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Biomedical subjects

A Del Genio

Publications and source records attributed to A Del Genio.

At least 19 recordsLinked to original sources
PubMed2004

Laparoscopic esophagectomy in the palliative treatment of advanced esophageal cancer after radiochemotherapy.

BACKGROUND: Esophageal cancer is associated with a poor long-term prognosis. Only a 10% 5-year survival rate is reported. This article aims to evaluate the feasibility and efficacy of laparoscopic esophagectomy for the palliative treatment of advanced esophageal cancer (T3-T4 Nx-N1) after neoadjuvant therapy. METHODS: From March 1998 to July 2002, 35 patients (mean age, 64.6 years; range, 35-72 years) affected by advanced cancer of the middle lower third of the esophagus came to the authors' observation. All received neoadjuvant radiochemotherapy. Of the 35 patients, 22 (62.9%) showed a positive response to treatment (>or=50% reduction of maximal cross-sectional area of the tumor), and surgical intervention was performed 4 weeks after the end of the therapy. The operations were accomplished through the laparoscopic approach and left lateral cervicotomy. RESULTS: The mean operative time was 160 min (range, 120-260 min). One patient (4.5%) experienced a cervical anastomotic leak. Three patients (13.6%) died in the postoperative period: one of myocardial infarction and two of acute respiratory failure. The mean postoperative hospital stay was 12.1 days (range, 9-23 days). After a mean follow-up period of 20.2 months (range, 10-40 months), 13 patients (68.4%) were alive. CONCLUSIONS: The laparoscopic approach seems to be effective for the palliative treatment of advanced esophageal cancer. Further trials will be necessary to evaluate the advantages of this technique.

Adult↗
PubMed2004

Laparoscopic approach in the treatment of epiphrenic diverticula: long-term results.

BACKGROUND: Thoracotomy represents the traditional surgical approach for the treatment of epiphrenic diverticula. A mini-invasive procedure has been reported in only few series. This article describes the authors experience with the laparoscopic approach for performing diverticulectomy, myotomy and Nissen-Rossetti fundoplication. METHODS: From 1994 to 2002, 13 patients (6 men and 7 women), mean age 57 years (range 45-71 years), with symptomatic epiphrenic diverticulum underwent laparoscopic diverticulectomy, myotomy, and Nissen-Rossetti fundoplication. RESULTS: The mean operative time was 145 min (range 110-180 min). No operative mortality was observed. The mean hospital stay was 13.9 days (range 7-25 years). The first three patients (23.1%) who underwent surgery experienced a partial disruption of the suture staple line. One patient (7.7%) died of a myocardial infarction. After a mean clinical follow-up period of 58 months (range 3-96 months), all the patients were symptom free. CONCLUSIONS: Laparoscopic management of epiphrenic diverticula seems to be as safe and effective as the traditional approach, although a longer follow-up period is necessary to confirm the study results.

Aged↗
PubMed2003

Laparoscopic treatment of Bochdalek hernia without the use of a mesh.

Bochdalek hernia is a rare pathology. The preoperative diagnosis is difficult, and few reports are available regarding its treatment. Herein we report the case of a 25-year-old woman referred for symptoms of dyspepsia, dysphagia, and thoracic pain exacerbated by pregnancy. Preoperative radiography, EGD, and CT scan revealed a paraesophageal hiatal hernia. Laparoscopic exploration showed the complete thoracic migration of the stomach through a left posterolateral diaphragmatic foramen. The diagnosis of a Bochdalek hernia was then made. The diaphragmatic defect was repaired without inserting a prosthesis, using five separate non-reabsorbable stitches (Rieder technique). The procedure was completed with a Nissen-Rossetti fundoplication. The duration of the procedure was 150 min. Hospital stay was 12 days. There were no complications. Postoperative Gastrografin radiography of the esophagus and stomach showed a normal-shaped fundoplication and confirmed the subdiaphragmatic location of the stomach. We conclude that the laparoscopic approach represents the gold standard for the diagnosis and treatment of Bochdalek hernia and any associated complications.

Adult↗
PubMed2003

[Surgical treatment of esophageal achalasia by Heller+Nissen laparoscopic procedure. A 24-hour ambulatory esophageal manometry study].

