Biomedical subjects
Publications and source records attributed to V Bresadola.
The experience with video-assisted mediastinoscopy in 16 cases examined, is reported. Initially the classic mediastinoscopic device with the aid of an operative thoracoscopy was used. Starting from April 1994 the Authors used the video-assisted mediastinoscopy which, enlarging the surgical field, allows to improve the operative performance and may be a good aid for multiple teaching.
The aim of the paper is to give a contribution to the understanding of the role of surgery in patients with N3 lung cancer. The A. describe their results on 32 patients with N3 lung cancer operated on mediastinectomy; histological examination of the specimens showed 27 squamous cell carcinomas and 5 adenocarcinomas. The operation was performed through a median sternotomy to gain access to the left and right paratracheal nodes, pretracheal, precarinal and subcarinal nodes, subaortic and left and right hilar nodes that were removed together with the fat of the mediastinum. Left pneumonectomy was performed in 5 patients. There was no operative mortality; 12 patients were irradiated in the postoperative period with 5,000 Rads (50 Gy), while 18 or the 27 patients with squamous cell carcinoma are still alive.
Tracheal sleeve lobectomy is right upper lobectomy extended to include resection of the main bronchus, the carina and a segment of the trachea with end-to-end anastomosi of the trachea and end-to-side anstomosis of the intermediate bronchus on the main left bronchus, or the upper lobe on the trachea. This operation is possible with the aid of high frequency jet ventilation. The surgical indication of this operation is bronchoscopic and functional and guarantees a good oncological radicality in the presence of N0.
Since 1959, when mediastinoscopy was introduced by Carlens, the practice has been technically unchanged. The authors suggest how the new video technologies could be very helpful to this procedure leading to an ergonomic position for the operator and a faster performance. Initial experience is reported.
Up until now the problem of surgical infections has been one of the most important which surgeons must confront daily. In 1989 our Institute began programs for control and surveillance of surgical infections; these include, among others, the use of chemo-antibiotic prophylaxis protocols applied to all of the patients hospitalized for surgery. The authors report two years application of three protocols of chemo-antibiotic prophylaxis related to 1722 patients, in which we pointed out the passage from 27.6% of infected cases in the control group to 10.2% infected cases in one of the groups subject to prophylaxis. In these cases the antibiotic prophylaxis also acted reducing in a spectacular manner the incidence of clinically not significant infections.
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Modern technology has recently provided us with new resorbable suture material for use also in vascular surgery. Clinical use of these sutures has been impeded however by not little mistrust and by old dogmas without a rational experimental basis. We have therefore begun studies of two slowly resorbable materials, polyglactin 910 and polyglycolic acid, in comparison with two classic nonreabsorbable materials, nylon and polypropylene, used in experimental model of end-to-end anastomosis rats'infrarenal aorta, following up the healing process and its evolution after an interval. The results are discussed in relation to data collected from current literature.
In this paper the Authors report their experience on diagnostic and surgical procedures with respect to aneurysms of the visceral district. The clinical review during the last ten years of surgical activity in the Istituto di Clinica Chirurgica (Università di Ferrara) regards 13 patients with different visceral aneurysms. The study reports the different percentage of localization, the diagnostic approach, the surgical procedure performed and discussion of results obtained. Patients at risk for this disease are pointed out.
Among the anomalies of internal carotid artery, agenesis and aplasia recur with a low rate: only about sixty cases are reported in literature. We observed a case of aplasia of the left internal carotid in a 49 year old male suffering from hypertension and showing cerebro-vascular symptoms due to TSA pathology: it was studied with arterial angiography and duplex scanner. The angiographic examination raised a suspicion of left internal carotid thrombosis; on the contrary the duplex scanner revealed a correct diagnosis of carotid aplasia.
The Authors report on the use of non-invasive techniques in the preliminary evaluation of revascularization of the femoral-popliteal axis. The study of this pathology, for which surgery has become less and less frequent, being limited to the more serious cases, has greatly benefited by the use of H/R echography and of Doppler. These techniques, which remain complementary to angiography, have proved very important and reliable for their capacity to visualize the arterial lumen, an important element for the pre- and post surgical evaluation of vascular recanalization and of the relationship of continuity and continuity with the nearby structures.
The cost/benefit ratio of stapled anastomoses in colorectal surgery has been retrospectively evaluated on the basis of a 8 year experience taking into account the overall costs in surgery as well as short term and long term benefits. With this aim, our experience was divided in two periods: 1st period: November 1970-January 1981: 598 hand sutures; 2nd period: February 1981-December 1988: 787 stapled sutures. Mechanical suturing was found to be superior based on the following: a) the average postoperative hospital stay decreased from 20.2 days to 14.7 days; b) temporary stomas decreased from 62.2 to 25.1%; c) abdominoperineal resection for rectal cancer decreased from 60.7 to 41.6%.
