Biomedical subjects
Publications and source records attributed to M Valente.
In esophageal resections, esophagogastric anastomosis can be performed either at cervical or intrathoracic level. A recent paper showed a greater incidence of postoperative leakages in cervical vs. intrathoracic anastomosis (26% vs. 4%). In the present paper we describe 55 cases of esophagectomy with a modified technique of cervical stapled anastomosis, where the incidence of fistula was 5%.
Between January 1983 and July 31, 1988 at the 1st Division of General Surgery of Cuneo S. Croce Hospital, 57 patients (33 m, 24 f) were subjected to abdomino-perineal amputation for rectal A.D.K. A definitive colostomy was fashioned for all patients. Neostoma complications were encountered in 33% of cases. 91% of patients completed the rehabilitative programme and 40% saw satisfactory results as regards the regularisation of the alvus and return to social life.
Consecutive autopsies (5241) performed in the Trieste area and consecutive autopsies (6511) performed in the Tokyo-Chiba area were analyzed to study the frequency of liver metastases in cirrhotics. The Italian material included 500 cases and the Japanese material included 529 cases of liver cirrhosis. Both of these groups were matched for sex and age with a control group. The results were similar in both areas and confirmed the widely held but disputed opinion that metastases in cirrhotic liver are rare. These results seem to be clinically important since they agree with the fact that most neoplasms in cirrhotic liver are primary. From a biologic and epidemiologic point of view, these results call for reconsideration of the complex relationship existing between cancer and liver cirrhosis, in relation to major causative factors such as alcohol and hepatitis B virus (HBV) infection.
A personally observed case of biliary ileus triggers this description of its clinical features, blood chemical and diagnostic aspects and surgical treatment. Emphasis is placed on the importance of the preoperative rehydration and restoration of the electrolyte balance in patients with upper intestinal occlusion which reduces the risk involved in subsequent surgery.
A series of 172 cases of acute pancreatitis encountered between 1-1-79 and 30-4-88, including 57 treated with somatostatin is presented. A comparison between the latter and the other cases treated with a variety of drugs (aprotinin, cimetidine, ranitidine) led to the following conclusions: 1) somatostatin significantly improves the clinical course of acute oedematous pancreatitis with circumscribed necrosis; 2) it makes no difference to the development of cases with diffuse necrosis and haemorrhage.
From 1981 to 1986, 17 patients with resected small cell lung carcinoma (SCLC) staged as I or II according to the new TNM classification were recruited for a prospective study to evaluate the effectiveness of surgery and postoperative chemotherapy (plus locoregional radiotherapy only when a nonradical resection was accomplished) in the treatment of early stages of the disease. Six patients received full protocol chemotherapy (6 courses) and 8 a mean of 79.1% of the planned courses. Three patients received non adjuvant treatment. Locoregional radiotherapy for residual disease was administered in 2 cases. One patient died for myelosuppression due to chemotherapy and 10 for recurrences of cancer, all within the 20th postoperative month. Metastases accounted 80% of overall recurrences. Six patients were alive and tumor-free at 18, 22, 39, 44, 47 and 51 months from resection. Actuarial observed 3-year survival was 32%.
Out of 52 consecutive patients resected for small cell lung carcinoma (SCLC) from 1976 to 1986, 19 were selected because they underwent nonradical surgery, 10 of them for locoregional spread and 9 for distant metastases. Of the former subset all received postoperative radiotherapy and 8 chemotherapy also. Three patients are alive and disease-free 37, 56 and 91 months after resection. Four patients had a distant recurrence, and 3 a locoregional failure. Patients of the latter subgroup received chemotherapy in 7 instances. None survived more than 16 months, distant metastases being the cause of death. In these patients N0 status was associated with 13.3 months of mean survival, N1 with 8.5 months, and N2 with 6.7 months. Surgery and adjuvant treatments seem effective in achieving local control of SCLC despite nonradical resections. Tumor burden at locoregional sites does not preclude the possibility of long term survival.
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The results of surgical management of 63 cases of pulmonary metastases from bone and soft tissue sarcomas, admitted at the Istituto Nazionale Tumori of Milan, between 1970 and 1987, are reviewed in this paper. To estimate the relative impact of metastasectomy on the overall performance of treatment, survival curves were calculated from the time of first thoracotomy, as well as from the initial treatment of primary sarcoma. In the present series, total actuarial survival at 10 years was 37% for osteosarcoma, 27% for soft tissue sarcomas, and 24% for the other bone sarcomas, with a median survival of 48, 56, and 36 months, respectively. Five-year survival from the first pulmonary resection was influenced by the number of metastases and the length of the first disease-free interval only in osteosarcoma, while in soft tissue sarcomas a major untoward factor was represented by local recurrence at the site of the primary tumor. These data support the concept of pulmonary metastasectomy as effective salvage therapy for radically treated sarcomas; this management can rescue a significant proportion of all relapsed patients.
