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Biomedical subjects

A Peracchia

Publications and source records attributed to A Peracchia.

At least 127 records · Page 7Linked to original sources
PubMed1991

[Cancer of the hypopharynx and cervical esophagus].

Between 1975 and 1988 we observed 169 patients with carcinoma of the cervical esophagus, 85 with a carcinoma involving the hypopharynx and the cervical esophagus, and 27 patients with a carcinoma of the cervical esophageal region arising after laryngectomy for laryngeal cancer. The mean age was 57.5 years (range 41-73). 167 patients underwent surgical exploration (operability rate 59.5%) and in 152 cases the tumor was resected (resectability rate 91.1%). The resection was complete in 129 patients (84.5%) and palliative in 23 (14.5%). In 33 cases a segmental laryngo-pharyngo-cervical esophagectomy with free intestinal loop transplantation was performed with an operative mortality of 6.1%. 101 patients underwent total laryngo-pharyngo esophagectomy and the gastrointestinal tract was reconstructed by means of pharyngo-gastrostomy and pharyngo-colostomy in 85 and 16 cases, with an operative mortality of 12.9% and 18.3%, respectively. Total esophagectomy without laryngectomy was performed in 18 patients with a carcinoma of the distal cervical esophagus refusing laryngectomy with a hospital mortality of 5.5%. The overall 5-year actuarial survival, excluding the operative mortality, was 15.8%. After complete resection, better results were recorded with patients operated for carcinoma of the hypopharynx than with patients with carcinoma of the cervical esophagus: the 2-year and 5-year actuarial survival was 59% vs 26% and 43% vs 17%, respectively. No patient undergoing palliative resection was alive at the 3-year interval.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Flow cytometric DNA analysis of squamous cell carcinoma of the esophagus.

Although an abnormal amount of cellular DNA content is known to occur in squamous cell carcinoma of the esophagus, the significance and clinical relevance of this finding have yet to be elucidated. Paraffin-embedded blocks from 77 patients with squamous cell carcinoma of the esophagus were dewaxed and made into a suspension by mechanical mincing and enzymatic digestion. The nuclei were stained with propidium iodide, and the DNA content evaluated with flow cytometric study. The DNA index (DI) and the coefficient of variation were determined and the results were compared with other pathologic prognostic features. DNA aneuploidy was identified in 70.1% of the specimens and found to correlate significantly with both histologic grading (P less than 0.025) and the incidence of postoperative recurrence (P less than 0.05). Although the 5-year survival was slightly better in the euploid group than in the aneuploid group (28.8% and 19.1%, respectively), this difference was not statistically significant (P greater than 0.1). There was no correlation of the DI with the extent of wall penetration by the tumor, the incidence of lymph node metastases, or the surgical staging, features previously shown to correlate with prognosis in patients with esophageal carcinoma.

Carcinoma, Squamous Cell↗
PubMed1990

Expression of ras oncogene p21 protein in esophageal squamous cell carcinoma.

In order to investigate the value of ras oncogene expression as a prognostic indicator in esophageal squamous cell carcinoma, we evaluated the level of ras oncogene protein product (p21) in 52 specimens resected between 1977 and 1986. All patients were followed until death or for at least 2 years. Pathology slides and archival paraffin blocks were retrieved for confirmation of the original diagnosis, study of histopathologic features, and measurement of p21 content. P21 titers were obtained using the RAP-5 monoclonal antibody in a semiquantitative immunohistochemical assay. Titer was expressed as the highest dilution of antibody giving definitive staining using the avidin-biotin peroxidase method. Ras oncogene was expressed in 88.5% of the specimens. We did not find a significant correlation between ras expression and any of a variety of clinical and histopathologic prognostic parameters. Although patients' median survival after resection of specimens with ras oncogene expression was less than half the median survival after removal of tumors without such expression, this difference was not statistically significant. Further prospective investigations are needed to assess the role of ras oncogene evaluation in clinical practice.

Adult↗
PubMed1990

Oesophageal cancer treated by photodynamic therapy alone or followed by radiation therapy.

