Management of postoperative bile leakage with endoscopic sphincterotomy (EST) and a naso-biliary drain (NBD).

Between July 1987 and December 1990, 13 patients with postoperative bile leakage were treated with endoscopic sphincterotomy and a naso-biliary drain. All the leaks healed in two weeks, except for one (intrahepatic) that needed two months to heal in association with percutaneous management. The non-surgical treatment of bile leakage is the preferred approach on account of the superior safety, efficacy and cost-effectiveness as compared with surgical repair, which is associated with significant morbidity, mortality and costs. The treatment of choice has to be endoscopic, which is much easier and safer than the transhepatic approach, especially in the non-dilated duct, while another advantage over radiology includes the possibility for rapid definitive treatment of distal obstruction (e.g. residual stones). A leak from an extrahepatic duct heals rapidly, while a leak from an intrahepatic duct takes longer to heal and sometimes needs associated percutaneous drainage. Finally, the authors propose treating an extrahepatic bile leak merely with naso-biliary drainage without cutting the papilla, and an intrahepatic bile leak with endoscopic sphincterotomy, nasobiliary drainage and a bilio-duodenal endoprosthesis.

Estrogen receptors in colorectal adenocarcinomas and in other large bowel diseases.

Seventy-two patients with tumor and ten with non-neoplastic colon disease were studied for the presence of estrogen receptors (ER) by three different methods. Only seven specimens (six primary adenocarcinomas and one recurrent cancer) had an ER concentration above 3 fm/mg of cytosolic protein, with no sex, age and tumor stage correlation. Our results suggest that the large bowel does not contain a cytosolic receptor for estradiol.

[Variations in serum kininase II activity in acute jaundice]. / Variazioni dell'attività sierica kininasica II negli itteri acuti.

An assay of Kininase II activity in the serum of 92 jaundice patients revealed a significant difference between the group with viral hepatitis (268.48 +/- 70.93 U/ml), that with biliary obstructions (133.05 +/- 37.64 U/ml) and with cirrhosis (173.76 +/- 79.56 U/ml). The increase encountered in patients with medical jaundice correlates well with total bilirubinaemia but not with cytolysis enzymes. This suggests failed demolition of ACE by the hepatocyte during cellular stress.

[Postoperative monitoring of patients operated on for digestive tract neoplasms using tumor markers. Preliminary results]. / Monitoraggio postoperatorio di pazienti operati per neoplasia digestiva mediante marcatori tumorali. Risultati preliminari.

The report analyses the comparative efficacy of three different tumour markers (CEA, GICA and TPA) in providing indications for the postoperative monitoring of patients treated for cancer of the digestive tract. Assessment of effectiveness of chemotherapy produced different results according to the site of the tumour (stomach, colon or pancreas). In the case of cancers of the pancreatic head, the influence of jaundice on the markers was also evaluated, to discover which marker provided most information on the tumour investigated.

[Infusion and transfusion therapy in polytraumatized patients]. / Terapia infusionale e trasfusionale nei politraumatizzati.

Considerations of a physiopathological nature are expressed with regard to haemorrhagic multiple-injury patients in the light of the experience acquired in first-aid practice at the University of Turin department of emergency surgery. While treatment of the basic injury is the key to therapy, sufficient infusion management and careful monitoring of coagulation parameters before and during transfusion may be of fundamental importance in survival. By the same token, not all blood products available can be used indiscriminately. A treatment and monitoring protocol for the reinstatement of volaemia and corpuscle mass, and for the correction of coagulopathy due to loss, consumption and wash-out is proposed.

[Use of computers in intensive care. EGAGE: a program for combined blood gas analysis and analysis of expired gas]. / L'uso dell'elaboratore in terapia intensiva. EGAGE: Un programma per l'esame combinato dell'emogasanalisi (EGA) e dell'analisi dei gas espirati (AGE).

The large amount of data resulting from arterial and venous HGA's and analysis of expired gases carried out during the monitoring of critical surgical patients has been statistically reduced to only seven parameters. Personal Mini Computer software able to quantify or predict the necessity for mechanical ventilatory assistance in individual cases has been developed on the basis of the 7 parameters. The system, presently used only as a check, has been found very reliable. Two cases are reported in order to illustrate its use in intensive treatment.

[Diagnostic and prognostic value of the carcinoembryonic antigen in colonic cancer]. / Valore diagnostico e prognostico del CEA nel carcinoma del colon.

A group of 50 patients operated for carcinoma of the colon in June 1980-December 1981 with a follow-up period of min. 2 months-max. 15 months is presented. C.E.A. measurements were taken in all patients pre and post-operatively and then every 2 months in an attempt to establish its diagnostic and prognostic value. In immediate diagnostic and prognostic terms, pre-operative C.E.A. appears to be insignificant. However both pre-operative C.E.A. and C.E.A. at a distance of 6 months were found to be reliable for long term (max. 15 months) prognosis.

[Clinical use of a minicomputer in the evaluation of chemico-clinical parameters in the diagnosis of hepato-biliary-pancreatic diseases of surgical significance. 3 methods compared]. / L'uso clinico di un minicomputer per la valutazione di alcuni parametri chimico-clinici nella diagnostica delle malattie epato-bilio-pancreatiche di interesse chirurgico. Tre metodi a confronto.

Bayes theorem; multivariance analysis, and the discriminating function of Mahalanobis applied to sixteen laboratory examinations employed in the diagnosis of diseases of the extrahepatic bile ducts and pancreas gave the following results: 1) the weight of each test was first measured in general terms, and then with regard to different levels of differentiation, with a classification in decreasing order in each case; 2) little redundancy was noted, and few examinations were of relatively negligible importance; furthermore, combinations of several tests did not lead to positive results; 3) reclassification according to the formula of Bayes and by means of the discriminating function proved sound supports for clinical decision, since they provided 70% and 80% of exact classification respectively; 4) the importance of the minicomputer in the construction of experimental diagnostic models was substantiated.

[Computerized methods in the diagnosis and prognosis of surgically treated bilio-pancreatic diseases]. / Metodi computerizzati per la diagnosi e la prognosi delle malattie bilio-pancreatiche di interesse chirurgico.

Multivaried and trend analyses were applied to a set of 27 periodic haematochemical checks on 37 patients given surgery for biliopancreatic pathology. Preoperative and postoperative data were separately analysed. The software employed was specially designed for the purpose. The discriminating function was used in the preoperative period to establish the best moment for diagnosis, which turns out to be 5 days after admission to hospital. Variance and regression analyses were used for short term prognosis by calculating survival chances. In one case the prognosis turned out to be distinctly inaccurate.