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A De Stefano

Publications and source records attributed to A De Stefano.

At least 37 records · Page 2Linked to original sources
PubMed1999

Prognostic significance of CEA, CA 19-9 and CA 72-4 preoperative serum levels in gastric carcinoma.

The prognostic value of preoperative serum levels of CEA, CA 19-9 and CA 72-4 tumor markers was investigated in 153 patients resected for gastric cancer. The positivity rates for CEA, CA 19-9 and CA 72-4 were 20.9, 34.6 and 28.1%, respectively. Multiple logistic regression analysis for positive levels of tumor markers indicates that CEA positivity is significantly related to the depth of invasion (p < 0.005) and the presence of distant metastasis (p < 0. 05), CA 19-9 positivity is related to nodal involvement (p < 0.05) and the depth of invasion (p < 0.05), whereas CA 72-4 positivity is influenced by tumor size (p < 0.005) and noncurative surgery (p < 0. 05). Positive levels of each tumor marker were associated with a worse prognosis if compared with negative cases using univariate analysis. Multivariate analysis of curatively resected cases identified depth in gastric wall (p < 0.0001), nodal status (p < 0. 0005), and tumor location in the upper third (p < 0.05) as significant prognostic variables; CEA, CA 19-9 and CA 72-4 serum positivity did not reach statistical significance. However, when the positivity of the three markers was associated, a p value < 0.05 was observed. The analysis of survival curves stratified by tumor stage revealed that marker positivity significantly affects survival in stages I, II and IV (p < 0.05). The combined assay of CEA, CA 19-9 and CA 72-4 preoperative serum levels provides additional prognostic information in patients resected for gastric cancer; patients with preoperative positivity for one of these tumor markers should be considered at high risk of recurrence even in early stages of gastric carcinoma.

Adult↗
PubMed1999

[Clinicopathological features of advanced gastric cancer. Report on 400 operated cases].

In the present study the Authors report the clinical and pathological characteristics of highly advanced cases of gastric carcinoma. Of 1204 primary gastric cancer cases observed between 1977 and 1994 at the Second Department of Surgery, University of Siena, 400 cases treated by non-curative surgery were selected for this study: 174 explorative laparotomies, 76 by-pass and 150 resective operations, of which 98 relatively non-curative and 52 absolutely non-curative resections. The clinical and pathological features of these cases were compared with curative resection cases. Of several variables examined at univariate analysis, tumor site, macroscopic aspect, tumor size, depth in gastric wall and lymph nodal involvement significantly influenced the operative rate and the rate of non-curative operations (p < 0.001). With reference to non-curative cases, the diffusion pattern of neoplasm, besides the above mentioned variables, significantly affected the resectability rate: distant metastases, and particularly peritoneal spread, involved a lower resection rate if compared to cases with loco-regional diffusion (p < 0.001).

Aged↗
PubMed1998

Complications after surgery for gastric cancer in patients aged 80 years and over.

Recent studies have shown a considerable increase in the number of aged patients with gastric cancer. In this retrospective study, we report our 18-year experience with 110 patients aged 80 years and over affected with this neoplasm. Postoperative morbidity and mortality rates and risk factors affecting their incidence were examined by univariate and multivariate analysis. Operability and resectability rates were 70.9% and 47.3% respectively. Of the resective procedures, 41 (78.8%) were subtotal gastrectomies. In five cases (9.6%), we performed combined resections. Twenty-five patients (32.1%) experienced postoperative complications; overall mortality rate was 12.8% (10 patients). In resective procedures, morbidity and mortality were 26.9% and 3.8% respectively, which are very low rates compared to other Western reports. Statistical analysis identified the number of preexisting medical illnesses as an independent predictor of morbidity and mortality. Crude five-year survival rate of curatively resected cases was 43%. Although multiple medical illnesses involved much higher operative mortality, neither the presence of postoperative complications nor the number of preexisting medical illnesses significantly influenced five-year survival rate of curatively resected patients. With careful evaluation and selection of patients, correct treatment of concomitant diseases and adequate peri- and postoperative care, gastric surgery provides good immediate and long-term results even in very old patients. Subtotal gastrectomy with limited lymphadenectomy should be the preferred procedure; total gastrectomy, combined resections and extended lymphadenectomy should be performed only when necessary, in patients with fewer than two illnesses. Surgery should be avoided in patients with highly advanced disease, if multiple medical illnesses are present.

Aged↗
PubMed1998

Effects of an asthma management program on the asthmatic member: patient-centered results of a 2-year study in a managed care organization.

OBJECTIVE: To report the results of a 2-year pilot program of asthma education based on National Heart, Lung, and Blood Institute treatment guidelines. PATIENTS AND METHODS: Asthmatic members (n = 6698) of a managed care organization received education about their condition directly or through their primary care physician. Medical and pharmacy administrative claims data were reviewed to measure acute asthma events and prescribed therapies in the first (the baseline) and second years of the study. The claims data were augmented by member surveys from a stratified random sample of 2734 asthmatic patients who were members (6 years of age or older) in the baseline year. RESULTS: Compared with the first year, asthmatic members received fewer inpatient services and the proportion of asthmatic members prescribed oral inhaled corticosteroids increased 30% in the second year. Health-related quality of life, measured with validated general and disease-specific instruments; satisfaction with the quality of care; exposure to patient education; knowledge of the disease; and member's confidence in their ability to manage their disease showed statistically significant improvements during the follow-up year of the program for both adult and child asthmatic members. CONCLUSION: For asthmatic members of this health plan, a comprehensive asthma health management program improved processes of care and outcomes.

Adolescent↗
PubMed1996

[Preoperative serum levels of CEA and CA19-9 in patients with gastric cancer].

