Radioguided occult colonic lesion identification (ROCLI) during open and laparoscopic surgery.

AIMS AND BACKGROUND: Intraoperative localization, during open and laparoscopic surgery, of small, nonpalpable colonic lesions located at peculiar sites or with concurrent inflammatory bowel alterations (diverticulosis, perivisceritis) is often difficult. The aim of our work was to assess the validity of radioguided identification after preoperative labeling. METHODS AND STUDY DESIGN: Patients who were candidates for colon surgery for occult lesions that, because of their size and location, were assumed to be difficult to detect, underwent colonoscopy 1 to 2.5 hours before surgery. A small dose of labeled albumin macroaggregates was injected with a sclerotherapy needle into the subserosa underneath the lesion. Immediately following the injection the lesion was identified with a transcutaneously placed gamma detecting probe. Intraoperative tracer detection was performed either during open surgery or by means of a laparoscopic probe (detection time 3-5 mins). The position of the lesion was marked with a suture or with a clip. Surgery was performed according to the type of lesion to be treated. RESULTS: In our initial clinical experience 15 colon lesions were preoperatively marked in 14 patients and were subsequently detected during surgery (four under laparoscopy) with a gamma detecting probe. This technique allows highly accurate, fast, and inexpensive surgical localization of lesions without irradiation and without complications. CONCLUSION: Our experience shows that preoperative endoscopic marking of nonpalpable colon lesions with 99mTc-labeled albumin macroaggregates followed by intraoperative detection with a gamma probe is a useful clinical method that is highly accurate and without complications.

[Doppler ultrasonography in the diagnosis of diseases of the supra-aortic trunks]. / L'ultrasonografia doppler nella diagnostica delle affezioni dei tronchi sovraaortici.

Systematic examination of the upper aortic arch vessels by direct Doppler ultrasonography of the common and internal arteries is proposed, together with calculation of the flow rate, pressure-perfusion index, carotid ratio, and carotid distensibility index on a systematic basis. Obligatory compression movements to evaluate the several supplementary pathways in the case of disease are also recommended to complete the examination.

[Doppler ultrasonic arteriography with colorimetric morpho-function analysis of frequency (Echoflow). Preliminary trials]. / L'arteriografia ultrasonica ad effetto Doppler con analisi colorimetrica morfo-funzionale delle frequenze (Echoflow). Esperienza preliminare.

Doppler arteriography with chromatic frequency analysis is a new and very sound diagnostic method in cases of vascular disease. It can be carried out with apparatus such as the Echoflow (reg'd), a natural development of the Doppler technique ultrasonography. Vessels are shown in red, yellow, or blue, depending on the rate of their intraluminal flow. Surface arteries lying 5-6 cm below the skin and not hidden by bone can be studied. Preliminary results on 23 supra-aortic trunks, 21 lower extremity arterial systems, and 5 upper limb systems are described. The use of the instrument in other situations in also recommended.

[Study of the axillary cavity using xeroradiography]. / Lo studio del cavo ascellare con xeroradiografia.

Personal experience with xeroradiography in the diagnosis of axillary lymph node conditions in cases of inflammation, systemic disease, and metastasis, particularly from breast cancer, is described. A brief account is given of the technique employed and the results obtained, as supported by the surgical findings.

[Massive hemorrhage from duodenal adenocarcinoma. A case report]. / Enterorragia massiva da adenocarcinoma duodenale. Caso clinico.

The Authors report a case of acute onset anaemia due to a bleeding duodenal adenocarcinoma, stressing the rarity of this clinical situation. Only in few cases such an important bleeding has been pointed out to require an emergency surgical treatment. The diagnostic and therapeutical criteria are exposed and compared with the literature ones. The Authors indicate duodenopancreatectomy as the only resective surgical procedure that can offer recovery or a chance of a long disease-free survival.

Pre-filled normal saline syringes to reduce totally implantable venous access device-associated bloodstream infection: a single institution pilot study.

Flushing totally implantable venous access devices (TIVADs) with manually filled saline syringes may increase contamination and catheter-related bloodstream infection (CRBSI). We used a retrospective cohort study to assess the impact of changing from manually filled syringes to manufactured pre-filled syringes on the frequency of CRBSI in 718 TIVADs. Manually filled syringes were used in 269 patients and pre-filled syringes in 449. The CRBSI rate was 2.7% in the pre-filled syringe group and 6.3% in the manually filled syringe group (P = 0.016). Sex, tumour type and stage, access site and access body side were not independent risk factors for CRBSI.

Effects of pirenzepine and atropine on gastroduodenal motor patterns in duodenal ulcer patients.

The aim of this study was to compare the effects of pirenzepine with those of atropine a non-selective antimuscarinic agent, on gastroduodenal motor patterns in duodenal ulcer patients. Twenty patients were allocated at random to 2 groups of 10 subjects each. The drugs were administered by bolus intravenous injection as equiactive antisecretory doses of 10 mg pirenzepine and 1 mg atropine. Before and 15 min after drug administration all patients underwent a gastroduodenal manometric and reflexogenic study with a specially designed probe and three inflatable latex balloons. Both drugs significantly decreased antral and duodenal pressure, but atropine was much more effective than pirenzepine: 91 +/- 2% verus 54 +/- 9% decrease in the motility index for the antrum and 95 +/- 1% versus 49 +/- 7% for the duodenum (p less than 0.01). The antral motor threshold was not modified by either drug. The results of this study confirm the selectivity of action of pirenzepine on gastric function.