Search PubMed⌕ Search

Biomedical subjects

T Perniceni

Publications and source records attributed to T Perniceni.

45 records · Page 3Linked to original sources
PubMed1988

[Does Barrett esophagus regress after total duodenal diversion?].

The outcome of Barrett's esophagus was evaluated in 21 patients who prospectively underwent total duodenal diversion and followed from 13 to 86 months. The total duodenal diversion procedure included troncular vagotomy, antrectomy and Roux-en-Y reconstruction incorporating a 70 cm loop. The diagnosis of Barrett's esophagus was made on endoscopy when a circular zone of columnar epithelium more than 3 cm long was found and was always corroborated by biopsies. All patients had esophagitis on endoscopy or acid reflux on pH-monitoring. During follow-up, for all cases, no esophagitis and no bile were detected in the stomach by successive endoscopies; none of the 16 pH-studies showed any aggressive reflux. The length of Barrett's esophagus was measured before and after Roux-en-Y duodenal diversion. In spite of the suppression of gastroesophageal reflux, regression of Barrett's esophagus was observed in one case only beginning 24 months after the diversion. No cases of adenocarcinoma or dysplasia were detected. In conclusion, regression of Barrett's esophagus is exceptional even after duodenal diversion.

Adult↗
PubMed1987

Inferior reach of ileal reservoir in ileoanal anastomosis. Experimental anatomic and angiographic study.

A possible technical problem encountered when performing ileoanal anastomosis with reservoir is the occurrence of tension when the reservoir is drawn to the anal canal. An anatomic study was performed to assess the gain of caudad reach that can be obtained by dissection of the mesentery root and vascular divisions applied to S- and J-shaped reservoirs, in association with angiographic control of terminal ileum vascularization. The study confirms the clinical experience that caudad reach of ileal reservoirs can be critical in some cases. Complete dissection of the root of the mesentery is a poor lengthening technique, the limiting factor being tension of the superior mesenteric artery. It is simple, however, and should be performed systematically because it can provide 1 or 2 useful centimeters of caudad reach. Division of the ileocecal pedicle is a safe, reproducible, efficient lengthening procedure that can serve all types of reservoirs. In this study, it gave a 5 cm or more gain in caudad reach in 80 percent of the cases, with a slight advantage to the S-shaped reservoir. Distal division of the superior mesenteric pedicle seems more hazardous and can serve only the J-shaped reservoir. For J-shaped reservoirs, maximum caudad reach was achieved when the pouch was built over the most inferior ileal point, which should be checked prior to the procedure, not judged according to predefined measures. The angiographic study showed that, in 38 percent of the cases, cecal vessels participated in vascularization of the last centimeters of the terminal ileum by means of recurrent ileal arteries, which, in 28 percent of the cases, provided exclusive blood supply to this area. Vascularization of the terminal ileum can and should be carefully preserved.

Anal Canal↗
PubMed1987

[Early treatment of biliary lithiasis in biliary pancreatitis].

Since 1982, 38 consecutive patients with biliary pancreatitis were treated prospectively in order to prevent recurrent migration of gallstones. Removal of the stones was achieved by "early surgery" i. e. within the first week after admission or by endoscopic sphincterotomy in patients with severe pancreatitis. Gallstones were visualized by ultrasonography in 31 patients (82 p. 100). Microlithiasis was present in 14 (37 p. 100) and was missed at ultrasonography in 7 patients. According to Ranson's prognostic signs, only 4 patients had 4 or more signs. These 4 patients and 2 additional patients aged more than 85 underwent urgent retrograde cholangiography and endoscopic sphincterotomy. No complications could be attributed to this technique. Among the 4 patients with severe pancreatitis, 3 developed an abscess which required delayed surgery without further complications. The 32 other patients underwent a biliary operation within the first week after admission. Common bile duct calculi were present in 14 patients being discovered by cholangioscopy in 6. One patient died after operation and one was reoperated on for a pseudocyst on day 40. No recurrent attack of pancreatitis was observed in either group. Our study suggests that slightly delayed biliary operation with cholangioscopy during the same hospitalization can be performed safety in patients with mild pancreatitis. In patients with severe attack and/or poor general condition, endoscopic sphincterotomy is a safe technique and deserves wider consideration in the management of severe acute pancreatitis for which delayed drainage of pancreatic necrosis may occasionally be required.

Acute Disease↗
PubMed1987

[Aseptic tracheobronchial aspiration].

Nosocomial lung superinfection is a frequent feature in ICU hospitalized patients. Up to 60 per cent of these patients may develop pneumonia, depending on the severity of their underlying disease. Necessary tracheobronchial irrigations and succions expose patients requiring mechanical ventilation to a risk of bacterial contamination by water containing infections particles. The "no touch method", elsewhere described, using disposable material and serious asepsis, try to diminish rate of one of the risk factors for acquired pneumonia. The use of a single-dose plastic bottle of sterile normal saline (solution ophta-ORL Faure) for tracheal irrigation is a clean and very low cost-price method, that minimize the risk of extrinsic contamination.

Cross Infection↗
PubMed1982

[Drainage of the bladder by suprapubic catheterization (author's transl)].

In most cases of urine retention due to lower urinary tract obstruction, the distended bladder can be drained by suprapubic catheterization. Only large intervesical blood clots cannot be removed by this method. The technique has been simplified and made non-traumatic and safe by the advent of small-diameter, self-winding, polyrethane catheters (Cystofix) which are easy to handle and well tolerated. The urethra and possible cervico-prostatis obstacles are left undisturbed, and radiological as well as manometric explorations can be performed. Complications do not occur if bladder distention is well ascertained, if the catheter is accurately inserted and if stringent aseptic precautions are taken. In the authors' unit suprapubic catheterization has become common practice and transurethral catheterization is seldom performed.

Humans↗