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G Poggioli

Publications and source records attributed to G Poggioli.

47 records · Page 3Linked to original sources
PubMedDate not supplied

Upper gastrointestinal involvement in diabetes mellitus: study of esophagogastric function.

The aim of our study was to evaluate in 18 diabetic patients (11 with and 7 without evidence of autonomic neuropathy as revealed by common cardiovascular tests) alterations indicative of autonomic nervous involvement of the gastrointestinal tract, independently of the presence of suggestive symptoms. All patients, without evidence of obstructive or mucosal pathology of the upper gastrointestinal tract, underwent the following: 1) study of gastric emptying time of nonabsorbable radiopaque markers (90, 120, 150 and 210 min); 2) study of gastric acid secretion: basal (BAO) and peak (PAO) acid output after sham-feeding (PAOSF) and peak acid output after pentagastrin (PAOPENT).PAOSF/PAOPENT ratio is an index of vagal integrity; 3) esophageal manometry. Our data confirm that a delayed gastric emptying of undigestible solids is a frequent finding in diabetic subjects. This was highly significant (p less than 0.01) at 150 min after a standard meal, in patients with signs of autonomic neuropathy and was often associated with asymptomatic esophageal motor abnormalities. No correlation was found with index of vagal integrity, hormonal pattern and degree of glycemic control. Autonomic neuropathy cannot be considered the only explanation for gastric and esophageal abnormalities in decompensated diabetes.

Adult↗
PubMedDate not supplied

Reducing the occupational risk of infections for the surgeon: multicentric national survey on more than 15,000 surgical procedures.

The objective of this study was to find the incidence of accidental exposures to blood and body fluids among surgeons during operations and to describe their dynamics. A probabilistic model was also used to predict the cumulative 30-year risk to the surgeon of contracting hepatitis B and C viruses (HBV, HCV) or human immunodeficiency virus (HIV) infection and estimate the effect of preventive strategies in reducing this risk. A multicentric prospective survey, based on self-administered questionnaires, was conducted during a period of 6 months in 39 Italian hospitals. As accidental exposure to blood or body fluids occurred in 9.2% of 15,375 operations. In about 2% of procedures a parenteral-type injury, such as actual skin puncture or eye contamination, was suffered by the operating surgeon. A needle-stick injury was the commonest accident, and its occurrence was found to vary with the phase of the procedure and its length. The current lifetime risk of acquiring HBV, HCV, and HIV infection in our regions was estimated to be as high as 42.7%, 34.8%, and 0.54%, respectively. The adoption of preventive strategies is expected to reduce this risk to 21% for HBV, 16.6% for HCV, and 0.23% for HIV infection. Active immunization of surgeons against HBV is strongly recommended. The case is also made for the use of a face-shield combined with a permanent change in our surgical practice capable of reducing the current high rate of parenteral injuries.

General Surgery↗
PubMedDate not supplied

Endoscopic assessment of acute inflammation of the ileal reservoir after restorative ileo-anal anastomosis.

Forty-seven patients, undergoing ileo-anal anastomosis for ulcerative colitis (42) or familial polyposis (5), were endoscopically examined after protective ileostomy or after restorative ileo-anal anastomosis. The neorectum and the ileum above were examined in all cases and multiple biopsies were taken. No symptoms of pouch inflammation were found in 41 subjects; 80.5% of these had non-macroscopic lesions and 19.5% had focal lesions such as congestion, petechiae, mucous hypersecretion (5), or single ulcers (3). None of these developed pouchitis. Pouchitis was observed in the other six subjects, who all underwent surgery for ulcerative colitis and developed 14 clinical episodes of pouchitis during the follow-up. In these cases the entire neorectum mucosa was always affected by the lesions which, in 50%, also extended to the ileum above. The most common endoscopic features (71.4%) were congestion, potechiae, oozing areas, mucous hypersecretion, and multiple superficial ulcers. In half the remaining cases (14.3%) the neorectum showed the features, described above, while the upper ileum was affected by deep round or irregular ulcers within normal mucosa; Crohn's disease was excluded in these cases. In the remaining 14.3%, pouchitis showed a pseudomembranous feature. In our experience, the endoscopic pattern of pouchitis is polymorphic. Although an ulcerative colitis-like feature prevails, pseudomembranous and Crohn's ileitis-like features may also be present.

Adenomatous Polyposis Coli↗
PubMedDate not supplied

Review--antibiotic treatment in inflammatory bowel disease: rifaximin, a new possible approach.

The etiology of inflammatory disease is still unknown, but a body of evidence from clinical and experimental observation indicates a role for intestinal microflora in the pathogenesis of this disease. Reduction of microflora using antibiotics, bowel rest and fecal diversion decreases activity in Crohn's disease and in ulcerative colitis. Several trials have been carried out on the use of antibiotic treatment in patients with active ulcerative colitis with contrasting results. A number of trials have been carried out using Rifaximin, a non-absorbable broad-spectrum antibiotic, confirming the absence of systemic bioavalaibility of the drug even when administered at very high doses and for prolonged periods. It may therefore be useful in treatment of ulcerative colitis and pouchitis, since its absorption through inflamed mucosa is negligible, it maintains a topical action without systemic effects and the lack of resistant bacterial strains may allow prolonged and repeated treatments.

Anti-Bacterial Agents↗
PubMedDate not supplied

[Immediate and long-term results in ileoanastomosis with reservoir in 335 consecutive cases].

Restorative proctocolectomy with ileal pouch anal anastomosis is the first choice procedure for the treatment of ulcerative colitis and familial adenomatous polyposis. The introduction of the stapled technique has shortened the duration of the procedure and reduced the complication rates. Data on 335 consecutive patients undergoing ileal pouch anal anastomosis for ulcerative colitis (277 pts), Indeterminate colitis (20 pts) and familial adenomatous polyposis (38 pts) between 1984 and 1998 were prospectively collected. Parameters evaluated included diagnosis, surgical technique, functional outcome, early and late complications and their management and results. Twenty-nine patients (8.6%) presented with pelvic sepsis. Twelve patients (3.5%) experienced late perianal fistulas. The pouch failure rate was 3.4%. Six patients required a re-do pouch procedure, with 75.9% preservation of sphincter function. No correlation was found between complication rates and diagnosis. The mean number of stools was 5.2/24 h. The study confirmed the safety and effectiveness of the procedure. In particular, morbidity rates are comparable to those of major abdominal procedures and the long-term functional results are satisfactory. However, a number of technical aspects, such as the anastomosis technique, the need for temporary ileostomy and the treatment of indeterminate colitis, still remain controversial.

Adenomatous Polyposis Coli↗
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↗