Acute post-exercise oxygen uptake, hormone and plasma metabolite response in obese men.

This study aimed to compare oxygen uptake ( VO2), hormone and plasma metabolite responses during the 30 min after submaximal incremental exercise (Incr) performed at the same relative/absolute exercise intensity and duration in lean (L) and obese (O) men. Eight L and 8 O men (BMI: 22.9 ± 0.4; 37.2 ± 1.8 kg · m(-2)) completed Incr and were then seated for 30 min. VO2 was monitored during the first 10 min and from the 25-30(th) minutes of recovery. Blood samples were drawn for the determination of hormone (catecholamines, insulin) and plasma metabolite (NEFA, glycerol) concentrations. Excess post-exercise oxygen consumption (EPOC) magnitude during the first 10 min was similar in O and in L (3.5 ± 0.4; 3.4 ± 0.3 liters, respectively, p=0.86). When normalized to percent change ( VO2END=100%), % VO2END during recovery was significantly higher from 90-120 s in O than in L (p ≤ 0.04). There were no significant differences in catecholamines (p ≥ 0.24), whereas insulin was significantly higher in O than in L during recovery (p=0.01). The time-course of glycerol was similar from 10-30 min of recovery (-42% for L; -41% for O, p=0.85), whereas significantly different patterns of NEFA were found from 10-30 min of recovery between groups (-18% for L; +8% for O, p=0.03). Despite similar EPOC, a difference in VO2 modulation between groups was observed, likely due to faster initial rates of VO2 decline in L than in O. The different patterns of NEFA between groups may suggest a lower NEFA reesterification during recovery in O, which was not involved in the rapid EPOC component.

[Aneurysms of the superior mesenteric artery]. / Gli aneurismi dell'arteria mesenterica superiore.

Splanchnic arteries aneurysmatic pathology is rare, even if, in the last decades it has been noticed an increase of its incidence, owing to the worldwide use of the recent diagnostic tools as echography, TC, MR and angiography. Among visceral aneurysms those of the superior mesenteric artery (SMA) range the 5.5-8%. In the majority of cases SMA aneurysms are of mycotic etiology (60%), of atherosclerotic ones are less frequent, even if their incidence has increased in the last decades. Other causes are exceptional. Dimensions are generally moderate (1-3 cm.), yet aneurysms of a significant diameter, ranging from 4 to 8 cm., are reported in the most recent literature. Aneurysms can be symptomatic with abdominal upper quadrants pain, due to the compressive mass effect on the contiguous structures. In some cases typical signs of claudication abdominis are present. A pulsating epi-mesogastric abdominal mass is present in the 50% of subjects. In the 20% of the cases the patients come to medical attention presenting a situation of hemorrhagic shock for aneurysmatic rupture in the peritoneal cavity, or in the digestive tract, considering also the possibility of a thrombosis with consequent acute bowel ischemia. Urgent surgical operations, when possible, imply an high mortality rate. For these reasons, there is indication of elective surgery for all SMA aneurysms, both symptomatic and of occasional finding. The performable surgical techniques are: proximal and distal ligation, with or without aneurysmectomy, that is the most utilized because commonly performed during emergency operations. This technique requires the presence of a sufficient collateral vascular supply. Endoaneurysmorraphy can be performed only in the case of mild-dimension saccular aneurysms. Revascularization techniques through substitution or by-pass are mandatory in managing voluminous mass aneurysms. It is reported a case of SMA aneurysm of exceptional dimensions (diameter approximatively 10 cm.) that for its enormous volume substituted completely the mesenteric axis, involving the origin of the jejuno-ileal and ileo-colic branches. In this case it has been mandatory the performing of the aorto-mesenteric by-pass technique, distally patch modelled and sutured to the residual posterior SMA wall, on the purpose to allow the revascularization of the emerging jejunal arteries and adapted to the residual distal stump to irrorate ileo-colic branches.

[Acute postoperative mediastinitis: retrospective analysis of various treatment methods]. / Mediastinite acuta postoperatoria: analisi retrospettiva di differenti metodiche di trattamento.