BACKGROUND: The aim of this work was to evaluate, by means of a 24-h esophageal manometry, the motor activity of esophageal body in achalasic patients before and after Heller's myotomy and Nissen's fundoplication. METHODS: Twenty-five achalasic patients underwent a 24-h esophageal manometry. After surgical treatment they had a further 24-h esophageal manometry during follow-up. RESULTS: A statistically significant increase of amplitude of contraction and an increase, but not statistically significant, of frequency and duration of contractions were observed. The study of peristaltic activity showed an increase of peristaltic activity in total and complete sequences and decrease of dropped and interrupted peristaltic sequences. CONCLUSIONS: These data surprisingly showed the presence of a peristaltic activity (31.2%), in achalasic esophageal body, and complete sequences in 20%. The improvement of peristaltic activity observed after surgical abolition of the functional sphincteral rub, proposes again the question about the fall of the peristaltic activity of the esophageal body, which could be due to the hard transit through the LES. This preliminary data seem to confirm, in qualitative and quantitative manner, the positive effect of Heller's myotomy and the null effect of Nissen's fundoplication on the esophageal transit.

English Abstract↗
PubMed2001

Short-term sacral nerve stimulation for functional anorectal and urinary disturbances: results in 40 patients: evaluation of a new option for anorectal functional disorders.

PURPOSE: There are several options in the treatment of fecal incontinence; it is often difficult to choose the most appropriate, adequate treatment. The consolidated experience gained in the urologic field suggests that sacral nerve stimulation may be a further option in the choice of treatment. The aim of our study was to evaluate the preliminary results of the peripheral nerve evaluation test obtained in a multicenter collaborative study on patients with defecatory and urinary disturbances. METHODS: Forty patients (9 males; mean age, 50.2; range, 26-79 years) underwent the peripheral nerve evaluation test, 28 (70 percent) for fecal incontinence and 12 (30 percent) for chronic constipation. Fourteen (35 percent) patients also had urinary incontinence; six had urge incontinence, two had stress incontinence, and six had retention incontinence. Associated diseases were scleroderma (2 patients), spinal injuries (4 patients), and syringomyelia (1 patient). All the patients underwent preliminary investigations with anorectal manometry, pudendal nerve terminal motor latency testing, anal ultrasound, defecography, and if required, urodynamic tests. The electrode for sacral nerve stimulation was positioned percutaneously under local anesthesia in the S2 (4), S3 (34), or S4 (1) foramen unilaterally (1 patient not accounted for because of no response to acute test), based on the best motor and subjective responses of paresthesia of the pelvic floor. Stimulation parameters were average amplitude, 2.8 (range, 1-6) V and average frequency, 15 to 25 Hz. RESULTS: The mean duration of the tests was 9.9 (range, 7-30) days; tests lasting fewer than seven days were not evaluated. There were four early displacements of the electrode. In 22 of the 25 evaluable patients with fecal incontinence, there was an improvement of symptoms (88 percent), and 11 (44 percent) were completely continent to liquid or solid stools, whereas in 7 symptoms were unchanged. Mean number of episodes of liquid or solid stool incontinence per week was 8.1 (range, 4-18) in the prestimulation period and 1.7 (range, 0-12) during the peripheral nerve evaluation test. (P = 0.001; Wilcoxon's signed-rank test). The most important manometric findings were: increase of maximum rest pressure (39.4 +/- 7.3 vs. 54.3 +/- 8.5 mmHg; P = 0.014, Wilcoxon's test) and maximum squeeze pressure (84.7 +/- 8.8 vs. 99.5 +/- 1.1 mmHg; P = 0.047), reduction of initial threshold (63.6 +/- 5.2 vs. 42.4 +/- 4.7 ml; P = 0.041) and urge sensation (123.8 +/- 0.6 vs. 78.3 +/- 8.9 ml; P = 0.05). An improvement was also found in patients with constipation, with reduction in difficulty emptying the rectum, with prestimulation at 7 (range, 2-21) episodes per week and end of peripheral nerve evaluation test at 2.1 (range, 0-6) episodes per week, P < 0.01) and in the number of unsuccessful visits to the toilet, which dropped from 29.2 (7-24) to 6.7 (0-28) per week (P = 0.01). The most important manometric findings in constipated patients were an increase in amplitude of maximum squeeze pressure during sacral nerve stimulation (prestimulation, 63 +/- 0 mm Hg; end of peripheral nerve evaluation test, 78 +/- 1 mm Hg; P = 0.009) and a reduction in rectal volume for urge threshold (prestimulation, 189 +/- 52 ml; end of peripheral nerve evaluation test, 139 +/- 45 ml; P = 0.004). CONCLUSIONS: In functional bowel disorders short-term sacral nerve stimulation seems to be a useful diagnostic tool to assess patients for a minor invasive therapy alternative to conventional surgical procedure.

Adult↗
PubMed1997

24-hour esophageal ambulatory manometry in patients with achalasia of the esophagus.

