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Biomedical subjects

G Ribotta

Publications and source records attributed to G Ribotta.

At least 37 records · Page 2Linked to original sources
PubMed1981

[Surgery of Zollinger-Ellison syndrome].

Two personal cases of Zollinger-Ellison syndrome (ZES) are described. Total gastrectomy (TG) was performed in the first case as an emergency measure, following acute peritonitis caused by a recurrence of ulcer, with perforation 27 days after the first gastric resection. The patients is in good health, though with persistently high blood gastrin levels. The second case was marked by a long history of recurrent ulcer, with two earlier gastric resections. Here, success was obtained by simply enucleating a small gastrinoma from the head of the pancreas in view of the arteriographic evidence. The patient is in excellent health 2 1/2 yr after surgery with stable, normal blood gastrin. The recent literature and these cases suggest that surgery is the method of choice for ZES, its primary aim being the removal of gastrinomas, since these prove malignant in 60-100% of cases, and TG does not in any way inhibit their growth, as was once supposed. Blood gastrin values permit early diagnosis and postoperative monitoring, while arteriography and transhepatic portal catheterisation constitute a useful guide to the location of the tumour. Hyperchlorhydria can be effectively controlled with H2 receptor inhibitors, both in the preoperative diagnostic stage, and after surgery in the event of failure. TG offers the best results in over 60% of cases, when the tumours is multifocal, widely metastasised, or undiscoverable.

Adult↗
PubMed1980

On radiation-induced extraskeletal osteosarcoma: report of a case.

A case of extraskeletal osteogenic sarcoma arising in the soft tissues of the lower portion of the anterior abdominal wall (subumbelical region) is reported. The tumor developed in an area that had received telecobaltherapy 2 years 8 months previously (total skin dose of 9,000 rads delivered in 45 exposures over two separate periods of 106 and 141 days), after surgical treatment for a Stage I carcinoma of the uterine cervix. The clinical description and histopathology of this unusual neoplasm are presented, and the literature is reviewed.

Abdominal Neoplasms↗
PubMed1980

Double-blind double-dummy crossover comparison of the effect of a single dose of cimetidine and trithiozine on gastric secretion.

Twelve patients with duodenal ulcer were admitted to a double-blind double-dummy single dose study in which the H2-receptor antagonist effect of Cimetidine and the activity of Trithiozine, endowed with an unknown mechanism, on gastric acid secretion were compared. For the balanced incomplete block design each patient received two out of four treatments. The single doses tested were 200 and 400 mg of both drugs. Cimetidine reduced all the parameters investigated, while Trithiozine increased basal acid output and acid concentration and did not affect maximal and peak acid output, basal and maximal volume and maximal acid concentration. The multiple range comparison between mean adjusted differences of the four doses were significantly in favour of Cimetidine, except for PAO, basal volume and basal acid concentration, despite the remarkable percent difference between Cimetidine and Trithiozine. In this study, Cimetidine confirmed its inhibitory properties, and Trithiozine did not appear to be an antisecretory agent.

Adult↗
PubMedDate not supplied

Restorative proctocolectomy: morphological and functional study with coronal CT.

BACKGROUND: Restorative proctocolectomy with ileal pouch has become the surgical treatment of choice for patients with ulcerative colitis (UC) and familial polyposis of the colon. Defecography is the radiological technique commonly employed to obtain detailed information on function and morphology of the ileal pouch; it allows the direct visualization of the ileal pouch and the anal canal, but it does not provide the visualization of the pelvis. METHODS: In all patients, computed tomography (CT) on coronal planes was performed to determine its possibilities as an alternative to defecography; 10 patients with UC submitted to restorative proctocolectomy and were examined. RESULTS: Coronal CT images provided a panoramic vision of the pelvis and demonstrated the morphology of the ileal pouch, the thickness of its walls, and its correlation with the surrounding tissues. Coronal CT also allowed the evaluation of the continence of ileo-anal and ileo-ileal anastomosis and the functional changes of the perineal muscles at rest and during squeezing. CONCLUSION: CT images acquired on coronal planes allows an easy and clear detection of the major postoperative complications, such as stenosis or dehiscences of the anastomosis, pelvic phlogosis, and fistulae.

