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Biomedical subjects

V Maffettone

Publications and source records attributed to V Maffettone.

At least 37 records · Page 2Linked to original sources
PubMed1991

[Evaluation of esophageal function in surgically-treated patients].

The authors report on their experience acquired in the surgical treatment of functional esophageal disease (achalasia, diffuse esophageal spasm, diverticula and gastroesophageal reflux). The authors affirm that a correct and meticulous functional study of the esophagus is fundamental for the adoption of precise surgical plotting, in order to circumvent all of the complications and failures described in Literature. Such an objective can be achieved intraoperatively thanks to myotomy and fundoplication with the aid of intraoperative manometry (IEM) that, when performed in the course of myotomy, circumvents the execution of incomplete procedures (incomplete myotomies). The same holds true in the case of anti-reflux plasty (Nissen's in particular) where IEM enables a plication that is neither too wide nor too narrow, too long, too short, but "calibrated". Then, instrumental probes are even more capable of assessing the effects of functional surgery, by enabling the documentation of perfect postoperative results. More precisely they make it possible to study patients presenting with motor disorders pre-operatively, as in the case of achalasia or diverticula, and to sanction their resolution postoperatively. In addition they enable documentation of the effectiveness of Nissen's fundoplication, performed either to prevent gastroesophageal reflux after myectomy or to treat primary reflux. This is made possible by studying not only the tone at a distance, but especially relaxation in the course of deglutition. Finally, pH-metry permits the documentation of the complete clearing of gastroesophageal reflux, even when physiologic and post-prandial (hypercompetent Nissen).

Diverticulum, Esophageal↗
PubMed1991

[Intraoperative esophageal manometry].

Intra-operative esophageal electromanometry (IEM), a method foretold by the authors since 1972, is indicated in the course interventions for functional esophageal disease. The main application of IEM occurs in the presence of myotomy and in the preparation of anti-reflux plasty. As far as myotomy is concerned, IEM can provide guidance in identifying a site for future intervention and, once accomplished, for documenting the completeness thereof. As far as anti-reflux plasty is concerned, it provides an opportunity to verify the onset of an anti-reflux high-pressure zone (nHPZ) that can be calibrated fittingly until the required values are achieved. IEM appears especially useful in effecting a Nissen fundoplication, the frightful complications of which compel many a surgeon to use other types of plasty, despite the lower rate of effectiveness. The perfect identity between the degree of loop closing and the manometric values obtained, and between the loop width and the length of the nHPZ, obtainable through Nissen's fundoplication only, testifies in favor of the use of IEM in preparation of this type of fundoplication only. The Authors present their case studies from 1985 to date, collected at the Service of Surgical Esophagology of the Faculty of Naples, covering 145 cases of Nissen's fundoplication, 70 of which after extramucosal cardias myotomy according to Heller, 54 cases of GER, including 2 cases of scleroderma, epiphrenic diverticula, DES and repeated surgery.

Esophageal Motility Disorders↗
PubMed1991

[Current views and controversies about reconstruction after esophagectomy].

The Authors examine the reconstructive procedures following total or partial esophagectomy, reporting advantages and disadvantages related to stomach, colon or jejunum transposition. The stomach is certainly the organ most widely employed for its adaptability and excellent vascularization; furthermore, only one anastomosis is needed. After a short note on pathophysiology of the most common complications, the Authors point out the advantages of using stapling devices, with special attention to the low incidence of anastomotic dehiscence.

Colon↗
PubMed1991

[Intraoperative esophageal manometry in the surgical treatment of achalasia].

Since 1985 we have done intraoperative manometry in 54 patients operated for achalasia. Manometry allows the assessment of the completeness of the division of the high pressure zone and ascertain the length of fundoplication (Nissen) as well as its pressure. In 26 patients pH and manometric controls were done postoperatively. Absence of reflux was noted in all and the pressure level after operation was 12.53 +/- 4.94 mmHg. Pressure measurements were not different from those of a group of 15 healthy subjects (15.2 +/- 2.45 mmHg). Dynamic studies of the high pressure zone revealed a post-deglutition relaxation of 72.5 +/- 16.32% over the basal tone. We believe that intraoperative manometry is essential in the surgical treatment of achalasia as it allows a precise control of myotomy as well as the fashioning of a high pressure zone to avoid reflux.