Absence of the peristaltic contractions in the esophageal body and the failure of the lower esophageal sphincter (LES) post-deglutitive relaxation are the major motor disturbances in patients with achalasia. These alterations are usually evidenced by means of stationary esophageal manometry, which is able to record changes over a brief period. The aim of this work has been to study the circadian esophageal motor activity of the esophageal body in patients with achalasia, using a non-perfused ambulatory manometry system. Ten patients with untreated esophageal achalasia (dilatation < or = 5 cm) had a 24-hour ambulatory esophageal manometry. The portable recording system consisted of a computerized data logger and a probe with four microtransducers 5 cm apart, the distal one being positioned 5 cm above the LES. A microtransducer, positioned 1 cm below the upper esophageal sphincter, recorded the swallow activity. Contractions frequency (n/min), mean amplitude (mmHg), mean duration of contraction (sec), percentage of contraction > 7 sec, percentage of multipeaked, repetitive and isolated contractions, and percentage of peristaltic and simultaneous sequences were evaluated and analysed during the following periods: meal-time (MT); upright (UP); supine night-time (NT). On the basis of the relationship with swallows the contraction events were classified as post-deglutitive or spontaneous. The data out of a group of 65 normal subjects were used as control. Student's t-test and Wilcoxon's rank-sum test were used for statistical analysis. Peristaltic sequences were detected in all patients, 27.8 +/- 12.6% of the total, and the 19.5 +/- 11.06% of these were complete. Moreover primary peristaltic sequences were present in 33.1 +/- 23.4% of all peristaltic sequences. In contrast to current trends, our results show surprisingly the presence of peristaltic activity in patients with achalasia (27.9% MT; 26.9% UP; 28.1% NT). We believe these results are related both to the use of an ambulatory system, which allows 24-hour monitoring and to the use of microtransducers, which are able to detect motor events with great accuracy. These motor events are usually not detectable by stationary perfused systems.

Adult↗
PubMed1997

Intraoperative esophageal manometry: our experience.

In order to improve the results of functional surgical procedures on the esophagus, the authors, after a number of experimental studies, proposed the use of intraoperative esophageal manometry (IEM). The technique was performed for the first time in 1972. IEM has been employed in the course of Heller's cardiamyotomies and Nissen-Rossetti (N-R) fundoplications, respectively, to document the ablation of the lower esophageal sphincter (LES) high-pressure zone (HPZ) and to calibrate the pressure of the fundal wrap between values ranging from 20 to 40 mmHg ('hypercalibrated Nissen'). This hypercalibration resulted from the retrospective evaluation of a former series when, at the beginning of our experience, we used to calibrate the fundoplication to pressure values similar to those of a normal sphincter ('normocalibrated Nissen': 10-20 mmHg). This experience, in fact, was followed by a high rate of gastroesophageal reflux (GER) recurrence (28.5%) in the first 12 months after surgery. Since 1985 to date, IEM has been employed in the course of 309 functional surgical procedures on the esophagus. This paper, however, reports on 281 patients: 144 with achalasia treated with Heller's myotomy + Nissen-Rossetti fundoplication and 137 with gastroesophageal reflux disease (GER-D) submitted to Nissen-Rossetti fundoplication. Our data suggest that IEM can be a useful tool in the field of functional surgery of the esophagus, and its routine use seems to be able to improve the postoperative results. In this series, in fact, IEM was able to detect the persistence of an HPZ in 15.2% of apparently complete myotomies, all performed with the aid of intraoperative endoscopy. As regards the manometric calibration of the n-HPZ, our results seem to confirm the validity of the technique, yet some findings still remain unexplained: i.e. two patients with a hypotonic n-HPZ and GER recurrence and two with an n-HPZ, exceeding 20 mmHg with postoperative persistent dysphagia. Finally, we would like to emphasize that the concept of a 'hypercalibrated Nissen' contrasts with the 'floppy Nissen' of Donahue and DeMeester; our wrap is also loose around the esophagus and does not impair the esophagogastric transit.

Adolescent↗
PubMed1997

Massive enterolithiasis associated with ileal dysgenesis.

A 20-year-old man with massive ileal enterolithiasis was investigated with plain radiography, ultrasound, computed tomography, barium follow through and double contrast barium enema. Ileocecal valve agenesis was found at surgery. The enteroliths were located in the distal ileum, which communicated with the large intestine via an ileotransverse fistula.

Adult↗
PubMed1994

[Endoscopic ultrasonography in preoperative staging of esophageal cancer].

