Biomedical subjects

A Peracchia

Publications and source records attributed to A Peracchia.

280 records · Page 16Linked to original sources

PubMedDate not supplied

[Extended resection in colorectal cancer. Personal experience].

At the moment of surgical intervention, colorectal cancer involves adjacent tissues or organs in a percentage of cases ranging between 5% and 12%. "En bloc" resection of these tumors, when not associated with distant metastasis, allows survival at 5 years in from 32% to 79% of cases. The authors discuss their personal experience on the subject of extended resection for carcinoma of the large intestine, in order to evaluate not only the possible anatomico-clinical peculiarities but also both short and long term results. In the period from 1976 to 1993 1164 patients underwent surgery for colorectal cancer, in 791 cases (68%) with a curative aim. 71 patients underwent extended resection, in 59 cases for the curative treatment of a primary tumor and in 12 for the treatment of a local recurrence (LR). Pathologic examination revealed neoplastic infiltration into at least one of the organs removed with the tumor in 43 cases (61%). It must, however, be pointed out that the above frequency was considerably higher (92%) when extended resection was carried out for LR than in cases of exeresis of primary cancers (54%). The reported results show that extended resection leads to potentially higher morbidity and mortality than can be observed after standard resection, but that, at the same time, it proves to be the only treatment able to provide these patients with good prospects for fairly long-term survival. Recourse to this procedure must therefore always be out of necessity, furthermore the extension of demolition must be adapted to the operative finding.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMedDate not supplied

[Multimodal treatment of intrahepatic lithiasis with traditional surgery, endoscopy, and extracorporeal lithotripsy. Report of a clinical case].

A patient with residual intra-/extra-hepatic bile duct stones, previously admitted in emergency for acute necrotic pancreatitis and cholangitis, underwent the following procedures: 1) endoscopic sphincterotomy and naso-biliary tube drainage; 2) surgical operation (choledocholithotomy, operative choledochoscopy and T-tube external biliary drainage); 3) extracorporeal shock-wave lithotripsy; 4) endoscopic sessions of fragmented stones removal. The above mentioned multimodal treatment, which resolved the intrahepatic lithiasis as shown 12 months later by endoscopic retrograde cholangiography, is therefore suitable in order to avoid, at least initially, invasive radiologic or surgical procedures, i.e. transparenchymal approaches, intrahepatic derivations and hepatic resections.

Bile Ducts, Intrahepatic↗

PubMedDate not supplied

Laparoscopic treatment of functional diseases of the esophagus.

The possibilities of laparoscopic surgery in the treatment of functional esophageal diseases (gastroesophageal reflux, achalasia and epiphrenic diverticula) are illustrated with special emphasis on the technical aspects, including intraoperative complications and postoperative care. Results are discussed on the ground of the following experience. Thirty-seven laparoscopic fundoplications were performed with 13% conversion rate, 2.7% postoperative morbidity (1 slipped Nissen requiring redo laparoscopic surgery). Median operative time was 140 min. One patient complained of dysphagia relieved by endoscopic dilation (2.7%). All patients are not asymptomatic after a median follow-up of 16 months although one has gastroesophageal reflux (GER) at 24-hrs pH monitoring. forty laparoscopic Heller-Dor procedures: 7% conversions, 5% postoperative morbidity. Median duration 120 min. One patient complained of persistent dysphagia requiring endoscopic dilation (2.5%) and asymptomatic GER was detected in 8% of patients. Finally, 2 patients underwent laparoscopic diverticulectomy, esophagomyotomy and Dor fundoplication without morbidity and excellent postoperative result. Laparoscopic treatment of functional diseases of the esophagus is safe and effective, provided it is performed by an experienced surgeon with respect for some important technical details. Further follow-up is needed to evaluate long-term results.

Adolescent↗

PubMedDate not supplied

[Surgical treatment of esophageal stenosis caused by reflux].

