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Biomedical subjects

A Mascaro

Publications and source records attributed to A Mascaro.

14 recordsLinked to original sources
PubMed2001

Lymph node dissection in surgical treatment of esophageal neoplasms.

BACKGROUND: Until now therapy of carcinoma of the esophagus has presented an aura of pessimism, resulting in an attitude among physicians that cure was impossible. Presently the overall 5-year survival is between 38.3% and 55% thanks to new radical surgical techniques. The aim of this work is to evaluate lymph node dissection in treatment of esophageal carcinoma by analyzing morbidity, mortality, survival and quality of life. METHODS: From 1975 to 1995, 170 patients with carcinoma of the esophagus and cardia underwent operation, of whom 165 underwent 2-field lymphadenectomy and four 3-field lymphadenectomy; one patient was submitted to self-transplanting jejunal loop to neck. One hundred and twenty-two patients had standard resection and 47 en bloc resection. RESULTS: Lymph node involvement is often found in patients with superficial carcinoma and it greatly influences outcome after esophagectomy. In 2-field lymphadenectomy morbidity and mortality are more frequent in en bloc resections; global 3-year survival was better in patients with early lesions. Three-field lymphadenectomy was performed in only few cases, not sufficient to express a definitive opinion. CONCLUSIONS: On the basis of our experience, we conclude that the better survival is particularly dependent on early diagnosis, histological type of neoplasia and following surgical treatment, especially on the type of resection with 2 or 3-field lymphadenectomy.

Aged↗
PubMed1993

[Anesthesia for laparoscopic cholecystectomy: the use of nitrous oxide in the anesthetic mixture].

A study carried out on 44 patients undergoing laparoscopic cholecystectomy was started in order to evaluate if nitrous oxide is or not contraindicated. The patients were divided in two groups of 22 subjects receiving or not nitrous oxide in the anaesthetic mixture. All the patients received the same preanaesthetic medication (diazepam and atrophine), thiopental and fentanyl as induction drugs, vecuronium as muscle relaxant and isoflurane for maintenance of anaesthesia. Bowel distension, technical difficulty, incidence of postoperative nausea and vomiting were examined. Our conclusions were that nitrous oxide has no clinically deleterious effects during laparoscopic cholecystectomy.

Adult↗
PubMed1989

Lumbar chemical sympathectomy in end stage of arterial disease: early and late results.

Hemodynamic variables were used to evaluate the effectiveness of lumbar chemical sympathectomy in 20 patients with ischemic foot lesions. Early clinical improvement was obtained in 68% of the cases. The two-year cumulative limb salvage rate was 52%. Results indicate that lumbar chemical sympathectomy offers the same benefits as surgical sympathectomy and represents a useful alternative in patients with advanced ischemic disease of the lower limb, decreasing the rate and the level of amputations.

Aged↗
PubMed1981

Changes in plasma and cerebrospinal fluid electrolytes in hypercapnia.

A study on two groups of patients in acute respiratory failure with hypercapnia (18 subjects) and in hypercapnic coma (18 subjects) has been carried out to determine the related changes in sodium ion, potassium ion, chloride ion, urea and osmolality in blood and cerebrospinal fluid. There were significant differences between the two pathological states and particularly in coma, changes in transmembrane active transport of electrolytes are significantly related to high concentrations of CO2 in the brain.

Carbon Dioxide↗
PubMedDate not supplied

Lung microcytoma: a multidisciplinary therapeutic approach.

This report is of 26 patients diagnosed with microcytoma of the lung in stages I, II, and IIIa. All patients received surgical treatment as well as postoperative chemoradiotherapy when indicated by stage. Mean survival rates were 16 months for stage 1, 10 months for stage II and 6 months for stage IIIa disease. For many years surgery was considered contraindicated in the treatment of pulmonary microcytoma. Now a multidisciplinary approach is being used in which surgery has a crucial role. Microcytoma of the lung has a poor prognosis due to its early metastasis and rapid growth. It is crucial to have early diagnosis and accurate, consistent staging as the basis for treatment. A review of literature shows that the use of surgery, chemotherapy and radiotherapy are all important in treatment of microcytoma. Chemotherapy is successfully utilized preoperatively to improve local control, decrease neoplastic mass, induce histological regression and as postoperative adjuvant therapy. Radiotherapy has been shown to be effective preoperatively to reduce local mass and prophylactically for cerebral metastasis. Surgery is crucial to irradicate the neoplastic mass, improve staging accuracy, decrease the possible selection of neoplastic clones resistant to postoperative therapy, decrease local recurrence and allow less aggressive chemoradiotherapy. We feel the most effective protocol for pulmonary microcytoma includes preoperative chemotherapy and radiotherapy when indicated followed by surgical intervention and finally successive adjuvant therapy. The limited number of our cases does not consent a statistically significative conclusion. Our data confirm the importance of the surgical procedure in stages I and II, where according also to other authors, the best results are obtained. Surgical indication in stage IIIa is still discussed due to precocius lymphnode dissemination that significantly affects long-term survival.

Carcinoma, Small Cell↗
PubMedDate not supplied

Hyperthyroidism and concurrent thyroid carcinoma.

