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Biomedical subjects

I Braghetto

Publications and source records attributed to I Braghetto.

90 records · Page 5Linked to original sources
PubMed1981

A prospective randomized study comparing forceful dilatation and esophagomyotomy in patients with achalasia of the esophagus.

A prospective and randomized study was performed comparing pneumatic forceful dilatation and surgical esophagomyotomy as primary treatment of patients with achalasia of the esophagus. Eighteen dilated and 20 operated patients were studied before and after treatment with 1 patient lost. Clinical, radiologic, and manometric evaluations were performed before and after treatment and acid reflux test in the late follow-up period. Immediately after treatment, a significant improvement was seen clinically, by radiologic studies and after manometric evaluation. In the late follow-up period, operated patients showed a permanent improvement in all of them, but dilated patients remained a symptomatic in about 50% of the cases. The rest had to be redilated or reoperated on due to a failure of primary dilatation leading to final good or excellent results in 60% and failure in 40% of patients. Acid reflux test showed a positive test in 31% of the operated patients and in 7% of the dilated patients. This controlled study suggests that surgical treatment of achalasia, used as primary treatment, is accompanied by significantly better long-term results compared with pneumatic dilatation according to the technique utilized by us.

Adolescent↗
PubMed1978

A surgical technic for high (cardial or juxtacardial) benign chronic gastric ulcer.

A surgical technic for cardial or juxtacardial ulcers is presented. The surgical principle consists of resection of the distal stomach including the ulcer in a way that the esophageal mucosa remains intact. Reconstruction of the transit is accomplished by a Roux-en-Y esophagogastrojejunostomy in one layer. A variable portion of gastric reservoir is preserved, and alkaline reflux is highly improbable due to the long intestinal loop. This technic has been performed in six patients with excellent postoperative results. Clinical and radiologic follow-up to three years has shown no esophagitis or strictures of afferent loop syndrome.

Cardia↗
PubMed1978

Relation of gastroesophageal sphincter pressure and esophageal contractile waves to age in man.

Gastroesophageal sphincter pressure (GESP) and contractile waves of the esophagus were measured in 113 normal subjects ranging in age between 2 months and 74 years. The amplitude and duration of the peristaltic waves of the thoracic esophagus were similar in both children and adults. Resting GESP pressures were dependent upon age. In children under one year, high pressures were recorded. The high pressures gradually diminished until between 15 and 24 years, whereafter they remained at similar values up to 65 years. After this age, a further decline in pressure was observed. The importance of these findings are discussed.

Adolescent↗
PubMedDate not supplied

Laparoscopic highly selective vagotomy: technical considerations and preliminary results in 119 patients with duodenal ulcer or gastroesophageal reflux disease.

The technical considerations and preliminary results of 119 patients submitted to laparoscopic highly selective vagotomy are presented. There were 33 with duodenal ulcers, 31 with duodenal ulcers plus gastroesophageal reflux, and 55 with gastroesophageal reflux. Operating time varied from 120 to 160 minutes. Six complications occurred: four perforations of the gastric fundus and two bleeding episodes. Conversion to open surgery was done in four cases and reoperation in one case. No deaths occurred, and the mean hospital stay was 3 days. The mean follow-up was 16 months, being 94% of the cases with Visick I or II and 6% with Visick III or IV. This technique is completely feasible by laparoscopic procedure and reproduces exactly what has been done with the laparotomy approach.

Adult↗
PubMedDate not supplied

Anatomic dilatation of the cardia and competence of the lower esophageal sphincter: a clinical and experimental study.