From 1976 to 1993, among 582 patients with reflux esophagitis seen at our Institution, 164 (28%) presented with an esophageal stricture, and 68 of these (41%) underwent surgical treatment. The male to female ratio was 1.6:1, and the median age 51 (range 15-78). Thirteen of the 68 patients (19%) had an associated Barrett's esophagus. Esophageal manometry revealed scleroderma in nine individuals (13%). In 11 patients (16%) observed before 1985 the stricture was not dilatable. Surgical therapy consisted of fundoplication (n = 39), Collis gastroplasty plus fundoplication (n = 10), total duodenal diversion (n = 4), and esophageal resection (n = 15). The mortality rate was 4.4%: two patients died of necrosis of the colon transplant and one of acute pancreatitis. The median follow-up was 27 months (6-129). Esophageal sparing procedures significantly reduced the need of further endoscopic dilatation (p < 0.001). Standard fundoplication was successful in 30 of 39 patients (77%). Regression of Barrett's epithelium was not recorded after any of the conservative surgical procedures.

Adolescent↗

PubMedDate not supplied

Iatrogenic perforation of the esophagus.

The treatment of iatrogenic esophageal perforation is still today subject of discussion. The present work relates our experience on 16 cases seen between 1955 and 1976, and compares the results with the 1,310 collected by French and English literature. The etiology of perforation is: endoscopy (50.5%), dilatation (19.5%), foreign bodies (14%), surgery and other causes (16%). The mortality rate of cervical perforations is 14.5% (7.3% with medical treatment, 18% with drainage, 12.6% with suture). In the thoracic esophagus it is 32.5% (50% with medical treatment, 40% with drainage, 18% with suture). The data demonstrate that the best results are obtained with surgical treatment, that may be simple drainage when the perforation is cervical, but must be the suture in the thoracic esophagus. We must emphasize that the operation must be performed within 24 hours, because, in the cases operated on after 24 hours, the mortality rate is nearly double.

Adult↗

PubMedDate not supplied

Thoracoscopic dissection of the esophagus for cancer.

Eighteen patients affected by a resectable intramural tumor of the esophagus have undergone esophagectomy with thoracoscopic dissection of the esophagus in the last 4 years. All patients had a relative contraindication to transthoracic esophagectomy with radical lymphadenectomy. All esophagectomies were completed thoracoscopically and reconstruction of the digestive tract was performed in 17 cases through cervical gastroplasty and in 1 case through cervical coloplasty. One cirrhotic patient died in the postoperative period due to cervical anastomotic leak. Six other patients experienced a postoperative complication (mortality rate 5.5%; morbidity rate 33.3%). After a median follow up of 17 months, 14 patients are alive without evidence of disease. One patient, who had excision of a cutaneous metastasis at a trocar insertion site 6 months postoperatively, eventually died with locoregional recurrence 14 months postoperatively. Another patient died 20 months after surgery with mediastinal recurrence. One patient died 28 months postoperatively after massive hematemesis with a suspect abdominal recurrence. The results of the present series and those reported by other authors do not seem to indicate presently evident advantages from the minimally invasive procedure during resection of the esophagus for cancer. At the present time, no indication to this procedure exists for standard clinical use; wider randomized trials and longer follow-up to be performed only in selected centers are needed to further evaluate the procedure.

Adenocarcinoma↗

PubMedDate not supplied

Ultrasonographic imaging of neoplasms of the cervical esophagus.

BACKGROUND/AIMS: We studied the effectiveness of ultrasonography in evaluating the cervical esophagus for the presence of large masses arising from the esophageal wall and consequently, the modifications of the visceral lumen. MATERIALS AND METHODS: The cervical esophagus can be evaluated by ultrasound with longitudinal and axial scans, using the left thyroid lobe as an acoustic window. The cervical esophagus can be visualized from the C5 to D2 vertebrae. From November 1992 to July 1996, 220 patients with esophageal cancer and 120 subjects without esophageal disease (control group) were examined with ultrasonography. Examination of the cervical esophagus was performed with a linear high definition small parts probe with a frequency of 7.5-10 Mhz. RESULTS: In all 31 patients with cancer of the cervical esophagus, ultrasonography of the cervical region showed the presence of an expanding mass from the esophageal wall as well as the modifications in the visceral lumen. The neoplasm of the cervical esophagus was visualized when its diameter exceeded 5 mm. CONCLUSIONS: The experience of the authors shows that, during ultrasound examination of the cervical region, it is possible to accurately evaluate the cervical esophagus, either morphologically or functionally.

