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Biomedical subjects

G Gozzetti

Publications and source records attributed to G Gozzetti.

162 records · Page 9Linked to original sources
PubMedDate not supplied

The surgical management of Crohn's disease of the colon.

The authors analyze their experience in the management of 64 cases of Crohn's disease, located in the colon in 47 cases. The clinical and therapeutical aspects are discussed with particular attention to the surgical problems for which even today there is no general consensus of opinion especially when the colon is involved.

Adult↗
PubMedDate not supplied

Aorto-enteric fistulae: spontaneous and after aorto-iliac operations.

Ten case of arterio-enteric fistula are presented, 3 spontaneous and 7 following surgery on the aorta. In the majority of cases "herald bleeding" allows enough time to study the patient. Spontaneous fistulae are very rare and their diagnosis can be very difficult if the aneurysm is not palpable. In any case of gastrointestinal haemorrhage in a patient who has undergone an aortic operation an A-E fistula will be suspect. The only useful diagnostic procedure is gastroduodenoscopy which usually does not show any organic cause for the bleeding. Arteriography seems only a dangerous waste of time: emergency explorative laparotomy, if a fistula is suspected, is surely harmless and preferable. The only sure surgical technique consists in removal of the prosthesis followed by an extra-anatomic by-pass.

Aged↗
PubMedDate not supplied

[Pulmonary complications from monoclonal antibody (OKT3) immunosuppression in patients who have undergone an orthotopic liver transplant].

The authors investigated the incidence of pulmonary complications following immunosuppression with monoclonal antibodies (OKT3) in a series of 100 consecutive cases of orthotopic liver transplantation (OLT). Of 17 patients treated with OKT3 (16 for acute rejection and 1 for cyclosporine toxicity), 11 pulmonary infections were observed (65%), 9 of which (53%) with onset within a mean of 9 days after OKT3 administration. The infections were severe in all cases and lethal in 8 cases: the most common pathogens were Candida (4 cases) and Pseudomonas aeruginosa (3 cases). On the contrary, of 39 cases of rejection treated with steroids, infections were observed in 3 cases only (8%). The 53% incidence of pulmonary infections in OKT3 patients, significantly higher than in the extant patients (19%), confirms OKT3 treatment as a strong risk factor for severe pulmonary infections. Furthermore, the occurrence of pulmonary edema was directly related to OKT3 administration in 7 OKT3 patients (41%), whereas only 20 cases (24%) occurred in the extant OLT patients (p < 0.001). OKT3-related pulmonary edema was always observed in hyperhydrated patients at the time of drug administration and it seemed to be related to the vasoactive myocardiotoxic agents released by damaged T-cells.

Acute Disease↗
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Distal splenorenal shunt and insulin secretion, plasma glucagon, and glucose homeostasis in cirrhosis.

Over the 1st postoperative yr, distal splenorenal shunt (DSRS) in cirrhotic patients is followed by a reduction in portal perfusion resulting from a spontaneous opening of portal-systemic collaterals. This can influence plasma levels of insulin and glucagon. Fasting plasma glucose, insulin, C-peptide, and glucagon and their 5-h responses to a protein meal (which directly stimulates the hormone secretions) were measured before and 3 and 12 mo after DSRS in 10 cirrhotic patients. Hormone effectiveness and pancreatic alpha- and beta-cell sensitivities to ammonia (NH3), amino acids, and glucose were also calculated. Liver function and portal vein diameter were assessed before each study. Seven cirrhotic patients treated with injection sclerotherapy of esophageal varices served as a control group. Liver function did not deteriorate in either patient group. An increase in fasting glucagon (from 181 +/- 22 to 242 +/- 22 and 255 +/- 22 pg/ml, p = 0.02) and NH3 (from 57 +/- 8 to 84 +/- 11 and 97 +/- 14 micrograms/dl, p = 0.04) and a decrease in glucagon effectiveness (from 0.56 +/- 0.06 to 0.39 +/- 0.05 and 0.035 +/- 0.03, p = 0.047) and portal vein diameter (from 16.0 +/- 1.1 to 11.3 +/- 0.8 and 9.4 +/- 0.6 mm, p < 0.001) was found only in DSRS patients. The elevation in glucagon was correlated with that of NH3 at 3 mo (r = 0.83, p = 0.003) and with the reduction of portal vein diameter at 1 yr (r = -0.81, p = 0.005). In cirrhosis, DSRS does not influence insulin secretion or its plasma level and effectiveness.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Duodenogastric and non acid gastro-oesophageal reflux in patients with reflux oesophagitis.

