Search

The authors analyse the results relating to the use of a technical variation of entero-enteroanastomosis preparation in the reconstruction of the continuity of upper digestive tract with a defunctionalised Roux en Y loop. This variation includes the use of a circular Proximate ILS mechanical stapler. The series examined, operated during the period June 1993 to November 1994, includes a total of 57 patients, of which 51 with gastric neoplasia. 43 cases underwent total gastrotectomy with R1-R2 lymphoadenectomy and 8 cases underwent gastroresection; a further 3 emergency operations were performed for benign pathologies responsible for upper digestive tract hemorrhage. Moreover, in the 3 remaining cases 2 cysto-jejunal derivations for pancreatic pseudocysts were also performed using the same method, together with 1 hepaticojejunostomy secondary to calculosis of the common hepatic duct. Attention is focused on the analysis and description of the operating technique in order to identify the basic key stages as accurately as possible. In conclusion, the authors indicate that, in view of the excellence of results and the simple and rapid technical execution of this entero-enteroanastomosis, the use of this method was amply justified and undoubtedly advantageous both for surgeons and patients.

Acute, severe injury of the rabbit spinal cord, induced by the weight-drop method, causes alterations of the enzyme activities related to cholinergic and energy metabolism. Morphological examinations at the trauma site show degenerative processes in neurons 0.5 hr posttrauma and a marked decrease in the number of living cells 24 hrs later. Both biochemical and cytochemical findings show that the tissue metabolic and morphologic derangement, caused by severe spinal cord injury, is mostly confined to the gray matter at an early stage (0.5 hr), whereas 24 hrs later the white matter is also involved. The decrease in choline acetyl-transferase and acetylcholinesterase activities in the gray matter parallels the impairment of complex IV (cytochrome c oxidase) of the respiratory chain and the presence of morphological alteration in neurons. The dramatic drop in the enzyme activities, observed 24 hrs after the induction of the severe trauma is clearly associated with the loss of cells.

Just because a patient has reached a certain age does not necessarily mean he or she requires specific treatments. This will vary depending upon the patient's general history, his or her oral hygiene, general health and diet. It is important to avoid stereotyping seniors: they all have different medical backgrounds, different lifestyles and different needs.

Amyloid goitre, defined as diffuse hyperplasia of the thyroid due to infiltration of amyloid substance, has been rarely reported as in confirmed by the latest reviews of the literature. This paper reports the case of a 23-year-old patient with a long history of systemic amyloidosis probably secondary to a Mediterranean fever with diffuse lymphoadenopathy, hepatosplenomegaly and chronic renal insufficiency, who was referred to our attention due to a struma which had increased in volume over the past few years. Aspirated needle biopsy showed the presence of amyloid and the patient underwent total thyroidectomy; the histological test confirmed amyloid struma. The postoperative evolution was normal and characterised by a slight but transient deterioration of renal function. The authors stress the importance of cytological tests using aspirated needle biopsy under polarised light and after Congo Red staining; this is the only test which enables a preoperative diagnosis to be made, thus conditioning the choice of surgery, even if full thyroidectomy is almost certain given the size of the goitre and the systemic pathogenesis of amyloidosis.

Penetrating cranio-cerebral trauma caused by fire-arm constitute the most frequent penetrating wounds in civilian ambit; in these cases the great extention of cerebral damage is the result of distructive forces generated by high velocity which moves this bodies. In civilian ambit cranio-cerebral wounds caused by penetrating bodies, but moved by low cinetic energy are increasing constantly, due to the development of industrial activities. The cases reported in literature are few; in the present paper we present the case of a cranio-cerebral wound caused by a nail, which is the longest nail ever reported in literature (9 cm). Cranio-cerebral penetrating wounds caused by nail are reported only as curious experience; none authors tried to standard the medical-surgical approach as for what concern the clinic valutation, as for treatment. We think that for these traumatic event, we can adapt the same valutations criteria used for wounds caused by fire-arms. For what concerns surgery of such injuries, we consider the emergency operation the best solution; generally in these cases the purpose of surgery is not the removal of devitalized tissues, evacuation of hematomas or removal of bone fragments or of penetrating bodies as happen in cases of penetrating bodies moved by high cinetic energy, but for the possible complications which can result immediately or after the trauma.