Adenomatous Polyposis Coli↗
PubMedDate not supplied

[Restoration of digestive continuity after subtotal gastrectomy: comparison of the methods of Billroth I, Billroth II and roux en Y. Randomized prospective study].

UNLABELLED: The aim of this study was to evaluate functional results after Billroth I, Billroth II and Roux en Y reconstruction in subtotal gastrectomy. MATERIAL AND METHODS: 45 patients were randomised between 1990 and 1995 and stratified in 3 different groups: 15 BI, 15 BII and 15 Roux. They were investigated by EGDS with multiple biopsies and upper gastro-intestinal scintiscanning, to evaluate gastro-esophageal reflux (GER) and dynamics of gastric emptying. Besides they answered a questionnaire: "Gastrointestinal Quality of Life Index" (GIQLI). RESULTS: A reflux esophagitis was found in 5 BI, in 7 BII and in 2 Roux (p < 0.001). No gastric lesions were found in 6 BI, in 5 BII and in 12 Roux, (BI vs. Y, p < 0.05; BII vs. Y, p < 0.001). Chronic superficial gastritis was present in 9 BI, in 4 BII and in 3 Roux (BI vs. Y, p < 0.05). Dynamic scintiscan demonstrated the presence of GER in 5 BI and gastric emptying was fast (37' < T 1/2 < 86'), but incomplete (60' residual activity: 49-62%). GER was evident in 7 BII with slow (28' < T 1/2 < 143') and incomplete (60' residual activity: 48-72%) gastric emptying. GER was detected in 2 Roux and radioactive bolus progression in the Roux limb was fast (24' < T 1/2 < 53') and complete (60 residual activity: 42-52%) (BI vs. Y; BII vs. Y, p < 0,001). There was not statistical significance between GIQLI score in the 3 groups. CONCLUSION: The authors affirm the Roux en Y is the technique of choice in subtotal gastrectomy, if compared with BI and BII.

Adult↗
PubMedDate not supplied

[Gastrointestinal stromal tumors: clinical and instrumental diagnosis. Analysis of a review of the literature].

AIM: From a personal experience of 23 treated gastrointestinal stromal tumor (GISTs), this study analyzed both clinical and diagnostic problems of this quite new nosological category. MATERIALS AND METHODS: A this literature review provides a rigid selection of papers (scientific basis, statistic inference, type/quality of the journal, etc.); only numerous series have been included (case reports were excluded) and only those published after 1990. Three-hundred-seventy-five cases have therefore been selected. Starting and late symptoms/signs and diagnostic tests employed were analyzed. RESULTS: Results show 1) a relevant GIST quantity (approx. 30%) is casually discovered, during operations carried out for other pathologies or diagnostic tests for other indications; 2) poor correlation between site of the tumor and clinical manifestations; 3) a positive correlation between tumor diameter and presence of symptoms/signs seems to exists. The accuracy of different diagnostic tests is reported. CONCLUSION: No specific symptoms/signs have been isolated; this kind of tumor is often accidentally found. An analysis of different diagnostic tests available today shows the very important role of endoscopic ultra-sound, together with CT and MRI.

Gastrointestinal Neoplasms↗
PubMedDate not supplied

[The extempore intraoperative cytology of peritoneal lavage fluid. A study of the reliability of the method].

Data are presented about a 100 cases prospective study, designed to evaluate sensibility/specificity of intra-operative cytology on peritoneal washing in case of cancer of digestive tract. Data analysis showed a very low sensibility of the test (according with most of literature observations) that does not allow to consider it fully reliable. Authors, thus, suggest a critical use of the test and state doubts about his real value in the intra-operative correct managing of therapeutic options.

Abdominal Neoplasms↗
PubMedDate not supplied

Use of autologous blood in general surgery.