Infective acute mediastinitis is a postoperative complication reported in 0.5-1% of patients undergoing open chest operations. The treatment of choice for this life-threatening complication is still a matter of debate. The aim of this study was to retrospectively analyse the efficacy of different therapeutic approaches in the treatment of postoperative infective mediastinitis. In the 2nd Division of Cardiac Surgery, from October 1986 to May 2000, 10,234 patients underwent cardiac surgery operations. In 42 patients (0.4%) the operation was complicated by acute infective mediastinitis requiring surgical treatment. On the basis of the treatment opted for, these patients were subdivided into 5 groups: 23 patients underwent continuous iodopovidone (Betadine) mediastinal irrigation (GL) associated with surgical omentoplasty in 8 patients (GLO); 5 patients underwent isolated omentoplasty (GO), and 4 patients were treated with a pectoral muscle flap (GF). In 8 patients other different procedures were performed (GS). There were no deaths in GF and GS despite 24% and 20% mortality reported among patients who underwent mediastinal irrigation (GL) and isolated omentoplasty (GO), respectively. The mean hospital stay was 15 +/- 1 days in GF, 16 +/- 1 days in GS, 25 +/- 11 in patients who underwent omentoplasty and 27 +/- 14 in patients who underwent mediastinal irrigation. Predictors of death were low cardiac output syndrome (P < or = 0.009) and respiratory insufficiency (P < or = 0.032) when found before treatment. Our study suggests that surgical omentoplasty should be the treatment of choice in deep mediastinal infections, whereas wound sterilisation, associated with surgical chest wall reconstruction, seems to be a better procedure in superficial infective disease. A more extended clinical series would be needed to confirm these preliminary data.

[Acute pancreatitis: resultos of a diagnostic-therapeutic protocol in 80 consecutive cases]. / Pancreatiti acute: risultati di un protocollo diagnostico-terapeutico in 80 casi consecutivi.

The treatment of acute pancreatitis cannot be standardized in the absence of a prompt diagnosis and of an accurate severity and prognostic score. This study, based on 80 consecutively observed patients, compared the aetiological, clinical, diagnostic (laboratory and imaging) and prognostic data used to select the most appropriate therapy for each patient. The results confirm that the Ranson score shows a satisfactory prognostic relationship between the number of positive parameters and the severity of the disease. Ultrasound, which is useful for defining the aetiologic factors and in the follow-up of peripancreatic effusions, has proved to be limited as a means of imaging abnormalities of the pancreatic parenchyma. CT scans are confirmed as being the only method of accurately demonstrating the presence of necrosis and of evaluating its effective extent. ERCP was performed as soon as possible in the presence of biliary stasis or of suspect ultrasonographic signs. Surgical treatment proved necessary only in 7.5% of cases, on each occasion to drain infected necrotic foci. Promptness of the surgical indication plays an important role in the outcome of necrosectomy and drainage performed with the closed technique. Mortality was limited to 1.25% in our series. A correct diagnostic approach together with prompt treatment can reduce the mortality rate of this disease to a minimum.

Shock and dyspnea after cardiopulmonary resuscitation: a case of iatrogenic gastric rupture.

Rupture of the stomach is a rarely reported complication of cardiopulmonary resuscitation. The number of cases reported in the literature since 1970 does not exceed 30. We present a recent case of a young woman submitted to cardiopulmonary resuscitation in whom a gastric rupture gave rise to massive pneumoperitoneum with haemodynamic shock and respiratory failure. Major distension of the abdomen and an extensive subcutaneous emphysema were present. After re-establishing the haemodynamic conditions and a diagnostic spiral thoracic-abdomen CT scan, an emergency laparoptomy was performed. We found two linear defects of the lesser curvature of the stomach, which were treated by closure with a primary interrupted two-layer suture. The postoperative recovery was uneventful. Iatrogenic gastric rupture carries a high risk of mortality. A prompt diagnosis and emergency surgical repair are essential for patient survival.

[Benign non-parasitic cysts of the spleen]. / Cisti benigne non parassitarie della milza.

