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Biomedical subjects

V Violi

Publications and source records attributed to V Violi.

At least 19 recordsLinked to original sources
PubMed1992

[Elective and emergency diagnostic laparoscopy].

A report is presented concerning 31 patients treated by laparoscopic approach under both elective and emergency conditions. The mini-invasive approach to an abdominal disease allows both the making of a direct visual diagnosis and the carrying out of biopsy or actual therapy without the need for laparotomy. Elective diagnostic laparoscopy has proved efficacious in the screening of patients affected by abdomino-pelvic neoplasms, determining the extension of the latter, staging them and judging their operability. Under emergency condition this method lends itself in particular to the study and the treatment of some cases of traumatic haemoperitoneum, intestinal obstructions resulting from adhesions and peritonitis of dubious aetiology. Explorative laparoscopy thus constitutes a valuable diagnostic and therapeutic aid, its possibilities being destined to increase with the improvement of laparoscopic techniques.

Adolescent↗
PubMed1992

[Videolaparoscopy and conservative treatment of splenic injuries].

The treatment of lesions due to blunt abdominal trauma has changed considerably in the last decade. With a view to the prevention of immediate and later complications of splenectomy, conservative surgical technique have been put forward, or else, when the haemodynamic conditions of the patient permit, techniques of non-operative monitoring of splenic lesions. Laparoscopy today constitutes an approach to the diagnosis and treatment of blunt abdominal trauma which decisively favours conservative treatment. The experience presented bears witness to the potential usefulness of laparoscopy in these cases. Technological progress will widen the possibilities of this method and more detailed studies will define its exact indications.

Abdominal Injuries↗
PubMed1990

[Emergency aneurysm of the abdominal aorta in a general surgery department].

We reviewed 26 consecutive patients from 1.1.81 to 30.6.89, 21 males and 5 females, mean age 72 (+/- 6.7) years, range 51-81, admitted and operated on for ruptured (19 cases) or leaked (7) abdominal aortic aneurysm in a general surgery unit at the University of Parma. Since we deal mainly with gastroenterologic and oncologic surgery, emergency operations were 70.2% of the overall series of aortic aneurysms, and were carried out over an actual 776 day period of emergency admission service. Nineteen patients had shock, ten being already anuric. Ultrasounds were carried out in nineteen cases, with an accuracy of 91.6% for ruptured and 57.1% for leaking aneurysms. Mortality rate, 50% was significantly related to the number of perioperative blood transfusions and anuria, which express the degree of shock and blood loss. Operative results were similar to other major series. A successful approach and management of aortic ruptured aneurysm is an uncommon challenge even in non-specialized surgical units. A vascular surgical training is therefore necessary for general surgeons.

Aged↗
PubMed1990

[Current status of the surgical treatment in colorectal carcinoma].

The Authors take into consideration some topical subjects, with reference to their own experience. The percentage of patients diagnosed as having localized disease, despite improvement in diagnostic techniques, has not changed over the last decade. In local recurrences without distant metastases, surgery is the sole treatment which may improve the survival. Resection however has to be thought over, since surgery of local recurrences may be considered as curative only in a few cases and the probability of a poor result in survival and quality of life does not justify a surgical procedure when it is associated with a high operative risk. In cancers of the middle 3rd and lower rectum, staplers have favoured the choice of anterior resection, which does not show a high rate of recurrences, when compared to abdominoperineal excision. At last, progress in surgery, anaesthesiology and intensive care determined a different therapeutical attitude in the aged, either due to a lower incidence of postoperative complications, or because life expectancy in the elderly seems to justify, whenever possible, a curative procedure.

Age Factors↗
PubMed1989

Automated selection of high-risk patients with acute pancreatitis.

