ABSTRACT
A computerized system for assisted clinical decisions in breast cancer was evaluated, comparing the therapeutic strategies suggested bt the program with those actually used in an oncology Division. One hundred patients treated at the Medical Oncology Department of the National Institute for Cancer Research of Genoa, Italy, were entered into the study. Results, showing a 95% concordance, are discussed.
Subject(s)
Breast Neoplasms/therapy , Decision Support Techniques , Therapy, Computer-Assisted , Adult , Aged , Aged, 80 and over , Clinical Protocols , Female , Humans , Middle AgedABSTRACT
On the basis of the results obtained in a previous perspective comparative study aimed to compare the diagnostic accuracy of a computerized diagnostic decisional support in gastroenterology with that of non-specialist physicians, the Authors have carried out a retrospective study, based on the same series and on the same results, but disaggregating the global comparisons according to the feature of the clinical presentations. The latter were therefore classified by independent gastroenterologists as "typical", "atypical", or "borderline", and for each group the difference of diagnostic accuracy between program and physicians was again evaluated. Even if the program proved more accurate in all groups, the greatest difference was observed in the "borderline" group which the Authors claim to include the kind of presentation which more than any other needs a decisional aid. This should suggest a possible useful implementation of the system in daily clinical practice.
Subject(s)
Diagnosis, Computer-Assisted , Gastrointestinal Diseases/diagnosis , Evaluation Studies as Topic , Gastrointestinal Diseases/classification , Humans , Retrospective StudiesABSTRACT
The intracholedochal pressure changes induced by timepidium bromide were studied in 12 patients who had undergone surgery because of gall bladder stones and were receiving transient external bile drainage by the Kehr method. Cholangiomanometric examination, carried out under basal conditions and after an intravenous dose of 15 mg timepidium bromide, revealed a statistically significant decrease in mean intracholedochal pressure in all 12 patients. It is concluded that timepidium bromide is likely to exert a direct action on the sphincter of Oddi, decreasing its basal tone and thus causing a decrease in intracholedochal pressure.
Subject(s)
Ampulla of Vater/drug effects , Piperidines/pharmacology , Sphincter of Oddi/drug effects , Aged , Drug Evaluation , Female , Humans , Male , Manometry , Middle AgedABSTRACT
The results of a prospective controlled study designed to evaluate the performance of a computerized diagnostic aid in the clinical setting are reported herein. Two hundred and fifty patients referred to an outpatient clinic for gastrointestinal complaints were entered into the study. The diagnostic aid program was used routinely and the findings elicited from patients' medical histories and physical examinations were entered into the computer at the time of initial evaluation. The accuracy of the program's diagnoses was measured and compared with the accuracy of diagnoses made by a control group of physicians. The overall diagnostic accuracy of the program was found to be 69.2% (P much less than .0000001), a value significantly greater (P = .0005) than the overall accuracy of the control group of physicians, which was found to be 52%. A high agreement rate between program and physicians was also observed. These preliminary results seem to indicate a practical use for the program as a support in the initial screening of patients presenting with gastrointestinal complaints.
Subject(s)
Computers , Diagnosis, Computer-Assisted/standards , Gastrointestinal Diseases/diagnosis , Microcomputers , Technology Assessment, Biomedical , Clinical Trials as Topic , Female , Humans , Italy , Male , Middle Aged , Outpatients , Prospective StudiesABSTRACT
Twelve to 15 days after cholecystectomy, endocholedochal pressure was measured in ten patients before and one hour after oral administration of 15 mg of pinaverium bromide (six patients) or placebo. The mean endocholedochal pressure was 7.1 +/- 0.25 mmHg before and 3.1 +/- 0.2 mmHg after pinaverium (P less than 0.01), and 7.0 +/- 0.2 and 6.8 +/- 1.2 mmHg in the placebo-treated patients. The results suggest that pinaverium bromide has a specific effect on the common bile duct and probably on Oddi's sphincter.
Subject(s)
Ampulla of Vater/drug effects , Morpholines/pharmacology , Parasympatholytics/pharmacology , Sphincter of Oddi/drug effects , Common Bile Duct/drug effects , Female , Humans , Male , Middle Aged , Muscle, Smooth/drug effects , PressureABSTRACT
The loss of function of Oddi's sphincter due to sclerosis secondary to a lithiasic or alithiasic phlogosis, is the only rational indication for sphincterotomy. An operative test of the Oddi sphincter function is proposed, based on an original manometric procedure. This method, employed on 567 patients undergoing biliary surgery, allowed demonstration of a loss of function of Oddi's sphincter in 53 patients (9.4%), in whom a sphincterotomy was performed.
Subject(s)
Ampulla of Vater/surgery , Common Bile Duct Diseases/diagnosis , Manometry/methods , Sphincter of Oddi/surgery , Common Bile Duct Diseases/surgery , HumansABSTRACT
The Authors report their experience of postoperative cholangiomanometry carried out through a T-tube on 19 patients; in 13 of such patients the Oddi's sphincter was intact, while 6 of them underwent sphincterectomy. In 8 patient's a manometric study of the duodenum was associated. They performed both variable flow and pressure and constant flow manometry and their results show that such examination is a reliable test both for the functional evaluation of the surgical procedure, and for the study of the action of various drugs on Oddi's sphincter function and its correlation with duodenal motility.