Aged↗

PubMedDate not supplied

Circular hemorrhoidectomy in advanced hemorrhoidal disease.

BACKGROUND/AIMS: Milligan-Morgan's hemorrhoidectomy has a high recurrence rate (> 10%) in patients with circular IV grade hemorrhoids. In such cases a circular hemorrhoidectomy with complete elimination of residual piles, and anoplasty might be more successful. The aim of this retrospective study was to compare the results of circular hemorrhoidectomy using the Hopital Leopold Bellan (HLB) technique (Paris) with the reported results of other techniques in patients with advanced hemorrhoidal disease. METHODOLOGY: From January 87 to December 96, 100 consecutive patients with circular IV grade hemorrhoids underwent radical hemorrhoidectomy. Mean hospital stay was 4 days (range 3-7). Patients were strictly controlled in the postoperative period and in cases of early fibrosis anal dilators were used. RESULTS: Eighty one percent of patients had a complete recovery. The recurrence rate was 4%. The cumulative rate of early and late complications was 34%. Early and late hemorrhages were more frequent than in traditional hemorrhoidectomy, while the incidence of anal stenosis was the same. CONCLUSIONS: The HLB operation is the best choice for patients with advanced circular hemorrhoids because of its radicality and good results. The postoperative morbidity of HLB hemorrhoidectomy is higher than traditional hemorrhoidectomy; nevertheless, all complications are tractable without extension of hospital stay.

Adult↗

PubMedDate not supplied

Surgical therapy in patients with failed antireflux repairs.

BACKGROUND/AIMS: Failure of antireflux surgery may be due to errors in patient selection, errors in the choice of the operation, or technical errors in the performance of the operation. The purpose of this work was to review a series of patients surgically treated for a failed antireflux procedure over the past two decades. MATERIALS AND METHODS: Seventy patients (62%) out of 113 consecutive individuals presenting with symptoms after one or more operations for gastroesophageal reflux disease underwent reoperation. Five patients had been operated on laparoscopically. The indications for reoperation were based on severity of symptoms and results of objective investigation. Surgical therapy was tailored to the individual patient based on pathophysiological abnormalities and on the results of intraoperative assessment. RESULTS: Reflux symptoms and dysphagia represented the major complaint in 62.8% and 35.7% of patients, respectively. The most common pathophysiological abnormality was an incompetent lower esophageal sphincter. Intraoperative assessment showed a disrupted or misplaced repair in 77% of the patients. The most common reoperation performed was a partial or total fundoplication (54.3%), followed by antrectomy and Roux-en-Y anastomosis (25.7%). There was no mortality. Postoperative morbidity rate was 8.5%. At a median follow-up of 48 months, 87% of patients were scored as Visick 1-2 and 90% declared themselves satisfied with the results of reoperation. CONCLUSIONS: Management of patients with failed antireflux procedures is challenging. However, detailed physiological evaluation and a surgical approach tailored to residual anatomy and function of the foregut can provide excellent results.

Adolescent↗

PubMedDate not supplied

Risk factors of local recurrence of colorectal cancer: a multivariate study.

BACKGROUND/AIMS: Duke's staging is still the most widely used parameter in the estimation of risk for local recurrence in patients with colorectal neoplasia. The aim of this study is to identify biological determinants that may be of use in segregating patients with similarly staged tumors into groups with different risk of local recurrence. METHODOLOGY: Ninety-eight patients who had undergone curative resection for colorectal cancer between 1989 and 1991 were prospectively studied. Statistical analysis of clinical and pathologic variables was carried out using a Cox multivariate proportional hazard model. RESULTS: Dukes stage and DNA ploidy were the only significantly predictive variables for local recurrence. In particular, the factors increasing local recurrence risk were seen to be the presence of lymph node metastases and aneuploid status. In the absence of both of these negative prognostic factors the risk of local recurrence is practically nil, in the presence of just one it reaches 16% and in the presence of both it rises to over 40%. CONCLUSIONS: The results of this study indicate that the presence of an aneuploid tumor with positive lymph nodes places patients at a higher risk of local recurrence, and calls for post-operative adjuvant therapy and intensive follow-up.

Aged↗