[The biocompatibility of suture materials used in colon surgery. An experimental study in the rat]. / Biocompatibilità dei materiali di sutura in uso nella chirurgia del colon. Studio sperimentale nel ratto.

BACKGROUND: The aim of this experimental study was to compare the tissue behavior of biofragmentable anastomotic ring (BAR) with other synthetic materials used in colonic surgery. METHODS: Thirty-three rats were divided into four groups: group 1, sham-operated control animals without material implanted; group 2, with fragments of polypropylene monofilament implanted extraperitoneally in abdominal wound, between musculature and peritoneum; group 3, with metal clips implanted extraperitoneally in abdominal wound, between musculature and peritoneum and group 4, with fragments of biofragmentable anastomotic ring implanted extraperitoneally in abdominal wound, between musculature and peritoneum. Animals were sacrificed 30 days after the operation. Macroscopic and histological criteria were used to characterize the resistance of the wound and the tolerance of the host to the foreign material. RESULTS: The inflammatory cell reaction of host tissue was significantly greater in group 4 compared with other groups (p < 0.05). In three cases, in group 4, we observed the adhesion of implanted fragment to epiploa. The enumeration of giant cells and the degree of fibrotic reaction was similar in all groups with material implanted, but no significant difference between the groups was observed. Our findings showed the greater biocompatibility of polypropylene and metallic clips, compared to the biofragmentable ring anastomosis. The strong inflammatory reaction in the host tissue caused by biofragmentable anastomotic ring may explain partially clinical postoperative complications (anastomotic wound infection and/or dehiscence and/or stricture). CONCLUSIONS: In conclusion, the choice of suture materials should be based not only on the mechanical properties, but also on their biological interactions between host and suture materials and on the evaluation of their effective cost/benefit.

[Anatomo-clinical considerations on intrahepatic calculosis]. / Considerazioni anatomo-cliniche sulla calcolosi intraepatica.

After reviewing the anatomoclinical classification of intrahepatic lithiasis, the authors underline the need to perform hepatic resections in selected cases. The case reported is an example of the indications for this type of surgery.

[Continuous suture in laparotomy using an absorbable eyelet thread according to the Smead Jones technique]. / Sutura continua di laparotomie con l'impiego di filo assorbibile ad asola secondo la tecnica di Smead Jones.

In 78 patients undergoing laparotomy suturing was carried out using absorbable thread (polyglyconate - Maxon) with eyelet to obtain a continuous knot-free suture according to Smead Jones' technique. A prospective study was made of all surgical wounds three months after the operation to evaluate the reliability of this technique. On examination, wounds were fully healed in 98% of patients. Less than 2% of patients revealed infections, dehiscence or anomalous granulations of the wound. No laparocele were observed at the time of control using this method. Continuous suture using a trimethylene polyglyconate (Maxon) thread with eyelet according to the Smead Jones technique was found to be safe and effective. A follow-up after a longer interval will be performed in this group of patients in order to confirm these conclusions.

[The impact of conventional proctocolectomy on sexual function]. / Impatto della proctocolectomia convenzionale sulla funzione sessuale.

Seventy-one women who had a proctocolectomy for ulcerative colitis (n. 41) or Crohn's disease (n. 30) were interviewed in the follow-up clinic for gynaecological problems and fertility. Forty-nine per cent (35/71) of the women had a distressing vaginal discharge after proctocolectomy, compared with 9% before surgery. At the gynaecological examination 45% (32/71) had a heavy vaginal secretion without any signs of an acute vaginal infection. In 68% (30/44) fluid retention in the vagina was associated with a caudally firmly-fixed and dilated posterior vaginal fornix. Twelve per cent (8/66) of the women reported dyspareunia before surgery. After surgery, 27% (18/66) complained of this symptom. Fertility was significantly reduced after surgery since only 37% (10/27) of the women who attempted to become pregnant succeeded within five years follow-up. The corresponding figure before surgery was 72% (39/54). Those who conceived went through pregnancy and parturition without any incident, 6 of 24 delivered by cesarean section. Fifty-seven men who had a proctocolectomy for ulcerative colitis (n.41) or Crohn's disease (n. 30) were interviewed in the follow-up clinic for the presence of sexual disturbances and their incidence was studied. Fifty-seven per cent of elderly patients (above 40 years old) complained of reduced libido and sexual satisfaction. In younger patients (below 40 years old) 33% complained of an impaired quality of sexual life and 22% complained of an impaired sexual satisfaction. However, despite some sexual dysfunction, 56% reported improved sexual life and 67% improved sexual satisfaction. This may be explained by improved general health and increased libido after removal of diseased bowel.(ABSTRACT TRUNCATED AT 250 WORDS)

[Malignant peritoneal mesothelioma: its evolution and outlook]. / Mesotelioma peritoneale maligno: evoluzione e prospettive.

Mesotheliomas are mesenchymal neoplasms which originate in the lining membrane of various serous cavities: pleural, pericardial and peritoneal. Peritoneal mesotheliomas are extremely rare. They are usually seen to middle to old age, predominate in men. We report a case and show the most recent concepts about histology, pathology, diagnosis and medical-surgical therapy of these diseases.

