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Biomedical subjects

A Peracchia

Publications and source records attributed to A Peracchia.

At least 253 records · Page 14Linked to original sources
PubMedDate not supplied

[Critical analysis of the new TNM staging (UICC, 1987) of cancer of the cervical esophagus in relation to therapeutic decisions].

66 consecutive patients with a tumor confined to the cervical esophagus underwent surgical resection. The comparison between clinical and pathological TNM stage showed a clinical understaging in 30 patients. 25 of the 56 patients who had undergone curative resection had lymph node metastases: positive mediastinal and abdominal nodes were found in 8 (32%) and 0 cases, respectively. The mean survival after curative resection of the 10 evaluable patients with metastatic periesophageal, recurrent and/or paratracheal nodes was 22.4 months; of the 6 evaluable patients with positive mediastinal nodes it was 10.3 months; and of the 5 patients with positive deep latero-cervical nodes it was 5.8 months. The 2-year actuarial survival after curative resection (in the 53 operative survivors) was as follows (according to pathologic TNM staging): Stage I (n = 3) 100%, Stage IIA (n = 17) 30%, Stage IIB (n = 3) 33%, and Stage III (n = 30) 22%. The exact location of neoplastic recurrence after curative resection was documented in 13 cases; it was in the neck in 8 cases (61%); both neck and at a distance in 3 cases (23%) and only at a distance in 2 (16%). The clinical TNM staging of cervical esophageal cancer was not in agreement with the pathological findings in nearly 50% of the cases and is, therefore, inaccurate and unreliable both for therapeutic decision-making and for prognostic evaluations. Endoscopic ultrasound, which was not used in most of the patients studied here, may improve the accuracy of clinical TNM staging. The N classification, which defines only the cervical nodes as regional nodes, appears to be arbitrary since the pathological staging showed metastatic mediastinal nodes in 32% of the N + cases, with a survival comparable to that of patients with metastatic nodes only in the neck. The prognostic value of pathological TNM staging was not confirmed in the present study since only Stage I patients had a significantly better prognosis than patients in the other stages. This may be due to the small number of patients considered or to lymph node understaging caused by the fact that most patients did not undergo mediastinal lymphadenectomy through a thoracotomy or a sternum splitting.

Esophageal Neoplasms↗
PubMedDate not supplied

[Pelvic recurrences after curative surgery for rectal cancer].

This report updates an experience with local recurrences of rectal cancer after curative surgery. Overall 13 year period (1976-1988) 254 patients were operated on in the II Surgical Clinic of Parma University for rectal cancer. Only 122 patients who underwent potentially curative resection were examined. Approximate recurrence rates according to patients age, site, type and stage of primitive tumour, tumour complications and surgical procedures were evaluated. The overall local failure rate was 17.2% with 12 patients having local failure alone and 9 patients having concurrent local failure and distant metastasis. Local failure occurred predominantly in tumour bed, involving the anastomosis in 2 cases. Relapse developed primarily at colo-rectal anastomosis in only 1 patients, 20% of recurrences were diagnosed within the first postoperative year; 65% within the second and 90% within the third. Stage of primary tumour was the most predictive factor for eventual relapse. Minute foci of tumour not encompassed by the first operation led to local recurrences in most of the cases, but relapses were independent of operative procedures adopted. The authors conclude that surgery, even if correctly performed, is not sufficient to prevent the risk of local recurrence of rectal cancer. They believe that routine adjuvant radiation therapy after surgical treatment of rectal cancer should improve survival rate.

Age Factors↗
PubMedDate not supplied

[Gastric carcinoma in the elderly (clinical findings and results)].

On the basis of a series of 643 patients operated on for gastric cancer, the Authors seek to establish whether this disease presents clinical differences with advancing age of such a nature as to have a significant effect on therapeutic management. The series is divided into two groups, the first consisting of patients aged below 70 and the second of patients aged over 70. The following aspects were evaluated: sex, tumour site, oncological stage, type of surgery performed, operative mortality, postoperative survival, as assessed in overall terms and also differentiated in relation to curative or palliative surgery and oncological stage. Analysis of the data confirms that, apart from certain particular aspects, carcinoma of the stomach in the elderly benefits from the same sort of indications and techniques as those proposed for younger patients, with comparable postoperative survival rates, but with a higher operative mortality. To achieve better operative results, what is needed, in addition to correction of metabolic and functional abnormalities, is thorough assessment of risk factors. In patients with tumours at advanced stages, usually characterized by very poor postoperative results, the presence of major risk factors may raise serious doubts as to the actual advisability of the surgical indication itself.

Actuarial Analysis↗
PubMedDate not supplied

[Locoregional recurrences following curative surgery for colon cancer].

