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Biomedical subjects

V Ziparo

Publications and source records attributed to V Ziparo.

At least 55 records · Page 3Linked to original sources
PubMed1981

A randomized controlled trial of mesentericocaval shunt with autologous jugular vein.

After a large uncontrolled experience, in April 1976, a randomized clinical trial between side-to-side portacaval anastomosis and a mesentericocaval shunt with internal jugular vein interposition was initiated. Up to April 1979, 23 patients were operated upon with a mesentericocaval shunt and 26 with a portacaval anastomosis. With a mean follow-up time of 23 months, no statistically significant differences in terms of operative mortality, hepatic encephalopathy and long term survival were found between the two operations. Therefore, a mesentericocaval shunt does not appear to offer effective advantages compared with the portacaval anastomosis, and it should be performed in particular instances in which, for anatomic reasons, a portacaval anastomosis cannot be performed.

Adolescent↗
PubMed1979

Hyperammonaemia, plasma aminoacid imbalance, and blood-brain aminoacid transport: a unified theory of portal-systemic encephalopathy.

It is proposed that hyperammonaemia in liver cirrhosis or after portacaval shunt contributes to plasma neutral aminoacid imbalance and to increased activity of the blood-brain neutral amino-acid transport system. Plasma neutral aminoacid concentrations are deranged, partly, but not completely, because ammonia stimulates glucagon secretion; a high rate of gluconeogenesis and hyperinsulinaemia follow. Brain uptake of neutral aminoacids rises because ammonia stimulates brain-glutamine synthesis, which results in rapid exchange of brain glutamine for plasma neutral aminoacids. Hyperammonaemia therefore contributes to encephalopathy indirectly, by raising the brain concentration of neutral aminoacids which after neurotransmitter metabolism, rather than directly, by toxic effects on neuronal metabolism.

Amino Acids, Branched-Chain↗
PubMed1979

Brain tryptophan and the neoplastic anorexia-cachexia syndrome.

The cause of anorexia associated with neoplasia is unknown, and some investigators have suggested a central mechanism. Recent neurophysiologic studies have revealed the possible role of serotoninergic system involving tryptophan (TRP) and its indole neurotransmitter metabolites in regulating particular aspects of feeding behavior. We therefore studied plasma and brain factors affecting TRP transport through the blood-brain barrier (plasma free and total TRP, albumin, nonesterified fatty acids, plasma neutral amino acids, brain uptake index [BUI] for TRP) and central serotonin metabolism (5-HT, 5-HIAA) in young, anorexic rats bearing the Walker-256 tumor injected intramuscularly. Plasma free TRP, but not plasma total TRP, and, more important, brain TRP and brain 5-HIAA were significantly higher in tumor-bearing rats than in pair-fed control animals. The results suggest an association between altered brain TRP metabolism and feeding behavior in tumor-related anorexia.

Animals↗
PubMed1978

Alterations in plasma and CSF amino acids, amines and metabolites in hepatic coma.

The dog with an end-to-side portacaval shunt (PCS) has been extensively used as a model to investigate hepatic encephalopathy (HE) as it demonstrates a plasma amino acid pattern similar to patients with chronic liver disease. In adult mongrel dogs, the effect of PCS on plasma and CSF amino acids, octopamine (OCT), phenylethanolamine (PEA) and CSF 5-hydroxyindolacetic acid (5-HIAA), were studied. Moreover, the effect of correction of plasma amino acids by infusional techniques was investigated.Tyrosine, tryptophan and phenylalanine levels increased dramatically during the development of HE in plasma and CSF, while valine, leucine and isoleucine decreased in plasma only, but CSF levels remained stable. Plasma and CSF octopamine and phenylethanolamine and CSF 5-HIAA increased markedly as clinical features in the dogs' behavior, characteristic of hepatic encephalopathy occurred, including hypersalivation, ataxia, flapping tremor, somnolence and finally coma. Once in coma, the dogs were infused with an amino acid mixture (F080) calculated to normalize the plasma amino acid pattern. After one to eight hours, the dogs began to awake. Simultaneously, blood, and CSF aromatic amino acids returned to their control values, as did OCT, PEA and CSF 5-HIAA. If F080 infusion was stopped, biochemical alterations would appear within one week, again accompanied by clinical hepatic encephalopathy.The results indicate that the altered levels of aromatic and branched chain amino acids, octopamine and PEA in plasma and CSF correlate well with the development of HE and that correction of the plasma amino acid abnormalities improves encephalopathy simultaneously with correction of neurotransmitter derangements in CSF.

Amines↗
PubMed1978

Mesentericocaval shunt with the internal jugular vein.

