Differential device performances for hepatic arterial chemotherapy: a technical report on totally implantable pumps and ports for both continuous and bolus infusion.

Performances of totally implantable infusion systems were analyzed in patients with colorectal liver metastases undergoing intra-arterial treatment. It consisted of 14-day continuous infusion of 5-fluor-2'deoxyuridine with pumps (pump14, 44 patients) or ports fed by external pumps (port14, 34 patients), or bolus infusion of cisplatin (port21, 57 patients) or epirubicin (port7, 22 patients) every 3rd week and weekly, respectively. Toxicity and disease progression were the most common causes of treatment interruption.

[Hypersplenism in surgery].

We studied 86 patients suffering from hypersplenism, associated with portal hypertension (39 patients), hematologic disease (45 patients) and with Gaucher's disease (2 patients). Inclusion criteria were the presence of thrombocytopenia < 100.000 x mm3 and leucopenia < 4.

Quality of life after proctocolectomy and ileo-anal anastomosis for severe ulcerative colitis.

Objective: Impaired quality of life (QOL) in patients with ulcerative colitis (UC) may be a prominent feature of the disease, and in some cases, may become an indication for surgical treatment. The objective of this study was to assess QOL in patients who underwent proctocolectomy with ileo-anal anastomosis with a J pouch for severe UC and to compare it with patients with UC of different severity who were under medical treatment.

Methods: We used a validated, disease-specific research instrument (a 29 item, self-administered questionnaire) that examines the following four functions: intestinal (score 0-24) and systemic symptoms (0-21), and emotional (0-27) and Social Function (0-15).

Role of color Doppler ultrasonography in the preoperative staging of pancreatic cancer.

We describe our experience with color Doppler ultrasonography (CDU) in the preoperative staging of pancreatic cancer and, particularly, in detecting the involvement of the portal-mesenteric trunk (PMT). Of the 54 patients studied, 43 (79.6%) underwent surgery and 11 (20.

[Etiopathogenic, diagnostic and therapeutic problems apropos of 2 observations of acute acalculous cholecystitis].

The acute acalculous cholecystitis (A.A.C.

Preoperative pneumatic dilatation represents a risk factor for laparoscopic Heller myotomy.

Background: The development of minimally invasive surgery has renewed interest in the surgical therapy of achalasia.

Methods: 21 patients with esophageal achalasia underwent Heller's laparoscopic myotomy with anterior fundoplication between August 1991 and March 1996.

Results: There were two intraoperative perforations of the mucosa sutured laparoscopically with no postoperative sequelae; both complications occurred in patients previously treated with pneumatic dilatation; no perforations occurred in the 14 patients who had not been submitted to pneumatic dilatation (28% vs 0%).

[Performance and complications of totally implantable port device in bolus hepatic intra-arterial chemotherapy].

The performances of totally implantable ports were analyzed in patients with colorectal metastases undergoing intraarterial treatment. Seventy-nine patients received bolus infusion of Cisplatin (DDP, 57 cases) or Epirubicin (EPI, 22 cases) every 21 and 7 days, respectively. Disease progression or toxicity were the most common causes of interruption of treatment, whereas failure of ports occurred in six and two patients out of DDP and EPI groups, respectively.

Timing of surgery related to menstrual cycle and prognosis of premenopausal women with breast cancer.

The influence of the timing of surgery in relation to the menstrual cycle on the survival of breast cancer patients has been both advocated and disputed. The records of 165 premenopausal M- breast cancer women consecutively operated from 1977 to 1991 were reviewed. All patients underwent modified radical mastectomies or quadrantectomies plus postoperative radiotherapy.

Adrenal location of the echinococcus. Considerations on a clinical case.

Adrenal location of a hydatic cyst is a clinical occurrence of exceptional rarity, especially in its primitive form and it could be evaluated, on the operative and autoptic comparison, not to exceed overall 0.5% of all the possible locations. Moreover, among all the cystic formations of the adrenal glands, parasitic ones are only 7%.

Effect of hyaluronidase on the pharmacokinetics of free and total platinum species after intra-arterial Cisplatin in refractory patients with colorectal liver metastases.

A pharmacokinetic study was carried out in patients with unresectable colorectal liver metastases who had primarily been included in a phase II trial of intra-arterial cisplatin (DDP) plus intravenous fluorouracil. Ten patients of those accrued for the clinical study underwent the pharmacokinetic investigation upon liver progression of the disease. Four patients were treated with DDP (24 mg/m(2)) through short intra-arterial infusion (baseline study) and 4 patients received intra-arterial hyaluronidase (HY, 100 000IU) 2 minutes before DDP infusion.

Binge eating in obesity.

Objective: To investigate the influence of dieting and of body shape dissatisfaction on binge eating.