This study explores the patterns of local recurrence after curative operations for colonic cancer. Over a 13 year period (1976-1988) 486 patients were operated on in the Surgical Clinic of Parma University for colonic cancer, but only 296 patients who underwent potentially curative resection were examined. The influence of patients' age, disease stage, site and grade, presence of obstruction or perforation and type of surgical procedures were examined as prognostic factors for local cancer recurrence. A total of 28 patients (14%) relapsed after surgery and 19 were found to have simultaneous distant metastasis. 86% of recurrences were evident within the first 2 years. Local recurrence rate increased with more advanced Duke's stage and stage of the primary tumour was most predictive for eventual relapse. The recurrences occurred within the operative resection site involving the anastomosis by inward growth at the suture line. Minute foci of adenocarcinoma not encompassed by the first operation might lead to local recurrences; the authors do not rule out, however, the rare possibility of the implantation of exfoliated malignant cells. Despite the attempt to carry out an intensive followup in terms of early diagnosis of recurrence in colonic surgery, the presence of local recurrences is associated with extremely poor prognosis independent of operative procedure performed. The authors believe that routine adjuvant radiation therapy after surgical treatment of locally advanced colonic cancer could improve survival rate.

Age Factors↗
PubMedDate not supplied

Tumor markers in squamous cell carcinoma of esophagus: immunometric assay in cytosol and membrane fraction.

Carcinoembryonic antigen (CEA), tissue polypeptide antigen (TPA), ferritin, and the monoclonal antibody-detected tumor-associated antigens CA19.9 and CA50 were measured by radioimmunoassay in tissue fractions of carcinoma and normal esophageal mucosa from 59 patients with untreated primary squamous cell carcinoma of the esophagus. Tumor markers were measured in cytosol (118 samples) and in a membrane-enriched fraction (32 samples). CEA, TPA and ferritin were detected in almost all the cytosol samples evaluated, CA19.9 and CA50 in 66% and 50% of cases respectively. Ferritin was significantly higher in carcinoma than in normal mucosa. The cytosol concentrations of CEA, TPA, CA19.9 and CA50 were not significantly different in carcinoma and normal tissue. Concentrations of CEA, CA19.9 and CA50 in the membrane fraction tended to be higher in normal tissue than in carcinoma, whereas the cytosol-to-membrane ratio was significantly higher in carcinoma. For CEA, CA19.9 and CA50, the phenotypic pattern of the malignant transformation seems to involve a different intracellular distribution rather than a quantitative change. No correlations were found between tissue and serum concentrations of the tumor markers, the former being related to the phenotypic characteristics of the tumor, the latter to the tumor burden.

Adult↗
PubMedDate not supplied

[Cancer of the colon and cholelithiasis: bile bacteria, composition of the stones and the bile].

Our recent studies have shown a significant association between lithiasic biliary disease and colorectal cancer. This could be due to the existence of risk factors common to both disease or to a cause-effect correlation between them. This latter hypothesis is supported by the observation in gallstone patients of the increase of biliary and fecal concentrations in secondary biliary acids. These could have co-carcinogenic effect on the colon. With a view to singling out further elements which might help us to understand more clearly the possible cause-effect correlation between cholelithiasis and colon cancer, we examined 12 patients affected by both diseases. In these, we evaluated the composition of the gallbladder stones, by means of spectrophotometry and diffractometry. Bile samples were taken from the gallbladder and used to examine the lipidic composition and the cholesterol saturation index according to Carey. In addition bacteriological examinations were carried out. The results were compared with those of 10 patients with cholelithiasis but not cancer, 10 with cancer but not cholelithiasis and 10 with neither. Analysis of the results did not reveal significant differences in gallstone and bile composition between colon cancer patients with concomitant gallstones and control groups. However, in cancer patients with gallstones a higher incidence of bile bacteria (35.7%) was observed than in the other groups. Bile bacteria were observed more frequently in right colon cancer patients who had pigment stones in 75% of the cases. The results seem to evidence peculiarities in patients with a cancer of right colon.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Cholesterol crystals in biliary microlithiasis.

A recent study put forward the hypothesis that microlithiasis may represent an early stage in the development of biliary calculi. It is an established fact that cholesterol crystals are the product of an inevitable stage in the sequence leading to gallstone formation. To test the hypothesis stated above ten patients affected by gallbladder cholesterol microlithiasis (CM) were examined in the lipid composition of the bile, the cholesterol saturation index and the presence of cholesterol crystals being calculated. The results were compared with those of 14 patients affected by pigment microliths, 24 with larger stones (LS) and ten control patients. The cholesterol saturation index was above one in all CM patients, whereas in some LS patients the gall-bladder bile was not supersaturated. Cholesterol crystals were observed in the gallbladders of all CM patients and seven LS patients. These results would seem to provide support for the hypothesis of microcalculi as being "young stones", with the bile of CM patients maintaining the conditions leading to gallstone formation.

