Biomedical subjects
Publications and source records attributed to M Nano.
A case of neurinoma of the vagus nerve localized in the cervical, intertracheo-oesophageal region is described. After a survey of the literature on the subject, the differential diagnosis and operative technique are discussed.
The effect of segmentary sectioning of the proximal jejunal tunica muscularis on intestinal propulsion was studied in the rat. Care was taken to avoid damage to the mucosa. In no instance was perforation or occlusion of the intestine observed. Myotomy was followed by a significant slackening of the passage of a test meal during the first 15 min after feeding, while the total transit time was virtually unchanged. Sectioning the musculature of the intestinal wall is shown to be responsible for retardation of bowel passage.
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The key concepts regarding nutrition of elderly patients prior to surgery are outlined. The main metabolic changes that occur during surgical stress, paying special attention to the characteristics of elderly patients, are described. Lastly, the caloric-energy intake required by postoperative geriatric patients is evaluated and the methods of food intake compared to the benefits obtained are analysed.
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The modern approach to rectal surgery aims at preserving the nerves to the urogenital system. The relationships between the lateral aspects of the rectum and the surrounding structures represent one of the most controversial points in the surgical anatomy of this area. This study was conducted on 27 fresh cadavers and 5 frozen pelvises. All dissections were performed with a technique similar to that used for the surgical mobilisation of the rectum. The lateral ligaments can be considered extensions of the mesorectum; they originate laterally to the middle portion of the rectum and descend posterolaterally to anchor to the endopelvic fascia. The lateral neurovascular pedicle of the rectum, comprising the middle rectal artery and the transverse autonomic nervous fibres, courses partially beneath the lateral ligament. The urogenital nervous bundle runs close to the point of insertion of the lateral ligaments in the endopelvic fascia, but is not covered with the same layer that forms the ligament itself. Anatomical dissection of cadavers is of invaluable help to the surgeon as it represents the basis for easy recognition of all the various structures in the rectal area.
Pancreaticoduodenal resection yields poor results, mainly because of cancer spread into retropancreatic nervous tissue. The aim of this study was to evaluate the feasibility of dissection capable of sparing a portion of retropancreatic nervous tissue in order to lessen, if not prevent, postoperative diarrhoea and severe malabsorption. From April 2000 to June 2001 20 dissections were carried out on 18 fresh cadavers (15 male) within 24 hours of death and on 2 frozen trunks. In all dissections the splanchnic nerves, coeliac plexuses, capital pancreatic plexus and superior mesenteric plexus were identified and traced. The capital pancreatic plexus is composed of two bundles, the first originating in the right coeliac plexus, the second in the superior mesenteric plexus. These two bundles join together just behind the head of the pancreas. The superior mesenteric plexus is composed of two preganglionic bundles, one ganglion, and another two postganglionic bundles. These latter two bundles receive fibres from both the right and left coeliac plexuses. In pancreaticoduodenal resection for cancer, the capital pancreatic plexus has to be completely removed, like the superior mesenteric plexus, as they are very often infiltrated and constitute a route for cancer spread. In small cancers, a thin layer of nervous tissue around the superior mesenteric artery might be spared in order to avoid diarrhoea due to intestinal denervation. The results of this study show that there is anatomical evidence that a thin layer of superior mesenteric plexus receiving fibres from both the left and right coeliac plexuses maintains adequate intestinal innervation.
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BACKGROUND: Gastroesophageal reflux disease (GERD) is a common intestinal disorder. Although fundoplication immediately achieves good results, some problems arise about duration. METHODS: From 1990 to 1992, thirty-seven patients underwent operation for GERD, the indications for surgery being: persistence of reflux symptoms after at least 6 months of medical therapy, esophagitis, manometric evidence of LES incompetence, augmented esophageal exposure to gastric juice documented by 24 hours pH monitoring. Nissen-Rossetti was the technique used; intraoperative calibration was 29.8 mmHg. RESULTS: Twenty-five patients were studied 12 months after the operation. They were submitted to clinical examination, gastroscopy, manometry, 24 hours pH monitoring. Clinically 2 patients were unable to belch. All of them showed LESP and intra-abdominal HPZ length decreased (32.3% and 13.5% respectively). The factors influencing LESP 12 months after surgery are age and intraoperative calibration. Pressure decrease is related to age and calibration. An older patient will show a smaller decrement, to a higher intraoperative pressure corresponds a higher pressure decrease with time. CONCLUSIONS: For these reasons we do not recommend hypercalibration especially in the elderly.
BACKGROUND: There are many causes of ulcer of the lower limb. In the elderly, venous ulcers and arteriosclerosis often coexist; for this reason pressure bandages might be contraindicated for the risk of precipitating a potentially critical arterial flow. In this work, the conditions which allow a safely treatment with pressure bandage in the elderly are evaluated. MATERIAL AND METHOD: Eleven self-sufficient elderly, with venous ulcerations to one leg only, and ankle pressure/omeral pressure between 0.92 and 0.86 were treated with elastic bandaging of the leg. RESULTS: All patients completed the treatment, with healing of the ulcer obtained in 3-8 months time. So far none of them relapsed. CONCLUSIONS: In the elderly, in selected cases, when Pc/Po > 0.86, pressure bandages can be safely applied to heal the ulcer, without running the risk of endangering arterial circulation.
BACKGROUND/AIMS: The investigators studied the surgical anatomy of the main structures involved in the mobilization of the rectum (Denonvilliers' fascia, mesorectum, middle rectal artery, superior and inferior hypogastric plexuses). METHODOLOGY: The study was carried out on 20 cadavers (17 unembalmed and 3 embalmed). To study Denonvilliers' fascia, ten embryos and fetuses (11 mm to 80 mm CRL) were also examined. RESULTS: Denonvilliers' fascia originates from the fusion of the primary pouch of Douglas. The two leaves making up this structure are easily separated. The mesorectum surrounds the rectum on three sides; it is easily separated from the presacral fascia and its connective tissue is bordered by a thin membrane. The middle rectal artery varies in appearance rate, origin, size, distribution and anastomosis. It runs under the lateral ligament and also sends branches to the genital apparatus. Of the two hypogastric plexuses, the inferior is the most difficult one to identify. Its superior branches extend to the rectum, and the inferior ones to the genital apparatus. Because the anterior part contains the parasympathetic nerves and the middle rectal artery, this region is at major risk during surgical dissection. CONCLUSIONS: A sound understanding of the surgical anatomy of the rectum enables the surgeon to perform a more correct and reasonable procedure in terms of both the extent of surgical treatment and the preservation of important anatomical structures.