Photodynamic therapy (PDT) with porphyrins and red light is receiving increasing attention in the management of malignant tumours. At present PDT is primarily indicated for the treatment of superficial or early-stage lesions. At the Department of Radiotherapy and the First Institute of Surgery in Padova (Italy) more than 150 cases of tumours of different types have been treated using this technique. This paper briefly describes 21 cases of superficial oesophageal cancer. A complete response was observed in 11 of 21 cases. Radiation therapy appeared to be very effective as a salvage treatment of non-response patients.

Antineoplastic Agents↗
PubMed1990

Surgical management of carcinoma of the hypopharynx and cervical esophagus.

Between 1975 and 1988 we observed 169 patients with carcinoma of the cervical esophagus, 85 with a carcinoma involving the hypopharynx and the cervical esophagus, and 27 with a carcinoma of the cervical esophageal region that developed after laryngectomy for laryngeal cancer. The mean age of the patients was 57.5 years (range: 41-73). One hundred and sixty-seven patients underwent surgical exploration (operability rate 59.5%), and in 152 cases the tumor was resected (resectability rate 91.1%). The resection was complete in 129 patients (84.5%) and palliative in 23 (14.5%). In 33 cases a laryngopharyngo-cervical segmental esophagectomy with free intestinal loop transplantation was performed, with an operative mortality of 6.1%. One hundred and three patients underwent laryngo-pharyngo-total esophagectomy, and the digestive tract was reconstructed by means of pharyngo-gastrostomy and pharyngo-colostomy in 85 and 16 cases, with an operative mortality of 12.9% and 18.3%, respectively. Total esophagectomy without laryngectomy was performed in 18 patients with a carcinoma of the distal cervical esophagus who refused laryngectomy, with an hospital mortality of 5.5%. The overall 5-year actuarial survival, excluding the operative mortality, was 15.8%. After complete resection, better results were recorded in patients operated on for carcinoma of the hypopharynx than in patients with carcinoma of the cervical esophagus: the 2-year and 5-year actuarial survival was 59% vs. 26% and 43% vs. 17%, respectively. No patient undergoing palliative resection was alive at the 3-year interval.(ABSTRACT TRUNCATED AT 250 WORDS)

Colon↗
PubMed1990

[Surgical treatment of carcinoma of the hypopharynx and cervical esophagus].

Between 1975 and 1988 we observed 169 patients with carcinoma of the cervical esophagus, 85 a carcinoma involving the hypopharynx and the cervical esophagus, and 27 patients with a carcinoma of the cervical esophageal region arose after laryngectomy for laryngeal cancer. The mean age was 57.5 years (range 41-73). 167 patients underwent surgical exploration (operability rate 59.5%) and in 152 cases the tumor was resected (resectability rate 91.1%). The resection was complete in 129 patients (84.9%) and palliative in 23 (14.1%). In 33 cases of laryngo-pharyngo-cervical segmentary esophagectomy with free intestinal loop transplantation was performed with an operative mortality of 6.1%. 101 patients underwent laryngo-pharyngo-total esophagectomy and the digestive tract was reconstructed by means of pharyngo-gastrostomy and pharyngo-colostomy in 85 and 16 cases, with an operative mortality of 12.9% and 18.3%, respectively. Total esophagectomy without laryngectomy was performed in 18 patients with a carcinoma of the distal cervical esophagus refusing laryngectomy with an hospital mortality of 5.5%. The overall 5-year actuarial survival, excluding the operative mortality, was 15.8%. After complete resection, better results were recorded with patients operated for carcinoma of the hypopharynx than with patients with carcinoma of the cervical esophagus: the 2-year and 5-year actuarial survival was 59% vs 26% and 43% vs 17%, respectively. No patient undergoing palliative resection was alive at the 3-year interval.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Cancer of the hypopharynx and cervical esophagus. Role and limits of the surgical treatment].

