Post-surgical effects on language in patients with presumed low-grade glioma.

OBJECTIVES: Low-grade glioma (LGG) is a slow-growing brain tumour often situated in or near areas involved in language and/or cognitive functions. Thus, language impairments due to tumour growth or surgical resection are obvious risks. We aimed to investigate language outcome following surgery in patients with presumed LGG, using a comprehensive and sensitive language assessment. MATERIALS AND METHODS: Thirty-two consecutive patients with presumed LGG were assessed preoperative, early post-operative, and 3 months post-operative using sensitive tests including lexical retrieval, language comprehension and high-level language. The patients' preoperative language ability was compared with a reference group, but also with performance at post-operative controls. Further, the association between tumour location and language performance pre- and post-operatively was explored. RESULTS: Before surgery, the patients with presumed LGG performed worse on tests of lexical retrieval when compared to a reference group (BNT: LGG-group median 52, Reference-group median 54, P = .002; Animals: LGG-group mean 21.0, Reference-group mean 25, P = 001; Verbs: LGG-group mean 17.3, Reference-group mean 21.4, P = .001). At early post-operative assessment, we observed a decline in all language tests, whereas at 3 months there was only a decline on a single test of lexical retrieval (Animals: preoperative. median 20, post-op median 14, P = .001). The highest proportion of language impairment was found in the group with a tumour in language-eloquent areas at all time-points. CONCLUSIONS: Although many patients with a tumour in the left hemisphere deteriorated in their language function directly after surgery, their prognosis for recovery was good.

Iatrogenic injury in videolaparoscopic cholecystectomy: difficult surgical correction biliary tract.

Two cases of biliary tract serious lesions during videolaparoscopic cholecystectomy are reported. In the first case of lithiasic cholecystitis there had been a complete damage of the common biliary duct; in the second case there had been a double main biliary duct binding with removal of a biliary tract segment. In both cases a biliary confluence-jejunal anastomosis with Roux-en-Y loop was made up. In the first one the operation was difficult because of the main bile duct's fragility and modest expansion. In the second one the presence of a secondary biliary duct in gallbladder fossa not recognized, but drained outside with a common drainage placed during the operation prevented appearance of jaundice with dilatation of biliary ducts. It was heavily conditioned performing confluence-jejunal anastomosis with Roux-en-Y loop. The post-operative course was characterized by appearance of an external biliary fistula which has spontaneously disappeared. One year later, neither of the two patients had any stenosis or cholangitis problems.

[Right adrenal adenoma: laparoscopic exeresis]. / Adenoma surrenalico destro: exeresi per via laparoscopica.

The authors report the case of a non functioning adrenal adenoma, incidentally diagnosed and excised through a laparoscopic approach. Indications to adrenalectomy for such a pathological condition and surgical technique are reviewed and discussed. In consideration of the relatively rare disease and of the scant literature on minimally-invasive approach to right adrenalectomy, it seemed worth reporting this case and the technical skills performed to ease this operation through laparoscopy.

[Current world experience in the surgical treatment of gross obesity]. / L'esperienza mondiale attuale nel trattamento chirurgico della grande obesità.

Since 1954 the aim of surgical treatment of severe obesity has been to perfect a specific treatment capable of obtaining a massive, long-lasting and well tolerated loss of weight in severely obese subjects in which different and repeated attempts using conservative medicine have proved inefficacious or non-resolutive. During the course of almost 40 years, bariatric surgery has gradually evolved in the search for the "ideal" surgical treatment: for this purpose, operative methodologies and techniques have been proposed and experimented using differing physiopathological concepts and means of application. After a brief analysis of the history of bariatric surgery, there is a short summary of the most internationally widespread surgical methods and the most recent techniques now used for the surgical treatment of severe obesity based on the Authors' ten year experience of 321 intestinal bypasses (jejuno-ileal and biliointestinal), 110 horizontal gastroplasties and 23 vertical gastroplasties with a silastic ring. Intestinal bypass almost always allows sufficient weight loss to be achieved (85% of operated patients lose 80% of excess body weight) and the various postoperative problems of differing degrees of severity can be prevented by adequate replacement therapy and regular outpatient monitoring. Gastroplasties lead to a slightly smaller loss of weight (73% of excess body weight) within a shorter period of time, with fewer postoperative problems, but at the expense of a drastic and continual reduction in food intake. All patients operated require intense and long-term postoperative follow-up carried out by experts in order to achieve the desired results.

[Horizontal gastroplasty in surgery for morbid obesity: an unjustified condemnation?]. / Gastroplastie horizontale dans la chirurgie de l'obésité morbide: une condamnation injustifiée?

Horizontal gastroplasty has been performed on 100 pathologically obese patients over the last nine years. In our series, the mean age was 39.3 +/- 8.2 years and the mean body weight was 120.8 +/- 19.6 kg. One year after surgery the average weight loss was 29.7 kg which corresponds to a reduction of 24.6% of the preoperative weight (BMI:-24%). After three years, the body weight stabilised, reaching a total weight reduction of 30.5% (BMI:-28.7%), corresponding to 36.8 kg. The incidence of complications directly related to surgery was generally acceptable. The absence of specific malabsorption problems, the low incidence of severe complications and the satisfactory weight loss induced and maintained make, in our opinion, horizontal gastroplasty one of the most suitable and effective interventions in the long-term management of morbid obesity.