Design: Longitudinal study following billiopancreatic diversion (BPD), when the body shape has become normal or nearly normal, and any worries over weight, dieting and food have probably been abandoned completely.

Subjects: 65 severely obese patients, evaluated by clinical semistructured interview for occurrence of binge eating episodes prior to, and at one and at two years following BPD.

Body composition and energy expenditure in obese patients prior to and following biliopancreatic diversion for obesity.

Body composition and resting energy expenditure (REE) were assessed in 69 obese patients prior to and 1 year following biliopancreatic diversion (BPD). Fat-free mass (FFM) and body fat sizes were very similar to those of nonoperated subjects closely matched for body weight and FFM size. In the BPD subjects, the REE data were high, thus excluding a dilatation of non-energy-consuming extracellular spaces and suggesting an increase in the ratio between the organs and the less metabolically active muscle mass within the FFM.

[Function and complications of diverse totally implantable systems for continuous intra-arterial infusion of FUdR in colorectal hepatic metastases].

Different totally implantable arterial infusion systems were compared in patients with liver metastases from colorectal cancer undergoing continuous intra-arterial infusion. Seventy-eight patients received continuous FUdR infusion using either totally implantable pumps (group a = 44 pts.) or ports fed by external portable pumps (group b = 34 pts.

[Preoperative eating behavior and weight loss after gastric banding for obesity].

The relationships between the cognitive restraint and the tendency to disinhibition prior to gastric banding for obesity, as assessed by the Three Factor Eating Questionnaire, and the weight loss at one year following the operation were investigated. The amount of overall weight loss was correlated positively to the disinhibition and negatively to the cognitive restraint score. When the food consumption overtakes the proximal gastric pouch capacity, the patient feels a strong aversive stimulus, thus stopping eating.

[Laparoscopic treatment of non parasitic liver cysts].

Various surgical treatments have been proposed for highly symptomatic hepatic cysts: enucleation, fenestration, hepatic resection and liver transplantation. The advent of laparoscopic surgery has provided new opportunities but, at the same time, has increased the uncertainties concerning the correct management of these patients. This study evaluates the results and defines the indications for laparoscopic fenestration of symptomatic nonparasitic hepatic cysts, either solitary or diffuse.

Adrenocortical carcinoma. Our experience.

Adrenocortical carcinoma represents only 0.2% of the causes of deaths from cancer and this extremely low incidence rate implies that few medical centers have sufficient experiences to permit logical conclusions to be drawn regarding its treatment. From 1979 to 1993 we operated on 215 patients for adrenal diseases.

[Role of axillary dissection in breast carcinoma].

Between 1986 and 1995, 965 patients with T1 breast cancer were treated with wide excision (796 pts) or mastectomy (138 pts). Axillary dissection was performed in 934 patients. Nodal positivity was 8.

[A clinical and instrumental study of the functionality of ileoanal "reservoirs"].

Twenty-five patients with ileo-anal "reservoir" have been evaluated by clinical examination, manometry, proctography, endoscopy and biopsy, at least six months from the closure of ileostomy. 80% of them presented with a satisfactory condition, although only one third reached a normal function; 20% suffered for one or more dysfunctions which lead to a variable degree of social handicap. The most frequent dysfunctions were incontinence (13 patients), urgency (10), frequency (9), pouchitis (6), incapacity to evacuate (2).

Use of color photocopying machine in surgical imaging.

Background: The photographic imaging of operative specimens is quite a puzzling procedure, especially in emergency situations and whenever a professional photographer is not available. A careful documentation of the gross pathology therefore is not always possible, and this is detrimental for the full clinical information on the patient. We suggest an original, quick, simple, and inexpensive use of a regular color photocopying machine to produce a real time 1:1 and magnified picture of operative specimens, biopsies, etc.

Role of bilateral adrenalectomy in Cushing's disease.

Of 206 patients with Cushing's syndrome observed from 1975 through 1991, 144 (69.9%) had pituitary-dependent Cushing's disease. Of the 110 patients who underwent pituitary surgery, 31 (28%) developed an early recurrence and 23 patients (20%) had a late relapse 1 to 5 years after primary pituitary exploration.

[Radical interventions in the treatment of thyroid carcinoma].

From 1970 to 1993, 196 patients with thyroid cancer were treated surgically. In 26 (13.2%) an invasion of local and regional structures was observed.

A simplified method of pig islet isolation.

This study reports a simplified, low-cost, easily performed chemico-mechanical isolation method of the islets of Langerhans. The experimental study was carried out on 15 adult pigs. Our method used collagenase and a digestion chamber for islet isolation and yielded 2,240 +/- 613 islets per g treated pancreas after purification.