Seventy-nine mesocaval shunts using the internal jugular vein and 54 side-to-side portocaval shunts have been performed during the past six years. Patients were evaluated from the stand-point of protection from recurrent bleeding, patency of the shunt, encephalopathy, rehabilitation and long term survival. All of the patients underwent follow-up observation. In a selected group of patients, postoperative angiographic control was performed, and serum levels of octopamine were examined. In the mesentericocaval group, patency of the shunt was demonstrated in 82 per cent, the incidence of encephalopathy was 35 per cent and the long term survival rate, as computed by the actuarial method, was 65 per cent. In the portocaval group, the incidence of encephalopathy was 54 per cent and the survival rate, 38 per cent. There was no correlation between octopamine serum levels and encephalopathy. Persistent perfusion of the liver was documented in 95 per cent of the patents controlled by arteriography in the mesentericocaval group with patent shunts. The mesentericocaval shunt seems to be an effective technique in terms of incidence of encephalopathy and survival rate, but a randomized study will be necessary to prove that this technique is more effective than the standard portocaval shunt.

Brain Diseases↗
PubMed1975

[Evaluation of hepatic encephalopathy in portacaval shunts and mesenterico-caval bypass with the jugular vein].

Data relating to 30 patients subjected to side-to-side porta-cava anastomosis and 30 to mesenterico-cava by-pass with the internal jugular vein are presented. At follow-up after a period of over 1 yr, encephalopathy was observed in 40% and 21% of the two groups respectively. Angiography of the coeliac tripod and superior mesenteric showed the existence of a post-operative hepatopetal flow in 80% of porta-cava cases. This incidence was only 30% in the mesenterico-cava group. The relation between the clinical and angiographic data is briefly discussed and neuropsychiatric findings in patients with a picture of hepatic encephalopathy are also presented.

Brain Diseases↗
PubMedDate not supplied

Total shunting and elective management of variceal bleeding.

A 20-year experience with treatment of esophageal varices in patients with cirrhosis is reported. Considering that total shunts are well tolerated immediately after operation (hospital mortality rate for all elective procedures being 6.4%), that they offer a good protection against rebleeding (rebleeding variceal rate of 7.6%), and that they offer the same long-term survival as given by other shunts (5- and 10-year survival rates of 57% and 31%, respectively), the authors affirm that these kinds of shunts are still useful in well selected cases. Late follow-up results of a prospective randomized trial of elective mesocaval shunts compared to portacaval shunt have shown no significant differences in operative mortality, rebleeding rates, encephalopathy rates, or survival. Based on this information, the authors currently use portacaval shunt as their operation of choice.

Actuarial Analysis↗
PubMedDate not supplied

Health care delivery systems: effects on surgical education in Italy.

Since 1989 a national health system (NHS) has been in effect in Italy based on the constitutional principle that health care is a right of all citizens. Until 1992 the NHS had a secondary role in medical education, as the 33 medical schools for postgraduate training are under the control of the Ministry of University. The European Community legislation allowing free movement of M.D.s and specialists between member countries has resulted in standardization of teaching programs and formative curricula in the European Community. Therefore beginning in 1992, every 3 years the Ministry of Health and University establishes the number of specialists that can meet the needs of the NHS and allocates funds to each school for the salary obligations. The actual number of paid residents for surgical specialties is 941 per year (192 for general surgery). Until recently surgical training in Italy was mainly theoretic, as no legislation guaranteed that physicians in training would perform surgery. New legislation, increased exchanges with European hospitals, and improved and loyal cooperation between universities and the NHS will certainly improve the situation in coming years.

Delivery of Health Care↗
PubMedDate not supplied

[Colorectal neoplasms in patients with ulcerative rectocolitis. Their surgical treatment and follow-up].

Patients with ulcerative colitis (UC), especially those with a long-term standing or severe disease, show a higher incidence of colorectal neoplasms. Dysplasia represents the most important risk-factor for malignancy in patients with UC. From 1989 to 1999, 71 patients with UC, were surgically treated at our Institution. Indications for surgery were: non responding disease or refractory bleeding in 61; pathologic evidence of severe dysplasia during endoscopic surveillance in 5 patients, evidence of a neoplasm in the remaining 5 patients. Operative mortality was 1.4%. Infections of the surgical wound has been the most common postoperative complication. In 4 cases pouchitis has been reported. In 7 patients because of progression of the proctitis a second surgical treatment has been made. When surgical treatment is indicated in the course of ulcerative colitis, several operations may be performed. In the large majority of patients, total colectomy, mucosectomy and ileal pouch-anal anastomosis is the procedure of choice.

