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Biomedical subjects

R Bardini

Publications and source records attributed to R Bardini.

71 records · Page 4Linked to original sources
PubMed1977

[Leiomyosarcoma of the esophagus].

The authors describe the anatomo-clinical characteristics of a case of leiomyosarcoma of the oesophagus which came under their observation, emphasizing its rarity: 39 cases in the literature examined. They then discuss the numerous problems that this neoplasia involves, especially diagnostic differentiation from other sarcomas and the pseudo-sarcomatous reaction of the stroma during the course of carcinomas. Lastly they divide leiomyosarcoma of the oesophagus into polypoid forms and infiltrating forms, owing to the different therapeutic and prognostic implications that such distinction implies.

Aged↗
PubMed1976

[Usefulness of the early study of intrathoracic digestive anastomoses].

The appearance of a dehiscence after an operation of oesophageal resection and reconstruction with stomach, jejunum or colon, constitutes a highly serious event frequently leading to the patient's death. Early recognition of dehiscence is therefore important for the purpose of starting adequate therapy as quickly as possible and preventing the rise and establishment of those lesions which condition an irreversible trend of the clinical condition. In this note the means today available for early diagnosis fo fistula, with particular reference to early radiological examination, are discussed. Early diagnosis and adequate prompt treatment may, in our opinion, lead to an improvement in the poor results reported by a number of surgical schools.

Colon↗
PubMedDate not supplied

Anastomosis.

Esophageal anastomosis is still associated with a high rate of complications even though they have decreased considerably in recent years. Anastomotic leaks are more frequent in the neck than in the chest, and related mortality rate is not different. The leakage incidence does not depend on suture materials or on technical modalities used to perform the anastomosis. In fact, there is no difference between the leakage rate when comparing manual and mechanical anastomoses. The leak incidence after both mechanical and manual anastomoses is much higher in collective reviews than in reports coming from leading centers. "Frequent" esophageal surgeons can learn from their previous experience and therefore avoid technical errors, whereas "causal" esophageal surgeons do not have this opportunity. Performing an esophageal anastomosis is a technical matter, and suture healing is independent of the patient's biologic situation. Anastomotic fibrotic strictures are frequent after both manual and mechanical anastomoses, and most can be avoided by meticulous suturing technique.

Anastomosis, Surgical↗
PubMedDate not supplied

[Critical analysis of the new TNM staging (UICC, 1987) of cancer of the cervical esophagus in relation to therapeutic decisions].

66 consecutive patients with a tumor confined to the cervical esophagus underwent surgical resection. The comparison between clinical and pathological TNM stage showed a clinical understaging in 30 patients. 25 of the 56 patients who had undergone curative resection had lymph node metastases: positive mediastinal and abdominal nodes were found in 8 (32%) and 0 cases, respectively. The mean survival after curative resection of the 10 evaluable patients with metastatic periesophageal, recurrent and/or paratracheal nodes was 22.4 months; of the 6 evaluable patients with positive mediastinal nodes it was 10.3 months; and of the 5 patients with positive deep latero-cervical nodes it was 5.8 months. The 2-year actuarial survival after curative resection (in the 53 operative survivors) was as follows (according to pathologic TNM staging): Stage I (n = 3) 100%, Stage IIA (n = 17) 30%, Stage IIB (n = 3) 33%, and Stage III (n = 30) 22%. The exact location of neoplastic recurrence after curative resection was documented in 13 cases; it was in the neck in 8 cases (61%); both neck and at a distance in 3 cases (23%) and only at a distance in 2 (16%). The clinical TNM staging of cervical esophageal cancer was not in agreement with the pathological findings in nearly 50% of the cases and is, therefore, inaccurate and unreliable both for therapeutic decision-making and for prognostic evaluations. Endoscopic ultrasound, which was not used in most of the patients studied here, may improve the accuracy of clinical TNM staging. The N classification, which defines only the cervical nodes as regional nodes, appears to be arbitrary since the pathological staging showed metastatic mediastinal nodes in 32% of the N + cases, with a survival comparable to that of patients with metastatic nodes only in the neck. The prognostic value of pathological TNM staging was not confirmed in the present study since only Stage I patients had a significantly better prognosis than patients in the other stages. This may be due to the small number of patients considered or to lymph node understaging caused by the fact that most patients did not undergo mediastinal lymphadenectomy through a thoracotomy or a sternum splitting.

Esophageal Neoplasms↗
PubMedDate not supplied

[Infectious chemoprophylaxis in colorectal surgery. A multicenter study of imipenem-cilastatin vs. cefuroxime and metronidazole or cefotetan].

The authors report the results of a multicentric clinical study on prevention of surgical infections in colorectal surgery by chemo-antibiotic prophylaxis. This trial was carried on to evaluate the effect of imipenem-cilastatin (1 g i.v. just before operation and 1 g i.v. 3 hours from surgical procedure) vs. cefuroxime + metronidazole (1.5 g + 0.25 g i.v.) or cefotetan (1 g i.v.) given with the same modalities. In 48 patients undergoing colorectal resection (47 with malignant neoplastic disease) 24 were treated with imipenem, 18 with cefuroxime and 6 with cefotetan. In group A (imipenem-cilastatin) the infection rate was 4.2% (1/24 cases), in group B (cefuroxime + metronidazole or cefotetan) postoperative infections were registered in 4 out of 24 cases (16.6%). This study documented the good results of systemic chemoprophylaxis and the great efficacy of imipenem-cilastatin in colorectal surgery.