One hundred six early features were retrospectively collected on 44 patients with acute pancreatitis and stored in a database programmed on a microcomputer. Intraoperative/autopsy findings or clinical course categorized patients as having severe (n = 16) or mild (n = 28) pancreatitis. The frequency of 88 early available variables was analyzed. Twenty significant differences were found and used to program a Bayesian prediction of severity, assuming their independence. The computer's performance was assessed by retrospective testing of the patients, and a further 47 (14 severe, 33 mild) were studied prospectively, with a comparison carried out involving the unaided prediction of the clinicians. Finally, all 91 patients were retrospectively tested with the early predictive Ranson's signs and the results were compared with the computer's output. In the prospective evaluation, the computer's performance was 89.4% accuracy, 100% sensitivity, 84.8% specificity, while that of the physicians was 65.9%, 71.4%, 63.6%, respectively, like the performances of Ranson's criteria. Methodologic problems were: selecting patients to study, based on wide inclusion and exclusion in hindsight of the false-positives; dividing them into groups, based on both pathologic and clinical criteria; and the assumption of independence within the variables. The use of the procedure in other populations requires a specific analysis of the discriminant variables, but this study suggests a method to compare several samples of patients which allows prospective and controlled clinical trials.

Acute Disease↗
PubMed1989

[Clinical implications of the infiltration level of early gastric cancer].

Sixty-nine cases of early gastric cancer (EGC) were taken into consideration, out of a series of 585 operations for gastric cancer, carried out between January 1976 and June 1988. Differences between two groups (I: EGC limited to the mucosa; II: EGC with invasion of both the mucosa and submucosa) have been assessed with reference to familiarity for gastric cancer, previous gastric and duodenal pathology, symptoms, site of the lesion, histological features, lymph node metastatic involvement and results. Despite some pathological and clinical differences, modification of current surgical treatment with endoscopic management is not justified by any features, even when dealing with intramucosal, intestinal type EGC, because of possible lymph node involvement or long-term recurrences.

Aged↗
PubMed1988

[Systems assisting decisions in clinical medicine].

There are numerous systems and computerized procedures which have been developed and tested as a guide to clinical decisions. The methods used in the development of these systems can be divided into two large groups: mathematical and logical. None of these can be considered as better than the other in absolute, but the efficiency of each system depends on that problem is to be described and solved. The mathematical methods seem more suitable in the description of biological systems and for the selection of groups which have discriminant and sufficiently defined characteristics. Meanwhile the logical methods are better in the description and the formalization of more complicated clinical problems, characterized by uncertainty and availability of more or less numerous alternatives. It is foreseen that in the next years the systems for aided decision making will be programmed making use of methods belonging to both categories, and particularly, the expert systems will be planned using both artificial intelligence techniques and mathematical and statistical methods. The increasing frequency in the use of such systems in clinical practice will cause a reevaluation and a checking of most aspects of medical proceedings, as seen by the new methodologies or the traditional methods whose use could be driven by computer.

Algorithms↗
PubMed1988

[Efficacy of a low-residue diet in the prevention of immuno-nutritional changes caused by the preparation of the colon for surgery].

Twenty-four patients about to undergo colorectal resection for cancer were randomly divided into two groups of 12: A and B. All had an uninterrupted colonic preparation for colonoscopy and surgery involving dietary restrictions for 4-8 days (450 calories; 25 g. proteins daily). In the group B an additional intake of 1200 Kcal. and 32 g. protein daily was given by a low-residue diet. Body weight, lymphocytes, albumin, prealbumin, C3, C4 and Complement activity (CH100) were evaluated on admission and after bowel preparation. In group A statistically significant decrease were found in all the parameters. In group B significant reduction occurred only in C4. The data confirm a relationship between immuno-nutritional state and preparation for colonic surgery, and suggest that a preoperative nutritional support may avoid or limit bio-humoral changes, indicative of an immuno-nutritional impairment.

Aged↗
PubMed1988

[Personal case series of intrahepatic lithiasis].

