[Erosion and intragastric migration of Angelchik's prosthesis. Presentation of a clinical case].
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Biomedical subjects
Publications and source records attributed to G Anselmetti.
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The Authors report their experience about 72 operations of bilio-digestive anastomosis done for obstructive icterus from 1972 to 1979, 48 of which due to pathology by neoplastic cause and 24 due to pathology by benign causes. 32 operations of bilio-jejunal anastomosis on ansa in the omega fashion have been done operations of bilio-jejunal anastomosis on Roux's ansa four of which operations of transtumoral drainage in accordance with Rodney-Smith's technic, 16 operations of bilio-duodenal anastomosis.
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Twenty-four cases of primary carcinoma of the gallbladder (1.3% of gallbladder operations) collected over a period of 8 years are compared with those reported in the literature. This form has a very poor prognosis due to delays in diagnosis, early regional extension, and often insufficient surgical management. Women over 60 are the main victims. Abdominal pain is nearly always present, with icterus in 50% of cases. In 5/24 cases, the diagnosis was based on histological examination of the surgical specimen in the absence of clinical signs preceding the operation. It is felt that prophylactic cholecystectomy is desirable in cases of symptomatic or asymptomatic lithiatic cholecystopathy, especially in subjects most at risk. Suitable treatment of curable forms requires cholecystectomy combined with cuneiform hepatic resection and regional lymphadenectomy.
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The physiopathological characteristics of senescence justify unremitting research into anaesthesiological techniques that increase the anaesthesia safety margin in the elderly. Althesin has been studied in 100 over-70s who underwent traumatological surgery. The drug was used in 10% solution administered by continuous drop by drop venous perfusion, for induction also. All patients were submitted to orotracheal intubation under local anaesthesia or using a small dose of succinylcholine. The condition was maintained by N2O in proportions equal to the oxygen and by small doses of analgesic (prevalently neuroleptoanalgesia drugs). Cardiocirculatory and respiratory parameters total anaesthetic consumption and the quality of arousal were studied. The value of Althesin in the narcosis of the elderly is stressed, with particular reference to the good cardiocirculatory stability, the little effect on pulmonary compliance, the early arousal with post-narcotic depressive phenomena and the high therapeutic index.
A review of the recent literature is accompanied by the presentation of 7 cases of biliary ileus. Enterolithectomy, repair of the fistula, and cholecystectomy were carried out during the same operation in 2 cases, and it is felt that this form of management should be used more often in selected and suitably prepared patients.
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Low molecular weight plasma expanders, proteinase inhibitor and phosphatidilcholine have been used in a city accident hospital prophylactically against fat pulmonary embolism (F.P.E.) in traumatised patients. Their routine use in patients at risk has shown a decrease in the frequency of this syndrome, suggesting the validity of such treatment.
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