A long-term experimental morphological study was carried out in 22 adult sheep to evaluate a new pericardial valve prosthesis (Pericarbon), which had been implanted in the tricuspid or mitral position. This prosthetic device differs substantially from others in that its construction design consists of two sheets of glutaraldehyde-fixed bovine pericardium and a low-profile flexible plastic stent (Delrin) covered by a pyrolytic carbon coated dacron fabric; one pericardium sheet forms the three cusp valve and is sutured to the second, which lines the inner surface of the plastic stent. Twenty animals were sacrificed at fixed intervals, while 2 are still living at about 3 years post-surgery. Tricuspid explants (mean duration, 295 days) showed significant fibrous sheathing and a mean calcium X-ray score of 1.75. Mitral medium-term explants (mean duration, 325 days) had fairly well preserved pliability and a mean calcium X-ray score of 2.5. Long-term explants (mean duration, 467 days) were all stiffened by calcification (mean score, 3.75). None of the explants had tears or perforations. Medium or long-term mechanical failure was not observed. A significant host tissue reaction took place in the tricuspid but not in the mitral position. Calcification mainly involved the collagen fibres and increased progressively with time. Ultrastructural studies invariably disclosed fair preservation of graft tissue structures, surface reendothelization and initial nuclei of calcification within the collagen fibres. These morphological findings confirm the potential advantages of this new prosthetic device and warrant long-term clinical trials to test its actual durability.
Pericarbon, a new generation pericardial valve, is characterized by a single, three cuspal shaped pericardium sheet, which is sutured to a second sheet lining the inner surface of the plastic, low profile stent. A coating of hemocompatible carbon film covers all the exposed, nonbiological surfaces. Optimal preservation of collagen and graft cells is achieved by fresh tissue glutaraldehyde fixation and cusp shaping without mold. Accelerated fatigue testing showed a duration of over 150 million cycles, a figure much higher than that observed when current pericardial and porcine valves were tested with the same apparatus. Results of long-term (greater than 7 months, average 10.5) implantation in 20 sheep (13 mitral, 7 tricuspid) disclosed no case of mechanical failure, mild to moderate primary calcification in older explants, and significant fibrous tissue overgrowth only in the tricuspid position. Transmission electron microscopy studies revealed collagen and elastic fiber integrity, no significant plasma protein insudation, and well-preserved graft cells. Re-endothelialization by host cells was a regular finding on scanning electronic microscopy. Early ultrastructural nuclei of calcification were seen mostly on collagen fibers. Pericarbon presents basic changes in pericardial valve design, and optimal morphological preservation is obtained after industrial processing. Accelerated fatigue tests in vitro show long duration. At medium long-term animal experimental follow-up, mechanical failure was not observed; significant host tissue reaction occurred in the tricuspid but not in the mitral position; primary calcification increased progressively with time and involved mainly collagen fibers.
Brainstem auditory and visual potentials were recorded from 6 patients with chronic idiopathic polyradiculoneuropathy. Evoked potentials were either completely absent or their latency was prolonged suggesting slow conduction in visual or auditory pathways. The results of our study provide further evidence suggesting subclinical involvement of cranial nerves and central nervous system sensory pathways in chronic inflammatory demyelinating polyradiculoneuropathy.
Confirming the literature data the authors describe that the heart rate is smaller in the newborn rats than in adult ones and increases until the adult values during the first two weeks of life. On the other hand, the blood thyroid hormone exhibits the same pattern, showing an early postnatal increment. As, according the Adolph's data (1967), the heart rate enhancement is not due to the catecholamines, the authors suppose that such enhancement might conceivably depend on thyroid hormone increment.
To establish whether thyroid hormone modifies the heart rate directly or through an action on other neuroendocrine modulators, the authors have examined several animals models differing in the plasma levels of such compounds. Induction of the hypothyroid state in rats produced a slow onset of bradycardia, which may be removed by a prolonged triiodothyronine treatment. The involvement of TSH was excluded as, by comparing thyroidectomized, hypophysectomized and cold exposed rats, the heart rate was found to vary according to the thyroid levels and not to the TSH levels. Moreover growth hormone, corticotropin and gonadotropins do not influence the heart rate, as the bradycardia induced by hypophysectomy was fully removed by triiodothyronine treatment. The lack of influence by ACTH and GnH was confirmed by treatment of thyroidectomized rats with corticosteroids or testosterone, respectively. Finally, thyroid hormone did not act on the heart rate by changing the norepinephrine output at the sympathetic nerve endings in the heart. In fact, thyroidectomy produced a more intense bradycardia than sympathectomy, and such bradycardia was equally removed by triiodothyronine treatment in thyroidectomized rats and in thyroidectomized and then sympathectomized ones. The authors suggest that the direct effect of the thyroid hormone on cardiac chronotropism is due to an early enhancement of beta-adrenoceptors, followed by a late modification of the electrophysiological properties of the myocardium.
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The findings at 26.879 autopsies, that is 70% of all the deaths registered in the Province of Trieste, obtained at the Institute of Pathologic Anatomy and Histology of Trieste from 1976 to 1985 were studied. Liver cancer showed in the Province the World Standardized Incidence Rate (WR) of 1.87 (females) and 12.78 (males), one of the highest ever observed in nonendemic areas. In view of close association between cancer of the liver and cirrhosis (88%), the authors studied the most important etiological factors of cirrhosis in the region, i.e. hepatitis B and alcohol abuse. Some effective measures are suggested to decrease the incidence of cirrhosis and eventually cancer of the liver.
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