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Biomedical subjects

A Picciocchi

Publications and source records attributed to A Picciocchi.

99 records · Page 6Linked to original sources
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Surgery of rectal cancer (technical observations).

The evolution of the surgical management of rectal cancer is briefly reviewed. Factors which influence the choice of the surgical procedure relatively to the tumor characteristics, are examined. The role played by preoperative staging as the basis of a correct therapeutic approach is underlined. Most common surgical procedures in rectal cancer treatment are reported, and emphasis is put on aspects of particular interest for radiodiagnosticians and radiotherapists.

Humans↗
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[Pancoast's tumor].

Explore the source record for details and available documents.

Combined Modality Therapy↗
PubMedDate not supplied

Prosthetic reconstruction of the chest wall.

Since January 1987, in a consecutive series of 56 resections of the chest-wall for cancer, the wall defect was repaired by a prosthetic implant on 14 occasions (10 silastic sheeting, 4 goretex soft tissue patch). Indications for thoracic wall resection were: T3 primary lung cancers (7 cases), local recurrences after breast cancer surgery (5 cases), primary and metastatic neoplasms arising in the chest-wall (2 cases). No rejection was reported nor episodes of flail chest or respiratory disorders. No major complications occurred in patients who underwent postoperative radiotherapy; only 1 case of persistent seroma was observed. Followup ranges from 3 to 37 months. In no case was a local recurrence of tumor observed. Cosmetic results were considered from acceptable to good in all patients. In every case a total control of pain symptoms was achieved. There were 6 deaths at a mean interval of 22 months from operation (4 lung cancers, 1 breast cancer, 1 osteosarcoma), all due to metastatic spread of the disease.

Breast Neoplasms↗
PubMedDate not supplied

[Prognostic factors in local-regional recurrences of colorectal neoplasms].

PURPOSE: The aim of this study was to evaluate, in a group of patients suffering of colo-rectal cancer, the influence on local recurrence of some clinical and anatomo-pathological variables. METHODS: The study was limited to 833 patients who underwent potentially curative resection and have been followed for at least two years. All patients were evaluated every six months for the first three years and yearly thereafter by means of clinical, laboratory, endoscopic and radiological investigations. Recurrence was observed in 78 patients (9.4%); 19 of these had evidence of distal failure simultaneously (2.2%). The incidence was 2.4% and 17.7% in the carcinoma of the colon and rectum respectively. Median time of recurrence was 16 +/- 11 months; 75% presents within 23 months from operation. Chi-square test was used to relate incidence of recurrence to clinical and anatomo-pathological factors and then a multivariate logistic regression analysis was used to evaluate the most significant variables. RESULTS: Univariate analysis reveals a significant relationship between recurrence and age under 50 years (p = 0.01), presence of preoperative complication (p = 0.01), stage (p = 0.01), site (p = 0.000) of primary tumor and lymph-nodal involvement (p = 0.0002). No statistically significant difference was found between recurrence and tumor wall infiltration, number of lymph nodes involved, grading and morphology of primary tumor. Multivariate logistic regression analysis confirmed these results except for preoperative complication (p = 0.9). CONCLUSIONS: Authors believe that selection of patients to undergo adjuvant therapies is improved by identification of high-risk patients.

Age Factors↗
PubMedDate not supplied

Intraoperative esophageal manometry in surgical treatment of achalasia: a reappraisal.

