Radiofrequency resection of bronchial tumours in combination with cryotherapy: evaluation of a new technique.

BACKGROUND: A number of treatments, including Nd-YAG laser therapy, brachytherapy, cryotherapy, electrocautery, and photodynamic therapy, can re-open the obstructed bronchial lumen in patients with inoperable obstructive bronchial tumours. None of these is considered to be a "gold standard". METHODS: The results of a retrospective study of 98 patients treated by radiofrequency tissue ablation and subsequent cryotherapy between January 1994 and June 1995 are reported. The patients were divided in two groups according to whether they were treated either after (group 1, n = 50) or before (group 2, n = 48) radiotherapy and/or chemotherapy. Bronchoscopic follow up was performed. The intervention was considered successful if the lumen was opened by > 80% and partially successful if it was opened by > 50%. RESULTS: In group 1 treatment was successful in 60%, partially successful in 32%, and unsuccessful in 8%. The median survival time was five months from the time of bronchoscopic surgery. In group 2 treatment was successful in 66%, partially successful in 21.5%, and unsuccessful in 12.5%, with a median survival time of 14 months from the time of bronchoscopic treatment. Forty patients (24 in group 1 and 16 in group 2) received a Dumon stent. CONCLUSIONS: Radiofrequency bronchoscopic surgery with cryotherapy appears to be a useful technique in the treatment of tracheobronchial obstruction.

[A case of secondary misplacement of the selective bronchial tube in thoraco-pulmonary surgery]. / Su di un caso di malposizionamento secondario del tubo bronchiale selettivo in chirurgia toraco-polmonare.

The authors, after a short synthesis of the causes of secondary misplacement of the selective bronchial tube in thoracic surgery, describe a clinical case. A patient, after the induction of anaesthesia and selective intubation with Carlens tube, undergoes a surgical procedure of right upper lobectomy. During this procedure, a very serious O2 desaturation stands out and only at the end of the procedure, after X-ray examination, it is possible to understand. The cause of the O2 desaturation is a secondary movement of the bronchial tube. The authors come to the conclusion that to diagnose the secondary misplacement of the bronchial tube during the surgical procedure it should be useful perioperative fiberoptic bronchoscopy.

[Dieulafoy ulcer associated with acute drug-induced gastritis: a rare case]. / Ulcera di Dieulafoy associata a gastrite acuta da farmaci: un raro caso.

The lesion in Dieulafoy's disease consists of an unusually large and tortuous artery in the base of an ulcer. The disease is underdiagnosed rather than truly rare and often presents with a massive and potentially fatal, usually repeated, haematemesis. The authors describe a case of Dieulafoy's disease associated with acute drug-induced gastritis whose gravity required, in the case reported, a very serious emergency treatment.

[Pancreatic encephalopathy. Description of an unusual case]. / Encefalopatia pancreatica. Descrizione di un raro caso.

The authors describe a case of pancreatic encephalopathy. This uncommon condition, rarely described in the literature, occurs with neuropsychiatric signs 3-4 days after the onset of acute pancreatitis. Diagnosis is due to clinical and biochemical findings and to post mortem examinations revealing also amylase in CSF.

[Anesthesia for pleuroscopy. Importance of intubation with the Carlens tube for a selective diagnosis of emphysematous bullae in primary spontaneous pneumothorax]. / L'anestesia per le pleuroscopie. Importanza dell'intubazione con sonda di Carlens per una diagnosi selettiva delle bolle enfisematose nel pneumotorace sponataneo primitivo.

A brief account of the origin of spontaneous pneumothorax and the indications for pleuroscopy in thoracopulmonary surgery is followed by an explanation of the advantages of this method in the selective detection of emphysematous bullae, their number and size, and the state of the lung parenchyma. The evaluation of these parameters is essential to the planning of oriented surgery. A general anaesthesia technique employing a Carlens tube in selective intubation is also illustrated. By permitting separate ventilation of the lungs this method allows a selective diagnosis to be made of emphysematous bullae (including microbullae), and prevents all forms of acute respiratory distress.

[Problems of anesthesia and resuscitation in the extraction of tracheo-bronchial foreign bodies in children]. / Problemi di anestesia e rianimazione per l'estrazione dei corpi estranei tracheo-bronchiali in età pediatrica.

After briefly considering the high incidence of foreign bodies found in the bronchi of children, and some characteristics connected with their nature, the early and late complications that may occur as a results are illustrated. Resuscitation and anaesthesia techniques are then described, stress being laid on the importance of the ketamine-TCT injection and local anaesthetic association. The latter has proved most effective in personal cases as it resolves the laryngotracheo-bronchial spasm responsible for asphyctic crisis and prevents any dangerous deepening of narcosis during bronchoscopic manoeuvres for the extraction of the foreign body.

[Problems of alimentation in massive intestinal resections]. / Problemi di alimentazione nelle resezioni intestinali massive.

Before reviewing the consequences of extensive exeresis of the small intestine, the physiology of the entero-hepatic circulation of bile salts, the absorption of triglycerides and the varying sites of absorption of foodstuffs at intestinal level are discussed. It has been found that massive (i.e. at least 2/3) removal of the small intestine is incompatible with life owing to the onset of serious metabolic disturbances due to the increase in the speed of transit of foodstuffs from stomach to colon. Malabsorption of lipides causes steatorrhoea and is often associated with choleriform diarrhoea owing to the massive losses of water and electrolytes (Na, Cl, Ca, Mg). Some surgical techniques are illustrated and the local compensation mechanisms (anatomical adaptation of the intestinal mucosa, functional adaptation) designed to prolong transit time are described. Feeding must be parenteral for the first 2--3 months and oral during the alimentary adaptation phase.

[The pancreatico-respiratory syndrome. Problems of intensive therapy and illustration of 5 clinical cases]. / La sindrome pancreatico-respiratoria. Problemi di terapia intensiva ed illustrazione di 5 casi clinici.

A short account of the mechanisms responsible for pleuropulmonary affections in the course of pancreatitis is followed by the presentation of personal cases observed over the previous four years and reference is made to the relatively high frequency of pleuropneumopathy. Lastly, mention is made of the treatment of pancreatitis. Recent criteria lay down that this should be conservative and medico-intensive in the acute stage. Surgery should be left for cases of peritonitic abdomen (exploratory laparotomy) and chronic pancreatitis.