cases and was well controlled by standard medical treatment. Analysis of the actuarial curve showed a 5-year survival rate of 63%. During the follow-up period, 17% of patients experienced at least one episode of acute encephalopathy. Chronic encephalopathy appeared in 14% of cases: ten patients suffered a mild form (10%) and four (4%) a moderate form. No patient had severe chronic encephalopathy. DSRS is effective as treatment of portal hypertension with a low long-term morbidity despite a more troublesome early postoperative period.

Actuarial Analysis↗
PubMedDate not supplied

Serum tumor markers in monitoring patients: interpretation of results using analytical and biological variation.

During cancer monitoring, data on biological and analytical variation are required in order to define the critical difference which provides an objective means to interpret serial values. We evaluated four tumor markers on serial samples collected from healthy subjects and patients. Analytical coefficients of variation (CV(A)), were obtained from "precision profiles" based on the differences between duplicates cumulated from assay runs in the laboratory. We defined the mean intrasubject biological variation (CV(I)) for CA 19-9 and TPA, separately for healthy people and patients; since the differences between the two groups were not statistically significant, we pooled the results and re-evaluated CV(I) in the combined groups (CA 19-9: CV(I) = 15.9%; TPA: CV(I) = 25.7%). In addition, we evaluated CV(I) for CEA (10.9%) and for TPS (25.9%) in patients. We then evaluated the inter-subject biological variations (CV(G)); the calculated indices of individuality for the four markers were less than 0.6 which shows conventional reference values to be of little utility for interpretation. We finally evaluated the critical differences (p < 0.05) for CA 19-9 (CD = 44.7%), for TPA (CD = 72.5%), CEA (CD = 32.7%) and TPS (CD = 72.5%); these are generally applicable since there was no heterogeneity in intra-subject biological variability.

Adult↗