Treatment of infected pancreatic necrosis without surgery. A reported case.
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Biomedical subjects
Publications and source records attributed to P Pederzoli.
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Failures in experimental and human pancreatic transplantation are mainly attributable to rejection, graft thrombosis, and technical problems. There are, however, problems related to other causes, such as preservation injuries, which we found to exhibit, at least within the first 6 h, the same histological patterns seen in experimental acute pancreatitis. We performed pancreatic transplantation in 110 syngeneic rats under different preservation techniques and administration of gabexate mesilate, a synthetic protease inhibitor. The results showed that antiprotease treatment reduces graft preservation injuries significantly.
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Taking a case of duodenal schwannoma, that they had observed, as a starting point, on the base of their experience and the data of literature, the authors discuss the epidemiological, of classification and anatomo-pathological aspects of this rare neoplastic form. They particularly outline the clinical aspect, the diagnostic pre-operating iter and the correct and radical surgical behaviour that must be practiced during laparatomy.
The findings observed with computed tomography (CT) in such pancreatic emergencies as necrotic-hemorrhagic pancreatitis, pancreatic abscess, broken pseudocyst, and pancreatic ascites with mediastinitis are presented. The value of CT in these conditions, which often require surgical intervention, is discussed. Computed tomography appears to be the ideal diagnostic procedure, especially for surgical treatment planning in pancreatic abscess. No deaths occurred in a group of pancreatic abscesses treated surgically with CT assistance.
On the basis of 45 cases of operated pseudocyst, the Authors tackle the problem of surgical tactis in treatment of these lesions and any complications. The paper outline the contribution that recent diagnostic methods--such as endoscopic retrograde cholangiopancreatography, computed tomography and ultrasonography--have made to solution of the problem and establishes the criteria for emergency or elective operation. In the first condition, consisting in cases of complications (haemorrhagic, suppurative, perforative etc.), abnormal development of pseudocysts and serious impairment of the patient's general conditions, the treatment of the pseudocyst generally takes the form of external drainage. The second condition, obtainable after a sufficient period of "ripening", usually consists in a cysto-digestive shunt or cysto-parenchymal demolition in view of the high morbidity arising from external drainage. Surgical treatment of the pseudocyst is completed by therapy of any basic chronic pancreatitis and by correction of probable associated lesions affecting the bile and digestive tracts and the splanchnic venous circulation. In the reported cases, 28 patients were treated by cysto-digestive shunt, 8 by cysto-parenchymal demolition and 9 by external drainage. There were 37 combined operations.
Among 45 operations for pseudocysts the authors report 9 cases of complications, three of them early (haemorrhage and acute pancreatic necrosis) and six delayed (persistence of fistulae and relapse); in six of these surgery was performed and two of them died. Among the different types of surgery performed, external drainage proved to be the one most burdened by complications (2/3 of cases), while their incidence was far lower in internal shunt (2 cases out of 28) and cysto-parenchmal demolitions (one case out of eight). Attention is drawn to the danger of post-operative haemorrhage and the need to combat this complication with decision. For recurring pseudocysts and for fistulae which do not benefit from conservative treatment, the surgical operation, when it does not result in demolition, must be capable of correcting the canalicular alterations of the base pancreatitis.
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A hepatic localised antiblastic chemotherapic technique combining limited discomfort for patients with appreciable palliative results is illustrated; a short description of the surgical procedure of intubation of the hepatic artery itself and of some auxiliary procedures is given. Lastly the possible complications and the results are illustrated.
Hepatic arterial vascularisation, as described by Michels in 1954, is outlined; the importance of selective angiography in preparation of the hepatic de-arterialisation operation is then stressed, and its theoretical foundations and the surgical technique are illustrated; other procedures which can usefully be combined are also indicated. Lastly an evaluation of the limits and results of this therapy is given.
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