From 1975 to 1988, we observed 169 patients with a carcinoma of the cervical esophagus, 85 with a carcinoma involving the hypopharynx and the cervical esophagus, and 27 with a carcinoma of the cervical esophagus occurring after laryngectomy for laryngeal carcinoma. The average age was 57.5 years (41-73). Exploration was surgical for 167 patients (operability ratio 59.5%), and the lesion was resected in 152 cases (resectability ratio 81.1%). Resection was complete in 129 patients (84.5%) and palliative in 23 (14.5%). A laryngopharyngoesophagectomy involving the cervical esophagus and requiring the transplantation of a free intestinal loop was performed in 33 cases, with an operative mortality rate of 6.1%. Pharyngolaryngectomy with total esophagectomy was performed in 101 patients, and the digestive tract was reconstructed by means of pharyngogastrostomy or pharyngocolostomy (respectively 85 and 16 cases) with an operative mortality rate of 12.9% and 18.3%, respectively. Complete esophagectomy without laryngectomy was performed for 18 patients with carcinoma of the distal cervical esophagus who refused laryngectomy, the hospital mortality rate being of 5.5%. The actuarial survival rate after 5 years (not including operative mortality) was 15.8%. Better results were achieved after complete resection for carcinoma of the hypopharynx than for carcinoma of the cerebral esophagus. The actuarial survival rates after 2 and 5 years were 59% vs. 26% and 43% vs. 17% respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1990

[Costs and benefits of mechanical sutures in esophageal surgery].

The cost/benefit ratio of mechanical sutures is a controversial issue. Aim of this work was to compare the cost of esophago-visceral anastomoses performed with staplers versus the cost of conventional anastomoses. Not only the cost of the material, but also the economical impact of the hospital stay and operative complications was evaluated. Results show a statistically significant decrease of morbidity in patients treated with mechanical sutures (3.7% vs 18.8%, p = 0.0001). The overall cost of a single mechanical suture was markedly lower than that of a single manual suture (934.000 vs 2,209.000 Italian lira). We conclude that a significant decrease of hospital cost can be expected using mechanical sutures. It has to be noted, however, that in order to achieve such results, an adequate surgical training with staplers is mandatory.

Anastomosis, Surgical↗
PubMed1990

[Esophagectomy without thoracotomy as a treatment of esophageal cancer. Indications, technical features and results].

Between 1980 and 1989, 229 patients with squamous cell carcinoma of the esophagus underwent esophagectomy without thoracotomy. The tumor was located in cervical and thoracic esophagus in 112 and 117 cases, respectively. Out the patient with a tumor of the thoracic esophagus, the mean age was 63 years (range 32-81). There were 90 males and 27 females. The locations inside the thoracic esophagus were as follows: upper thoracic 39, middle thoracic 40, lower thoracic 38 cases. A complete resection of the tumor was performed in 87 patients and in 30 cases the procedure was palliative. The digestive tract was reconstructed by means of esophago-gastrostomy in 101 patients, esophago-colostomy in 13, esophago-jejunostomy in 2, and pharyngo-colostomy in 1 patient, respectively. The post-operative morbidity was as follows: pulmonary complications 13.6%, anastomotic leak 17.1%, necrosis 5.1%, recurrent laryngeal nerve injuries 10.2%. The overall hospital mortality was 7.6%. Actuarial survival rates after curative and palliative resection were 82.4% and 47.1% at 7 year, 46.3% and 8.1% at 2 years, 39.0% and 0% at 3.5 and 6 years. In our experience, esophagectomy without thoracotomy is an excellent technique, with low morbidity but with oncologic limitations. Patients with carcinomas of the thoracic esophagus in whom thoracotomy is contraindicated can be resected with this technique with morbidity and mortality rates comparable to those of patients undergoing transthoracic esophagectomy.

Actuarial Analysis↗
PubMed1990

[Current status of the surgical treatment in colorectal carcinoma].

The Authors take into consideration some topical subjects, with reference to their own experience. The percentage of patients diagnosed as having localized disease, despite improvement in diagnostic techniques, has not changed over the last decade. In local recurrences without distant metastases, surgery is the sole treatment which may improve the survival. Resection however has to be thought over, since surgery of local recurrences may be considered as curative only in a few cases and the probability of a poor result in survival and quality of life does not justify a surgical procedure when it is associated with a high operative risk. In cancers of the middle 3rd and lower rectum, staplers have favoured the choice of anterior resection, which does not show a high rate of recurrences, when compared to abdominoperineal excision. At last, progress in surgery, anaesthesiology and intensive care determined a different therapeutical attitude in the aged, either due to a lower incidence of postoperative complications, or because life expectancy in the elderly seems to justify, whenever possible, a curative procedure.