Adult↗
PubMedDate not supplied

Gallstones and risk of colonic cancer: a matched case-control study.

The aim of the research was to verify the existence of an association between neoplasms in the colon and cholelithiasis, treated surgically or non-surgically. The case-control study was carried out on 109 patients operated on for cancer of the colon, and on 109 control patients operated on for benign pathology. Matching was carried out according to sex, age, region of origin and dietary habits of the patients. Results showed a significant association of cancer of the colon with concomitant cholelithiasis (odds ratio = 2.42) but not with previous cholecystectomy. This correlation was more evident in female patients (odds ratio = 3.2), over 65 years of age (odds ratio = 3.6), with neoplasms in the right colon (odds ratio = 5). Observations suggest cholecystectomy has a protective role as regards an increased risk of cancer of the colon in cholelithiasic patients. A confirmation of this association might also be beneficial in terms of early diagnosis of cancer of the colon, thereby allowing identification of a large population of risk patients to be submitted to monitored screening.

Aged↗
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Surgical treatment of cervical anastomotic leaks following esophageal reconstruction.

Cervical anastomotic leaks occurring in the early postoperative period after esophageal reconstruction are life-threatening complications, with a mortality rate similar to that of intrathoracic leaks if the posterior wall of the anastomosis is affected. Prompt diagnosis and aggressive surgical treatment is vital. The surgical procedures commonly used are often inadequate or unsatisfactory because of the difficulties encountered in the subsequent reconstruction. Twelve patient with an early cervical anastomotic leak following elective esophageal surgery were treated using an original surgical technique which allows diversion and simple delayed reconstruction of the anastomosis without risk of late stricture. Uncontrolled mediastinal sepsis accounted for the three deaths of the series and occurred in patients with a leak of the posterior anastomotic wall in whom definitive surgical treatment was delayed.

Adolescent↗
PubMedDate not supplied

Total esophagectomy without thoracotomy: results of a European questionnaire (GEEMO).

The results of a questionnaire answered by the European Members of the GEEMO concerning esophagectomy without thoracotomy are reported and discussed. 172 cases of esophagectomy without thoracotomy following benign lesions and 666 cases following various levels of esophageal neoplasia were grouped in the 26 Centers that have answered the questionnaire amounting to a total of 838 cases. The most frequent indications for benign lesions were as follows: decompensated or relapsed megaesophagus (83 cases), acute or stabilized lesions caused by caustic agents (59 cases), stenoses from gastroesophageal reflux (17 cases), scleroderma (7 cases) and spontaneous or iatrogenic perforation (6 cases). Concerning the esophageal site where the technique was employed with esophageal carcinoma, the most frequent was the cervical (201 cases), then the lower (150 cases), the middle (91 cases) and upper thirds of the esophagus (48 cases). Adenocarcinoma of the cardia seems to be an additional indication for many Surgeons to use esophagectomy without thoracotomy (142 cases). In general, the most frequent intra-surgical complications (from benign and malignant lesions) were as follows: pleural lesions (34.4%), lesions of the left recurrent nerve (7.8%), severe endo-mediastinic hemorrhages (8.5%), tracheo-bronchial (1.5%) and thoracic duct (0.5%) lesions. The intra-operative mortality was 0.36%. The post-operative complications were as follows: pleural effusion (17.8%), anastomotic fistulas (15.2%), hemothorax (5%) and post-operative mortality (10.3%). Cancer of the cervical esophagus and adenocarcinoma of the cardia were considered sensitive to this radical treatment whereas in intra-thoracic cancer it can have only a palliative effect.

Esophageal Diseases↗
PubMedDate not supplied

Changes in nutritional and immunologic parameters after preparation for colonic surgery.

In 15 patients about to undergo colorectal resection for cancer (group I), body weight, lymphocytes, albumin, prealbumin, complement components C3 and C4 and total hemolytic complement activity (TC) were evaluated on admission to hospital and after preroperative preparation which involved dietary restrictions for 5-9 days (450 calories, 25 g protein daily). The same parameters were evaluated in 15 patients admitted for other major surgery not requiring colonic preparation (group II). Statistically significant reduction in prealbumin, C3, C4 and TC were found only in group I. The observations suggest a relationship between immunonutritional status and preparation for large-bowel surgery, reproducing a state of acute malnutrition.

Adult↗
PubMedDate not supplied

Biliary microlithiasis and acute pancreatitis.

Forty-two patients with homogeneous biliary microlithiasis were studied to assess the incidence of the various clinical and anatomopathological characteristics of secondary acute pancreatitis resulting from this condition. The findings confirm that the risk of acute pancreatitis is particularly high in these patients and that the steatonecrotic form is the most common. Consequently, the authors stress the importance of thorough pre- and intraoperative investigations whenever the presence of biliary microlithiasis is suspected, and confirm their preference for the radical treatment of this disease.

Acute Disease↗