Duodenal obstruction by self-expanding biliary stents in patients with pancreatic cancer.

Self-expanding biliary drains seem to allow long-term patency and prevent stent migration in peri-ampullary neoplastic lesions. We report two cases of duodenal occlusions due to the stent advancing towards the intestinal lumen in patients with tumours of the pancreatic head. The stents had been percutaneously positioned after an endoscopic papillotomy or palliative choledocho-jejunostomy and were impacted by alimentary debris, blocking the passage of food.

Use of virtual reality simulator in the training of postgraduated surgical residents.

Aim Of The Study: The purpose of this research project, granted by the Italian University and Scientific Research Ministry (MIUR) and carried on among four Surgical Departments in Padua, Verona, Pisa and Rome-Tor Vergata Universities, is to study the effectiveness of a virtual reality simulator as a tool for surgical residents training and as a method for measuring the surgical skills.

Materials And Methods: The residents performances on the computer were compared with those obtained by other training groups: medical students with no surgical background, senior surgeons with experience in the laparoscopy field and non medical students with referred ability in videogames. The residents were also sent to a well certified live animal laboratory where they could perform a cholecystectomy in a pig.

Surgery for chronic pancreatitis: what quality of life ahead?

We attempted to evaluate the quality of life of patients with proved long-lasting chronic pancreatitis. We measured the clinical and psychological status of 60 patients who had undergone various surgical treatments for their disease. The presence and severity of depression and other symptoms of distress were assessed, as were disease-specific functional and physical problems.

Effect of octreotide acetate on pancreatic exocrine and endocrine functions after pancreatoduodenal resection.

In view of forecasting the effect of octreotide acetate (Sandostatin) in preventing fistula formation after pancreatic surgery, 9 patients, who had pancreatoduodenectomy 8-12 days before, underwent a 2-day study. The first day, by means of a catheter located in the jejunal loop separately anastomosed to the pancreatic remnant, basal and after secretin stimulation pancreatic secretion was evaluated. During the 2nd day the possible inhibitory effect of octreotide on basal and stimulated secretion was investigated.

Percutaneous CT-guided fine needle aspiration cytology in the differential diagnosis of pancreatic lesions.

Cytologic results were retrospectively evaluated in 83 patients who underwent CT-guided fine-needle aspiration of pancreatic lesions during a 5-year period. Sixty seven patients had malignant disease and 16 benign disease. The sensitivity, specificity, positive and negative predictive values, and diagnostic efficiency of fine-needle aspiration (FNA) cytology in detecting malignancy were 91%, 100%, 100%, 73%, and 93%, respectively.

[Malignant mesenchymal tumors of the breast. Report of 3 new cases].

Malignant tumors of the breast arising from the connective tissue of the gland are rare and underestimated. Three new cases are here reported: 1 malignant fibrous histiocytoma and 2 malignant phylloides tumors. Tumor size, mammographic findings and cytologic aspect of the needlebiopsy lead to the correct diagnosis.

Biliary cyst. A case report.

A case of type-IA biliary cyst, according to the Todani classification, is reported in a 44-years-old man admitted to hospital with epigastric pain. Ultrasound was misleading; CT scanning and preoperative cholangiography confirmed the biliary duct's dilatation. Cyst excision and hepaticojejunostomy were performed with a view to avoiding possible cyst cancerization.

[Adrenal cystic masses. Our experience].

Cystic masses of the adrenal gland are clinically and pathologically rare findings and few cases have been reported up to now in the medical literature. In the present work 5 new cases are reported: 3 adrenal pseudocysts, 1 lymphangioma, 1 cystic pheochromocytoma. In 3 cases there were clinical symptoms of retroperitoneal mass (lumbar pain, palpable mass, digestive symptoms); in 3 cases conventional radiology was helpful; ultrasonography was used for diagnosis in 1, CT scan in 2.

[Omeprazole prevention of the recurrence of peptic ulcer: the efficacy of treatment with 20 mg on alternate days].

Omeprazole, 20 mg every second day, in prevention of duodenal ulcer relapse has been tested. 15 patients with peptic ulcer, which was endoscopically proved and then healed, underwent the treatment. No matter of ulcer original seat as well as antacid drug previously employed, recurrences were not seen after a 6 months period, while clinical symptoms and possible adverse reactions appeared to be very slight.