BACKGROUND/AIMS: Intraoperative Esophageal Manometry is used during surgery for gastroesophageal reflux disease to obtain a better lower esophageal sphincter pressure, or during the Heller procedure for achalasia to verify the myotomy. The effectiveness of this manometry is not explicit. MATERIAL AND METHODS: From 1977 to 1987, 58 patients underwent surgery for achalasia at our Institution. A transabdominal Heller's myotomy and a modified Dor's anterior fundoplication were performed in all cases. During the operation, Lower Esophageal Sphincter Pressure was measured in 38 patients (A group) to verify the completeness of the càr-diomyotomy; the fundoplication-induced pressure increase was also recorded. Twenty patients (B group) underwent surgery without intraoperative manometry. Forty-six patients (30 of A group and 16 of B group) were followed up for 24 to 120 months (median 68 months) by means of a clinical questionnaire, barium meal, manometry and 24-hour esophageal pH monitoring. RESULTS: In 21 cases, intraoperative manometry showed the completeness of the myotomy at the first record, while in the remaining 17 it revealed the persistence of a High Pressure Zone; in these, a more accurate incision of the muscle layers on the anterior surface of the esophagus was subsequently performed up to a complete abolition of the HPZ. Long-term results were excellent or good in 27 (90%) patients of A group and in 9 (56%) patients of B group. Dysphagia and gastro-esophageal reflux were the commonest findings in patients with poor results. CONCLUSION: The usefulness of intraoperative manometry in the surgical treatment of achalasia is emphasized and some technical details are reported.

Adult↗
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Conservation surgery for breast cancer.

Advances in early diagnosis of breast cancer have allowed most patients to come to treatment at an early stage (in the US in 1993, 75% of cases were stage I-II). In these cases, conservation surgery has played in the last two decades the role of first choice thearpy following randomized studies which definitely showed the same safety and effectiveness as compared to conventional mastectomy. In time, indications for breast conservation therapy underwent modifications as for the size and site of primary tumor, and the presence of concomitant metastases to ipsilateral axillary lymph nodes. Absolute contraindications are still a multicentric diseases, and the presence of diffuse microcalcifications, while tumors over 3 cm in diameter may be amenable to conservation therapy with primary chemotherapy, retroareolar tumors can be resected with central quadrantectomy and clinically evident axillary metastases do not influence local treatment. There are still open problems as for the extent of peritumoral parenchymal excision, indications for complementary radiotherapy and axillary lymphadenectomy.

Breast Neoplasms↗
PubMedDate not supplied

Pancreatic resection for periampullary cancer in elderly patients.

BACKGROUND/AIMS: Major abdominal surgery in elderly patients has traditionally been thought to carry a high operative risk. Recent data, however, have suggested that with proper selection, elderly patients can withstand pancreatic resection. METHODOLOGY: The medical records of 102 patients who underwent pancreatic resection for pancreatic or periampullary tumors were retrospectively reviewed. Twenty-nine patients were aged 70 years or older (mean age: 74 years) and 73 patients were younger (mean age: 56 years). Concomitant comorbid conditions were evaluated in the patients of both groups, and no significant differences were identified. A pancreaticoduodenectomy was performed in 81 cases and a total pancreatectomy in 21. RESULTS: The operative mortality rate was 0% in the older patients and 6.8% in the younger patients. Major complications occurred in 28% of the patients. There were no significant differences in morbidity among the two age groups. The overall actuarial survival curves showed similar trends in both groups. CONCLUSIONS: With appropriate preoperative selection, pancreatic resection can be performed with low operative risk in elderly patients. Chronological age alone should not be considered an absolute contraindication for pancreatic resection.

Adult↗
PubMedDate not supplied

Surgical management of pulmonary tuberculosis.

Surgery for pulmonary tubercolosis (PTB) is now the second place treatment. Among the surgical indications the most debated is the multi-drug resistance of a focal pulmonary tuberculous disease. Other indications are: bronchiectasis, hemoptysis and the presence of a broncho-pleural fistula. Pulmonary Aspergilloma is a frequent indication for surgery; it is commonly a PTB sequela and causes severe complications. The presence of an unknown pulmonary mass or nodule is a surgical criterion because it might signal a cancer. Surgery therefore now constitutes a valid option for the treatment of clinical patterns of PTB unresponsive to medical treatment in severe, potentially fatal clinical conditions.

Aspergillosis↗