[Total thyroidectomy in recurrent goiters (anatomicosurgical observations with the operating microscope)]. / La tiroidectomia totale nelle recidive di gozzo (osservazioni anatomo-chirurgiche con l'ausilio del microscopio operatorio).

The relapses of the multinodular goitre, often linked with an insufficient surgical treatment of primitive lesions, make serious problems about the operating technique. The current guidance of surgeons is directed towards the complete thyroidectomy which profits, during the operating time, by the use of microscope to identify and to protect the recurrent nerves. This equipment has to be used by those equipped which know how to use it. In our work we report the results obtained with this technique and it's underlined how the complete thyroidectomy for the benign relapsing goitre could be considered curative towards those cases which present hidden microcarcinoma.

[The functional and manometric-volumetric results following abdominal rectopexy for total rectal prolapse]. / Risultato funzionale e manovolumetrico dopo rettopessia addominale posteriore per prolasso totale di retto.

Functional changes after the posterior abdominal rectopexy for the treatment of rectal prolapse are not fully understood. We studied the effects of Wells' or Ripstein's rectopexy on functional characteristics as related to anal sphincter function, rectal volume and sensory function in 21 patients with complete rectal prolapse. We have observed an improvement of continence over 70 per cent in both groups. However, an absent or a decreased call to stool, constipation and evacuation difficulties are the aftermath of Wells' rectopexy, while these complaints appear basically unaffected by Ripstein's technique. Sensory thresholds for sense of filling and urge were significantly raised after Wells' rectopexy even one year after operation, whereas after Ripstein's operation sense of filling was not significantly affected and while sense of urge was increased early postoperatively, it was not significantly changed at one year postoperative control. In conclusion, when fecal incontinence appears associated to a complete rectal prolapse has good chances to improve postoperatively. Preoperative evacuation difficulties seems to be unaffected by a posterior abdominal rectopexy, Wells or Ripstein, but an extensive dissection of the rectum with the division of the lateral stalks, as it is performed in Wells' operation, seems to be a procedure that can create a further burden of problems to the patient and it seems coupled to a manovolumetric elevation of rectal sensory thresholds.

[Usefulness of preoperative biliary drainage: comparison of therapeutic strategies]. / Sull'utilita' del drenaggio biliare preoperatorio: strategie terapeutiche a confronto.

This work shows the results obtained by the comparison between a period in which obstructive icterus was treated only surgically and a mixed period, based on endoscopic or endoscopic surgical treatment. In a period of 9 years (1979-87), 186 patients suffering from obstructive icterus were admitted into the 1st Division of General Surgery at Ospedale Maria Vittoria, Turin. In the first five years (1979-83) all the patients (78) were indistinctly operated after the usual diagnostic controls. In the following four years (1983-87) 62 out of 108 patients, considered as high-risk ones, underwent drainage by endoscopic way. In the high-risk patients, both neoplastic and not, morbidity rate, death rate and average stay in hospital were evidently lower after endoscopic or endoscopic-surgical treatment than after surgery alone. In conclusion, endoscopic pre-operating drainage in selected and/or high-risk patients greatly reduces perioperative complications and mortality.

Sequential, free and Y internal thoracic artery grafts.

The internal thoracic artery (ITA) has excellent durability and its ability to survive for 10 years or more far exceeds the saphenous vein graft (SVG). In an attempt to improve long-term survival from coronary artery bypass grafting (CABG), three or more (up to six) ITA coronary anastomoses have been placed in 718 patients since 1982. Initial flow in the ITA immediately after grafting is critical to the success of the operation. Careful dissection and preparation of the ITA pedicle to prevent injury and spasm, constructing parallel and perpendicular anastomoses so the most proximal portion of the ITA is used for anastomosis and the use of the free right ITA to increase length of graft available are measures employed to increase critical flow. Actuarial survival at 6 years is 92.5% in this group of patients, which includes elderly patients, patients with left ventricular dysfunction and patients undergoing emergency operations.

Measures to increase the number of mammary artery coronary artery anastomoses.

Patients with single internal mammary artery (IMA) grafts along with saphenous vein grafts have been found to have fewer coronary events and longer survival after operation. To reduce bypass graft failure from intimal hyperplasia and atherosclerosis, as well as to improve results, three or more IMA grafts were placed in 215 patients from October 1982 through May 1985. Careful planning helped in bypassing the maximum number of coronary artery obstructions with arterial conduits. By using bilateral IMA grafts, sequential, and Y grafts, the number of IMA coronary artery anastomoses increases and the need for saphenous vein grafts decreases. Meticulous dissection and preparation of the entire IMA and proper construction of the anastomosis are essentials for these procedures to be successful. Two of the 215 patients died early and four died late. Ninety-five percent of the postoperative stress tests were negative and 92% of the 39 IMA grafts visualized in 13 patients studied postoperatively were patent. We found this to be a safe, challenging procedure that improved late bypass conduit success and prolonged survival.

Expanding the use of the internal mammary artery to improve patency in coronary artery bypass grafting.