[Clinical course of diabetes in patients operated upon for chronic pancreatitis].

Diabetes evolution among patients who underwent surgery for chronic pancreatitis has been evaluated (10 had left pancreatectomy, 23 pancreatoduodenectomy, 39 pancreaticojejunostomy, 13 other operations not on the pancreas). On the basis of insulin needs for achieving a normal glycemic status, left pancreatectomy proves to cause or at least to hasten the development of diabetes which appears hardly kept under control and easily followed by complications. The choice of such surgical treatment should be justified, besides the local pathologicoanatomic situation, by a well established endocrine impairment.

A simple method for the determination of lipid composition of human bile.

The Entero-Test, a device for easy sampling of gastrointestinal contents, including bile, has been used for determination of biliary lipid composition. The device consists of a weighted gelatin capsule containing 140 cm of a highly absorbent nylon line. The capsule is swallowed while one end of the string is taped to the face.

C reactive protein in pancreatic cancer and chronic pancreatitis.

Serum C reactive protein was determined in 30 control subjects, 32 patients with pancreatic cancer, 28 with chronic pancreatitis and 23 with extra-pancreatic diseases of the upper gastrointestinal tract. The aim was to ascertain possible alterations of this index in chronic pancreatic disease and to speculate on some influencing factors. Higher C reactive protein levels were found in pancreatic cancer as compared to controls.

Tissue polypeptide antigen, galactosyltransferase isoenzyme II and pancreatic oncofetal antigen serum determination: role in pancreatic cancer diagnosis.

The clinical usefulness of tissue polypeptide antigen, galactosyltransferase II and pancreatic oncofetal antigen was evaluated in detecting pancreatic cancer and in differentiating this malignancy from chronic pancreatitis and other diseases (mainly of the liver and biliary tract) which may enter in differential diagnosis. TPA seems to be the most sensitive among these indices in detecting pancreatic cancer and appears to discriminate this malignancy quite satisfactorily from chronic pancreatitis. It is also frequently pathological in a number of other diseases and is influenced by the presence of liver dysfunction.

Transhepatic portal sampling for preoperative localization of insulinomas.

The data of 72 patients with pancreatic insulinomas were analyzed. Twenty-one were obtained from personal experience and 51 from a review of the literature. In all instances, detailed information about insulin levels in the portal tree as obtained by means of a transhepatic portal sampling (THPS) and localization of the tumor as found during the surgical procedure was available.

Central venous catheter guidewire replacement according to the Seldinger technique: usefulness in the management of patients on total parenteral nutrition.

While on total parenteral nutrition (TPN), 37 patients underwent replacement of a central venous catheter (CVC), during which a wire introducer was used, according to the Seldinger technique. In 25 patients, the CVC was placed in the superior cava via the subclavian, and, in 12, via the jugular vein. Overall, 82 CVC changes were performed.

Evaluation of carbohydrate antigens 19-9 and 12-5 in patients with pancreatic cancer.

The diagnostic value of the tumor-associated antigens Ca 19-9 and Ca 12-5 was tested in 130 subjects (38 healthy controls, 37 carcinomas of the pancreas, 23 chronic pancreatitis, 23 extrapancreatic gastrointestinal cancers, 9 endocrine pancreatic tumors). Ca 19-9 levels above 37 U/ml were obtained in 67.6% and Ca 12-5 levels above 39 U/ml in 45.

Surgical experience with adenocarcinoma of the ampulla of Vater.

Between 1968 and 1982, 13 patients in this study had a pancreaticoduodenectomy (PD), one patient had a total pancreatectomy, two had an ampullectomy, and one patient had a choledochoduodenostomy for neoplasia of the ampulla of Vater. The operative mortality was zero, and the 5-year actuarial survival rate for the 16 resected patients was 52.6 per cent.

An unusual complication of chronic pancreatitis: a recanalized portal tree communicating with a pancreatic pseudocyst.

A patient with chronic pancreatitis was admitted for digestive bleeding from esophageal varices. Portal thrombosis and cavernomatous periportal collateral circulation were found at laparotomy. The partially recanalized portal tree was excluded from the portal circulation and filled with pancreatic juice due to a communication with a pancreatic pseudocyst.