Cefotetan↗
PubMedDate not supplied

Surgical treatment of cervical anastomotic leaks following esophageal reconstruction.

Cervical anastomotic leaks occurring in the early postoperative period after esophageal reconstruction are life-threatening complications, with a mortality rate similar to that of intrathoracic leaks if the posterior wall of the anastomosis is affected. Prompt diagnosis and aggressive surgical treatment is vital. The surgical procedures commonly used are often inadequate or unsatisfactory because of the difficulties encountered in the subsequent reconstruction. Twelve patient with an early cervical anastomotic leak following elective esophageal surgery were treated using an original surgical technique which allows diversion and simple delayed reconstruction of the anastomosis without risk of late stricture. Uncontrolled mediastinal sepsis accounted for the three deaths of the series and occurred in patients with a leak of the posterior anastomotic wall in whom definitive surgical treatment was delayed.

Adolescent↗
PubMedDate not supplied

Total esophagectomy without thoracotomy: results of a European questionnaire (GEEMO).

The results of a questionnaire answered by the European Members of the GEEMO concerning esophagectomy without thoracotomy are reported and discussed. 172 cases of esophagectomy without thoracotomy following benign lesions and 666 cases following various levels of esophageal neoplasia were grouped in the 26 Centers that have answered the questionnaire amounting to a total of 838 cases. The most frequent indications for benign lesions were as follows: decompensated or relapsed megaesophagus (83 cases), acute or stabilized lesions caused by caustic agents (59 cases), stenoses from gastroesophageal reflux (17 cases), scleroderma (7 cases) and spontaneous or iatrogenic perforation (6 cases). Concerning the esophageal site where the technique was employed with esophageal carcinoma, the most frequent was the cervical (201 cases), then the lower (150 cases), the middle (91 cases) and upper thirds of the esophagus (48 cases). Adenocarcinoma of the cardia seems to be an additional indication for many Surgeons to use esophagectomy without thoracotomy (142 cases). In general, the most frequent intra-surgical complications (from benign and malignant lesions) were as follows: pleural lesions (34.4%), lesions of the left recurrent nerve (7.8%), severe endo-mediastinic hemorrhages (8.5%), tracheo-bronchial (1.5%) and thoracic duct (0.5%) lesions. The intra-operative mortality was 0.36%. The post-operative complications were as follows: pleural effusion (17.8%), anastomotic fistulas (15.2%), hemothorax (5%) and post-operative mortality (10.3%). Cancer of the cervical esophagus and adenocarcinoma of the cardia were considered sensitive to this radical treatment whereas in intra-thoracic cancer it can have only a palliative effect.

Esophageal Diseases↗
PubMedDate not supplied

Esophagogastric anastomotic leakage.

Anastomotic leakage of esophagogastric anastomoses can be prevented by administering adequate preoperative nutritional support and by employing mechanical circular staplers. In a series of 299 intrathoracic anastomoses, 35 leakages were observed, 11 of which gave asymptomatic radiological findings. In a series of 46 cervical anastomoses, nine leakages were observed. In the majority of cases conservative treatment was adopted. This is based upon external drainage of septic collections, gastric emptying, antibiotics and intensive nutritional care. The mortality rate in cases of anastomotic fistulas was 1.74% (6 patients) in the patients with esophagogastric anastomoses.

Cardia↗
PubMedDate not supplied

Thoracoscopic removal of benign tumours of the oesophagus.

Thoracoscopic excision of an oesophageal leiomyoma was successfully performed in 4 patients. The tumours were enucleated easily without intraoperative complication. A patient in whom the muscular layer was not sutured after removal of the myoma presented with a pseudo-diverticulum one year after the operation and required a thoracotomy for resection. This new procedure which reduces the operative trauma and postoperative pain and allows quick recovery, is described.

Adult↗
PubMedDate not supplied

Thoracoscopic resection of benign tumours of the esophagus.

Thoracoscopic excision of an esophageal leiomyoma was successfully performed in 5 patients. The tumours were enucleated easily without intraoperative complications. A patient in whom the muscular layer was not sutured after removal of the myoma, one year after the operation presented an esophageal pseudodiverticulum requiring a thoracotomy for resection. This new procedure which reduces the operative trauma and postoperative pain and allows quick recovery is described.

Adult↗
PubMedDate not supplied

Disconnection of the ampulla of Vater: a new technique for reconstruction.

We report the case of a 42 year-old patient who had undergone gastric resection and Billroth I reconstruction for a duodenal ulcer 15 years earlier. The patient was admitted to our Department for a high output biliopancreatic fistula which developed after another gastric resection with Billroth II reconstruction which was performed for a peptic stricture of the gastroduodenal anastomosis. At laparotomy, a complete disconnection of the ampulla of Vater was found, with the duodenal stump oversewn 5 cm distally to the papillary area. After plasty of the biliary and pancreatic ducts, a direct anastomosis between the new ampulla and a Roux-en-Y jejunal loop was performed. The post-operative course was uneventful. The details of the surgical technique are reported.

Adult↗