Subject(s)
Ampulla of Vater/physiology , Cholelithiasis/surgery , Manometry , Sphincter of Oddi/physiology , Bile Ducts/physiology , Ceruletide/pharmacology , Duodenum , Fentanyl/pharmacology , Gastrointestinal Motility/drug effects , Humans , Metoclopramide/pharmacology , Neostigmine/pharmacology , Nitroglycerin/pharmacology , Postoperative Care , Pressure , Sphincter of Oddi/drug effects , Succinylcholine/pharmacologyABSTRACT
Experimental studies and clinical observations are referred to in stressing the frequent correlation between duodenal, biliary and pancreatic disturbances, and the importance of the role of spontaneous or iatrogenic impairment of Oddi's sphincter in the origin of this pathology. These physiopathological concepts are regarded as fundamental in the correct surgical management of cholelithiasis. A pre- and postoperative diagnostic protocol designed to investigate the anatomofunctional aspects of the duodenum and pancreas as well as bile duct morphology and Oddi sphincter function is described. Its employment enabled 633 cases to be divided six well-defined groups for diversified treatment.
Subject(s)
Cholelithiasis/diagnosis , Cholelithiasis/physiopathology , Cholelithiasis/surgery , Duodenum/physiopathology , Gastrointestinal Motility , Humans , Pancreas/physiopathology , Sphincter of Oddi/physiopathologyABSTRACT
A pre-and intraoperative diagnostic protocol offering morphological and functional evaluation of the bile ducts, Oddi's sphincter, duodenum, and pancreas was employed to classify 633 patients with biliary lithiasis into 6 groups and hence the therapeutic application of 6 surgical techniques, namely: 1) cholecystectomy alone; 2) choledocholithotomy plus closure of the choledoch; 3) choledocholithotomy plus Kehr drainage; 4) papillosphincterotomy alone; 5) papillosphincterotomy plus anterior seclective duodenal vagotomy; 6) hepaticojejunostomy, so as to ensure a rational choice of the best operation fro each situation. Comparison with the literature and prior personal results substantiated the soundness of this approach, as shown by a marked reduction of complications, mortality and residual disease on both short and medium-term follow-up.
Subject(s)
Cholelithiasis/surgery , Ampulla of Vater/surgery , Cholecystectomy , Cholelithiasis/diagnosis , Gallstones/surgery , Hepatic Duct, Common/surgery , Humans , Jejunum/surgery , Postoperative Complications , Sphincter of Oddi/surgery , VagotomyABSTRACT
The Authors report on their cases of biliary surgery reoperation, necessary in 267 cases out of 3193 primary operations. After a short discussion of the aetiological, diagnostic and therapeutic problems of relapsing biliary pathology, they compare their results with those of the most important sets of cases reported in world literature.
Subject(s)
Cholelithiasis/surgery , Biliary Fistula/surgery , Biliary Tract Diseases/surgery , Cholangitis/surgery , Cholecystectomy , Cholelithiasis/complications , Cholelithiasis/etiology , Chronic Disease , Constriction, Pathologic/surgery , Humans , Pancreatitis/surgery , Recurrence , Sphincter of Oddi/surgeryABSTRACT
86 carefully selected patients with cholesterinic cholecystic lithiasis were submitted to litholytic treatment with chenodesoxycholic acid at a dose of 15 mg per kg of body weight as part of a multidisciplinary therapeutic approach to biliary lithiasis. Follow up of these patients up to 24 months showed the positive action of the drug on dyspeptic pain symptomatology, the absence of significant side effects, and the absence of hepatotoxic effects of chenic acid at therapeutic doses, as well as its effectiveness with respect to total or partial litholysis in 78% of patients. These data confirm the positive role of litholytic treatment as an alternative to cholecystectomy in highly selected patients treated at specialist centres.
Subject(s)
Chenodeoxycholic Acid/therapeutic use , Cholelithiasis/drug therapy , Adult , Aged , Alkaline Phosphatase/blood , Chenodeoxycholic Acid/administration & dosage , Cholesterol/blood , Female , Humans , Male , Middle Aged , Transaminases/blood , Triglycerides/bloodSubject(s)
Biliary Tract Diseases/surgery , Manometry , Bile Ducts , Biliary Tract Diseases/diagnosis , Cholangiography , Cholecystography , Duodenum , HumansSubject(s)
Biliary Tract Diseases/surgery , Manometry , Bile Ducts , Duodenum , Humans , Manometry/instrumentation , Manometry/methodsSubject(s)
Chenodeoxycholic Acid/therapeutic use , Cholelithiasis/drug therapy , Adult , Aged , Cholelithiasis/surgery , Female , Humans , Male , Middle AgedABSTRACT
A review of the techniques and presentation of a new method.--Cholangiomanometric techniques and methods described in the literature are reviewed, with particular reference to their associated anaesthesiological and pharmacological problems. Original physiological concepts are relied on in a proposal for the adoption of a new intraoperative method with pharmacological tests and specifically direct to functional evaluation of Oddi's sphincter as a means of determining indications for surgery.
Subject(s)
Biliary Tract Diseases/surgery , Cholangiography , Manometry , Biliary Tract/drug effects , Biliary Tract Diseases/diagnosis , HumansSubject(s)
Ampulla of Vater , Biliary Tract Diseases/etiology , Duodenum , Pancreatitis/etiology , Sphincter of Oddi , HumansABSTRACT
Based on experimental and clinical studies we have deduced the existence of a neuro-osmotic dumping syndrome and a truly osmotic dumping syndrome that differ in pathogenesis and clinical symptoms.
Subject(s)
Dumping Syndrome/etiology , Adult , Dumping Syndrome/physiopathology , Dumping Syndrome/therapy , Female , Humans , Jejunum/physiopathology , Male , Pyloric Antrum/physiopathology , Water-Electrolyte BalanceABSTRACT
On the basis of the observation that the dumping syndrome is seen very rarely now compared to the past, experimental and clinical research was carried out with a view to explaining this phenomenon. These studies showed that it is possible that the gastric antrum plays a basic role in the pathogenesis of the dumping syndrome.