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Biomedical subjects

A Picciocchi

Publications and source records attributed to A Picciocchi.

At least 91 records · Page 5Linked to original sources
PubMedDate not supplied

[T-downstaging after neoadjuvant chemotherapy in locally advanced gastric carcinoma].

Only a limited number of trials on neoadjuvant chemotherapy for resectable advanced gastric cancer have been planned or conducted up to date, still in recent years this treatment strategy has been considered by many the most promising tool in order to improve survival of locally advanced tumors of the stomach. Aim of this study is to evaluate the clinical significance and the possible impact on survival of tumor downstaging after neoadjuvant chemotherapy followed by D2-gastrectomy in an accurately staged and thoroughly selected group of 30 locally advanced gastric cancer patients, with a complete follow-up of at least 3 years. In our series, T-downstaging was observed in 43.3% of patients; this parameter, along with other known prognostic factors, was found to be significantly associated with survival (p <0.05). Moreover, T-downstaging induced by preoperative chemotherapy was significantly associated with absence of residual tumor (R0) and no lymph node metastases (ypN0) (p <0.05). At multivariate analysis, R0-resection was the only independent prognostic factor (HR 9.439, p <0.0001). According to our results we feel encouraged to consider neoadjuvant chemotherapy a promising modality for increasing the R0-percentage by tumor downstaging.

Chemotherapy, Adjuvant↗
PubMedDate not supplied

[The prognostic role of anatomo-pathological factors in colorectal cancer: an univariate analysis].

An univariate analysis of pathologic data of 987 patients with primary colorectal carcinoma treated over a period of 22 years was performed. Six variables such as tumor site, histologic type, depth of invasion, nodal involvement, distant metastases, histologic grade and tumor stage were tested for their prognostic value. 5-year survival rate was investigated. Patients with tumors in the left colon and rectum have shown a better prognosis than patients with tumors in the right colon (53-51% vs. 38% p = 0.0007). As regard histologic type non significant differences between mucinous and non-mucinous carcinoma was observed (44% vs 48% respectively p = 0.4). The depth of tumor invasion was an important prognostic factor; according to tumor infiltration patients can be divided in four groups (T1, T2, T3, T4) with 5-year survival rates of 80%, 74%, 39% and 16% respectively (p = 0.0000). Highly significant decrements in survival occurred when lymph node metastases were demonstrable (20% vs. 67% p = 0.0000). Prognosis was still strongly related to histologic grade, with significant difference in survival rates between G1 and G2-G3 tumors (71% vs. 48%-42% p = 0.0000). Finally prognosis was closely related to the stage of spread at the time of diagnosis.

Adenocarcinoma↗
PubMedDate not supplied

[Hartmann's procedure in emergency surgery of the colorectum].

The authors report their experience with Hartmann procedure. 28 patients were treated: 21 males and 7 females. The mean age was 58 years. Perforative diverticulitis was the commonest indication (14 patients), followed by carcinoma (11 patients). Miscellaneous causes accounted for 3 patients. This procedure was primarily performed as an emergency operation (71%). One patient died post-operatively (3.5%); post-operative morbidity was 10.7%. A second operation was not planned if the first operation had been performed for palliation of metastatic or locally advanced cancer (7 patients). Restoration of colonic continuity was achieved successfully in 14 patients with no mortality and morbidity. According to their experience, authors believe Hartmann procedure to be the most suitable operation facing a left colon emergency. It is usually easy to perform and well tolerated by poor risk patients.

Anastomosis, Surgical↗
PubMedDate not supplied

Cell-mediated immune response in human hepatic echinococcosis. Analysis of antigen-induced lymphoproliferation and NK activity.

In vitro cellular immune responsiveness was studied in 25 patients undergoing surgery for hepatic hydatid disease and in 22 matched healthy controls. Proliferation of peripheral blood mononuclear cells (PBMC) induced by phytohaemagglutinin (PHA) was not statistically different in the two groups, while proliferation induced by antigenic preparations obtained from the human commensal microorganism Candida albicans was depressed in patients as compared to healthy subjects. Confirming previous data, antigen specific proliferative response to hydatid cyst fluids was greatly enhanced in patients as compared to controls (P less than 0.01). On the other hand, natural killer (NK) activity was significantly reduced (P less than 0.005). Both impairment of NK activity and lymphoproliferation induced by commensal microorganisms suggest that patients following the parasitic infection present a condition of relevant hyporesponsiveness in cell-mediated defence.