BACKGROUND/AIM: The role and the identification criteria of non acid gastro-oesophageal reflux (GOR) are still debated. Moreover, the relationship between nonacid GOR and gastric alkalinizations, particularly if secondary to duodeno-gastric reflux is yet to be defined. MATERIALS AND METHODS: One hundred and forty one patients affected by GORD symptoms and oesophagitis entered the study. Oesophagitis was divided into four categories, according to a modified Savary and Miller classification. Acid (pH<4), alkalacid (4 7), alkaline (pH>7) GOR and duodenogastric reflux were measured by means of ambulatory three channel esophago-gastric pH monitoring with a combined analysis of the pH traces recorded in the oesophagus fundus and antrum. RESULTS: Total time percentage (T%) of acid GOR was significantly greater in patients than in healthy volunteers (HV) and between groups of patients in direct relation with the severity of the oesophagitis. Alkaline GOR was hardly detectable in every class of esophagitis. Alkalacid GOR increased with the grade of severeness of oesophagitis. Alkalacid GOR occurred prevalently in the postprandial period; it was only 8% of the time in patients with mild reflux oesophagitis and even less in patients with moderate or severe oesophagitis. The 24 hr total time percentage of duodenogastric reflux was similar in the patients and healthy volunteer groups. The frequency distribution in 0.1 intervals of fundic and antral pH samples showed a greater number of them in the acid range (0.8-1.2) in the patients than in healthy volunteer group (0.0006 7) samples was similar in patients and in healthy volunteers. CONCLUSIONS: Our findings demonstrate that alkaline GOR is rare in GORD patients and that non acid GOR has a minor role in the pathophysiology of reflux esophagitis.

Adolescent↗
PubMedDate not supplied

Surgery for esophageal achalasia. long-term results with three different techniques.

BACKGROUND/AIMS: In surgery for achalasia, the length of the myotomy and the opportunity of associating an antireflux procedure are still debated. Prospective and comparative studies on different techniques are few. The aims of this work is to compare the long term results of three different techniques successively adopted by the same surgical group. MATERIALS AND METHODS: Between January 1955 and December 1991, 185 achalasic patients were submitted to myotomy by using in temporal sequence three different techniques. The first technique utilized (1955-1972) was a long esophagogastric abdominal myotomy (83 patients), secondly (1973-1978) a limited transthoracic myotomy (30 patients) and at last (1979-1991) a long esophagogastric abdominal myotomy associated to the Dor gastroplasty (72 patients). Since 1972, patients were prospectively followed up according to a protocol which included a clinical interview, x-rays, manometry and endoscopy at given dates. Post-operative esophagogastric transit and gastro-esophageal reflux were assessed to verify the therapeutical outcome. Results obtained with the three different techniques were analyzed and compared by using the actuarial Kaplan-Meier curves. RESULTS: The mean follow up was 193.3 months for the patient group that underwent abdominal myotomy (62/83 patients), 137.3 months for the thoracic myotomy group (30/30 patients) and 86.9 months for the abdominal myotomy plus Dor gastroplasty group (69/72 patients). Long-term results in the abdominal myotomy and in the thoracic myotomy groups were respectively poor in 51.6% and in 46.6% of patients. Major causes of failure were insufficient myotomy (6.5%), periesophageal scarring (9.6%) and reflux esophagitis (22.6%) for the abdominal myotomy group; insufficient myotomy (20%) and reflux esophagitis (23%) for the thoracic myotomy group. In the abdominal myotomy plus Dor gastroplasty group long-term results were excellent or good in 87% of patients and poor in 13%. Reflux esophagitis (10% of cases) was the principal cause of failure. CONCLUSIONS: The comparison of the actuarial curves shows a significantly better long term outcome for the abdominal myotomy plus Dor antireflux procedure than for the abdominal myotomy (p = 0.01) and for the thoracic myotomy (p = 0.002) techniques.

Actuarial Analysis↗