Clinical Outcome of Neoplastic Meningitis Associated with Breast Cancer.

 Neoplastic meningitis (NM) is considered as a terminal event with poor prognosis. Its impact in clinical oncology is growing.  To analyze the clinical outcome of patients with carcinoma breast diagnosed with NM.

Oxygen metabolism during and after cardiac surgery: role of CPB.

Background: Cardiopulmonary bypass (CPB) has been reported to increase oxygen metabolism and to influence the relation between oxygen consumption (VO(2)) and delivery (DO(2)) in the early hours after cardiac surgery. To investigate the role of CPB, we studied oxygen metabolism in coronary artery bypass procedures performed on-pump (CABG) and off-pump (OPCAB).

Methods: Twenty-five patients were randomized to undergo CABG (n = 14) or OPCAB (n = 11).

Protectant activity of defibrotide in cardioplegia followed by ischemia/reperfusion injury in the isolated rat heart.

Background: Previous studies have shown that defibrotide, a polydeoxyribonucleotide obtained by depolymerization of DNA from porcine tissues, has important protective effects on myocardial ischemia, which may be associated with a prostacyclin-related mechanism. The purpose of this study was to investigate the direct effects of defibrotide (given in cardioplegia or after ischemia) on a model of rat heart recovery after cardioplegia followed by ischemia/reperfusion injury.

Methods: Isolated rat hearts, undergoing 5 minutes of warm cardioplegic arrest followed by 20 minutes of global ischemia and 30 minutes of reperfusion, were studied using the modified Langendorff model.

Cardiopulmonary bypass and oxygen consumption: oxygen delivery and hemodynamics.

Background: This study was undertaken to investigate the relations between whole body oxygen consumption (VO2), oxygen delivery (DO2), and hemodynamic variables during cardiopulmonary bypass.

Methods: One hundred one patients were studied during cooling, hypothermia, and rewarming. Oxygen consumption, DO2, hemodynamics, and DO2crit were measured at these times.

Role of right gastroepiploic artery in myocardial revascularization with arterial grafts.

Between July 1990 and December 1992. 112 patients underwent myocardial revascularization with arterial grafts in the Department of Cardiac Surgery, University of Milan. Monovascular patients were excluded from the study.

"Thinning-down phenomenon" and vasomotor adaptability of the inferior epigastric artery graft.

We report a case of diffuse thinning of an inferior epigastric artery early after its implantation as a coronary free graft. This phenomenon showed reversibility at the 20-month angiographic follow-up in response to progression of the proximal lesion in the recipient coronary artery. Graft vasodilation in response to atrial pacing and nitroglycerin infusion at late angiography confirmed the vasomotor adaptability of this arterial conduit.

The effect of multiple blood conservation techniques on donor blood exposure in adult coronary and valve surgery performed with a membrane oxygenator: a multivariate analysis on 1310 patients.

The object of the study was to retrospectively evaluate protective and risk factors for receiving donor blood products and red cell transfusions after coronary and valve surgery performed with a hollow-fiber oxygenator and with multiple blood-saving techniques. During the period of January 1991 to June 1993, 1310 patients underwent primary coronary and valve surgery using a hollow-fiber oxygenator at our institution; the mean age of this population was 61 +/- 10 years; 977 patients were men (74.6%).

Prostacyclin production by different human grafts employed in coronary operations.

Segments of human saphenous vein, internal mammary artery, right gastroepiploic artery, and inferior epigastric artery were incubated in vitro in Krebs-Henseleit solution and compared in terms of their capacity to generate and release into the medium 6-keto-prostaglandin F1 alpha (PGF1 alpha), the stable metabolite of prostacyclin. The four vascular conduits were also challenged with endothelin-1 (40 ng/mL), and accumulation of the lipidic material in the bathing fluid was also studied. The results obtained show clearly that under both normal and endothelin-1-stimulated conditions, the four vascular segments generate a substantial amount of 6-keto-PGF1 alpha.

[The use of the inferior epigastric artery as alternative conduit for myocardial revascularization: our experience].

When complete revascularization can not be obtained with the internal mammary artery and saphenous veins, the inferior epigastric artery may be an excellent alternative conduit. We describe our experience with this conduit, review the anatomy of this artery, and present the evolution of our harvesting technique through a pararettal approach. Proximal anastomoses were made first with the aid of an oval cuff of the common femoral artery (5 cases, Group A).

Extracranial carotid artery aneurysms. Report of two cases.

Two cases of extracranial carotid artery aneurysm are reported. Treatment of this uncommon but interesting vascular disorder is still under discussion even if the present tendency is to treat them actively, by reconstructive techniques. We present our surgical experience and discuss the diagnostic problems and management.

[Postoperative hyperamylasemia in surgery of the biliary tract (clinical contribution)].

The Authors refer on the presence of hyperamylasemia in 46 patients subjected to surgery of the bile ducts. A rise in serum amylase values was found in 22,42 of the cases. In one case only, hyperamylasemia was accompanied by a clinical picture of acute pancreatitis.

[Emergency surgical treatment in complications of Crohn disease].

The Authors refer to four cases of complications in patients suffering from Crohn's disease. Three patients were already subjected to surgery for the same illness. The Authors value the opportunity of an urgency surgery on the complications of this disease.

[A fairly common complication of acute appendicitis (a propos of 42 cases of abscess of Douglas' pouch)].

After a brief review of the literature, 42 cases of Douglas-pouch peritonitis are described, with particular regard to those cases arosen as a complication of acute appendicitis. Symptomatology and anatomo-pathological pictures are carefully described and the most likely pathogenetic causes are discussed. Particular attention is paid to the surgical techniques used.

[Umbilical angiofibroma (apropos of a case)].

A woman aged 15 without any notable pathological history, was submitted to an operation because of a gradual growth of her umbilical region for a month. A tumor as large as an hazel-nut, was an angiofibroma of the round ligament of the liver. The round ligament may give cysts and tumors as the allantois does.

[Traumatic rupture of the diaphragm caused by closed injury].

Our experience with 26 Patients who sustained traumatic laceration of the diaphragm caused by blunt forces is described. Automobile accidents were the most frequent cause of rupture and young adult males the most vulnerable. The left hemidiaphragm is most frequently injured, but with sufficient force significant tears in the right hemidiaphragm will occur.

[Early diagnostic laparotomy in patients with multiple injuries (apropos of 125 cases)].

Hundred twenty five patients with multiple areas of injury requiring surgical repair outside of the abdomen too were subjected to laparotomy. In patients with multiple areas of trauma the abdomen is almost always suspect. The proliferation of diagnostic tools to detect intraperitoneal damage have, in some ways, helped phisicians decide as to laparotomy.