The present retrospective study is related to 7 cases of non-parasitic splenic cysts, 5 post-traumatic and 2 true epidermoid. Symptoms of displacement and pressure on adjacent viscera or physical examination showing an enlarged spleen have caused the beginning of diagnostic investigation in some patients, in others the cyst has been incidentally discovered. The young age and the positive history for prior trauma suggest for pseudocyst but they didn't give us absolute value. We have valued the contribution of the different radiological techniques (scintigraphy, US, CT, selective celiac arteriography, percutaneous biopsy) in the diagnosis of these lesions. The CT has shown to be the gold standard but it wasn't able to distinguish the post-traumatic from true splenic cysts. Such diagnosis is often not sure neither thought the histological study since the epithelial lining typical of the true cysts may have partially or completely destroyed by secondary alterations. However it can be observed also in the pseudocysts by proliferation of epithelial cells included in the traumatic hematoma. Surgery is primarily recommended for the prevention of complications as infection, hemorrhage, rupture in both types of cysts. Partial splenectomy according to the anatomic vascular distribution have permitted in 3/7 cases to resect the cyst preserving the functioning splenic tissue avoiding the long-term adverse effects of splenectomy.

[Primary malignant tumor of the 4th duodenal segment at the angle of Treitz. Report of a case]. / Tumore maligno primitivo della IV porzione duodenale esteso all'angolo di Treitz. Descrizione di un caso clinico.

A case of 34-years old woman with adenocarcinoma of the IVth duodenal segment extended to the angle of Treitz, treated with duodenojejunal segmentary resection, is described. Clinical features and diagnostic strategies are reported. Personal observation compared with Literature confirms the difficulty of an early diagnosis. The most appropriate surgical techniques for the treatment of these particularly and uncommon neoplasms often discovered in advanced stage are discussed. The better prognosis of these adenocarcinomas compared with those of the proximal duodenum (Ist and IInd segments) can be supported by embryological differences currently to be investigated.

[Hilar localization of splenic cyst does not always exclude the possibility of resective treatment]. / La localizzazione ilare di una cisti splenica non sempre esclude la possibilità del trattamento resettivo.

Non parasitic cysts of the spleen require surgical treatment because of their progressive growth and in order to prevent the potential severe complications associated with such cysts. Since it is now well known that total splenectomy, especially in young patients, has potential for short- and long-term complications, much emphasis has been placed on splenic salvage, suggesting partial splenectomy as procedure of choice for splenic cysts. However various Authors suggest that many but not all splenic cysts can be treated with partial splenectomy. In particular cystic mass arising from the anterior aspect of the hilum near to vascular peduncle contraindicate partial resection requiring splenectomy. In a case observed TC scan demonstrated a very large epidermoid cyst penetrating hilar parenchyma just above splenic vessels insertion. Preoperative imaging suggested splenectomy as the only possible procedure to remove the cyst. At operation the exposure of the splenic artery extended proximally along the pancreatic tail showed an arterial branch running with satellite vein in the splenopancreatic ligament for inferior segment of the spleen. As we found this branch it was possible to resect cyst preserving a large inferior parenchymal segment normally perfused and functioning at postoperative scintigraphic controls. In conclusion not all hilar cysts must be considered an absolute indication to splenectomy. An accurate and extensive exposure of splenic artery and vein can demonstrate vascular anatomical variations permitting resection also for large cysts located near the splenic hilum.

[Splenectomy in immune thrombocytopenia and other hematological diseases]. / La splenectomia nelle trombocitopenie immuni ed in altre malattie ematologiche.

The Authors report a retrospective study of 74 splenectomies performed for hematologic diseases. The role of splenectomy has changed over recent years with increased indications for immune thrombocytopenic purpura (ITP). The aim of this study was to assess indications to surgery in relation to clinical presentation with typical hemorrhagic features or severe thrombocytopenia only; interval between onset of symptoms and splenectomy; failure of medical management and complications from steroid administration; scintigraphic studies predictive of response to splenectomy and preoperative treatment in patients with severe thrombocytopenia were also studied. The Authors reported response rates to splenectomy of 84% without mortality and only 11% of postoperative complications. These results encouraged to surgery for treatment of those patients with severe thrombocytopenia, who fail to obtain remission or develop serious complications after medical therapy. The splenectomy cured severe thrombocytopenia also in some patients with acquired immunodeficiency (HIV+). Moreover the Authors discuss the indications in patients with chronic lymphatic leukaemia and lymphoma diseases. In selected patients the splenectomy has the potential to relieve symptoms due to splenomegaly, correct cytopenias, specify hystological diagnosis and modify the disease course of malignant lymphomas. In fact splenomegaly sometimes complicated the course of malignant lymphomas because of hematologic abnormalities that are inconsistent with active chemotherapy.