Acta bio-medica de L'Ateneo parmense : organo della Societa di medicina e scienze naturali di Parma最新文献

The improvement in surgical and anesthesiological techniques have allowed a reduction in oncological surgical morbidity and mortality. The objective of this retrospective study is to evaluate the morbidity and the mortality in oncological gastric surgery up to date. Between 1979 and 1994 we evaluated 281 patients for gastric cancer, of whom 249 underwent surgery. The patients ranged in age from 34 to 88 years, with a mean age of 67.8 years, and included 158 males and 91 females. An oncological radical excision was performed in 184 patients (122 gastroresections and 62 gastrectomies). The other 65 patients underwent exploratory or palliative surgery: 26 explorative laparotomies, 26 gastroenteroanastomoses, 9 gastroresections, 3 digiunostomies and one gastrostomy. The overall post-operative morbidity has been 40.1%, 27.3% was generic and 12.8% was surgical morbidity. The overall mortality has been 9.6%, of whom about one third following surgical complications. In our experience the factors related with morbidity and mortality have been: age, preoperative nutritional state and stage of the disease.

Since the 1993, a series of 22 women with stress urinary incontinence underwent bladder neck suspension, according to Gittes (pubovaginal suspension). No patients had preoperative detrusor instability or intrinsic sphincter dysfunction; 14 pts had a significant cystocele (II-III degree). We followed up 20 pts at 6 months: 9 pts (45%) were cured, 3 were significantly improved and 8 were not improved. Disappearance or marked improvement of moderate or severe cystocele wasn't confirmed in all pts. No serious complications were recognized. We believe that this procedure is quick and easy to perform with low morbidity and is useful where the indication is correct: patients with stress incontinence without significant anterior vaginal wall prolapse.

Latent coeliac disease (L.C.D.) is an extremely rare condition to describe. In this study we analyzed three cases of patients affected by L.C.D.: two of them suffered from insulin-dependent diabetes mellitus (IDDM) and the other one from infantile cerebral palsy and eosinophilic gastroenteritis. We confirm the existence of this form of coeliac disease (C.D.), by means of duodenal biopsy, and stress the importance of an early diagnosis in order to prevent the serious consequences caused by untreated C.D.

The osseointegration of biomaterials for dental and orthopaedic use is a still open topic in experimental and clinical research. Some aspects of this complex mechanism are not completely research. Some aspects of this complex mechanism are not completely explained yet. These reasons make the process of osseointegration a topical subject both in clinical and experimental view points. The authors describe how this complex event has not been studied with standard investigation and report also most of present research lines on the basis of their experience. A particular attention is paid to some factors related to both biomaterial and implant site, which can influence significantly the process of osseointegration.

The general pattern of the organization of the thalamo-cortical projections to the agranular frontal cortex of the monkey is still matter of debate. An important issue is whether each motor area is the target of a single thalamic nucleus or it receives afferences from multiple thalamic sources. In this light it is of interest to determine whether the basal ganglia and cerebellar outputs, which are segregated in the thalamus, remain segregated also at the cortical level or, on the contrary, both converge on the same cortical areas. In the present article we present data concerning the thalamic input to mesial area 6 obtained with cortical injections of retrograde neural tracers. This cortical sector, classically considered as coextensive with the so called supplementary motor area (SMA), was recently found to be formed by two independent anatomo-functional areas: F3 (SMA-proper) and F6 (pre-SMA). On the basis of the neurophysiological properties of the two areas we have proposed that F6 plays a hierarchically higher role in motor control than F3. The present results allow us the following main conclusions: a) Each motor area is the target of a distinct set of thalamic nuclei. b) Each area is the target of both basal ganglia and cerebellar outflows. c) As far as the basal ganglia input is concerned, F3 is a part of the so called "basal ganglia motor loop", whereas, F6 belongs to the "basal ganglia complex loop". This differential basal ganglia input provides further evidence in favor of a higher hierarchical role of F6 in comparison to F3.