To improve the early and late benefits from coronary artery bypass grafting, we have expanded the use of the internal mammary artery by bypassing three or more coronary arteries with mammary grafts. Experience with higher power magnification and the use of the single internal mammary artery are necessary prerequisites of this procedure. The first 100 patients who had three or more mammary artery-coronary artery anastomoses are reviewed. Eighty-six patients received three mammary-coronary anastomoses, 13 received four, and one received six. An average of 3.2 internal mammary artery grafts and 1.7 saphenous vein grafts per patient were placed. Twenty-five of 27 mammary grafts were open on postoperative graft visualization. There were no early deaths and only one patient died late of complications of gangrene of the lower extremities. None of the patients had significant left ventricular failure and only three had perioperative myocardial infarctions. None of the patients complain of angina and 58 of 59 postoperative stress tests were normal. This procedure should significantly reduce the late closure of bypass grafts and the complications thereof, including the need for reoperation.

The role of the sequential internal mammary artery graft in coronary surgery.

The use of sequential internal mammary artery grafts is a possible method of improving overall long-term graft patency in patients receiving coronary artery bypass grafts. Twenty-nine patients who had sequential grafts were studied. The left internal mammary artery was anastomosed side-to-side to the diagonal and end-to-side to the left anterior descending coronary artery (LAD) in 24 patients, side-to-side to the proximal LAD and end-to-side to the distal LAD for proximal and midvessel obstruction in four patients, and in one patient the left internal mammary artery was grafted side-to-side to the first marginal branch of the circumflex artery and end-to-side to the second marginal branch. There were no operative deaths, but one patient died 10 months after surgery from viral pneumonia. There was no evidence of left ventricular failure. None of the patients suffered perioperative myocardial infarction or return of their angina. Eleven patients underwent postoperative stress tests and results were negative in all. Graft visualization in three patients showed patent grafts without kinking or narrowing. These findings suggest that the sequential internal mammary artery graft is safe and should improve overall long-term patency. We particularly recommend its use in the younger patient.

The internal mammary artery graft: the best choice for bypass of the diseased left anterior descending coronary artery.

The atherosclerotic plaque that critically obstructs the proximal left anterior descending coronary artery is three times more likely to produce a fatal myocardial infarction than lesions in the other coronary arteries. Severe obstruction in a bypass graft to the proximally stenosed left anterior descending artery is probably at high risk of provoking a fatal infarction. Selection of the bypass graft with adequate flow and the greatest longevity is of great importance. Review of 298 patients who received internal mammary artery grafts illustrates that this bypass has excellent long-term patency, minimal attrition, and little evidence suggesting late atherosclerotic formation. Difficulties with anastomosis and pedicle injury during preparation (the most frequent reasons for internal mammary artery failure) can be reduced to 2% or less by introducing magnification and microsurgical techniques. The properly prepared internal mammary artery graft has the longest lasting patency and should be used when bypassing proximal left anterior descending lesions.

[Protective effect of citicoline on renal ischemia]. / Effetto protettivo della citicolina sull'ischemia renale.

The protective role of cyticholine was investigated on rabbit and dog kidneys subjected to temporary ischaemia. Following right nephrectomy, the right kidneys of 13 rabbits were subjected to warm ischaemia for 60'. Death occurred for various reasons within 48 hr. Histological examination suggested that tubular epithelium damage was less in the animals treated with cyticholine. In a similar experiment on 6 dogs after local and general infusion of cyticholine, warm ischaemia for 90' was followed by death in 33%, compared with 87.5% of the controls. Blood creatinine and BUN returned to normal between the 6th and the 8th days in the four surviving animals. The data suggest that cyticholine assists the functional recovery of kidneys subjected to warm ischaemia for more than 30' and limits tubular damage.

[Morphological studies of gastric arteries in patients with gastro-duodenal ulcer]. / Oservazioni morfologiche sulle arterie gastriche di pazienti affetti da ulcera gastro-duodenale

Microscopic lesions of the gastric arteries have been studied in 21 patients subjected to resection for gastroduodenal ulcer. The left gastric artery, particularly in patients with gastric ulcer, presents lesions to the intima and media and these can lead to obliteration of the lumen, classifiable as atherosclerotic disease. The seriousness of the lesions would seem to be independent of sex and age. In some cases gastric artery lesions were compared with those to the arterioles in the vicinity of the ulcer. At least as far as the gastric district is concerned, there would not appear to be any gravity correlation between large and small vessels. Some aspects of the vascular pathogenesis of gastroduodenal ulcer are discussed.

[Effects of slowly progressive constriction on the proximal pancreas of the rabbit]. / Effetti della costrizione lentamente progressiva sul pancreas prossimale di coniglio

Slow, progressive constriction with cellophane tape was experimented on the proximal segment of the rabbit pancreas. Histological examination of the distal segment over a period of 10-30 days showed the appearance of morphological changes reminiscent of chronic pancreatopathy in man. Stress is laid on the need for an experimental model suitable for the provocation of chronic forms, particularly if similar results can be obtained on animals of larger size.