Adenocarcinoma↗
PubMedDate not supplied

[Transverse minilaparotomy as an access route in right colon disease: a valid alternative to midline laparotomy].

AIMS OF THE STUDY: 1. To evaluate the feasibility and appropriateness of transverse right minilaparotomy for right colectomy and lymphadenectomy. 2. To identify the clinical advantages, if any, of this access route compared to the more traditional midline incision. PATIENTS: 44 patients with right colon adenocarcinoma undergoing colonic resection via a transverse or midline laparotomy. METHODS: The transverse incision starts 1 cm above the umbilicus, running from the midline to the anterior axillary line. RESULTS: 17 (39%) transverse minilaparotomies and 27 (51%) midline laparotomies were performed, respectively. The mean operative time was 107 min for patients with the transverse incision and 157 min. for those with midline laparotomy. Twelve out of 17 patients (70%) with the transverse incision experienced no or only mild pain as against 11 out of 27 patients (41%) with midline laparotomy. Bowel function was slightly faster in the first group of patients, though the difference was not statistically significant. Forty-seven percent of patients with transverse minilaparotomy were discharged within 8 days postoperatively as against 4% with midline laparotomy (P = 0.001). No major complications occurred in the first group, while 2 patients (7%) operated on via the midline laparotomy experienced complications (haemorrhage, deep venous thrombosis). CONCLUSION: Although this is a preliminary study in only 44 patients, our results support the idea that transverse minilaparotomy is a less traumatic access route to the right colon, in addition to offering an adequate exposure of the operative field, faster postoperative recovery and a shorter hospital stay. We believe it to be a good alternative to midline laparotomy for right colon surgery.

Adenocarcinoma↗
PubMedDate not supplied

[Intestinal endometriosis. Three new cases and review of the literature].

OBJECTIVE: The study was undertaken to identify some features of the intestinal endometriosis such as symptoms, helpful investigations, pattern of distribution and surgical management. PATIENTS: Three consecutive cases, observed during a sixteen month period, are reported. The most frequent symptoms were chronic pelvic and abdominal pain, dysmenorrhea, alterated bowel habit and menorrhagia. The diagnosis of intestinal endometriosis was incidental in all but one case admitted for an intestinal subocclusive syndrome in patient with a past history of pelvic endometriosis previously documented by laparoscopy. RESULTS: All patients presented a sigmoid localization of endometriosis with different degree of stenosis and underwent sigmoid resection, followed by a resolution of abdominal symptoms. DISCUSSION: Although the exact frequency of intestinal endometriosis is difficult to know because of the lack of specific symptoms and reliable investigations, it has been estimated that implants to the bowel may occur in 3%-37% of women affected by endometriosis. The sigmoid colon is the most common site of localization. The main symptoms are pelvic pain, dysmenorrhea, infertility and diarrhoea or constipation; rarely patients present bowel occlusion due to stenosis (less than 15% of the cases) or cyclic rectal bleeding. CONCLUSION: Generally, intestinal endometriosis is not suspected preoperatively in those patients without a past history of this condition; however an accurate diagnosis can be provided throughout laparoscopy, before open surgery. The hormonal therapy is not successful in alleviating moderate to severe obstructive symptoms. Thus surgery still remains the most effective treatment for advanced intestinal endometriosis.

Adult↗
PubMedDate not supplied

[Laparoscopic cholecystectomy. The beginning of a new era].

An important breakthrough in the field of general surgery, laparoscopic cholecystectomy (LC) offers significant advantages for patients. Major reasons for the rapid worldwide acceptance of this new surgical procedure is that patients experience reduced postoperative pain, ileus is virtually abolished, and the patient is able to leave the hospital the following day without a major abdominal scar. This appears to respond to patients' desire for less invasive approaches to the treatment of gallstone disease. LC is thus becoming the treatment of choice for symptomatic gallbladder disease. Its rapidly growing popularity is evident in Italy where many centers are offering LC routinely, in alternative to open cholecystectomy. A critical appraisal of this new technology is necessary, in light of recent data from centers presenting results and complications of large series of LCs. Adequate training of surgeons who will perform LC is also becoming a major concern. In this review the authors describe patient evaluation and selection for LC. Effective therapeutic strategies are illustrated, including the central, but nevertheless controversial role of endoscopic retrograde cholangiopancreatography (ERCP) as an approach to common bile duct lithiasis. Currently, LC should be performed in centers with the availability of an endoscopist with expertise in ERCP. Following the success of LC, other minimally invasive techniques will evolve in various surgical specialties. New generations of surgeons will thus have to familiarize with these emerging techniques while maintaining a critical attitude of evaluation.

Cholecystectomy↗