[Does jejunoileal bypass still have a place in the surgical treatment of morbid obesity?]. / Y a-t-il encore une place pour le court-circuit jéjuno-iléal dans le traitement chirurgical de l'obésité morbide?

Jejuno-ileal bypass has been widely used for the surgical treatment of morbid obesity since 1954, but from 1978 onwards the operation has met with increasing disfavor, especially in the USA as a result of its unacceptably high complication rate. From 1982 onwards, 235 morbidly obese patients had a side-to-side jejuno-ileal bypass in our Department. Our data concerning weight loss and the overall incidence of complications show that jejuno-ileal bypass can still play a role in the surgical treatment of morbid obesity.

[Recurrence of pernicious anemia. Description of 2 cases]. / La recidiva dell'anemia perniciosa. Descrizione di due casi.

Two cases of pernicious anaemia both recurring after 14 years are examined. Both patients had voluntarily suspended parenteral vitamin-B12 intake a few months after their first hospitalisation. The earliest signs of B12 deficiency and the clinical and biological alterations arising during the recurrence are reviewed.

[Hypopotassemia and megaloblastic anemia. Presentation of a case]. / Ipopotassiemia ed anemia megaloblastica. Presentazione di un caso.

A case of megaloblastic anaemia probably caused by malabsorption is analysed. Blood potassium levels were monitored before and during treatment with vitamin B12. It is concluded that low potassium levels in chronically hypoxic patients may be dangerous and that blood potassium should be monitored constantly during the treatment of this type of anaemia.

[A case of recurrence of pernicious anemia]. / Su un caso di recidiva di anemia perniciosa.

A case of pernicious anaemia recurring after 14 years in a patient who had suspended parenteral vitamin B12 treatment two months after the first hospitalisation is described. The earliest haematological signs of vitamin B12 deficiency are examined and the apparent failure to absorb the vitamin B12 regularly taken with the diet when no longer administered parenterally is discussed.

Clinical evaluation of triletide versus antacids in the treatment of duodenal ulcer out-patients.

Thirty out-patients with endoscopically assessed, active duodenal ulcer of mild to moderate intensity were randomly assigned to 8-weeks' treatment with either antacids (0.8 g/day each of aluminium hydroxide and magnesium hydroxide), triletide (1.5 g/day) or a combination of the two treatments. Every other week, the intensity of subjective symptoms and of objective signs was scored and recorded, and the endoscopic outcome assessed at the 8th week. Three patients on antacids alone and 1 on triletide alone were withdrawn at the 4th week because of therapeutic failure. Symptoms and signs improved in the three groups significantly faster, to a significantly greater extent, and in more patients with triletide, alone or in combination, than with antacids. Endoscopic evidence of therapeutic response was detected in significantly more patients given triletide, alone or in combination, in comparison with the group who had antacids. A significant influence on promoting ulcer healing could be attributed to triletide (p less than 0.05, multiple linear regression) and not to antacids. Tolerance was complete in all patients. It is concluded that triletide appears to be equally well tolerated as, but significantly more effective than, antacids in relieving symptoms and promoting healing in patients with mild to moderate duodenal ulcer.

[Heart rupture in acute myocardial infarct]. / La rottura cardiaca nell'infarto miocardico acuto.

24 cases of cardiac rupture (CR) (12%) were found in 200 necropsies of patients who died from acute myocardial infarction (AMI). Examination of the various factors that may affect the onset of this complication showed that age, sex, the site of AMI, the presence of coronary thrombosis, the association of persistent arterial hypertension, diabetes mellitus or previous angina syndrome and anticoagulant and corticosteroid treatment are insignificant. On the other hand, previous myocardial infarction would appear to reduce incidence considerably. CR was much more frequent in the first 3-4 days after onset of AMI and never occurred more than 21 days after. An important premonitory sign is persistent precordial pain in the absence of pericardial friction. Cardiokinetic therapy was used in 70% of the CR cases examined here. Over the past decade, the frequency of CR secondary to AMI has risen appreciably and it is hypothesised that this increase may have been influenced by the readiness with which cardiokinetics are employed now during AMI, often in very high doses. Particularly in the case of patients at high CR risk, it is considered that cardiokinetic therapy should only be employed in cases of clear cardiac insufficiency, in small, fragmented doses and after diuretics and vasodilators have proved ineffective. Such patients can also usefully be transferred to specialist wards for emergency surgery or preventive infarctectomy.

Treatment of acute respiratory failure with low-frequency positive-pressure ventilation and extracorporeal removal of CO2.

Terminal respiratory failure was reversed in three patients with a combination of extra-corporeal CO2 removal through a membrane lung and oxygen diffusion into the diseased lungs between mechanical breaths induced at a frequency of 2-3/min. The technique seems to prevent the pulmonary barotrauma and extrapulmonary derangements caused by conventional mechanical ventilation.