Biliopancreatic diversion with transitory gastroplasty preserving duodenal bulb: 3 years experience.

BACKGROUND: The authors have performed 521 bariatric surgery operations (319 restrictive procedures and 202 malabsorptive procedures). METHODS: During the last few years we have introduced an evolution of biliopancreatic diversion (BPD): BPD with transitory gastroplasty, preserving the duodenal bulb (53 cases). From a technical point of view, the operation consists of a BPD, coupled with a gastroplasty which is transitory due to the use of a polydioxanone (PDS) band. In the last few cases, instead of a VBG (with PDS band) in order to make the operation completely reversible without any suture on the stomach, we made a gastric pouch by banding with PDS calibrated with the same tube as for the Lap-band (20 cc). We maintained completely the duodenal bulb (5 cm from the pylorus), making an end-to-side duodeno-ileal isoperistaltic anastomosis. RESULTS: With this anastomosis, only 2% of patients developed an anastomotic ulcer. With this new procedure, results have been good in terms of weight loss (similar to that of BPD-AHS) and in nutritional complications. No patient has had hypoalbuminemia, diarrhea or halitosis. CONCLUSION: BPD with temporary gastric restriction has provided satisfactory results.

Reflections on Four Years' Activity of an Interdisciplinary Centre for the Treatment of Obese Patients.

Since 1988, there has been an interdisciplinary center for obesity treatment in Stradella's Hospital's Surgery Department,. Patients are followed by a group of surgeons, anesthetists and dietitians, who choose the proper treatment for the patient. The surgical treatments are two: (1) vertical banded gastroplasty; and (2) a new technique consisting of biliopancreatic diversion plus a vertical banded gastroplasty with stomach ad hoc. The authors explain the new surgical procedure showing positive results, without giving final conclusions because of the small number of patients treated.

Location of central venous catheters in children by endocavitary ECG: A new technique.

A new technique to establish the position of a central venous catheter (CVC) by endocavitary ECGraphy is described. The principle is based on the fact that the catheter itself may be considered as an electrical conductor by means of its liquid content (saline solution), therefore acting as an exploring electrode. The intrinsic deflection of the P wave shows the proper position of the CVC tip at the sinus node level. The technique has been successfully utilised in 52 children needing antineoplastic chemotherapy and/or total parenteral nutrition, thus avoiding chest X-ray control, which is troublesome and potentially harmful in neonates and infants.

[Malignant hyperthermia. The need for anesthesia in a patient manifesting this syndrome]. / Ipertermia maligna. Necessità di sottoporre a narcosi un paziente che già aveva manifestato la sindrome.

Successful treatment of malignant hyperthermia, following its prompt recognition in a young patient during general anaesthesia with halothane and succinylcholine, preceded the equally successful employment of ketamin, with no signs of enzyme alteration and circulatory stability, when the same subject had to be operated 20 days later.

[Ketamine hydrochloride by continuous drip intravenous infusion in thoracic surgery]. / Il cloridrato di ketamina in perfusione venosa decelerata per la chirurgia del torace.

The Authors report an open trial on 50 patients anaesthetized with Ketamine hydrochloride, by continuous drip infusion progressively slowed, with the aid of Fentanil, in thoracic surgery. The proposed anaesthetic technique proved to be excellent as for as analgesia during and after operation as well cardiovascular stability and lackness of side effects is concerned. Recovery from anaesthesia was quick and extremely quite and free from side effects which are common in Ketamine anaesthesia.

[0.75% and 0.5% bupivacaine in peridural lumbar block for surgery on the lower abdomen; a double-blind comparison and myographic study]. / Bupivacaina 0,75% e 0,50% nel blocco peridurale lombare per chirurgia del basso addome; confronto doppio cieco e studio miografico.

A double blind study has been carried out on 40 patients subjected to peridural block with 0.50% and 0.75% bupivacaine for operations on the low abdomen. While no significant differences were observed with regard to the latency and duration of anaesthetic action, 0.75% marcaine was more effective as regards the duration and degree of motor block. This result was also confirmed by an electromyographic study of the muscles of the hypothenar eminence.