BACKGROUND/AIMS: Autologous blood predonation is still not as widespread as it should be in general surgery practice, even if the method is well-known and has benefits established in international literature. Authors describe the impact of an autotransfusion program, in a general surgery university department, focusing on management and cost problems. METHODOLOGY: A description of the efficacy of the program during a yearlong activity period is presented. An analysis has been made about the quantity of predonated blood/plasma units, the quantity actually transfused and use of homologous blood. The problems which occurred and the cost are discussed. RESULTS: The most used autotransfusion method was preoperative predeposit of autologous blood. The analysis of results focused on some organizational problems that need to be avoided in order to show the methods maximum benefits. In a large number of cases (some 50%) predeposit was not made because of several managing/technical problems. In another large number of cases (38%) the quantity of units predonated did not fully supply the needs and several patients received homologous products. In another number of cases predonated blood units were not used at all (61/34%). CONCLUSIONS: Predeposit, preoperative hemodilution and intraoperative recovery, are methods that should all be available in a general surgery department to manage in the best way the single patients blood/plasma needs, reducing post-transfusion complication. To optimize the program and minimize waste some guidelines must be established, with the aim of a rational and correct use of the procedure. Despite the value of the method, and the favor encountered by the patients, we must not forget that the use of autologous blood is not costless.

Blood Transfusion, Autologous↗
PubMedDate not supplied

[The use of autotransfusion in general surgery].

Authors expose their experience with autotransfusion, made during several years in a general surgery university department. Discussion is made about ethic and economical aspect of the philosophy guiding the most general concept of blood sparing, and different methods of autotransfusion; attention is then focused on practical experience made during two years (1995-1997) when the program worked well. On the whole, in 94 patients, 172 blood units were collected plus 10 plasma units obtained by aferesis. No method-related complications are have been observed. Elements who corresponded to difficulties or obstacles to the fully application of the method have been critically analyzed. Authors propose finally guide-lines which want to be valid proposal to increase method use while respecting at the best ethics, economics, efficacy and efficiency that must guide our work.

Blood Transfusion, Autologous↗
PubMedDate not supplied

[Gastrointestinal stromal tumors: a series of 23 surgically treated cases].

AIM OF THE STUDY: The recently introduced new nosological category, Gastro Intestinal Stromal Tumors, brought the Authors to a revision of their series and to a critical analysis of surgical behaviour for the treatment of that pathology. MATERIAL AND METHOD: A series of 23 cases of GIST, observed between 1977 and 1999 has been taken into account. In the earlier cases, histopathological classification has been reviewed according to the most used criterions in international scientific literature. RESULTS: 17 of 23 observed tumors were located on the stomach, 4 on the duodenum and 2 on the jejunum. 20 of these cases derived from muscular tissue and 3 cases derived both from muscular and neural tissues. In 7 cases (30%) tumors were accidentally discovered during surgical intervention or diagnostic procedures for other causes. Surgical treatment was performed in all cases and consisted in 6 gastric resections, 14 gastric free-margin excisions, 2 duodenal resections and 1 jejunal resection. The follow-up (performed on 18 patients, with a minimum of 1 year, a maximum of 17 years and a median of 6 years) showed 2 deaths (11%) due to oncological causes, while 2 of the patients (11%) died for other causes. CONCLUSIONS: The only treatment for that group of tumors is, at the moment, surgery. Although that kind of neoplasms has mainly non-aggressive biological behaviour, a radical resection must be performed, due to the absence of macroscopic criterions to help distinguishing, during surgical intervention, aggressive tumors from non-aggressive ones.

Adult↗
PubMedDate not supplied

Angiogenesis as a prognostic indicator in pancreatic ductal adenocarcinoma.

BACKGROUND: Angiogenesis has gained wide acceptance as a reliable prognostic factor in several solid tumors. However, to date, experience in pancreatic adenocarcinoma is limited. MATERIALS AND METHODS: Specimens from 45 patients radically operated on at our departments from 1988 to 1997 were stained immunohistochemically with the antibodies anti-mutant p53, anti-bcl2, anti Ki67 and anti-CD31. All the slides were reviewed by the same pathologist without knowledge of the patients' outcome. RESULTS: Mutant p53, Ki67 index and vessel count were significantly related to tumoral behaviour and patients' outcome. Among patients with nodal involvement (Stage III), cumulative survival between hypovascular and hypervascular subgroups differed significantly (p = 0.03). Angiogenesis was independent from TNM in assessing the patients'prognosis at COX analysis (p = 0.02). CONCLUSION: In patients with pancreatic adenocarcinoma, angiogenesis is a reliable indicator of tumor extension, lymph node status and survival. Its evaluation as a common procedure may contribute to a further improvement in the management of these patients and to a proper selection of those who could benefit from different follow-up protocols or adjuvant treatment.

Carcinoma, Pancreatic Ductal↗