Annali italiani di chirurgia
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Comparative Study
[TNM staging system of lung carcinoma: historical notes, limitations and controversies].
The TNM System as originally proposed by Denoix in 1946, provides a consistent, reproducible description of the anatomic extent of disease in cancer patients at a specific time in the life history of the cancer. C. F. ⋯ Many different types of tumour such as multiple masses, synchronous multiple primitives, discontinuous tumour foci in visceral or parietal pleura as well neoplastic involvement of various mediastinal structures, could be now staged with a major benefit for their treatment protocols. In conclusion the Staging System represents today a standard clinical methodology which basically helps in a better clinical approach to lung cancer even if it cannot fully cover and consider all the innumerable manifestations of the tumor. Therefore, if it is true that in the near future the new molecular predictors of prognosis are expected to measure more deeply the extent of disease, for the present time the International Staging System still continues to act as the best common method for measuring prognosis.
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During extracorporeal cardiac surgery it is difficult to measure the severity of metabolic acidosis thru arterial bloods gas determination. During bypass surgery a decrease in Colloidosmotic Pressure (COP) may influence the degree of acidosis. We studied 90 patients in whom the following parameters were measured before, 30 minutes after beginning bypass, immediatly after bypass, upon arriving bypass, upon arriving in the Intensive Care Unit (ICU) and upon discharge (ICU): pH, lactic, acid, pO2, pCO2, base excess correlating them with COP. ⋯ A greater COP was found with a lower blood lactic acid levels. We recommend the use of colloids perfusion as priming fluid instead of electrolytes solutions, specially in patients in extreme ages and also in those in whom a prolonged bypass time is foreseen. This may prevent an increase in blood lactic acid levels.
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Clinical Trial
[Evaluation of the tolerance of a lipid emulsion administrated during total parenteral nutrition in surgical patients].
Tolerance's evaluation of a lipid emulsion given in course of parenteral total nutrition in surgical patient's. The first fat emulsions for intravenous application were thrown on the market in the 1920's years. ⋯ They also suggest, on the same time, a protocol for the survey of these reactions. The results suggest a good tolerance to Lipofundin S intravenous administration and no influence on haematic biochemical parameters.
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Objectives of this paper are the analysis of the confidence in the complementary investigation for the differential diagnostic between schwannoma and neurofibroma, and the retrospective evaluation of the therapy based on the consequent follow-up. The study has been conducted on 36 patients, most of them observed by University Clinic of Navarra (Pamplona), and the others by N. ⋯ In conclusion we feel that this pathology has to be suspected every time we find a tumor with neurologic symptomatology and that surgical indication of exeresis is the most correct in the majority of cases; moreover imaging investigations is rather useful, but if any doubt occurs we must proceed to biopsy or directly to exeresis of the tumor. Our experience shows that schwannoma, thanks to its anatomic patterns, can be treated less radically toward the nerve continuity than neurofibroma, and that the technique of nerve graft could be a useful alternative in this kind of surgery.