[Complications of jejunoileal bypass].
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Biomedical subjects
Publications and source records attributed to F Mazzeo.
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Androgen, progesterone and estrogen receptors were analyzed in 12 primary colonic cancers and 16 primary rectal cancers. Androgen and progesterone receptors were positive in some colonic cancers and rectal carcinomas; however, none of the specimens analyzed showed estradiol receptor.
Thirty-two patients affected by monolateral breast cancer and five patients with benign mammary pathology were submitted to pre-operative lymphoscintigraphy by sub-areolar injection of nanocolloidal albumin with the aim of evaluating any axillary lymphonodular involvement. The 32 patients, affected by cancer, subsequently underwent a surgical operation so as to permit a pathological-anatomical study of the axillary cavity. A comparison between the clinical and instrumental examinations brought to light the much greater reliability of the latter which gave 87.5% of correct diagnoses. The authors emphasize the absence of false positive results and the excellent sensitivity of the method in bringing to light even limited involvements of the axillary lymphonodes. The authors believe that axillary lymphoscintigraphy deserves to be included in the pre-operative protocols which afford a correct staging of the disease and, consequently, a better assessment of the extent of the surgical action.
A multicentre double-blind study was carried out on a total of 197 patients, to evaluate the safety and efficacy of an 800 mg nighttime dose of cimetidine in comparison with 400 mg twice daily in the treatment of duodenal ulcer. At 4 weeks 84% of the 187 patients eligible for analysis had healed ulcers with the once daily regimen and 68% with the twice daily regimen (p less than 0.05). An early decrease in both day and nighttime pain and in antacid consumption was observed during the first 2 weeks. Adverse effects were few and mild, confirming the safety profile of cimetidine.
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A double blind trial was conducted in seven centres to evaluate the safety and efficacy of cimetidine 800 mg given at night compared with 400 mg given at breakfast and at bedtime. Altogether 197 patients with active duodenal ulcer confirmed by endoscopy entered the study, of whom 187 were eligible for analysis. After four weeks' treatment the ulcer was healed in 76 of 91 patients (84%) receiving the once daily regimen and in 65 of the 96 patients (68%) receiving the twice daily regimen (p less than 0.05). Both dosage regimens were equally effective in reducing ulcer pain and consumption of antacids. Pain relief was considerable within the first two weeks, and most of the patients were free of symptoms by the end of treatment. No patients were withdrawn because of adverse events as these were few and mild, consistent with the proved safety profile of cimetidine. Cimetidine 800 mg given at night is as effective as 400 mg twice daily; the single dose regimen may improve patient compliance, thus facilitating treatment.
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Regional lymph nodes of the rectum are not demonstrable by pedal lymphoscintigraphy. We have evaluated the technique of rectal lymphoscintigraphy, using a technique similar to that which has been used in the assessment of lymph nodes in breast and prostatic cancer. Thirty-five patients were studied: ten normal subjects and 25 patients with rectal cancer. In normal subjects, the lymph nodes accompanying the superior hemorrhoidal artery and the inferior mesenteric artery are demonstrable in succession; after three hours the aortic lymph nodes are demonstrable. The 25 patients with rectal cancer underwent resection of their primary tumor and the stage was defined according to Dukes (1932). In five patients (stage A) no alteration was demonstrable. In 11 patients (stage B) the demonstration of regional lymph nodes was delayed vs. the control group. In nine cases (stage C) the demonstration of regional lymph nodes was delayed and defective versus the control group.
The case of a surgical patient with a full blown syndrome of zinc deficiency is presented and the various implications related to a deficiency of this trace mineral are discussed. The symptomatology involved mental depression, visual disturbances, glucose intolerance, decreased serum alkaline phosphatase levels, wound healing impairment, eczematoid dermatitis and reduced humoral and cellular immune defences. Oral supplementation with zinc sulphate dramatically reversed the signs and symptoms of the syndrome and resulted in rapid wound healing. This case seems to have exhibited most of the different signs and symptoms reported from time to time in the literature. Awareness of zinc deficiency is being brought to light in many medical and surgical conditions. Total parenteral nutrition (T.P.N.) can exacerbate the lack of this trace metal and supplementation with fresh blood derivate are, as demonstrated, useless in these cases. Zinc, as component of various metalloenzymes, accounts for the clinical manifestations of its deficiency.
The "in vitro" aneuploidy of peripheral lymphocytes in 13 members of a family affected by familial polyposis coli and in 5 patients affected by familial adenomatosis and belonging to other two families, was examined. The increase in aneuploidy of lymphocytes was significant only in 6 of the 13 members of the family (2 affected by polyposis and 4 not affected) and in all 5 patients with polyposis. Aneuploidy could be, for these reasons, a marker for polyposis.
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Reflux into the blind loop in end-to-side jejuno-ileal bypass is commonly considered the cause of weight loss failure, but the lower morbidity and mortality suggest that this procedure should be preferred to end-to-end bypass in the surgical treatment of morbid obesity, with the proper technical modifications to prevent the reflux. An antireflux single or double valvular system created 3-6 cm proximally to the anastomosis, with few introverting seroserous stitches, parallel and perpendicular to the ileal axis, is reported. This technique, as compared to others, is not time consuming, is easily feasible and does not interfere with the blind loop down-flow. Comparative clinical data and x-ray controls demonstrated the value of this procedure which is able to give excellent results in cases where other procedures (gastric operations, bilio-intestinal, bilio-pancreatic bypass etc.), are contraindicated.
The term "Minimal Breast Cancer" includes different neoplastic changes, the common characteristic of which is an high survival rate (90% of cases) when the treatment is early started. In all patients with palpable nodules and in patients "at risk", thermography, mammography, xerography, echography and cytological examination by suction-needle, must be performed to rule out the existence of a "Minimal Breast Cancer". The methods of treatment preferred by the Authors, according to the different types of pathological changes, are the following: a) through follow-up or, alternatively, subcutaneous mastectomy when a "lobular carcinoma in situ"; b) subcutaneous mastectomy and axillary emptying when the diagnosis is found in "intraductal carcinoma"; c) mastectomy, performed according to Patey's technique, or removal of all the involved breast quadrant, axillary emptying and radiotherapy of the residual glandular parenchyma in case of ductal carcinoma or invasive lobular carcinoma less than 0.5 cm in diameter.
The indications and contraindications for the various types of bilio-digestive anastomosis operations are assessed with due allowance for the physiopathological aspects of main bile way function. Careful analysis of the data obtained in pre- and intra-operative investigation permits a precise choice of the required intervention in all cases. The advantages offered by restoral of bile flow at duodenal level, as occurs in EDDP, are stressed.
The authors studied the influence of some suture materials (normal and chromic catgut, silk, polygalactic acid and polypropylene) on the process of healing of the small intestine in the rabbit. From the macroscopic, microscopic and mechanical examinations, it results that polygalactic acid is the material which comes closest to the ideal material. There follow, in that order: silk, polypropylene, chromic catgut and normal catgut.
The criteria underlying the choice of operation in a given case and the personal technique adopted are described. The technique in question is a personal modification of end-to-side jejuno-ileal bypass codified by Payne. To minimize reflux into the blind loop, a number of technical steps are considered indispensable: 1) fluted section of the jejunal stump; 2) isoperistaltic construction of the anastomosis and, particularly, 3) the creation of a single or double valve system upstream from the anastomosis by spiral introflexion of the mucosa using seroserous stitches parallel and perpendicular to the ileal lumen. Other techniques in use are reported. These are held to be extremely interesting but are not yet supported by a long enough follow-up.