This paper reports on the pharmacotherapy and long-term follow-up of a child treated with clozapine. It is one of the earliest American experiences with this agent in children to date. Clozapine was relatively effective and safe in this patient. Additional features of the case are the early social and developmental delays preceding schizophrenia, the response of symptoms of childhood-onset schizophrenia to clozapine, and the reduction in tardive dyskinesia symptoms while taking clozapine. Compared to recommendations for dosing adults, a slower rate of increasing clozapine doses was important for this child. For future reference, the protocol and consent form used for this course of treatment are included.

Clinical and nutritional follow-up was performed in 96 patients who had undergone total gastrectomy. We studied the incidence of clinical complications and alterations of nutritional parameters in those patients who had undergone curative resection and were alive and free of neoplastic disease 1 year (36 patients) and 2 years (26 patients) after operation. We observed a very low incidence of late complications, and nutritional parameters, 1 year and 2 years after operation, were normal in almost all the patients. We obtained these results because we performed a Roux en Y esophagojejunostomy using an at least 60 cm-loop; we also adopted a strict and rigorous follow-up, able to guarantee an adequate daily calorie intake. In fact, a close relationship between calorie intake and the variations of nutritional parameters was observed.

Prompted by several cases of barium peritonitis of their own observation, the authors review the literature on the subject and outline the more common etiopathogenetic factors involved and gross and histological aspects of the disorders. After describing their own four cases of barium peritonitis, the authors outline some basic principles for the prevention and treatment of this rare complication.

With the study of two families in treatment we can see the roles that each one gets, and the functions that the psychotic assumes. Because the family has a particular story, a lot of myths appear and the interpretation is the hermeneutic method which serves to explain them. This fact is very important because some of those myths show the pathologic unconscious of the family. Through the myths, the family expresses the values, the credences, the familiar ideology and the ideals, which generally are neither possible, real nor concrete. To consider the clinic material, we start from the description of a pathological family and we continue with the theoretical approximation of Pichon Riviére: the antipsychiatry, the structuralism and the theories about the communication of Palo Alto. Then, we arrive at universal situations about the roles in the psychotic's family: fixation and immobility, stereotypy and aupplementarity, double vinculum situation, the family gives up modifying the structure and the patient who assumes the family pathology is almost permanently disqualified. There is a downfall in the identity of the psychotic mainly because the father's function is perverted (in both families, the father appears as "powerful" and considered in society, but disqualified in the family).

Ten cases of abdominal internal hernia observed at the Niguarda Hospital Emergency Surgery Division, Milan, during the period 1969-1978 are described. Even though it is extremely uncommon, this form must be kept in mind in the course of differential diagnosis when the picture includes: typical and striking symptoms of ileal strangulation, radiographical evidence of marked distension of the ileal loops with hydro-air levels, and a negative history of abdominal surgery.

The authors describe a truly uncommon case of internal abdominal hernia attributable to malformation of the falciform ligament. The patient, a man aged 26, had complained in the past of cramping pain in the epigastric region, usually occurring after meals and sometimes ending with vomiting of ingested food; but all diagnostic methods and procedures had consistently ruled out any extant pathology of the stomach, duodenum, biliary tract, or pancreas. Present hospitalization was justified by a clinical picture suggesting peritonitis from perforated gastric or duodenal ulcer. At operation the authors found a strangulated loop of small intestine following left-to-right migration through a hole in the falciform ligament of the liver. In the authors' interpretation the background cause of the trouble was incomplete development of the falciform ligament, and the immediate cause of the acute episode was abnormal motility and exaggerated peristalsis of the ileum, possibly due to the presence of a diverticulum; the latter two conditions are invoked as a possible explanation for the repeated episodes of abdominal pain in the patient's history.

A 3 years old girl presented with clinical feature of an acute hepatitis-like illness, with jaundice, hepatosplenomegaly, high alanine aminotransferase activity (ALT) and high gamma-globulin values. We were able to demonstrate high titre of anti-liver-kidney microsome antibodies type 1 (LKMA1) in the serum of this patient using immunofluorescence, ELISA (Enzyme-linked immunoabsorbent assay) and Western blot (WB) analysis. This observation together with the liver morphology and after excluding other possible causes of hepatitis established the diagnosis of chronic active hepatitis associated with anti-LKM1 antibody. Immunosuppressive therapy was therefore started immediately.