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Biomedical subjects

L Bonavina

Publications and source records attributed to L Bonavina.

At least 109 records · Page 6Linked to original sources
PubMed1989

Great saphenous vein protection in arterial reconstructive surgery.

An original method of great saphenous vein bypass protection during reconstructive arterial surgery is described. The use of a reinforced prosthetic support (Ringed PTFE), surrounding the vein, avoids possible compression by anatomical structures and strangulation by scar tissue after reoperation. This technique can also prevent eventual dilatation of the vein graft. Since 1981, this technique has been successfully applied to 30 selected patients. On the basis of clinical experience, the authors conclude that this method is safe and effective, and may increase the long-term patency rate of saphenous vein grafts.

Blood Vessel Prosthesis↗
PubMed1989

[Early cancer of the esophagus: results in 61 operated cases].

From 1980 to 1987, 1338 patients with esophageal cancer were observed and 703 underwent esophagectomy. Pathologic exam of the operative specimen showed 61 early cancers of the esophagus: 10 mucosal and 51 submucosal. Hospital mortality in patients operated on (2 cases) for early esophageal cancer was 3.3% (2 cases). The 5-year survival rate in the cases of mucosal and submucosal tumors was 100% and 33%, respectively. The location of neoplastic recurrence was detected in 9 patients, all of whom had a submucosal tumor. The recurrence was local-regional in 4 cases, and remote in 5. The authors think that submucosal cancers of the esophagus may need a multimodality therapeutic approach to improve prognosis and prevent recurrence. Patients who are not surgical candidates and in whom the diagnosis of early cancer is likely on the basis of clinical staging may undergo endoscopic laser therapy.

Adult↗
PubMed1988

Stroke risk reduction in asymptomatic and symptomatic patients treated surgically: the effectiveness of carotid endarterectomy with patch graft angioplasty.

From March 1980 to March 1987, 217 consecutive patients underwent 252 carotid revascularisations with routine use of continuous EEG monitoring and selective use of an intraluminal shunt for symptomatic (70%) or asymptomatic (30%) internal carotid artery (ICA) atherosclerotic stenosis. All carotid endarterectomies were routinely performed with a patch graft angioplasty. None of the patients suffered permanent or transient neurological deficits in the immediate postoperative period and none of them died. There was an 0.8% stroke rate and 0.4% mortality rate in the early postoperative course. Neurological assessment, Doppler and Echo doppler sonography of both the operated and the contralateral ICA was performed every 6 months. One-hundred and twenty-one patients (142 carotid revascularisations) operated on up to December 31st 1985 were reassessed in July 1986. The mean follow-up time was 35 months (range: 6 months to 6 years). New neurological symptoms were present in 7.4% of the patients; 2.5% of patients developed a stroke and 8.9% showed progression of stenosis in the contralateral ICA. One patient had a common carotid artery stenosis 2 years after surgery. Re-stenosis of the ICA was found in two patients who underwent re-operation without difficulty. The late mortality was 21.4% (11.9% of the overall series). In only two patients (7.6%) was stroke the cause of death.

Blood Vessel Prosthesis↗
PubMed1987

[Esophageal lesions caused by oral drugs. Epidemiology, physiopathologic bases, prospectives of prevention].

Esophageal injuries caused by oral medications have recently been recognized as a iatrogenic entity. This pathogenesis is due to the retention in the esophagus of drugs with caustic properties. The main predisposing factor is the practice of taking oral drugs with a small quantity of water of and/or in a recumbent position. Elderly subjects and patients with pre-existing esophageal disorders are at higher risk, so that fluid formulations or different routes of drug administration are strongly recommended. A more widespread education to the correct use of drugs and a better drug formulation are necessary for effective prevention.

Administration, Oral↗
PubMed1987

Interposition of a prosthetic patch to prevent aorto-enteric fistula.

Aortoenteric fistula is an uncommon but disastrous complication of aortic reconstruction with prosthetic grafts. Therefore, prevention of enteric erosion when using a vascular prosthesis must be a primary concern. A flap of greater omentum can provide an adequate coverage of the graft when retroperitoneal tissue is insufficient. If the omentum is not available due to atrophy or previous abdominal surgery, interposition of a prosthetic patch represents another means of preventing duodenal erosion. Polytetrafluoroethylene is our choice of material because of its softness, elasticity, and thickness.

Aortic Diseases↗
PubMed1987

Drug-induced esophageal strictures.