The serum level determination of tumor markers in gastric cancer, more than other neoplasia, presents, many difficulties for the impossibility to identify specific molecules released during neoplastic growth. In this research the authors report their experience on the preoperative determination of two tumor markers diffusely used in gastrointestinal neoplasia: CEA and CA19-9. The study has been done in order to establish relations between the expression of markers and some considered variables. The values have been studied on 113 patients. A total of 24% sensibility was reported for CEA while 48% for CA19-9 applying cut-off levels of 10 mg/ml and 37 U/ml respectively. The results have shown a better sensibility of CA19-9 with a statistical significance between the expression of this marker and stage of disease (from 21% to 66%), lymph nodal involvement (from 31% to 59%), histologic grading (from 39% to 48%) and surgical purpose (from 37% to 78%) (p < 0.001).

Adenocarcinoma↗
PubMed1996

[A case of pancreatic somatostatinoma].

The authors describe a case of somatostatinoma localized in the body and tail of the pancreas. They emphasize the rarity of this finding (only 33 cases with certain pancreatic localization are reported in literature) and the absence of a distinctive syndrome, which could direct to an early diagnosis, the authors are in doubt about the real incidence of this disease. The absence, generally, of a distinctive syndrome, the poor condition of these patient and then the lack of surgical treatment and histological examination, could lead to a lower valuation. Delayed diagnosis and then the local extension of this neoplasm often make surgical treatment vain. Nevertheless since somatostatinoma has more possibilities of radical resection than pancreatic cancer, it's required to know its features and course so to increase possibilities of an early diagnosis. In fact disregarding surgical treatment, the survival of these patients, one year after diagnosis, is about 48%. This result is better than the survival of patients with pancreatic or biliary duct cancers. Current diagnostic procedures are reported.

Adult↗
PubMed1992

[Postoperative morbidity and mortality after surgical intervention for gastric carcinoma in advanced stage].

The paper reports the authors' experience in a group of 546 patients who underwent surgical treatment for gastric cancer from 1981 to 1988. Of 437 patients (80%) with advanced gastric cancer, 121 (28%) received palliative treatment and 316 (72%) were treated for curative purposes. Postoperative care was normal in 331 patients with a mean hospital stay of 11 days; various complications occurred in 106 patients with a mean hospital stay of 26 days. Overall operative mortality was 6% (27 patients). This study aimed to assess the main factor responsible for postoperative morbidity and mortality. Findings were compared to previously reported data and were shown to be similar.

Adult↗
PubMed1989

[Validity and limitations of the CEA test in the treatment of colorectal carcinoma].

CEA appears to be a good marker in the follow up of patients operated for colorectal cancer. The Authors analyse, on the base of literature data, the results of CEA test in their experience of colorectal cancers operated from 1978 to 1987. They confirm the importance of CEA as recurrence marker, however the test, by itself, is not sufficient to always identify a new onset of the disease.

Carcinoembryonic Antigen↗
PubMed1989

[Use of mechanical staplers in colostomy].

The authors used the technique of Chung, slightly modified, to perform the end colostomy in five patients who underwent abdomino-perineal resection according to Miles for rectal carcinoma. The technique proved to be easy and quick. The results have been satisfactory, without complications such as infections, necrosis, stenosis, retraction or paracolostomy hernias.

Aged↗
PubMed1988

[Health status of journalists and organization of work in a national daily newspaper].

A multidisciplinary investigation was performed on 173 reporters (53 men and 20 women) of a newspaper. The microclimate and illumination conditions of the main seat, in which the use of VDT was beginning, were satisfactory, although not all the instruments were correctly adjusted. A very low percentage of reporters working in the main center was suffering from arterial hypertension indicating the presence of the "healthy worker effect". The values of plasma cortisol and arterial blood pressure of 10 reporters of the main seat, except two cases, changed normally during the evening hours. It is to point out that among the reporters there was significant correlation between spondylosis and astigmatism. The psychological investigation evidenced that the reporters were aggressive, eager of success and with constant attention. The EMG biofeedback demonstrated in the reporters with a more prolonged period of employment nervous tension and difficulty in relaxing. Particularly, in the reporters of the main center, the Stait-Trait Anxiety Inventory was more altered than in those of the peripheral seats.

Adult↗
PubMed1984

[Unusual clinical aspects of 3 cases of primary humoral immunodeficiency].

The clinical behaviour of three patients with primary antibody deficiencies was studied. Two of three were affected by X-linked agammaglobulinemia and one by common variable hypogammaglobulinemia that, besides clinical features common to most of the immunodeficiencies, showed pre-existent physiopathologic conditions completely different from the features traditionally found in primary antibody deficiencies. Moreover, the development of some immunologic parameters (monoclonal antibody analysis, surface markers and electrophoretic mobility of lymphocytes) has been carefully checked in these patients after immunotherapy by intravenous infusion of immunoglobulins. The lymphocyte electrophoretic mobility underlines how peripheral blood lymphocytes, faster than those normally controlled before therapy, normalized their velocity after immunotherapy.

Adult↗
PubMed1984

Oral route administration of medroxyprogesterone acetate (MAP) at high doses in the treatment of advanced breast cancer: clinical results.

Twenty-six patients with metastatic breast cancer were treated with high dose medroxyprogesterone acetate (MAP) p.o. according to currently available pharmacokinetic data (2000 mg/day b.i.d. for 30 days, 1000 mg/day for the following 60 days). Objective response (WHO criteria) was obtained in seven patients (CR + PR = 27%), with good results on visceral and soft tissue localizations; performance status improvement and/or pain relief was obtained in twenty-three (88%). Oral high dose MPA seems to be an effective and well tolerated palliative treatment in advanced breast cancer.

Administration, Oral↗