S.C.S. effectiveness in patients affected by peripheral chronic arterial disease: our 5 years experience.

Spinal cord stimulation (S.C.S.) showed a valid clinical effect in the treatment of chronic obliterative arteriopathy of the lower limbs at an advanced stage (III-IV stages) and of phantom limb pain syndrome (P.L.P.S.). Secretion patterns of various biochemical mediators were evaluated and mechanism, by which analgesic and vasodilatator actions occur, were thus accounted for. There is not agreement on this subject. We report our experience on 60 patients (age range 28-91), observed over the period 1987-92. Blood values of some chemical mediators (beta-endorphins, Kinins, Serotonin, PGE) were determined before and after stabilization of the S.C.S. implant (from 2 up to 6 months) and compared with the objective clinical and TCpO2 data. Statistical significance was checked of variations obtained (Student's "t" test). High significant increase of TCpO2, beta-endorphins, PGE, (p < 0.01) and the Kinins (p < 0.05) was found but there were no significant alteration of Serotonin. Results are explained and an S.C.S. effect at the spinal cord metamer level with a cortical integration (pointed out by the increase of the beta-endorphins) is suggested. Analgesic effectiveness and vasodilatator action of S.C.S. implant is stressed as long as it is carried out only when a correct indication is established in the absence of contraindications or important risk.

Atherothrombotic microembolism of the lower extremities (the blue toe syndrome) from atherosclerotic non-aneurysmal aortic plaques.

Six patients with no hemodynamically significant atherosclerotic lesions of the lower limb arteries but with ischemic changes of the feet or toes were studied and diagnosed as having atherothrombotic microembolism. All patients were non claudicators and had peripheral Doppler examinations on admission. Five patients experienced more than one separate episode of microembolization involving both extremities. None presented with a history of heart disease or diabetes. Biplanar arteriograms revealed in every case atherosclerotic degeneration of the aorta without any obstructing lesions and anatomical arterial continuity between the aorta and the site of distal embolization. Three patients who refused operation, were treated conservatively, with a combination of dipyridamole plus aspirin. Three other patients had surgical repair of their atheromatous infrarenal aorta: in two cases thromboendarterectomy was performed, and in the other a Dacron bifurcated graft interposition. No amputations resulted in the patients treated medically, but one of the surgical group lost one toe. This study confirms that atherothrombotic microembolism from an ulcerated atherosclerotic aorta is a potential threat to the extremities and indicates that the optimal therapy for this syndrome has yet to be found.

[Application of hemodilution and autotransfusion in elective surgery]. / Applicazione in chirurgia di elezione della emodiluizione ed autotrasfusione.

Following careful consideration of physiopathological modifications during haemodilution, reference is made to experience with patients submitted to major surgery, mainly chest and vascular. The technique employed is preoperative normovolaemic moderate acute haemodilution. Reference is also made to the criteria for selecting patients, and the evaluation of clinical and haematochemical parameters used in applying this technique. The experience is judged to be positive and haemodilution is regarded as a useful tool for reducing the use of homologous conserved blood and for preventing the risks connected with it.

[Treatment of pain in the cancer patient]. / Il trattamento del dolore nel malato neoplastico.

Consideration is given to the problem of treating pain in the tumour patient with an examination of the methodological basis of the therapeutic approach in the light of the antalgic, pharmacological and instrumental means at present available. Consideration is also given to the need for setting up multidisciplinary structures (on the lines of the American "Pain Clinic"), which can alone ensure the full effectiveness of therapeutic treatment of "intractable" pain.

[Assessment of the surgical risk by skin tests of cell-mediated reactivity and other methods]. / Valutazione del rischio operatorio mediante tests cutanei di reattivita' cellulo-mediata e altre metodiche.

In examining some procedures of general evaluation of the operative risk the Authors direct their attention to the performance of cell-mediate reactivity skin tests and consider a set of 42 patients (of whom 11 as controls, and 31 "high risk"). The results obtained are interesting and evidence the high reliability of these tests in evaluation of infective morbidity and mortality in neoplastic and non-neoplastic patients: in fact a negative response means high morbidity and mortality while a positive response corresponds to normal surgical healing. In tumoral patients, moreover a relationship between skin tests and clinical stage of the disease is observed: negativity of the test means a terminal stage and hence absolute inoperability: positivity corresponds to an advanced stage and hence relative operability (exploratory laparatomy and thoracotomy). The Authors conclude by stressing that the tests have a practical utility and prognostic value higher than those of other methods.

[Orthotopic homograft of the rat stomach: microsurgical technic]. / Omotrapianto ortotopico di stomaco nel ratto: tecnica microchirurgica.

The principal aim of this study is to set up a new microsurgical technique that can be reproducible easily for the execution of orthotopic homograft of stomach in rat. The vascularization of homograft is given, for arterial district by a termino-terminal anastomosis between celiac artery of donor and right renal artery of receiving, and, for venous district, by a termino-lateral anastomosis between portal vein of donor and vena cava of receiving. The middle survival of rats that were had a graft, in this first stage of research, has been of 3 days, therefore it hasn't't been possible to look into the function of graft.

[Heterotopic homograft of the rat stomach: microsurgical technic]. / Omotrapianto eterotopico di stomaco nel ratto: tecnica microchirurgica.

More than by a practical viewpoint, the experimental graft of stomach is very useful like model for the study of gastrointestinal physiopathology. Starting from these considerations the AA. have set up a new method for the execution of stomach heterotopic homograft in rat and they have studied the secretory activity without immuno-suppressed therapy. Not inbred rats have been used; their middle survival has been of 9,3 days. The secretion has been regular up to 5th-6th day; in the same time the AA. have made histopathologic studies on the transplanted stomachs of animals that had been sacrificed at programmed intervals of time, which have outlined the progressive growth of a reaction of intense immunological rejection.

[Mechanical sutures in digestive surgery. II. An experimental study of the cicatricial repair process]. / Le suture meccaniche in chirurgia digestiva. II - Studio sperimentale del processo riparativo cicatriziale.

The AA. intend to study the healing process of digestive sutures in dog that have been made with mechanical instruments that have metal agraphes. The used instruments are the American models of United Surgical Corporation in New York that have: --LDS pliers; --GIA pliers; --TA mod 90, 55, 30, pliers. They had made 15 operations of digestive surgery: gastric resections sec. Billroth II, anastomoses of ileum, colic anastomoses. In total they have made 45 sutures. After an established period the same animals were operated on again for controlling the results of made operations and the macro and microscopic evolution of sutures. The study of healing has shown a quick and exact repairing process for first intent, different from sutures that are made manually with threads that, notoriously, develop slowly for second intent.