In the last twenty years, medical studies have reported a significant increase in thyroid neoplasms among patients with hyperthyroidism. Aim of the present work is to reconsider the real incidence of this not uncommon association and to establish a model for surgical treatment of hyperthyroidism for a possible concurrence with thyroid carcinoma. At the Department of Surgical Sciences and Applied Medical Technologies "La Sapienza" Rome's University, during the period 1994 to 1999, an homogeneous group of 82 patients was surgically treated for hyperthyroidism. Of our patients, fifty-four (66%) had a "multinodular toxic goiter" (MTG), twenty (24%) a "functional autonomous nodule" (FAN) while the remaining patients were affected by Graves' disease. The surgical procedures adopted were: 1) total extracapsular ipsilateral lobectomies and isthmectomies in sixteen patients with FAN; 2) total extracapsular thyroidectomy in all patients with MTG and with Graves' disease and in the remaining four patients with FAN after a long time treatment with thyrostatic drugs. On six (7%) of our patients we found out a thyroid carcinoma: five with MTG and one with Graves' disease. However, no association with thyroid carcinoma was observed in anyone with FAN. The correct treatment of thyroid surgical diseases is a single definitive operative approach. The procedure must be a total thyroidectomy in MTG and Graves' disease. However, in patients with FAN it's possible, after careful evaluation, to carry out a total extracapsular ipsilateral lobectomy with isthmectomy, justified by the normal morphology of the remaining thyroid tissue. It is always possible, in these cases, a subsequent complete exeresis if a carcinoma is present in the removed lobe.

Aged↗
PubMedDate not supplied

Therapeutic approach of carcinoid tumours of the lung.

In the carcinoid tumours of the bronchopulmonary tract surgical resection is still the primary goal. Many problems are, however, unclear: the extent of resection, formal lymph node dissection or not, the role of Video-Assisted Thoracic Surgery (VATS) and of the multidisciplinary approach. In the Department of Surgical Sciences and Applied Medical Technologies, "La Sapienza", Rome's University, from 1969 to 1994, we observed 18 patients with carcinoid tumours of the lung: 13 typical carcinoid (TC) and 5 atypical carcinoid (AC). In our series, the choice of therapeutic procedure was made on the basis of histological criteria and TNM classification. We performed 3 conservative and 10 extensive resections on typical carcinoid and 5 extensive resections on atypical carcinoid tumours. In our series VATS played a minor therapeutic role. Formal lymph node dissection was carried out on all our patients except in the cases of those with typical carcinoid tumours without enlarged hilar and mediastinal lymph nodes. The efficacy of adjuvant chemotherapy in carcinoid tumours treatment is controversial and will be confirmed by further trials. In bronchial carcinoid tumours the long-term prognosis is excellent. In our series the ten-year survival rate is 77 per cent in typical carcinoid and 40 per cent in atypical carcinoid cases.

Adult↗
PubMedDate not supplied

Surgical treatment of differentiated microcarcinomas of the thyroid.

Thyroid microcarcinomas (TMC) are histologically malignant diseases, despite their limited dimensions and non-aggressive behaviour; frequent multifocality of the disease and local recurrence is really possible after conservative resection. Modern therapeutic approaches to thyroid microcarcinoma include both radical surgical treatment, influenced by the frequent locoregional diffusion of TMC, consisting of a total thyroidectomy with an eventual central and/or functional unilateral lymphadenectomy, depending on the clinical evidence of lymh node metastases and conservative treatment based on more limited resections which take into account the slow clinical progression of this type of tumour. The aim of our work is to examine the therapeutic guidelines for surgical treatment of TMC which, in our experience, are closely dependent on clinical presentation type. From 1991 to 2000, more than 400 patients with thyroid disease were referred to the Department of Surgical Science and Applied Medical Technologies "F. Durante". Threehundred-seventythree patients received surgical treatment: in 311 patients a benign disease was diagnosed, while in 62 neoplasia was present. In total we observed 30 TMC, consisting of 28 papillary and 2 follicular microcarcinomas. On the basis of clinical presentation we divided patients in three groups: A--patients with a clinically suspicious neoplastic lesion before surgical treatment; B--patients in whom histological diagnosis of cancer was "incidental" after an operation performed for benign disease; C--patients in whom a neck lymph node metastases were clinically found before diagnosis of an "occult" papillary carcinoma in the thyroid gland. 27 total thyroidectomies and 3 conservative resections, that required successive total exeresis, were performed. In 5 cases a central neck lymph node dissection was carried out and in 5 + 1 cases functional modified lateral neck dissections was deemed necessary. Our data suggest that an evaluation of tumor's malignancy cannot be carried out on the basis of its dimensions alone. Indeed, biological aggressivity, whether local or at a distance, is a prerogative of both large and small tumours. Therefore a microcarcinoma must be considered a full-blown form of thyroid cancer and as such must be treated. Total thyroidectomy may be followed by identification of possible local metastases. "Whole body" scintigraphy allows to identify and treat with radioiodine therapy, possible recurrent lesions. Therefore in conclusion, total resection is not only a useful, but also a necessary treatment for the correct diagnostic and therapeutic follow-up of these patients.

Adult↗
PubMedDate not supplied

Pain therapy in elderly cancer patients.

In most (65-80%) cancer patients at an advanced stage of illness we find significant, invalidating symptoms of pain. Cancer pain is a complex pain (with a nociceptive, neuropathic and deafferentation component), which requires a multidisciplinary approach (surgery, radiochemotherapy, and pain therapy). Pain therapy has various pharmacological strategies at its disposal (opiates, anti-inflammatory and adjuvant drugs) together with modulation and neurodestructive techniques, which must be applied taking account of both the stage of the disease and the pain intensity. In elderly patients, a careful, tailored management of pharmacological therapy is required. In older age, personality disorders are also to be found (anxiety, depression, hypocondria and feeling of abandonment), which make therapy more complex and varied. Knowledge of these problems will, however, make it possible to control cancer pain in elderly patients to the best possible effect and improve the quality of life in the advanced and terminal stages.

Aged↗