Adult↗
PubMed1990

Evaluation of normal subjects by defecographic technique.

A simple method of defecation radiography using video recording of evacuation of a suspension of radiopaque barium sulfate in ten normal volunteers to establish physiologic parameters is described. Clinical perineal descent and defecographic measurement have been performed. The anorectal angle (ARA) was, on the average, 90.00 +/- 4.76 degrees (SEM) at rest and 111.00 +/- 5.02 degrees (SEM) during evacuation. The width of the anal canal (W) was, on the average, 1.29 +/- 0.13 cm (SEM). The duration of sphincteric relaxation (SRT) was, on the average, 4.50 +/- 1.04 sec (SEM), with a total average evacuation time (TET) of 12.00 +/- 3.54 sec (SEM). The authors confirm the effectiveness of defecographic techniques and recommend the standardization of the method to have an unequivocal interpretation of the obtained data.

Adult↗
PubMed1990

[Liver transplantation and portal thrombosis].

One hundred and thirty-eight transplants were performed between April 1986 and June 1990 in 116 patients of whom 9 (7.75%) were affected by liver cirrhosis complicated by portal vein thrombosis. Occlusion of the vascular lumen was total in 3 cases, semitotal in 1 case and the percentage of obstruction ranged between 25% and 75% in the remaining patients. Venous dissection and thrombectomy were performed in 6 cases and simple thrombectomy in 3 cases in order to obtain a satisfactory blood flow. Anastomosis was effected using the spleno-mesenteric confluence in 2 cases and the portal vein itself in other patients. Recurrent thrombosis occurred in the first 4 patients in the series, but it was only fatal in 2 cases. The paper analyses the data obtained from the study and in conclusion confirms the use of transplant in cirrhotic patients with portal vein thrombosis.

Adult↗
PubMed1986

Pharyngoesophageal transmucosal potential difference in normal subjects and in patients with peptic esophagitis.

Results of a study carried out on pharyngoesophageal transmucosal potential difference (PD) in normal subjects and in patients with peptic esophagitis are reported. Ten healthy individuals used as control group and 12 patients with peptic esophagitis were examined. In all the cases an electric junctional pharyngoesophageal zone was evidenced, characterized by increased negativity at the level of the upper esophageal sphincter between the pharyngeal and esophageal potential difference. No statistically significant differences were observed between the two groups as for the length of PD and its location, which was always shown to be included in the high pressure zone. In healthy subjects the pharyngoesophageal PD was -16.2 +/- 4.23 mV; in patients with peptic esophagitis PD was -25.4 +/- 8.51 mV. However, in the latter PD was shown to be higher than normal in 66% of cases (p less than 0.01). No correlation was evidenced between PD values and manometric alterations of the upper esophageal sphincter. On this basis, such alterations should not be related to possible mucosal injuries, as suggested by several authors, but most likely to a reflected or primary phenomenon, common to that causing the gastroesophageal reflux.

Esophagitis, Peptic↗
PubMed1985

[Behavior of the pressure of the lower esophageal sphincter after intravenous administration of domperidone in normal subjects].

Manometric studies on the action of domperidone 10 mg and 20 mg i.v. on the lower esophageal sphincter pressure (LESP) have been carried on ten healthy volunteers. Domperidone inhibits dopamine receptors and results in an increase of LESP. A dose of 10 mg produces a significant increase in LESP which is rapid and prolonged for thirty minutes; a dose of 20 mg is less efficient. The stimulatory effect of domperidone on LESP suggests an important role for endogenous dopamine as an inhibitory neuromodulator of LES pressure. The use of domperidone in therapy for reflux esophagitis is suggested.

Adult↗