Age Factors↗
PubMed1989

Tumor markers in serum of patients with primary squamous cell carcinoma of the esophagus.

Serum levels of several tumor markers were studied in 96 patients with untreated primary squamous cell carcinoma of the esophagus. Three markers specific for digestive tract malignancies--CEA, CA19.9 and CA50--and two non organ specific indicators of malignancy--ferritin and TPA--were evaluated. Positivity rates of CA19.9 and CA50 were very low (4.4% and 8.6% respectively); the markers were therefore considered ineffective in the disease. CEA, TPA and ferritin showed a fair positivity rate (27.1%, 28.1%, 33.7% respectively); CEA and TPA were directly related to clinical stage, CEA levels being significantly higher in stage IV than in stage III cases (p = 0.016). TPA preoperatory levels were also directly related to a lower survival probability (p = 0.004). CEA showed significantly lower levels in tumors of lower than in those of middle (p = 0.03) and upper esophagus (p = 0.004). TPA showed a similar behaviour with lower levels in tumors of lower than of middle esophagus (p = 0.03). These findings could be due to a bulky metabolism of tumor markers drained via portail vein in the liver. From our data the following conclusions may be drawn: 1) CEA and TPA may be useful in the staging of esophageal cancer as an ancillary tool to assess the extent of the disease; 2) tumor location is an important variable when evaluating blood levels of tumor markers in patients with esophageal cancer.

Adult↗
PubMed1989

Surgical and endoscopic palliation of esophageal carcinoma.

We reviewed the records of 732 patients with advanced esophageal carcinoma to determine the efficacy of palliative therapy. Palliative resection was performed in 156 patients. Hospital mortality was 9.6%, 1-year survival was 29.1%, and median survival was 7.8 months. Excellent or good palliative results were obtained in 78% of operative survivors. Bypass procedures were performed in 49 patients: hospital mortality was 20.4%, with a median survival of 6.2 months. Excellent or good palliative results were obtained in 71% of operative survivors. Intubation of the tumor was performed in 254 patients. Thirty-day mortality was 10.2%, and median survival was 4.0 months. No patient received excellent palliation. Neodymium:yttrium-aluminum-garnet laser therapy or photodynamic therapy was performed in 50 patients. No procedure-related deaths were recorded, and median survival was 4.1 months. Excellent or good results were obtained in 83% of patients. Lesser procedures were performed in 106 patients, and 117 had only staging examinations. Although surgical palliation of esophageal cancer with resection or bypass provides good results, the cost is high. Improvements in palliative results require reduction in operative mortality, increased accuracy of preoperative staging, continuing use of laser therapy, and increased use of chemotherapy alone or in combination with radiotherapy and operation.

Adult↗
PubMed1989

Automated selection of high-risk patients with acute pancreatitis.

One hundred six early features were retrospectively collected on 44 patients with acute pancreatitis and stored in a database programmed on a microcomputer. Intraoperative/autopsy findings or clinical course categorized patients as having severe (n = 16) or mild (n = 28) pancreatitis. The frequency of 88 early available variables was analyzed. Twenty significant differences were found and used to program a Bayesian prediction of severity, assuming their independence. The computer's performance was assessed by retrospective testing of the patients, and a further 47 (14 severe, 33 mild) were studied prospectively, with a comparison carried out involving the unaided prediction of the clinicians. Finally, all 91 patients were retrospectively tested with the early predictive Ranson's signs and the results were compared with the computer's output. In the prospective evaluation, the computer's performance was 89.4% accuracy, 100% sensitivity, 84.8% specificity, while that of the physicians was 65.9%, 71.4%, 63.6%, respectively, like the performances of Ranson's criteria. Methodologic problems were: selecting patients to study, based on wide inclusion and exclusion in hindsight of the false-positives; dividing them into groups, based on both pathologic and clinical criteria; and the assumption of independence within the variables. The use of the procedure in other populations requires a specific analysis of the discriminant variables, but this study suggests a method to compare several samples of patients which allows prospective and controlled clinical trials.

Acute Disease↗