Thirty-two consecutive patients with esophageal carcinoma (squamous cell carcinoma: 23, adenocarcinoma: 9) were pre-operatively examined by endoscopic ultrasonography (EUS) in order to evaluate the accuracy of this diagnostic procedure in loco-regional staging. Six patients were not operated on, due to a poor general conditions or widespread tumor disease and were not included in this study. Results of EUS staging from the remaining patients were compared with intra-operative exploration and histopathological evaluation of resection specimens. Seven stenosing tumors were not traversable by echoendoscope. In such cases the lesion was visualized only in part by scanning the top of the stenosis. The overall EUS accuracy in T staging was 80.7% (75% in T2 stage, 90.9% in T3, 71.4% in T4). Three tumors were overstaged; two not traversable stenosing tumors were understaged. The overall accuracy in N staging was 73% (sensitivity 77.7%, specificity 62.5%). For celiac nodes EUS sensitivity was only 57.1%. Authors conclude that the presence of a not traversable stenosis is still a limit for EUS in diagnosing infiltration of adjacent structures as well as in detecting lymph node metastases.

Adenocarcinoma↗
PubMed1992

[Use of the Ravo bypass in high-risk colonic anastomoses].

The Authors report a case of high risk colonic anastomosis treated by intracolonic by-pass procedure. The technique of Coloshield application is described. Its use prevents fecal contamination of the anastomotic site and, in case of dehiscence, anastomotic fistula formation.

Aged↗
PubMed1991

[Intraoperative esophageal manometry].

Intra-operative esophageal electromanometry (IEM), a method foretold by the authors since 1972, is indicated in the course interventions for functional esophageal disease. The main application of IEM occurs in the presence of myotomy and in the preparation of anti-reflux plasty. As far as myotomy is concerned, IEM can provide guidance in identifying a site for future intervention and, once accomplished, for documenting the completeness thereof. As far as anti-reflux plasty is concerned, it provides an opportunity to verify the onset of an anti-reflux high-pressure zone (nHPZ) that can be calibrated fittingly until the required values are achieved. IEM appears especially useful in effecting a Nissen fundoplication, the frightful complications of which compel many a surgeon to use other types of plasty, despite the lower rate of effectiveness. The perfect identity between the degree of loop closing and the manometric values obtained, and between the loop width and the length of the nHPZ, obtainable through Nissen's fundoplication only, testifies in favor of the use of IEM in preparation of this type of fundoplication only. The Authors present their case studies from 1985 to date, collected at the Service of Surgical Esophagology of the Faculty of Naples, covering 145 cases of Nissen's fundoplication, 70 of which after extramucosal cardias myotomy according to Heller, 54 cases of GER, including 2 cases of scleroderma, epiphrenic diverticula, DES and repeated surgery.

Esophageal Motility Disorders↗
PubMed1991

[Current views and controversies about reconstruction after esophagectomy].

The Authors examine the reconstructive procedures following total or partial esophagectomy, reporting advantages and disadvantages related to stomach, colon or jejunum transposition. The stomach is certainly the organ most widely employed for its adaptability and excellent vascularization; furthermore, only one anastomosis is needed. After a short note on pathophysiology of the most common complications, the Authors point out the advantages of using stapling devices, with special attention to the low incidence of anastomotic dehiscence.

Colon↗
PubMed1991

[Intraoperative esophageal manometry in the surgical treatment of achalasia].

Since 1985 we have done intraoperative manometry in 54 patients operated for achalasia. Manometry allows the assessment of the completeness of the division of the high pressure zone and ascertain the length of fundoplication (Nissen) as well as its pressure. In 26 patients pH and manometric controls were done postoperatively. Absence of reflux was noted in all and the pressure level after operation was 12.53 +/- 4.94 mmHg. Pressure measurements were not different from those of a group of 15 healthy subjects (15.2 +/- 2.45 mmHg). Dynamic studies of the high pressure zone revealed a post-deglutition relaxation of 72.5 +/- 16.32% over the basal tone. We believe that intraoperative manometry is essential in the surgical treatment of achalasia as it allows a precise control of myotomy as well as the fashioning of a high pressure zone to avoid reflux.

Adult↗
PubMed1987

[Classical Kaposi's sarcoma. Study of the lymphatic system of lower limbs].

Eight patients with classical Kaposi's sarcoma histologically confirmed underwent lymphoscopic and/or lymphographic exploration of the lower limbs where the lesions were located. In all patients lymphoscopy showed abnormal images ranging from irregular distribution of the colouring agent to "starlike images" and dermal reflux. Lymphography was performed in 3 patients and demonstrated, in 2 of them, "lymphatic pools", obvious hyperplasia of the superficial lymphatic vessels and areas of lymphangectasia. The finding in all 8 patients of dynamic abnormalities of the lymphatic system should encourage further investigations in this field, notably to detect a possible correlation between lymph stasis, disorders in regional immunity and the development of classical Kaposi's sarcoma.

Female↗