[Present status of double truncal vagotomy with antrectomy in the surgical treatment of duodenal ulcer].
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Biomedical subjects
Publications and source records attributed to M Bartolotta.
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Results are reported from a study on the presence and concentration of nitrites and nitroso-compounds in the gastric juice of 53 patients operated on for duodenal ulcer and in 15 controls. The investigations were made after various postoperative intervals. In the patients who had undergone Billroth II operation, the concentrations of nitrites and of nitroso-compounds were higher than in those with Billroth I operation and in the controls. It is concluded that patients with Billroth II operation may be particularly susceptible to subsequent primary neoplasm of the gastric stump, as a result of the carcinogenic action of these substances.
From 1971 to 1982, 126 blunt thoraco-abdominal trauma were seen: in 9 cases (7,1%), diaphragmatic rupture was present. Automobile accidents were the most frequent cause of diaphragmatic rupture and, in only one case, the injury was single. Diaphragmatic rupture was suspected preoperatively in two patients, who had positive physical and radiologic chest findings. The lesion was seen intraoperatively in the other patients, who underwent surgical operation because of severe intra-abdominal injuries. In the author's experience, roentgenologic examinations and adjuntive studies were not important for diagnosis of diaphragmatic injuries. Surgical treatment depended on entity of associated intra-abdominal and intrathoracic injuries, especially in patients observed during immediate post-traumatic period. Authors conclude that single diaphragmatic injury, generally, give no surgical or prognostic problems. High mortality rate seen in these patients is due to multiple organ involvement.
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In veiw of the interest represented by the possible development of cholelithiasis after peptic ulcer surgery, the authors report their results in 848 patients undergoing surgery for peptic ulcer, 521 were followed up in order to determine whether the biliary complication developed and in how many cases. They conclude that their results showed nothing which might support the possibility of the development of cholelithiasis after any from of surgery for peptic ulcer.
Different vascular clamp methods in liver surgery have led to less complications. The aim of this study was to evaluate the results after hepatic resection involving different vascular clamping methods and liver function outcome. Our study examined 46 patients who underwent surgery for liver lesions, developed on cirrhotic and noncirrhotic livers, applying the technique of selective clamping and pedicular clamping. There was one death (1/17; 5.9%) due to postoperative liver failure which occurred in a cirrhotic liver patient who underwent left hepatectomy with pedicular clamping. Complication rate was higher, but not significant (4/7; 57.1%) in the group with selective clamping compared to those with pedicular clamping (3/10; 30%). Hemorrhagic complications were observed in a higher rate among patients with selective clamping (3/7; 42.9%) compared to those with pedicular clamping (1/10; 10%). Selective clamping seems to find major indications in patients with chronic liver disease undergoing minimal hepatic resections. Intermittent pedicular clamping seems to be more effective in regards to blood loss and postoperative hepatic function.
To evaluate the results of single and multinodular thyropathies surgical treatment, 1.300 cases operated on from january 1974 to december 1987 were reviewed. 842 patients (64.7%) were female; the average age was 41 +/- 2.4 year. Thyroid pathology was represented by solitary nodule in 643 cases (49.4%); multinodular goitre in 559 cases (43.0%) (377 euthyroid, with multinodular lesions extended to the entire gland; 182, hyperthyroid); retrosternal goitre in 78 cases (5.9%); recurrent goitre in 20 cases (1.5%). The patients underwent to: total thyroidectomy (525 cases); subtotal thyroidectomy (132 cases); total lobectomy (322 cases); subtotal lobectomy (321 cases). Post-operative follow-up (clinical exam; T3, T4, TSH, calcemia and phosphatemia) was performed at 3, 6, 12, 18 and 24 months after surgery). The overall mortality was 0.13 percent (two deaths, respectively after total = 0.1% and subtotal thyroidectomy = 0.7%). Immediate postoperative complications were: recurrent palsy (9 cases: 0.6%; acute respiratory failure with temporary tracheostomy (10 cases: 0.7%); hypoparathyroidism (3 cases: 0.2%). Late sequelae (1-3 year) were: recurrent nerve palsy in 7 patients (0.5%); hypoparathyroidism in one case (0.07%). 46 patients (34.8%) which underwent subtotal thyroidectomy were hypothyroid to T3, T4, TSH tests (1 year). Such sub-clinic pathology required levo-thyroxin treatment. New concepts on the pathogenesis of multinodular goitre (growth autonomy of goitre human tissue; the lack of levo-thyroxin therapy to prevent relapses after subtotal thyroidectomy) and the results drawed from the revision of this series seems confirm the indication to lobectomy for solitary "cold" nodules and thyroidectomy for treatment of normo and hyperthyroid multinodular goitre.
To evaluate the actual rate of both elective and emergency surgical operations for peptic ulcer, a questionnaire on the incidence of these operations was sent to 60 european departments of digestive surgery. 28 centers entered the trial, with the following results: 1,800 patients operated on; marked decrease of elective operations (100 percent of the centers); High decrease of emergency operations for hemorrhagic ulcer (80 percent of the centers). Decrease of emergency operations for perforation (50 percent of the centers). Decrease of operations for stenosis (70 percent of the centers). No-responders ulcers (ever more rare) and acute complications of patients with acute ulcer (elderly patients, under steroid or chemotherapy or intensive care) represent the resting indications to surgery. These results confirm the decline of surgery ten years after the introduction of H2 receptor antagonists.
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