[Complications of pelvic ileal pouches].
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Biomedical subjects
Publications and source records attributed to S B Doldi.
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Ultrasonography of the extremities was performed in 91 patients with unilateral or bilateral peripheral lymphedema of the arms or legs. Linear 3.5 to 10 mHz ultrasonographic linear probes were used in accordance with standardized procedure. The data demonstrated a volumetric increase of the lymphedematous limb with increased thickness of both the subcutaneous and subfascial (muscular) compartments consistent with fibrosclerosis in both compartments with chronic disease. Whereas dermal thickening was minimal, subcutaneous and subfascial changes were more prominent in primary than secondary lymphedema. By providing information about the volumetric and structural alterations with chronic lymphedema, ultrasonography safely and simply supplements conventional and isotopic lymphography in assessing patients with chronic lymphedema.
Since 1954 the aim of surgical treatment of severe obesity has been to perfect a specific treatment capable of obtaining a massive, long-lasting and well tolerated loss of weight in severely obese subjects in which different and repeated attempts using conservative medicine have proved inefficacious or non-resolutive. During the course of almost 40 years, bariatric surgery has gradually evolved in the search for the "ideal" surgical treatment: for this purpose, operative methodologies and techniques have been proposed and experimented using differing physiopathological concepts and means of application. After a brief analysis of the history of bariatric surgery, there is a short summary of the most internationally widespread surgical methods and the most recent techniques now used for the surgical treatment of severe obesity based on the Authors' ten year experience of 321 intestinal bypasses (jejuno-ileal and biliointestinal), 110 horizontal gastroplasties and 23 vertical gastroplasties with a silastic ring. Intestinal bypass almost always allows sufficient weight loss to be achieved (85% of operated patients lose 80% of excess body weight) and the various postoperative problems of differing degrees of severity can be prevented by adequate replacement therapy and regular outpatient monitoring. Gastroplasties lead to a slightly smaller loss of weight (73% of excess body weight) within a shorter period of time, with fewer postoperative problems, but at the expense of a drastic and continual reduction in food intake. All patients operated require intense and long-term postoperative follow-up carried out by experts in order to achieve the desired results.
Indications and procedures of restorative proctocolectomy in the surgical treatment of ulcerative colitis and familial polyposis are reported. Surgical procedure and some technical innovations are discussed.
A case of adenomatous polyposis of the stomach associated with familial polyposis of the colon is presented. The relevant literature is reviewed and the data thus collected (with the exception of definitely non-adenomatous, extracolic cases) are presented in tables, depending on whether familial polyposis of the colon or Gardner's syndrome was the accompanying form. A systematic account is given of the association and reference is made to simple polyposis of the stomach, and that of the duodenum. Close attention is paid to the question of diagnosis, the risk of cancerous transformation, and treatment. Stress is laid on the importance of optic fibre endoscopy in diagnosis and therapy (by means of the surgical fibroscope). Examination of the literature, it is felt, substantiates the need for: 1) routine systematic investigation of the digestive apparatus in all subjects with FPC and GS, and the report of even isolated cases to establish the true frequency of the association; 2) histological assessment of radically resected formations in the correct determination of both diagnosis and prognosis; 3) preventive and systematic endoscopic control as a means of investigation and postoperative surveillance; 4) correct strategy based on the nature, extent, number and size of the polyps and the polypogenetic capacity of the gastric mucosa.
Reference is made to the experimental preliminary remark and the first, clinical observations underlying the surgical management of severe obesity, together with the techniques employed, starting with the jejunal-colic by-pass of Payne et al. This, however, led to serious liver damage and electrolyte imbalance, whereupon Payne et al. proposed end-to-side and Scott end-to-end jejunal-ileal by-pass. The end-to-end variety has been used with excellent results in 33 cases. Mason's gastric and gastroplastic techniques is till now unfrequently used. An account is also given of experimental ileo-cholecystostomy and biliopancreatic by-pass. In agreement with most other workers, a preference is expressed for the end-to-end jejunal-ileal by-pass as the most suitable technique available at present.
Changes in body weight (absolute and percent), overweight index, and body surface area were examined in 27 grossly obese subjects after jejunal-ileal by-pass. Curves were steeper and linear for 3-4 months and then flattened out for the remainder of the twelve-month period of observation. They were parallel to each other even when a division was made between patients weighing more and less than twice their ideal weight. This shows that if a person weighs more than 120 Kg his weight loss curve will depend on the time that has elapsed since surgery. It is virtually independent of the start value.
The short-term tolerability of two types of end-to-end jejuno-ileal bypasses with different distal ileal loop lengths was evaluated. A comparison was made for 20 days of the behaviour of the main parameters influenced by the malabsorption syndrome thus induced. It was found that the operation involving a greater loss of small intestine was burdened with a greater number of discharges per day, an increase in total water loss, and an elevatem operative risk. This was compensated by more rapid and more evident loss of weight. Evaluation of the real meaning of the inversion of the A:G ratio observed in the short term with this type of operation was postponed to allow a longer follow-up period to run.
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Alkylating drugs, alkylating drugs + antimetabolites, and alkylating drugs + antimetabolites + Vinblastine were used to treat 62 patients. The results were assessed in terms of Karnofsky's classes and related to the following parameters: age, free interval, menopausal status, results of prior endocrine management, site of dominant metastases, length of survival. 44 failures (71%) and 18 objective responses (29%) were noted. A mean survival of 17.3 months was noted for the entire series. Subjects who failed to respond survived an average of 14 months, as opposed to 25.5 months for the responders. This difference was just significant. No relation could be shown between the results and the other parameters, whereas that between the results and the length of survival was highly significant. It is clear that the variables considered cannot be relied upon in predicting the outcome of chemotherapeutical management. If the latter is effective, however, survival will almost certainly be prolonged.
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