[The role of surgery in the prevention of pulmonary thromboembolism].
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Biomedical subjects
Publications and source records attributed to F Lavorato.
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Reference is made to the experimental preliminary remark and the first, clinical observations underlying the surgical management of severe obesity, together with the techniques employed, starting with the jejunal-colic by-pass of Payne et al. This, however, led to serious liver damage and electrolyte imbalance, whereupon Payne et al. proposed end-to-side and Scott end-to-end jejunal-ileal by-pass. The end-to-end variety has been used with excellent results in 33 cases. Mason's gastric and gastroplastic techniques is till now unfrequently used. An account is also given of experimental ileo-cholecystostomy and biliopancreatic by-pass. In agreement with most other workers, a preference is expressed for the end-to-end jejunal-ileal by-pass as the most suitable technique available at present.
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Alkylating drugs, alkylating drugs + antimetabolites, and alkylating drugs + antimetabolites + Vinblastine were used to treat 62 patients. The results were assessed in terms of Karnofsky's classes and related to the following parameters: age, free interval, menopausal status, results of prior endocrine management, site of dominant metastases, length of survival. 44 failures (71%) and 18 objective responses (29%) were noted. A mean survival of 17.3 months was noted for the entire series. Subjects who failed to respond survived an average of 14 months, as opposed to 25.5 months for the responders. This difference was just significant. No relation could be shown between the results and the other parameters, whereas that between the results and the length of survival was highly significant. It is clear that the variables considered cannot be relied upon in predicting the outcome of chemotherapeutical management. If the latter is effective, however, survival will almost certainly be prolonged.
Transient hypomagnesiaemia was noted postoperatively, particularly on the 1st day in patients submitted to intestinal procedures. Slight hypocalcaemia was also observed; this was often related to a low plasma Mg value. A hormonal mechanism is presumed to be the cause of this stress-linked fall in blood magnesium.
An association of 5-fluoruracyl (or methotrexate) and cyclophosphamide was used in the treatment of 20 cases of hormone-resistant breast cancer. Five objective regressions were obtained. Mean survival here was 28.25 (S.D. 2.87) months, as opposed to 12.75 (S.D. 6.93) months in the remainder. Side-effects of various kinds were noted in 9 patients.
The results obtained in 14 patients suffering from hormone-resistant metastatic breast cancer treated with the following association: methotrexate (5-fluorouracyl in case of methotrexate intolerance), cyclophosphamide, vinblastin administered i.v. once every 10-13 days, are reported. 4 objective regression (29%) were observed but survival did not very appreciably differing therapy. In 9 cases (65%) intolerance of various types was observed but in 8 these signs regressed in a short time and the therapy was resumed.
The results obtained in 26 patients suffering from metastatic cancer of the breast no longer sensitive to hormone treatment are reported. The patients were treated with ciclophosphamide (CTX) (500 mg i.v.) once a week and triethylenethiophosphamide (20-30 mg i.m.) (TSPA) every 4 weeks associated with cyclophosphamide as follows: CTX--CTX--CTX--CTX+TSPA. 9 objective regressions (34.6%) were observed. Those with objective regression lived 28 months on average (SD 23.45) and those without lived on average 11.41 months (SD 9.89). The difference is statistically significant. Side effects of various types were observed in 7 patients (27%).
This reviews 839 isolated lumbar sympathectomy performed between 1950 and 1975. The patients are stratified by decades and grouped in 3 periods : 1950 to 1959, 1960 to 1969 and 1970 to 1975. In the first period most patients were between 50 and 59 years old; in the last period most were between 60 and 69 years old. At this time direct vascular reconstruction had become more frequent. The approach described by Pearls was used exclusively in the last period. Isolated lumbar sympathectomy yields a symptomatic improvement. Best results are obtined in peripheral and isolated lesions.
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