Adolescent↗
PubMedDate not supplied

Double stapling technique for low colorectal anastomoses after anterior resection for rectal cancer.

A group of 26 patients submitted to anterior colorectal resections for carcinoma is reported: all of the anastomoses were performed using the so-called "Double Stapling Technique" (DST), first introduced by Knight and Griffen in 1980. The technical results are discussed, in the light of recent reports. "DST" offers clear advantages, over both traditional hand-stitched and end-to-end stapled anastomosis. This procedure is considered cost-effective and time-saving and offers lower intra-operative risks. It permits optimal sterility of the operative field and lower risk of neoplastic spreading. Furthermore it eliminates some technical problems such as the preparation of the distal purse-string suture and the inequality between the two intestinal stumps to be anastomosed.

Aged↗
PubMedDate not supplied

Surgical approach to renal cell carcinoma extending into the right atrium through the inferior vena cava.

Successful management of a patient with an intracardiac tumor thrombus of renal carcinoma is described. This case and a few others in the literature have led us to consider the clinical signs of cavo-atrial obstruction, frequently silent and unspecific; the diagnostic methodology, especially based upon CAT scan and cavography, and the type of surgery and surgical technique called for, especially as regards the approach and the possible use of extracorporeal circulation (ECC).

Adenocarcinoma↗
PubMedDate not supplied

Therapeutic and prognostic problems in lung cancer with mediastinal lymph node involvement.

From January 1st, 1978 to 31st December, 1981, 28 patients with lung cancer and mediastinal lymph node metastases, underwent surgery. In four patients, only exploration was performed, in five patients, an incomplete resection and in 19 patients, a complete resection (resectability rate 86%). In the first two groups of patients, survival never exceeded two years. In the 'complete resection' group, 78% of the patients survived for one year, 61% for two years and 47% for three years. Patients with adenocarcinoma had a higher three year survival rate than those with squamous cell carcinoma (60% vs. 37%). No 30-day mortality was observed. All patients were treated postoperatively with MACC + BCG. The prognosis of lung cancer classified as N2 is strongly influenced by a series of factors some of which are included in the TNM system. In any case, it would still appear that the best treatment for this kind of tumor is radical surgical resection followed by adjuvant radiotherapy and/or multichemotherapy.

Adenocarcinoma↗
PubMedDate not supplied

Combined modality therapy of resectable high risk rectal cancer.

Aim of this phase I-II study was to evaluate the efficacy of preoperative concomitant radiochemotherapy in resectable high risk (TNM stage: II and III) rectal tumors, 64 patients entered the study: 37 had low rectal cancer, 27 mid-rectal cancer. 50 patients were clinically staged as stage III (Dukes C) and 14 as stage II (Dukes B). Treatment protocol included bolus mitomycin C at the dose of 10 mg/m2 on day 1 and 5FU continuous infusion at the daily dose of 1000 mg/m2 on day 1, 2, 3, 4. Concomitant external radiotherapy up to a dose of 3780 cGy was delivered at the daily dose of 180 cGy. Surgery was performed 4 to 5 weeks after radiation therapy (RT). Before surgery all patients were clinically restaged to evaluate the response to concomitant radiochemotherapy. Treatment compliance was 97%. Toxicity was 27% prevalently shown as bone marrow depletion and radiodermatitis. In 37 patients (61%) there was 50% reduction (partial response) of neoplastic volume. In 5 patients (8%) no neoplastic cells were evidenced in the surgical specimen on histology (complete response). The distance between the lower margin of the tumor and the internal anal orifice increased in 72% of cases. Postoperative morbidity was 28%. The incidence of anastomotic dehiscences was 8.7% over 46 anterior resections. Postoperative mortality was nil. Definitive staging evidenced 24 patients (39%) stage I or with no evidence of tumor. The incidence of local recurrence was 5% and that of distant metastasis 8%.

Antibiotics, Antineoplastic↗