Biomedical subjects

A Paolini

Publications and source records attributed to A Paolini.

77 records · Page 5Linked to original sources

PubMedDate not supplied

Modality of failure following resection of stage I and stage II non-small cell lung cancer.

The pattern and sites of recurrence were studied in 270 patients with resected Stage I (NO) or Stage II (Nl) non-small cell lung cancer (NSCLC). Survival, incidence, and type of intrathoracic locoregional recurrence versus distant extra-thoracic recurrence after surgical excision were analyzed. Prognostic parameters, such as postsurgical stage, histologic type, degree of cellular differentiation, and surgical approach, were examined to discern their influence on tumor recurrence. The total incidence of recurrence in patients with stage I and II tumors was high, with a radical surgical approach often resulting ineffective, because of incomplete locoregional neoplastic extirpation due to micrometastases. Lymph node metastases worsened prognosis, with Nl tumors demonstrating a significantly higher recurrence rate at 5 years (63%) than NO neoplasms (48%) (p < 0.01). Stage I tumors showed an elevated incidence of local recurrence (45%), with tumor T-factor making a significant contribution in such cases. N1-factor combined with an elevated T-factor (Stage II Subclass pT2Nl neoplasms) promoted a higher incidence of distant rather than local recurrence. A shorter disease-free interval was observed in patients with N tumors as opposed to NO neoplasms. Histologic type did not play a statistically significant role (p = ns) in the total incidence of recurrence. A similar total incidence of recurrence was observed in Stage I and II tumors treated by lobectomy (51%) or pneumonectomy (56%), with locoregional recurrence appearing more frequently after lobectomy.

Adult↗

PubMedDate not supplied

Pectus excavatum in adults: destructive surgery or simple correction of an aesthetic defect?

Pectus excavatum, a congenital depressive malformation of the sternum, is described since 1594 by Johannes Schenk and has successively been the subject of many studies because of its various inherent problems. The repercussions on the respiratory and cardiac dynamics caused by the compression on the mediastinal structures and by the reduction of the respiratory volume have only recently been valuated completely with the application of the latest techniques to diagnosis, cardiology and radiology. The aesthetic defect, often the first aspect to attract the attention of patient and doctor, has serious psychological implications, especially for what concerns the affective life and relationships in general. The surgical therapy consists in radical interventions with large sternocostal resections and repositioning of the sternum (turnover), or in interventions with a less invasive technique to correct only the aesthetic defect. In this study have been examined 7 cases of patients affected by pectus excavatum who were operated at the Institute of General Surgery IV and the Department of Plastic surgery of the University of Rome "La Sapienza" between 1983 and 1993. The patients were divided in two groups: a first group of 4 patients who underwent a sternal turnover, and a second group of 3 patients who were operated with conservative methods to correct the aesthetic defect. In both groups the results were good without any post-operatory complications. The experience gained during these years consents us to propose radical interventions for patients who have a severe malformation with evident physiopathological implications; this intervention is especially indicated if the patient is young, to prevent further disabling complications. Less invasive methods, on the other hand, should be applied to all other cases, considering the higher degree of tolerance of the intervention, the absence of postoperatory complications and the minor cost, thanks to a shorter hospital stay.

Adolescent↗

PubMedDate not supplied

Subcapsular splenic hematoma due to infectious mononucleosis.

Spontaneous subcapsular splenic hematoma formation without rupture in infectious mononucleosis is a very unusual occurrence. A conservative management is successful in those patients in stable condition. We describe the presentation and the clinical progress of a case in whom a sudden enlargement in hematoma's diameter needed a splenectomy to avoid the risk of blood effusion in the abdominal cavity.

Adult↗

PubMedDate not supplied

[Epidemiology of esophageal cancer].

The Authors examine the epidemiological features of esophageal cancer. This tumor is today the fourth neoplasm of the digestive tract, and represents 2-5% of all tumors.

Adenocarcinoma↗

PubMedDate not supplied

Jejunal interposition for peptic stenosis of the esophagus following esophagomyotomy for achalasia.

Retrospective analysis of the results of esophagojejunogastrostomy in 21 patients with peptic stenosis after esophagomyotomy for achalasia is reported. All patients complained of severe dysphagia. The esophagogram showed the presence of a 2 to 3 cm long stenosis in the lower esophagus with a diameter < 10 mm. Endoscopic dilatation was possible in 18 cases and it was pursued until the passage of the endoscope was possible. Manometry confirmed the presence of an aperistaltic esophagus with incompetent LES in all cases examined. GERD was detected by 24 hour pH-metry in 15/21 patients (71.4%). One patient died because of postoperative cardiopulmonary failure. Other minor complications occurred in 6 patients. During an 11 year mean follow-up good results were achieved in 17 patients (85%), fair in 2 (10%) and poor in 1 (5%), in whom redundant jejunal loop was resected after 8 years. Resective surgery in peptic strictures after esophagomyotomy is the treatment that guarantees the best long-term results. Esophagojejunogastroplasty represents a valid technique. Careful selection of patients and an accurate surgical technique are fundamental to reduce mortality and morbidity.

Adolescent↗