Fifteen cases of intrahepatic lithiasis are reported, on 1798 operations for non malignant diseases of the biliary tract (0.8%), carried out by the Authors in the last 11 years. Two cases were described separately, consisting respectively of an "eastern" hepatolithiasis, and a secondary form, due to stenosis of a choledochoduodenostomy, which had been performed after surgical injury of the common bile duct. The other 13 patients had a "mixed" form. Jaundice was present in 8 of these cases, cholangitis in 4. Intrahepatic stones were diagnosed preoperatively in 3 cases and intraoperatively in 10. A bilioenteric anastomosis was carried out in 9 cases, a sphincteroplasty in 3, and a T-tube drainage in a patient with suppurative cholangitis. Two patients died postoperatively, both from sepsis: the first in the early postoperative phase, after emergency operation for cholangitis; the other, with "primitive" hepatolithiasis, 3 months after the operation. Clinical results are satisfactory after 1-11 years. On the basis of data from current literature, diagnostic and therapeutic aspects are set forth, with specific reference to the mixed and secondary forms: the bilioenteric anastomoses seem to give better chances of success, but the need to have access to lobar ducts may sometimes impose hilar derivations. Spincteroplasty may have a few indications, solely in selected patients.

Adult↗
PubMed1987

[Research on correlations between immuno-nutritional parameters and oncologic stage in patients operated on for cancer of the stomach].

A correlation was sought, in 40 patients operated on for gastric cancer, between a number of immunological and nutritional variables and oncological stage. Prealbumin, transferrin, C3, C4, total complement (CH100), total serum lymphocytes, IgG, IgA and IgM were evaluated preoperatively prior to commencing any nutritional treatment. Statistical analysis was performed with a view to assessing whether the values of the above-mentioned parameters, taken singly or as a whole, differed in the 4 in the 4 oncological stages (UICC 1978). Analysis of individual parameter values showed a significant difference between stage I and stage IV with regard to prealbumin and between stages I and II with regard to C3 (p = 0.0165 and p = 0.0329, respectively). When evaluating the 9 parameters as a whole, no significant differences emerged, though such differences might be detected on increasing the study population and by adopting statistical procedures aimed at eliminating the least significant variables from the model.

Aged↗
PubMed1986

Early decrease in total hemolytic complement activity (CH100) after fasting or intestinal bypass in the rat.

An evaluation of total hemolytic complement activity (CH100) after fasting or intestinal bypass was performed in rats. The experiment lasted 6 days. Three groups, of 5 animals each, were studied. On the 1st day, basal values of total complement (TC), albumin and body weight were determined. Group A received normal, ad libitum feeding, group B started on a 'water only' diet, group C underwent intestinal bypass. On the 4th and 6th day the parameters were assessed. TC mean values were significantly lower in groups B and C, as compared to group A, on the 4th as well as on the 6th day (p less than 0.01 by Mann-Whitney's U test). Body weight showed a similar trend. Differences in albumin were never statistically significant. Limitations of the analytical method are discussed. The data show that fasting or bypass-induced malabsorption may determine an early decrease in total hemolytic complement activity, though a development of an immune deficiency is not proved.

Animals↗
PubMed1986

Effect of perioperative somatostatin administration of sphincteroplasty-induced increase of amylase.

Twenty patients undergoing sphincteroplasty for cholelithiasis were randomly divided into two groups of 10. The former (T) were treated with a 4-h somatostatin intravenous drip (250 micrograms/h), started at the beginning of operation, while the latter (C) made up the control group. Serum and urine amylase, amylase creatinine clearance ratio, and liver function tests were assessed for 2 days before surgery, after the operation and for a period of 5 postoperative days. Homogeneity between the two series was verified in experimental conditions. Statistical differences occurred postoperatively in amylase creatinine clearance ratio, which proved higher in C group, and gamma-GT, which was higher in T group. Short-term somatostatin administration proved effective in reducing the postoperative amylase creatinine clearance ratio, although more evident results are reported after long-term administration. Cholestasis or any serious impairment in liver function did not occur, suggesting the suitability of somatostatin use even in patients with jaundice. Since a relationship between postoperative amylase levels and risk of pancreatitis has not yet been proved, the value of somatostatin in the prevention of postoperative pancreatitis after sphincteroplasty needs to be further verified.