A case of retroesophageal right subclavian artery, occasionally observed in a patient submitted to diagnostic investigation and surgical treatment for bilateral steno-obstructive involvement of the carotid district, is described.
BACKGROUND: Quality-of-life (QoL) assessment includes health status, disability, psychological wellness, and social performance. We sought to evaluate the effect of liver transplantation (OLT) on the QoL of patients awaiting the procedure and its variations up to 8 years afterwards. METHODS: LEIPAD-perceived QoL and BSI-psychological distress tests were used. Patients were divided in four groups (waiting list patients, 1 to 2 years after LT, 3 to 4 years after LT, 5 to 8 years after LT). Patients were also evaluated for type and severity of liver disease. RESULTS: We evaluated 126 patients, 71% male, 29% female, median age 60.7 years (range 40 to 76 years), median follow-up 4 years (range 1 to 8). The patients on the waiting list scored worse both in global stress index (GSI) and total LEIPAD scores than transplanted patients. Upon univariate linear regression analysis, the only dimension associated with time groups was LEIPAD--physical functioning, showing a progressive improvement of perceived physical status with time from transplant. Severity of liver disease showed a protective effect, probably reflecting a better control of stressful events from patients transplanted at advanced stages of liver disease. Protective effects were found for male sex, retired, cohabitant patients, and the degree of education. Housewife and widow patients showed negative associations with BSI and LEIPAD dimensions. No independent predictors of QoL were found in this study. CONCLUSIONS: OLT improves most, but not all, QoL and psychological distress domains.
Cancer of the cervical esophagus has a poor prognosis in relation to stage. Correct staging is thus essential in order to establish the prognosis and the treatment program. Distant metastases can involve the lymph nodes (mediastinal and celiac lymph nodes) or they can be extranodal visceral types. Correct lymph node staging can be performed with esophageal endoscopic ultrasonography, computed tomography (CT) scan and, currently, with positron emission tomography (PET) and minimally invasive surgery. For hematogenous metastases, CT scan and PET are mainly used, as well as minimally invasive surgery, with the eventual aid of intraoperative ultrasonography.
The authors report a case of anomalous implantation of the base of the appendix, observed in a 8-year-old boy, arising from the anterior wall of ascending colon at 15 cm from the ileo-cecal valve. After a brief review of the most frequent congenital anomalies of the appendix and the few cases of anomalous implantation described in international literature, the authors emphasize the importance of an accurate exploration and mobilization of the ascending colon to reduce the risk of diagnostic and therapeutic mistakes, also related to the small incision of McBurney, usually made for the routine laparotomic appendectomy.
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The aim of the experimental study was to evaluate the possibility of performing an end-to-end anastomosis by using fibrin adhesive as the only means of suture. To this end, 24 Wistar rats were used, of which 16 underwent ilear resection and 8 underwent colotomy, and they were divided respectively into two groups. On the rats of the first group the anastomosis was performed by using only fibrin adhesive; on the rats of the second group operated the anastomosis was performed by using fibrin adhesive in association with non adsorbable suture material, while on those operated of colectomy the anastomosis was performed by fibrin adhesive and adsorbable suture material. The anatomo-phatological studies on the anastomosis have shown a similar healing process in the cases treated only with fibrin adhesive and by using absorbable material and has demonstrated the trange material from the suture, which are a possible causes of complication.
The pathophysiology of gastroesophageal reflux disease (GERD) is often multifactorial, as abnormal function of the lower esophageal sphincter (LES) may be associated to abnormalities of the esophageal peristalsis, the esophageal clearance, and the gastric reservoir. The preoperative evaluation of patients with GERD must include esophageal function tests (esophageal manometry and ambulatory pH monitoring) and evaluation of the gastric emptying in addition to UGI series and endoscopy. The information provided by these tests is essential to identify the pathophysiology of the disease in the individual patient, and tailor the operative treatment accordingly. For patients with an incompetent LES but normal esophageal peristalsis, the Nissen fundoplication is the procedure of choice. When abnormal peristalsis and delayed clearance are identified by preoperative esophageal function tests, a partial fundoplication must be chosen in order to avoid postoperative dysphagia and gas bloat syndrome. Too many eponyms have been used to describe antireflux surgery (Nissen, Rossetti, Toupet, Lind, Hill, Guarner). It is time to go beyond these eponyms, and focus on the technical details which contribute to the stability of the wrap, as this is the main determinant of long term outcome.