Biomedical subjects
Publications and source records attributed to G C Viglione.
The Authors report some observations on gallbladder calcification with the presentation of two clinical cases. The pathologic anatomy and the clinical aspects of this infrequent affection are described. The Authors underline the importance of surgical treatment, considering the frequency of carcinoma in porcelain gallbladder.
The Authors report a case of carotid bifurcation endarterectomy under loco-regional anesthesia. Despite a stump pressure of 44 mmHg, considered by the most of the Authors, the borderline value for carotid endarterectomy without shunt, the patient had a cerebral ischemic attack after 30 seconds of carotid clamping. So, the local anesthesia represents a valid alternative in order to detect an intolerance to clamping and underlines the importance of cerebral protection in this kind of surgical approach.
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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.
The technique used to carry out pancreaticogastrostomy after duodenocephalopancreatectomy in 4 cases is described. The technique is better than pancreaticojejunostomy, which is associated with a high incidence of postoperative complications, such as abscesses, fistulae, haemorrhage, and autodigestion at the site of anastomosis.
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.
Oesophagogastroplasty has been performed in 4 patients in the Turin Department of Emergency Surgery. Three of them presented high neoplastic lesion of the oesophagus, while the fourth was suffering from mediastinic compression due to sclerosing mediastinitis. The technique and results are reported in detail. Indications for surgery for both malignant and benign lesions are presented. The real advantages of the operation with respect to stomach to chest transposition and oesophagocolonplasty which have in the personal series created considerable inconvenience, are discussed. The reasons making it necessary to carry out the operation in two stages, with different modalities, are also discussed. Complications are indicated and postoperative treatment discussed. This plays a notable part in the success of the operation, as does correct technique.
Personal experience acquired in the course of 177 mitral valve replacements with a Lillehei-Kaster prosthesis up to June 1977 is discussed. Intraoperative mortality was 8.5%. Postoperative mortality (as at 31-12-1976) was 5.3%. The clinical, radiological, and ergometric findings were fully satisfactory. Haemodynamic examination at rest and during effort revealed improved pressure and heart capacity values. The mean transprosthetic gradient at rest was 5.61 and rose to 13.53 (after uncalibrated effort). Thromboembolism was noted in 5 patients (3.1%), as in the literature. The haemodynamic features and low thrombogenicity of the Lillehei-Kaster prosthesis would thus appear to make it a sound replacement for the mitral valve.
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Reference is made to the literature data and a personal series for the proposal of ligation of hepatic artery as a useful means of controlling: 1) massive haemorrhage following certain forms of liver trauma; 2) haemorrhage following lobectomy or atypical subtotal resection; 3) post-traumatic haemobilia. It is a valuable alternative to lobar resection which, in spite of its over 50% mortality, is still the treatment of choice in serious lesions, especially if these are associated with lesions of the suprahepatic veins or cava, or massive crushing of the parenchima. Haemorrhagic shock following liver damage is usually met by reduced portal and increased hepatic artery flow. It is obvious that ligation of the hepatic artery leads to considerable ischaemia and hypoxia. This disadvantage can only be offset by massive replacement transfusions, protracted parenteral feeding (fasting leads to maximum oxygenation of the portal blood), and intravenous glucagone, to improve the overall liver blood flow and the oxygen saturation of the portal blood.
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