A retrospective study of 55 patients with a benign esophageal stricture showed that in 11 patients (20%) the cause was a drug-induced lesion due to potassium chloride (3), tetracyclines (3), aspirin (2), vitamin C (1), phenytoin (1), and quinidine (1). Five of the 11 patients would have been diagnosed as having a reflux etiology of their stricture if 24-hour esophageal pH monitoring was not performed. Six patients responded to dilatation and five patients required resection or bypass. A prospective study of 18 asymptomatic volunteers showed a high incidence of esophageal lodgment of a radiolabeled medicinal capsule, with subsequent dissolution and release of the isotope. This occurred most frequently in elderly subjects and was reduced by increasing the volume of water chaser. The sites of lodgment correspond to the location of the observed strictures in the patient population. An in vitro study showed that, when the causative drugs were mixed with saliva, dissolution occurred within 60 minutes and was associated with significant changes in pH. These investigations show that drug-induced esophageal strictures are more common than previously appreciated, and can be confused with a reflux etiology. Diagnosis is suggested by a history of drug ingestion, location of the stricture, and a normal esophageal acid exposure on 24-hour pH monitoring. The severity of the esophageal injury is variable and requires dilatation to resection for therapy.

Adolescent↗
PubMed1987

Manometric characteristics of the distal oesophageal sphincter and patterns of gastro-oesophageal reflux in healthy volunteers and patients.

Three manometric characteristics of the distal oesophageal sphincter (DOS; pressure, length below the respiratory inversion point, i.e., abdominal length, and overall length) were investigated in 10 healthy volunteers and in 66 patients with typical symptoms of gastro-oesophageal reflux (GOR) disease. The aim of the work was to correlate the DOS deficiency with symptoms, endoscopic oesophagitis and with specific patterns of GOR as determined by means of 24-hour oesophageal pH monitoring. The results showed that patients with and without GOR disease cannot be separated solely on the basis of the standard manometric test, even adopting more parameters besides the traditional DOS pressure measurement. A functional defect of the DOS may be hypothesized for those patients with an apparently normal DOS on standard oesophageal manometry.

Adolescent↗
PubMed1987

Factors influencing the transit of a gelatin capsule in the esophagus.

The tendency of a gelatin capsule to lodge in the esophagus, dissolve, and release its contents, as a potential etiology of drug-induced esophageal injury, was studied in 18 asymptomatic volunteers. Their ages ranged from 21 to 81 years, with nine subjects over 70 years old. Esophageal transit time of liquids was measured in all subjects after which the esophageal transit time of a #00 gelatin capsule containing technetium (99mTc) sulfur colloid was measured with a 120 ml and a 15 ml water bolus. The capsule lodged in three subjects (17 percent) with the 120 ml bolus and in 11 subjects (61 percent) with the 15 ml bolus. Esophageal manometry demonstrated a lower mean amplitude of esophageal contractions in subjects in whom the capsule lodged with the 120 ml bolus and in the elderly subjects. We conclude that the esophageal transit time of a gelatin capsule is related to the volume of fluid chaser. Our findings that a lower amplitude of esophageal contractions was associated with elderly patients and those in whom the capsule lodged with the large fluid bolus are worthy of further investigation.

Adult↗
PubMed1987

Adenocarcinoma of the cardia: the choice of surgical treatment.

The ideal surgical treatment for adenocarcinoma of the cardia is still controversial. Out of 168 consecutive patients resected in a 10-year period, 98 underwent esophagogastric resection (EGR) and 70 total gastrectomy with esophageal resection (TGER). Early and long-term results were compared in order to define specific indications for both surgical procedures. Abdominal nodes were metastatic in 62% of the cases; mediastinal nodes were metastatic in 20.3% of 138 thoracotomized patients. Neoplastic permeation of the section margin occurred in 4.7% of the patients. No positive section margins were found in the cases with 10 cm or more of uninvolved esophagus resected. The superiority of the thoracoabdominal approach was therefore evident in terms of oncologic radicality. Anastomotic leakages occurred in 13.3% of EGR and in 7.1% of TGER patients. No correlation between the stage of the tumor or the neoplastic permeation of the section margin and the incidence of leak was found. Operative mortality was 7.1% after EGR and 10% after TGER, which may suggest that EGR is the procedure of choice in poor-risk and elderly patients. Loco-regional or systemic neoplastic recurrence was responsible for long-term mortality in 70% of the cases. Anastomotic recurrence was found in 12.2% of EGR patients and in 1.4% of TGER patients. Overall five-year survival was 19.1%. Mean survival was 29.5 months, 30 after EGR and 27 after TGER (p = NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1986

Length of the distal esophageal sphincter and competency of the cardia.

