Treatment of esophageal anastomotic leakages after cancer resection. The role of total parenteral nutrition.

A series of 16 cases of esophageal anastomotic leakages after cancer resection observed from 1978 to 1982 is analyzed in a retrospective manner. Eight patients related to the period 1978 to 1980 (series A) were treated with emergency surgery while the remaining eight patients observed from 1980 to 1982 (series B) were treated conservatively with total parenteral nutrition (TPN) and complete fasting. Seven patients from series A eventually died postoperatively and one patient had a good recovery after emergency reintervention. In the series B six patients left the hospital with complete healing of the anastomotic leaks after 27.2 +/- 13.5 days of TPN and complete fasting, while failure of the treatment was observed in two patients who died from septic mediastinitis and acute respiratory failure. Different incidence of positive clinical results in Series A and B was statistically significant (p less than 0.01). The role of TPN and complete fasting will be discussed as the primary approach for the management of this severe complication, taking in consideration the suture line drainage and the control of infection.

Perianal Paget's disease: case report of an elderly patient treated with polychemotherapy and radiotherapy.

The authors report a case of an 85-year-old patient suffering from perianal Paget's disease treated with polychemotherapy and radiotherapy, and followed for 30 months with no evidence of recurrence. Such treatment may be an effective alternative to surgical resection in elderly patients, although no definitive conclusion can be drawn due to the rarity of the disease.

Clinical and therapeutic applications of a new pathogenetic theory on the dumping syndrome.

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.

Rational indications for sphincterotomy through intraoperative cholangiomanometry.

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.

Biofeedback training to obtain continence in permanent colostomy. Experience of two centers.

Biofeedback training is proposed as rehabilitative training for patients with permanent colostomies to help them achieve fecal continence. The results of a preliminary study of 18 patients are reported.

Clinical application of a computerized diagnostic aid in the initial evaluation of 250 outpatients with gastrointestinal complaints.

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.