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Biomedical subjects

M Carboni

Publications and source records attributed to M Carboni.

At least 91 records · Page 5Linked to original sources

Portal stump pressure monitorization in the conscious rat after porta-caval shunt and total liver arterialization with the left gastric artery.

A method for portal stump pressure monitorization following arterialization is presented. Both intra and postoperative pressure determinations were performed and a significant difference between intra and postoperative values was observed. The pressure of the arterialized portal stump either using the left gastric artery or one of its branches, when compared to the free portal pressure did not reveal significant differences. According to these data, the proposed method of arterialization seems to create a "physiologic" arterialized stump pressure. This information while contributing to a better understanding of the complex hemodynamics of the arterialized liver represents essential guidelines for further studies on liver trophism and experimental portal hypertension.

Animals↗

Occult gallbladder microlithiasis causing acute recurrent pancreatitis. A report of three cases.

Gallbladder microlithiasis may be a cause of acute recurrent pancreatitis. When this process cannot be detected with routine investigative procedures, a precise etiologic diagnosis cannot be formulated. In such circumstances, endoscopic collection of bile followed by microscopic examination for presence of cholesterol crystals constitutes a valid diagnostic tool. Three cases of acute recurrent pancreatitis are presented in which cholesterol crystals were found in the bile. The technique and advantages of the method are described and a useful diagnostic approach is proposed.

Acute Disease↗

Role of cholesterol and calcium bilirubinate crystals in acute postoperative acalculous cholecystitis.

Acute acalculous cholecystitis is rather unusual, but it is considered an increasing entity. Particularly interesting are the post-traumatic or post-operative forms of acute acalculous cholecystitis. Ischemia of the gallbladder and biliary stasis are the most likely pathogenetic factors. A case of acute acalculous cholecystitis after total gastrectomy for cancer is presented. Particular emphasis is put on the significance of cholesterol and calcium bilirubinate crystals findings in the bile of the gallbladder. The pathogenetic role of this microscopic form of lithiasis in post-operative acalculous cholecystitis is discussed. It is concluded that all surgeons should be aware of this pathology since it is becoming much more common to be faced with elderly patients having life-threatening post-operative gallbladder complications unrelated to macroscopic lithiasis.

Acute Disease↗

[Surgical risk of the Oddi sphincterotomy. Results of an international survey (25541 cases)].

Operative risks of transduodenal sphincterotomy (T.D.S.) are the principal subject of discussion between those surgeons who practice the operation and those that condemn it. An international survey of 25, 541 cases treated by 130 surgeons showed that the incidence of specific complications such as acute pancreatitis (0.6 p. 100), hemorrhage (0,65 p. 100), and early cholangitis (0,5 p. 100), and relative mortality were lower than those usually reported by surgeons attributing an excessive operative risk to the procedure. Data was also obtained indicating that certain "risk factors" due to teh surgical technique were statistically significant (X2 test) and that knowledge of these enabled complications to be avoided. Morbidity and mortality of TDS could then be reduced to the level of those common to biliary tract surgery.

Acute Disease↗

Gastric juice nitrite and bacteria in gastroduodenal disease and resected stomach.

The N-nitroso-compounds and the bacteriological contamination of gastric juice could represent a risk factor for cancer of the stomach when the mucosal barrier is altered. In the unresected stomach and gastric stump, the hypo-achlorhydria and bilopancreatic reflux permit the development of bacterial flora and the production of N-nitroso-compounds in the presence of nitrite. A survey was performed on 71 patients: 15 normal controls, 31 with gastroduodenal disease (9 gastrites, 10 gastric ulcers, 10 duodenal ulcers, 7 neoplasias), 20 patients with gastric resection (8 BI, 12 BII), using an endoscopic-histopathologic control and a chemical-bacteriological analysis of the gastric juice. We studied the gastric juice for the following parameters: pH, concentration of nitrite, identification of bacterial type, count and nitrate-reductase activity. An inverse relationship was found between the concentration of nitrite and the hydrogen ion concentration. In the alkaline gastric juice, we identified aerobic bacteria with nitrate-reductase activity and anaerobic bacteria. The latter has the ability to transform biliary salts into carcinogenic and cocarcinogenic compounds and to catalyze the nitrosations. The chemicobacteriological characteristics of the gastric juice from gastric ulcers (Johnson type I), atrophic gastrites, and resected stomachs lead one to think that there is a risk of carcinogenesis brought about by the N-nitroso-compounds.

Adult↗

Transduodenal sphincteroplasty.

Sphincteroplasty is an inferior partial sphincterotomy followed by suture approximation of both the duodenal and common bile duct walls. We have described our operative technic employed in 770 sphincteroplasties performed in the past 14 years.

Ampulla of Vater↗

The value of arteriography in the diagnosis and treatment of insulinomas.

Six arteriograms were performed in five patients with insulinoma. The method showed with precision the size and location of the tumor in five instances, whereas in one instance the method was unsuccessful. Arteriography was performed again with more refinements in technic, but was adequate in locating only the largest tumor. Since diagnostic accuracy of arteriography depends on the size of the tumor, and nonpalpable tumors are only occasionally located, the main problems in surgical treatment of insulinomas are unresolved.

Adenoma, Islet Cell↗

Roux-en-Y hepaticojejunostomy: a reappraisal of its indications and results.

A critical evaluation is made of 131 patients submitted to choledocho or hepaticojejunostomy. The main indications for hepaticojejunostomy were iatrogenic strictures of CBD (60 patients), and choledocholithiasis with markedly dilated duct (41 patients). The overall mortality rate was 4% representing principally renal hepatic failure, bile peritonitis and bleeding. The complications following hepaticojejunostomy included only in one case biliary fistula which required reoperation. The long-term results of 80 patients available for a followup study were as follows: 63 patients (78.7%) were symptom-free at 2-13 years followup; 8 patients had brief episodes of cholangitis which responded to antibiotic and corticosteroid treatment; 9 patients required reoperation for stricture of anastomosis. These overall results are a strong argument for hepaticojejunostomy which, compared with choledochoduodenostomy, avoids the hazards of the so-called sump syndrome and of the reflux of enteric contents in the CBD. An increased incidence of peptic ulcer disease in the patients submitted to hepaticojejunostomy was not observed. In very high strictures and in reinterventions anastomosis between left hepatic duct and Roux-en-Y jejunal limb was carried out. The results achieved with this technique, which was performed in 26 patients, were about the same following hepaticojejunostomy.

Adult↗

Hypoglycemia and insular hyperplasia: review of 148 cases.

On the bases of personal experience and the series of 148 cases from an international inquiry and a review of the literature, the relation between insular hyperplasia and hypoglycemia was examined. The fundamental points in this investigation included: age, diagnostic investigations, histological findings and postoperative results. The data on the patients with insular hyperplasia indicates that 83% were of adult age. Insular hyperplasia was the only abnormal factor determined to be present. Through treatment a high percentage of cases (71%) was cured. From a practical surgical point of view, differentiation between occult insulomas and insular hyperplasia is not critical. Consequently, good results can be achieved in botlh diseases by practicing a progressive blind resection guided by examination of the operated specimen and by intra-operative blood sugar levels.

Adenoma, Islet Cell↗