Electronic dental anaesthesia for third inferior molar surgery.

AIM: The aim of this study was to evaluate the efficacy of Electronic Dental Anaesthesia (EDA) for third molar surgery. METHODS: Third molar extraction under regional anaesthesia (inferior alveolar and buccal nerve blocks) was performed in 2 groups of 30 patients each: group 1 = controls, group 2 = EDA treatment. Anxiety and pain level were reported by means of Visual Analogue Scale, postoperative pain description with the McGill Pain Questionnaire. A postoperative phone interview to all patients was made. Computerized randomization was performed; values expressed as mean+/-SD, data comparison evaluated by means of ANOVA and chi squared, statistical significance indicated by P values <0.05. RESULTS: Features of the patients and surgical interventions were similar. EDA has determined lower pain level; moreover, the control patients has shown higher values of blood pressure and heart frequency. Phone interview has reported no amnesia about the perioperative events. A smaller number of EDA treated patients has reported pain during needle prick and/or intraoperatively; 80% of the EDA treated patients has reported a good opinion about the treatment, 93% of the patients would repeat the treatment, if needed. CONCLUSION: EDA is a complementary analgesic technique for dental surgery. Cardiovascular changes, frequently observed during third molar extraction, were not present in the EDA treated patients. These data confirm that EDA is able to modify the physiologic responses to stressful events, blunting the adrenergic upset, maybe by means of an analgesic action on A, fiber and an increase of endorphins' central level. These results underline that the complementary use of EDA in the third molar extraction may be better than regional anaesthesia alone.

Treatment of esophageal achalasia with laparoscopic Heller myotomy and Dor partial anterior fundoplication: prospective evaluation of 100 consecutive patients.

In this article we report our experience in 100 consecutive achalasia patients who were treated with laparoscopic Heller myotomy and Dor antireflux fundoplication, with particular regard to the technical problems encountered, the learning curve, and the long-term follow-up. The operation was completed laparoscopically in 94 patients, with a median operative duration of 150 minutes, and a continuous steady reduction in the operating time from the first patients to the last. In six patients the operation was completed through "open" access. Postoperative complications were recorded in six cases. Follow-up was completed in all 100 patients, with a median follow-up of 24 months. Overall, actuarial life-table analysis showed a probability of 90% that patients would be symptom free over a 5-year period. Radiologic assessment showed a significant reduction in the esophageal diameter, and manometry showed a significant reduction in the lower esophageal sphincter resting pressure and residual pressure. Twenty-four-hour pH monitoring showed postoperative reflux in 6.9% of the patients. Persistent dysphagia or chest pain was reported by eight patients, which constituted treatment failures. Seven of these eight patients were eventually treated with multiple pneumatic dilatations, which were successful in six cases. It was concluded that laparoscopic Heller myotomy with Dor fundoplication is a feasible and effective treatment for achalasia, with an actuarial success rate of 90% at 5 years.

Esophageal achalasia: laparoscopic versus conventional open Heller-Dor operation.

BACKGROUND: The laparoscopic treatment of esophageal achalasia has recently been introduced, and the occasional reports in the literature seem to indicate considerable advantages for patients in terms of surgical trauma, postoperative discomfort, and appearance. As yet, however, no studies have directly analyzed the benefits and shortcomings of the new surgical technique by comparison with the conventional open procedure. The objective of our study was to review recent experience with the laparoscopic Heller-Dor operation (LAP-HD) at the Department of Surgery of Padua University and compare it with the traditional open Heller-Dor procedure (OPEN-HD) to assess early effectiveness in patients with primary esophageal achalasia. PATIENTS AND METHODS: The records of 17 patients who had LAP-HD and a matched group of 17 patients who had OPEN-HD were retrospectively reviewed. The duration of procedures, morbidity, several aspects of the postoperative course, and hospital costs were recorded and compared. Results of clinical follow-up and of manometric and pH-monitoring studies performed 6 months postoperatively were also evaluated in both patient groups. RESULTS: LAP-HD took longer than OPEN-HD (mean 178 versus 125 minutes). There was no mortality or major morbidity in either group. Postoperative pain and ileus and need for IV nutrition lasted a shorter time for LAP-HD patients (P < 0.0001). Consequently, the median postoperative hospital stay and the median interval before returning to normal activity were also shorter (4 and 14 days for the LAP-HD group versus 10 and 30 days for the OPEN-HD group, P < 0.0001). During follow-up, dysphagia recurred in 1 patient of the LAP-HD group and gastroesophageal reflux was registered in 1 patient of the OPEN-HD group. Lower esophageal sphincter pressure decreased significantly after both procedures. CONCLUSIONS: Laparoscopic management of achalasia leads to short-term results comparable to those of the well-established open technique. In view of the less severe surgical trauma and lower hospital cost, the laparoscopic approach is preferable, but long-term studies are needed.

The surgical treatment of cancer of the cervical esophagus: complications and preliminary results.

Out of 129 cancers of the cervical esophagus, 74 (57%) were resected. After laryngopharyngectomy and segmentary esophagectomy, the reconstruction was performed by substernal coloplasty in 18 cases and by free bowel autotransplantation in 18. When total esophagectomy was performed, pharyngogastroplasty was performed in 32 cases and pharyngocoloplasty in seven. The total postoperative death rate was 18.9%. In cases of segmentary resection the three-year survival rate was 14.34% and 15.87% in cases of total esophagectomy.

[Cytological studies in diagnosis of cancer of the esophagus]. / Indagine citologica nella diagnostica del cancro dell'esofago.

