Bladder reconstruction after cystectomy: use of ileocecal segment and three-loop ileal reservoir.

We report on 11 patients who in 1980-1982 had bladder reconstruction, after cystectomy for bladder cancer, utilizing the ileocecal valve as an antireflux mechanism and a direct urethrocecal anastomosis. They received preoperative irradiation (2,000 rad) and had some early complications such as pelvic abscesses and temporary urinary fistulas. We have since omitted preoperative radiation on cases performed in 1984-1987 and they did not have these complications.

[Carcinoma fo the gallbladder. Experience and proposals]. / Ca. della colecisti. Esperienze e proposte.

Poor survival observed in a series of 40 females and 44 males with cancer of the gallbladder treated over a period of about 16 years ar referred to in the formulation of three proposals designed to achieve better results: I) Earlier and more reliable diagnosis based on selective arteriography, echography and careful intraoperative examination; II) More rational management based on more radical surgery, including, for example, resection en bloc of the gallbladder, hepatic fossa and adjacent liver, and cysticocholedochic, posterior pancreaticoduodenal and coeliac efferent lymphatics; III) Prevention based on prophylactic cholecystectomy in classes of subjects most at risk, such as women over 50 with cholelithiasis.

[Segmental transplant of the pancreas in the pig with suppression of the exocrine secretion. Technical aspects]. / Trapianto segmentale di pancreas nel maiale con soppressione della secrezione esocrina. Aspetti tecnici.

Twenty autotransplantations and five allotransplantations were performed in female pigs; exocrine secretion was suppressed by injecting an acrylic glue into the ductal system; pancreatic segment was transplanted extraperitoneally in the iliac fussa. We describe an original technique most suitable to the morfologic caratheristics of pancreatic gland in pigs.

[Prevention of complications of surgery of diverticular disease]. / Prévention des complications dans la chirurgie de la maladie diverticulaire.

Results are reported for 335 patients hospitalized for diverticular disease of the symptomatic colon: bowel movement disorders, abdominal pains and/or rectorrhagia. Of 81 patients that received operative surgery, 62 presented inflammatory stenosis or perforation. Recurrence is prevented by surgical treatment combining sigmoidectomy and exeresis of the rectosigmoid junction.

Ileocaeco-urethroplasty after total cystectomy for bladder cancer.

Eleven cases of ileocaeco-urethroplasty, performed over a 2-year period, are presented. The patients had low grade bladder cancer infiltrating into but not extending beyond the muscle layer (B-T3a). Following radiotherapy a total cystectomy was performed up to the verumontanum; afterwards the prostatic cuff was anastomosed to an ileocaecal segment. The patients have been followed up for 13 to 39 months. One died from metastases after 30 months. The others are alive and in good psychological condition, with satisfactory micturition. We believe this surgical option deserves more careful consideration.

Calorimetric response to amino acid infusion in sepsis and critical illness.

The effect of the infusion of mixed amino acids with glucose and fat on metabolic rate (MR) in sepsis (S) and in nonseptic trauma (NS) was investigated. The results demonstrated that diet-induced thermogenesis (specific dynamic action) controlled in S and in NS 25% and 18% of the MR variability, respectively (r2 = .25 and .18, p less than .01 for both). Also, diet-induced thermogenesis represented a quantitatively relevant portion of the total MR. There was a larger thermogenic effect of amino acids in S with respect to NS (22.3 vs. 5.7 cal/mg N, p less than .01) with a concomitantly increased thermogenic effect of fat. The results suggest the importance of recognizing the thermogenic effect of administered nutrients as an important determinant of MR during calorimetric measurements. The finding of an enhanced thermogenic effect of amino acids and fat in S also implies the need for more complete investigations of the impact of these substrates in modifying oxidative and energy metabolism in S.

Cardiorespiratory and metabolic adequacy and their relation to survival in sepsis.

Cardiorespiratory and metabolic data were collected in 36 septic patients and 80 patients critically ill after nonseptic general surgery or trauma. Septic patients, particularly nonsurviving septics, showed early and sustained increases in metabolic rate, oxygen consumption, cardiac work, and minute ventilatory volume. They had lower levels of respiratory quotient and total peripheral resistance than nonseptic patients. High cardiac work was related to increasing oxygen transport. Both increases in metabolic utilization with high CO2 production, and abnormal increases in VD/VT appeared responsible for the higher minute ventilatory volumes. Respiratory quotient was negatively related to metabolic rate; this relation was modulated by the rate of caloric intake and, in nonseptic patients, was also influenced by the hemodynamic state. These data suggest that poor prognosis in sepsis is characterized by an early sustained stress response with more severe abnormalities in cardiovascular, metabolic, and respiratory function than is seen in the nonseptic stress response. The need for early support of physiologic functions and early and aggressive nutritional intervention is emphasized.