Pressure and abdominal length of the distal esophageal sphincter are important factors in maintaining competency of the cardia against challenges of intraabdominal pressure. Some patients with normal distal esophageal sphincter pressure and position may have reflux which could be due to the inability of the cardia to overcome challenges of intragastric pressure. Three experimental studies and one clinical study were designed to evaluate this problem. The results showed that the resistance to flow through the cardia is related to the integrated effect of distal esophageal sphincter pressure and length; the ratio of distal esophageal sphincter to intragastric pressure necessary to maintain competency is inversely related to the length of sphincter present; gastric dilatation has an adverse effect on the degree of competency achieved by a given distal esophageal sphincter length; and patients with an overall distal esophageal sphincter length of 2 cm or less measured at rest in the fasting state are subject to reflux caused by gastric dilatation, increased intragastric pressure independent of intraabdominal pressure, or both.

Adolescent↗
PubMed1986

Nissen fundoplication for gastroesophageal reflux disease. Evaluation of primary repair in 100 consecutive patients.

One hundred consecutive patients had a primary Nissen fundoplication for gastroesophageal reflux disease. None of the patients had previous gastric or esophageal surgery or evidence of esophageal stricture or motility disorder. The primary symptom was persistent heartburn in 89 patients and aspiration in 11. An abnormal pattern of esophageal acid exposure was documented in all patients with 24-hour esophageal pH monitoring. By actuarial analysis, the operation was 91% effective in the control of reflux symptoms over a 10-year period. The incidence of postoperative symptomatic gas bloat and increased flatus was lower in patients with preoperative abnormal manometric measurements of the distal esophageal sphincter (p less than 0.05). Three modifications in operative technique were made during the course of the study to minimize the side effects of the operation. First, enlarging the caliber of the bougie to size the fundoplication reduced the incidence of temporary swallowing discomfort from 83 to 39% (p less than 0.01). Second, shortening the length of the fundoplication decreased the incidence of persistent dysphagia from 21 to 3% (p less than 0.01). Third, mobilizing the gastric fundus for construction of the fundoplication increased the incidence of complete distal esophageal sphincter relaxation on swallowing from 31 to 71% (p less than 0.05). This was done to prevent the delayed esophageal acid clearance secondary to incomplete sphincter relaxation observed after operation in five of 36 studied patients. It is concluded that by proper patient selection and the incorporation of the above surgical techniques, the Nissen fundoplication can re-establish a competent cardia and provide relief of reflux symptoms with minimal side effects.

Endoscopy↗
PubMed1986

Splenic abscess: the rationale for selective non-surgical treatment.

Abscess of the spleen is a potentially lethal condition, with an associated mortality rate of 60-100% in untreated patients. Splenectomy, or in selected cases, surgical or percutaneous drainage of the abscess is currently considered the standard of care. So far, conservative treatment with antibiotics has been successfully employed in four patients, including the two reported herein. The importance of a careful clinical and ultrasonographic monitoring for best therapeutic decision-making in patients with splenic abscess, is stressed.

Abscess↗
PubMed1985

Pharyngoesophageal dysfunctions. The role of cricopharyngeal myotomy.

Eighteen patients were evaluated for primary symptoms of cervical dysphagia and/or laryngeal aspiration and subsequently had a cricopharyngeal myotomy. Twelve patients had a neurologic lesion as the cause of the symptoms. Four patients had a Zenker's diverticulum as demonstrated by barium contrast roentgenograms. Two patients complained of persistent suprasternal dysphagia following one or more antireflux repairs for gastroesophageal reflux disease. Esophageal manometry identified a pharyngoesophageal motor disorder in all but four patients, two of the four with Zenker's diverticulum and the two who had an antireflux procedure. The results show that cricopharyngeal myotomy should be reserved for patients with an identifiable motor disorder confined to the pharyngeal phase of swallowing, ie, failure of the pharyngeal pump or cricopharyngeal incoordination and/or incomplete relaxation. Exceptions to this rule are as follows: Zenker's diverticulum, in which an abnormality may not always be detected but of which the results of surgery demonstrate the effectiveness of this procedure; and pharyngoesophageal complaints associated with reflux, most of which resolve with the restoration of distal esophageal sphincter competence. In those few patients in whom these conditions persist, a cricopharyngeal myotomy may be beneficial. Caution should be used in applying the procedure to individuals who have had multiple antireflux repairs.

Adult↗