The importance of exfoliative cytology in the diagnosis of cancer of the oesophagus is stressed. The examination uses a straightforward, economical technique and, in association with traditional investigations, offers diagnostic positivity of close to 100%. The interest in exfoliative oesophageal cytology does not derive solely from its confirmation of clinically certain oesophageal cancer, but from the fact that it offers early diagnosis outside of dysphagic symptomatology. Its field of use is thus extended and it proves to be a complementary but indubitably useful technique for diseases of the oesophago-gastric tract, particularly in those presenting high cancerization risk. Its use is therefore recommended for the screening of oesophageal cancer.

[13 cases of double neoplastic localizations, 1 involving the esophagus]. / Considerazioni su 13 casi di doppia localizzazione neoplastica di cui una interessante l'esofago.

During the course of nine years 494 patients suffering from oesophageal cancer have come under our observation, including 13 cases characterised by the phenomenon of double neoplastic localisation. In some cases, in view of the histological identity of the two neoplasias, remote endocanicular colonisation may be presumed, while in other cases the rise of the tumour "disease" may be correlated with the action of carcinogenetic agents on sites of lesser resistance in organisms whose immunitary defences have been decreased in relation to neoblastogenesis. This is supported by the increase in the incidence of malignant neoplasias in patients subjected to immuno-suppressive treatment.

[Primitive gastric lymphoma: considerations in 3 cases (author's transl)]. / Il linfoma gastrico primitivo (considerazioni su 3 casi).

The authors describe three cases of primitive lymphoma localized in the stomach. All three were diagnosed with precision only after surgery and histological examination of removed tissues: two were histiocytic malignant lymphomas and one was a malignant lymphoma with poorly differentiated lymphocytic elements. From the ensuing discussion of the diagnosis and prognosis of this malignancy it emerges that the long-term results are better than those pertaining to gastric adenocarcinoma.

[The prognosis in patients with esophageal cancer: statistical study in relation to age, histotype, tumor stage, and immunological reactivity]. / La prognosi nei pazienti affetti da cancro esofageo: studio statistico in relazione ad eta, istotipo, stadio tumorale, reattivita immunitaria.

This paper analyses the prognostic factors in cancer of the oesophagus in relation to site, histological type, age, and the patient's immunitary reactivity evaluated histologically in the lymphonodes and the tumoral tissue itself, and the invasion or otherwise of the loco-regional lymphonodes. The survival curves are calculated by the actuarial method. In particular, it was seen that patients with absence of peritumoral lymphocytic infiltrate and depletion of the loco-regional lymphonodes present a survival curve stopping at the second year after the operation, whereas reactive patients survive beyond that date in 29% of cases. It may therefore be asserted that the presence of lymphocytic infiltrate in the tumour and of lymphonodal reactivity are a pointer to an attitude of defence of the organism, and the importance of the study of these factors as prognostic criterion in patients subjected to resection of the oesophageal tumour clearly emerges.

[Anastomotic stenoses correlated with the use of mechanical staplers in the surgery of esophageal cancer]. / Le stenosi anastomotiche correlate all'uso delle suturatrici meccaniche nella chirurgia del cancro dell'esofago.

From 1990 to 1995, 187 patients underwent esophagectomy and esophagogastrostomy with the anastomosis performed inside the chest using a circular stapler. Twenty-three patients (12.3%) developed an anastomotic stricture. The incidence of anastomotic stricture was inversely related to the diameter of the stapler. Also concomitant cardiovascular diseases, morpho-functional disorders of the tubulized stomach (possible related to duodeno-gastric reflux) and neoadjuvant chemotherapy were recognized as significant risks factors. Endoscopic dilations were safe and effective in the treatment of anastomotic strictures.

In vivo activation of renal phospholipase activity by bradykinin in the rat.

Activation of a renal acylhydrolase by bradykinin (BK) with subsequent release of prostaglandins precursor arachidonic acid has been postulated but not yet demonstrated. BK was infused into the left artery of 27 rats which were subdivided into 9 groups according to BK concentration (10, 100 and 1000 ng/min) and time of infusion (20, 40 and 60 min). The rats were then sacrificed and the left to right ratio of renal phospholipase activity was determined. The data obtained were processed by a factorial analysis of variance which allowed the effect of BK and the time of infusion to be evaluated independently as well as interdependently. The results of the statistical analysis showed that phospholipase activity depends on both BK dosage and infusion time and that there is no interaction between dose and time. These findings offer evidence for the "in vivo" activation of the kidney phospholipase activity by BK.

Anastomotic stenoses occurring after circular stapling in esophageal cancer surgery.

BACKGROUND: Circular staplers have reduced the incidence of anastomotic leaks in esophagovisceral anastomosis. However, the prevalence of stenosis is greater with staplers than with manual suturing. The aim of this study was to analyze potential risk factors for the onset of anastomotic stenoses and to evaluate their treatment and final outcome. METHODS: Between 1990 and 1995, 187 patients underwent esophagectomy and esophagogastrostomy with anastomosis performed inside the chest using a circular stapler. RESULTS: Twenty-three patients (12.3%) developed an anastomotic stenosis. The incidence of strictures was inversely related to the diameter of the stapler. Concomitant cardiovascular diseases; morphofunctional disorders of the tubulized stomach, such as those related to duodenogastric reflux; and neoadjuvant chemotherapy were also recognized as significant risk factors. Endoscopic dilatations proved safe and were effective in the treatment of most anastomotic stenoses. CONCLUSIONS: To reduce the risk of anastomotic stenosis after stapled intrathoracic esophagogastrostomy, adequate vascularization of the viscera being anastomized should be maintained, and it is mandatory to use the largest circular stapler suitable. Furthermore, it is essential to reduce the negative inflammation-inducing effects of duodenogastroesophageal reflux to a minimum. Endoscopic dilatations are safe and effective in curing the great majority of anastomotic stenoses.