The evaluation of the temporal characteristics of the acoustic stapedius reflex is one the fundamental aspects of the impedance audiometry, since significant biological information to be used as sensitive indicators of distinctive pathologies can be obtained. At the Audiology Service of the E.N.T. Department of Parma four parameters of the acoustic stapedius reflex have been studied (onset latency, latency at 10% of the maximum amplitude, rise time, offset latency) in a group of people having normal ears without previous otological problems, with the aim to establishing some rules. The equipment used is the Madsen Impedenzometro ZO 174 which enables to obtain an average among a desired number of reflex responses. The report shows the value of the four parameters of the stapedius reflex obtained from the study of 10 normoacusic patients totalling 20 ears. The resulting guidelines can make up the basis for further research in pathological cases with cochlear, neural and central lesions.

The authors report their experience with a third generation lithotripter Storz-Modulith SL 20 with fluoroscopic and echography stone localization. A total of 284 patients, between september '92 and august '94, with 149 renal and 135 ureteral stones, underwent 483 treatments. The mean treatment rate was 1,7 and the over-all stone free rate was 93%. Auxiliary procedures before ESWL were performed in 5.1% of the sessions (stenting, nephrostomy tube) and in 1% post-ESWL manipulations for lithiasic steinstrasse. Complications as: renal damage, steinstrasse etc. occurred in 2.5% of the session; in 20 patients ESWL procedure failed.

Spontaneous intracerebral hemorrhage is a significant cause of morbidity and mortality. The disease primarily affects men between the age of 45 to 75 years. Arterial hypertension is the most frequent etiologic factor. Here is presented a case-record of 148 intracerebral hemorrhages observed during a five years period. Several clinical and radiological features have been correlated and analyzed from a statistical point of view. The most important prognostic factor is the state of consciousness. Either deep coma and a normal state of consciousness do not represent surgical indications.

The Authors report their experience in the endoscopic treatment using pneumatic dilatation for 18 patients with achalasia, seen in the period January 1992 August 1995 at the Laboratory of Digestive Endoscopy of the Institute of General Thoracic and Vascular Surgery of the University of Parma. Ten were males and 8 females, age range 23-79 years (average age 48 yrs.). The most common symptoms was dysphagia, all patients were radiologically and manometrically studied confirming the clinical and endoscopic diagnosis. All underwent pneumatic dilatation under endoscopic control. In all, 36 dilations were carried out without registering complications related to the method. A maximum follow-up of 30 months confirmed a good-excellent outcome in 89% of cases. In 3 cases a gastroesophageal reflux symptomatology was registered, but successfully treated medically. The Authors conclude that the pneumatic dilation for achalasia is to be considered the treatment of choice, leaving the surgical approach only for cases resistant to such treatment.

High levels of lipoprotein Lp(a) are related to cerebrovascular disease clinical manifestations, as well as to the severity of extracranial carotid atherosclerosis assessed by ultrasonography. In order to investigate the relationship of Lp(a) to the severity of carotid atherosclerosis in the elderly, 100 subjects, aged 78.5 +/- 0.6 yrs underwent an echo-color-doppler scanning of carotids; atherosclerosis severity, assessed as maximum percentage stenosis, presence of complicated plaque and Intima-Media Thickness (IMT), was related to Lp(a) levels, assayed by an immunoenzymatic procedure. A slight association between Lp(a) and CVD clinical manifestations was apparent only in subjects under 78 yrs and for Lp(a) values above 25 mg/dL. Lp(a) levels were not related either to the degree of stenosis, the presence of complicated plaque, or IMT. As for other selected risk factors, while no relationship was found for clinical CVD and IMT, the maximum percentage of stenosis and the presence of complicated plaques were positively related to LDL-cholesterol in subjects under 78 yrs. We can conclude that Lp(a), albeit unrelated to the severity of extracranial vessel atherosclerosis, maintains a role as cerebrovascular risk factor in the elderly, being slightly related to clinical manifestations; however its discriminant power is lower than in middle-aged people and further decreases throughout ageing.