Anatomic and clinical data suggest that the gastroesophageal junction or cardia in patients with gastroesophageal reflux disease GERD) may be dilated. We hypothesized that anatomic dilatation of the cardia induces a lower esophageal sphincter dysfunction that may be corrected by narrowing the gastroesophageal junction (i.e., calibration of the cardia). We measured the perimeter of the cardia during surgery in control subjects and patients with GERD and Barrett's esophagus. We then tested our hypothesis in a mechanical model. The model was based on a pig gastroesophageal specimen with perpendicularly placed elastic bands around the cardia simulating the action of the "sling" and "clasp" fibers. "Dilatation" of the cardia was induced by displacing the sling band laterally and decreasing its tension. "Calibration" of the cardia was performed by reapproximation of the sling band toward the esophagus but maintaining the same tension as the dilated model. In the "basal," "dilated," and "calibrated" states, the perimeter of the cardia was noted and rapid mechanized pullback manometry with a water-perfused catheter was performed. The opening pressure was determined, and three-dimensional sphincter pressure images were analyzed. The average cardia perimeter was 6.3 cm in control subjects, 8.9 cm in GERD patients, and 13.8 cm in patients with Barrett's esophagus. The arrangement of the bands in the experimental model generated a manometric high-pressure zone similar to that in the human lower esophageal sphincter. Dilatation of the cardia resulted in a decrease in the resting pressure, length, and vector volume of the high -pressure zone, and reduced the opening pressure. Calibration restored the resting and opening pressure, and normalized the three-dimensional pressure image. In patients with GERD and Barrett's esophagus, the cardia is dilated. Our model supports the hypothesis that lower esophageal sphincter function is compromised by anatomic dilatation of the cardia and can be restored by approximation of the "sling" fibers toward the lesser curvature "clasp" fibers). This provides evidence for a correlation between gastroesophageal sphincter dysfunction in reflux disease and its correction by antireflux surgery.

Adult↗
PubMedDate not supplied

Gallbladder carcinoma during laparoscopic cholecystectomy: is it associated with bad prognosis?

Laparoscopic cholecystectomy is the treatment of choice for gallstone disease. The ultrasonogram has failed for the early detection of gallbladder cancer, especially if inflammation (chronic or acute) is present. Incidental gallbladder could be an important cancer finding during laparoscopic cholecystectomy, due to the potential cancer cell dissemination during the procedure. In our Department, 6500 laparoscopic cholecystectomies have been performed in the last 5 years and in 15 cases (0.23%) gallbladder cancer was found during surgery or after histological examination of the resected gallbladder. In none of these 15 patients was pre-operative diagnosis of gallbladder carcinoma postulated. When re-evaluation of the pre-operative ultrasonograms was done, it was possible to observe signs suggesting the presence of neoplastic infiltration in 4 of them (28.6%). During videoscopic exploration, also in 4 patients, the suspicion of gallbladder cancer was noted. Laparoscopic cholecystectomy was completed in 9 patients. In 2 of them, in situ or mucosal invasion was demonstrated with a long survival. One patient presented recurrence at the biliary hilum 2,5 years after surgery. Six patients were re-operated and in 4 of them peritoneal or port site metastasis was found; all died early (4.5 month median survival). The other 2 patients were submitted to liver bed resection and lymph node dissection. These patients are free of cancer recurrence after 15 months of follow-up. Six patients were converted to open surgery, performing palliative procedures and died before the 12 month follow-up. The suspicion of pre-operative gallbladder cancer is generally unlikely to be confirmed based on ultrasonographic signs; but, in some cases with high suspicion, further investigation (TAC, tumor markers, etc.) must be indicated in order to avoid poor results. Laparoscopic cholecystectomy could be associated with bad prognosis, and then, when gallbladder cancer is suspected during the laparoscopic procedure, conversion to open surgery could be the best choice.

Carcinoma↗
PubMedDate not supplied

[Endoscopic esophagitis findings in patients with gastroesophageal reflux symptoms].

The experience concerning the findings of endoscopical esophagitis in patients with reflux symptoms studied between January 1984, and December 1986, is presented. Endoscopical esophagitis, according to the European classification was found in 5% of the patients. Grade I (mild) and Grade III (Barrett) were the most frequent findings. Symptoms were similar to those reported in the international literature. No difference in age, sex distribution, for each group of esophagitis were seen. The distance of the squamous-columnar limit from the incisors was significantly higher in patients within esophagitis group III or IV.

Adolescent↗
PubMedDate not supplied

[Gastrocolic fistulae of neoplastic origin].

Three cases of gastrocolic fistula secondary to cancer of stomach or transverse colon are presented. The incidence of this complication is very rare, and in the last years (20-30 years ago) the anastomotic peptic ulcer due to gastrojejunostomy has been the most common cause. Recent reports indicate that gastric or transverse colonic carcinoma are the most frequent causes. The predominant symptoms are epigastric pain, loss of weight, diarrhea, and feculent vomiting. The diagnosis is based on clinical, radiological and endoscopic findings. The treatment is based on nutritional support with parenteral and or enteral hyper alimentation and resective surgery, if possible.

Adult↗