Biomedical subjects
Publications and source records attributed to M Frazzetta.
A case of intersigmoid hernia, personally observed is described, The various aspects of this pathology are examined and the imprecise clinical picture as well as the anatomical and diagnostic aspects and surgical techniques are underlined. The conclusion is drawn that a preoperative diagnosis is not easy and the importance of enteroclysma and TAC to prove the presence of hernia is underlined.
The Authors report 6 cases of Warthin's tumor of the parotid gland recently observed. In all cases the tumor was intraglandular, single, and no noteworthy disorders or symptoms except for a 2 to 5 cms tumefaction were present. At surgery all lesions appeared well-capsulated and the exeresis followed a cleavage plane easily identifiable which enabled the preservation of the residual glandular tissue as well as the surrounding nervous and vascular structures. All the patients, up to now, are free from relapse.
The authors have reported two laparocele cases in the place of insertion of the umbilical trocar, on 156 laparoscopic accesses made by them. Both cases took place at the beginning of their experience when the navel fascial breach had not yet been stitched. The authors made an extensive review of the medical literature and have found out that such complication is rare and to prevent it, it is right to stitch the navel fascial defect, being careful for not englobing the epiploon or an intestinal loop in the suture.
The authors report their laparoscopic access technique. It has to be considered a variation of the classical closed technique, with the introduction of the Veress needle and the first trocar directly at the level of the fascia which is kept in traction by two Kochers.
Persistent sciatic artery is a rare vascular anomaly particularly interesting for possible complications as buttock aneurysm and ischemic or embolic. Authors describes a case of buttock aneurysm of persistent sciatic artery personally observed analyse its anatomic and clinical features, and lay stress on the importance of angiography as essential examination in order to an exact surgical treatment.
Cancer of the small bowel observed at the 1st Surgical Clinic of Palermo University between 1964 and 1985 have been examined. In the light of reported data, the various factors that might explain the low frequency are analysed, stress being laid on the fact that non-pathognomonic clinical features present considerable diagnostic problems for an early diagnosis. The primary role of surgery in the treatment of such cancers is emphasised.
A case of cancer of the small bowel associated with Crohn's disease with onset 21 years after the first clinical signs of the latter is reported. The patient survived for 20 months after cancer diagnosis. After noting the rare association between the two conditions, the aetiopathogenetic relations that can be called on to explain relations of causality are analysed and it is emphasised that it is impossible to distinguish symptoms from those of cancer due to the renewed inflammatory activity. Finally it is considered that to clarify unequivocably the relations between the two conditions further studies are required.
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There is both clinical and experimental evidence for the antigastric effect of calcitonin. A study was therefore made of gastric secretion after maximum insulin stimulation, and during its inhibition by calcitonin. Evaluation of basal acid flow and the maximum acidity peak in these two tests showed that the difference between the two peaks was related to the increase in gastrin. This was not the case during inhibition. The results show that selective evaluation of gastric secretion enables selective surgical techniques to be employed in the treatment of duodenal ulcer.
Basal secretion and the acidity peak have been evaluated in ulcerous patients during pentagastrinic stimulation and during atropinic inhibition, on the basis of the observations of Schofield et al. and in relation to the need to achieve correct identification and quantification of hydrochloric acid gastric secretive function. The results obtained with this technique suggest the possibility of a selective evaluation of the secretive function of oxyntic cells. This is extremely interesting because it opens the way to the most suitable surgical techniques for the treatment of ulcers.
In the present study the efficacy and safety of pefloxacin (400 mg/5 ml vial) intravenously administrated for surgical prophylaxis was assessed. Nine hundred and fifty-two patients were treated (599 M, 343 F), with a mean age of 57.9 years +/- 18.6 SD, and in all cases surgical prophylaxis was carried out according to the following scheme: short-term with 2 vials (800 mg) 1 h before the operation, repeated at 12 and 24 hours after the operation; long-term 2 vials (800 mg) 1 h before the operation repeated at 12 and 24 hours after the operation and followed by 1 vial every 12 h for other 2 days. The choice between the two schemes was conditioned by the type of operation and by the basic conditions of the patient. Pefloxacin was seen to be effective in preventing the onset of post-surgical infections (97%), also maintaining the clinical parameters considered within normal limits. Safety was also highly satisfactory, since only 22 (2.3%) cases of side effects occurred, particularly involving the gastro-intestinal system. Thus, in conclusion, the validity of pefloxacin in surgical prophylaxis, with special emphasis on its efficacy in elderly and compromised patients is asserted.
The Authors analysed the complications observed during 156 laparoscopic accesses. In 38 cases following the classic closed technique, two pneumoderma, one pneumoscrotum, one pneumoepiploon and two laparoceles were observed in the umbilical area. In 30 patients the laparascopic access was performed according to the open technique, registering a significant loss of gas during the operation though not compromising it in 4 patients, and two infections of the umbilical incision. In 88 cases the modified closed technique was used and only one infection in the umbilical trocar insertion area was observed. After discussing the incidence, the etiopathogenesis, the diagnosis and the treatment of complications related to the laparoscopic access, the Authors emphasize the fact that in patients with surgical scars near the naval or patients who have already undergone laparascopy, or those with a positive history of affections causing abdominal adherence, the laparoscopic access must be performed using the open technique.
The aim of this study is to evaluate, after laparoscopic (CL) or open (CO) cholecystectomy, the incidence of pulmonary atelectasis and hypoxaemia which are strictly related to the onset of pulmonary complications. Two groups of 20 consecutive patients affected by symptomatic and not complicated gallstone disease were cholecystectomized either using CO or CL. Hypoxaemia was assessed preoperatively and after operation. Postoperative determination was performed at the 4th, 8th, 12th and 24th hour and then every 12 hours until discharge from hospital. A not informed radiologist evaluated atelectasis through two X-rays, preoperatively and postoperatively at the 3rd day. Atelectasis cases were divided in micro, focal, segmental, lobar and of the entire lung. Statistic analysis was performed using the "t" Student test. No mortality or intraoperative complications occurred. The two groups were similar for age, sex, smoker percentage, obesity, preexisting pulmonary dysfunctions and anaesthesiological risk (ASA). Operative time resulted in longer in CL compared to CO patients although in an insignificant way. PO2 value resulted significatively reduced (P < 0.05) at 4th, 8th, 12th and 24th postoperative hour after CO, while subsequent measurements did not show significant differences. There was no evidence of PO2 significative reduction after CL. After operation atelectasis was found in 11 patients (55%) of CL group (P < 0.05) and in 17 patients (85%) of CO group (P < 0.001). Atelectasis observed in the group of 11 CL patients was represented by 7 micro and 4 focal types, while in the CO group 7 micro, 8 focal and 2 segmental types were found. This study suggests that CL alters the pulmonary function less than CO.
The authors analyze the most current methods for the treatment of ulcerated breast cancer in the elderly. They describe a peculiar case recently observed, characterized by an ulcerative lesion spreading from the hemiclavicle to the foreaxilla including the axillary cavity, causing a large phlebo-lymphaedema, anaesthesia and paresis of the homoteral upper limb. After an initial treatment with tamoxifen a scapulo-humeral disarticulation and a suture of the cutaneous wide defect were performed using a myo-skin graft which included the deltoid muscle. A radiotherapeutic treatment followed by tamoxifen therapy was carried out. No distant metastases and no local relapses were registered in the one year follow up. The Authors on the basis of their experience and according to the review of the Literature suggest that age itself is not a limiting factor to the therapeutic approach of ulcerated breast cancer.