Aged↗
PubMed1986

Early detection of necrotizing pancreatitis by computer.

In 59 patients admitted with a clinical picture compatible with acute pancreatitis, 88 features, recorded within the first day, were retrospectively collected and stored in a database programmed on a NCR DM V personal computer. On the basis of the final diagnosis, the patients were divided into two groups, according to Becker's grading of acute pancreatitis. A third group comprised the false-positives. Using 14 significant differences (p less than 0.025) between the three groups, a Bayesian analysis was programmed for early prediction, in terms of percentage probability, of each of the three final diagnoses. A retrospective assessment of computer performance was carried out in the patients entered the initial database, and further 38 underwent a prospective test. In the detection of necrotizing pancreatitis the procedure gave 95.8% accuracy, 91.9% sensitivity and 98.3% specificity. Previous diagnosis of pancreatitis, estimate of the degree of necrosis, data to be used for the processing, are discussed. Performances, similar in retrospective and prospective series, proved higher as compared to diagnostic peritoneal lavage. Comparison with Ranson's multiple criteria or computed tomography is inappropriate. The system seems to be reliable feasible and adaptable. The choice of treatment is difficult in acute pancreatitis. A computer-aided analysis may provide a better approach, than an unaided clinical estimate, to several decisional problems in acute pancreatitis.

Acute Disease↗
PubMed1985

[Colon-rectal anastomosis with mechanical sutures (personal experience in 96 cases)].

From 1 October 1981 to 30 September 1985 ninety-six patients underwent colorectal resection with EEA Auto-suture stapled anastomosis for cancer or diverticula. As compared with manual suture, the mechanical procedure involved some technical problems and peroperative drawbacks (partial leakage, hemorrhage), which decreased after the initial phase of our experience. The EEA Stapler proved a reliable and useful procedure, especially in low colo-rectal anastomoses, which present a higher risk of leakage, owing to difficulties with manual technique. Clinical or x-ray fistulas occurred in four patients after colon-to-colon (5.8%) and were six following colorectal anastomoses (22.2%). Only in three cases a colostomy was necessary. In spite of suitability of the mechanical procedure, a colostomy was carried out to protect low colo-rectal anastomoses, when general risk factors were present or when the suture was improperly performed or transection circles were incomplete. The introduction of the EEA Stapler allowed for a higher number of anterior resection of the rectum, with a corresponding decrease of abdominoperineal procedures, and promoted a more extensive indication to palliative anterior resection. It is still a matter of concern whether the high number of anterior resections would be followed by an increased local recurrence rate, in consideration that radicality depends on a wide exeresis with a complete lymphoadenectomy.

Aged↗
PubMed1985

Metabolic, water and electrolyte changes after moderate surgical trauma. Observations after different schedules of parenteral nutrition.

The effects of a moderate surgical trauma on body composition, in conditions comparable to fasting were assessed in a balance study. Two groups of patients under normal nutritional conditions were compared after cholecystectomy. The patients underwent for three days the following schedules of parenteral therapy: incomplete nutrition with balanced intake of water, sodium and potassium but carbohydrate deficient and lacking in amino acids (group 1, 10 cases); or complete nutrition with respect to calories, amino acids and other electrolytes (group 2, 9 cases). An evident loss in body weight was observed in patients undergoing incomplete nutrition, not justified by a moderately negative water balance. Statistical comparison of the two groups showed equal or positive balances for group 1 while group 2 gave negative results for all the parameters, particularly for nitrogen and potassium, suggestive of a loss in lean body mass greater than that usually occurring after simple fasting. Results confirmed the poor significance of serum values in expressing even significant degrees of electrolyte depletion. Substantial modifications in body composition may appear as clinical manifestations in cases with pre-existing malnutrition or when drugs that affect or are affected by the water and electrolyte balance are administered.

Adult↗