[Computerized multivariate analysis of the evaluation of the prognosis of the cancer of the lung after excision surgery].
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Biomedical subjects
Publications and source records attributed to A Tocchi.
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The activity of tiropramide chlorhydrate in the pre-medication for the endoscopical examinations has been evaluated. In particular ERCP has been studied considering as parameters the timing of the different stages of the examination and the activity of Oddi's sphincter. At the end of endoscopy the pressure of the sphincterial region was measured a 3-way miniature catheter. Patients included in the study were divided into two different groups: group A treated with tiropramide chlorhydrate and diazepam vs group B treated only with diazepam. The group with patients pre-medicated with tiropramide chlorhydrate presented a significant reduction in the timing of the different stages of endoscopy. Endoscopy was better tolerated. Manometry showed an antispastic action of the drug without side effects. An important reduction of the degree and duration of the sphincterial phase activity, with a possible improvement of biliary defluxion into the duodenum, was observed.
The first known case of mucinous cystadenoma occurring in heterotopic pancreatic tissue is described. Histogenesis, clinical behaviour, diagnostic and therapeutic problems of such tumor are analyzed as well as the endocrine and associated neoplastic diseases.
Among 1000 consecutive patients submitted to surgery for lung carcinoma, 24 underwent minimal resections. Minimal resections although occasionally curative are, as a rule, palliative procedures to be used in patients with limited cardio-pulmonary reserve or previously submitted to lung resection. Whenever possible lateral, muscle-sparing thoracotomy and wedge resections should be performed.
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With the purpose to study the eventual existence of a correlation between biliary lithiasis and colon-rectum carcinoma, the authors effected a retrospective study of the clinical material concerning 1283 patients hospitalized in the 1st Surgery Institute for large intestine carcinoma. The relative anamnestic data were compared with those of a control population. The results emerging from the research, checked in their statistic significance, seem to support the existence of such correlation. The hypothesis of a possible common etiopathogenesis of both diseases is proposed.
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A case of giant phaeochromocytoma occurring in a 47-year-old man with no signs or symptoms of catecholamine secretion is reported. Abdominal ultrasound scanning, chest X-ray, computed tomography and magnetic resonance imaging were preoperatively performed. The patient was operated through a thoracoabdominal incision and section of the left hemidiaphragm. The giant retroperitoneal mass was en-bloc resected together with the left adrenal gland. Macroscopic sectioning showed a smoothly rounded 29 x 21 x 12 cm tumour attached to a normal left adrenal gland, weighing 4050 gr. The huge size of the neoplasm, the several areas of necrosis, the size and monomorphic appearance of the cells, and the large number of mitotic figures afforded a diagnosis of malignant phaeochromocytoma.
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AIMS: An association between elevated serum gastrin levels and the presence of human colorectal cancer has been reported, and gastrin has been shown to stimulate the growth of experimentally induced colon neoplasia. The aim of this study was to determine the preoperative and postoperative concentrations of serum gastrin in 53 patients with colorectal cancer and to assess the correlation between gastrin levels and tumor characteristics and prognosis. MATERIALS AND METHODS: A prospective study was performed over a six-year period during which 53 patients received potentially curative surgery for colorectal cancer. The prognostic variables used for the analysis included age, sex, tumor site, stage and degree of differentiation, preoperative and postoperative serum values of carcinoembryonic antigen (CEA) and gastrin, cancer-related mortality, and survival. CEA and gastrin serum values were determined using radioimmunological methods. Follow-up was carried out with clinical and radiological tests. RESULTS: The mean preoperative gastrin concentration was 51.2+/-27.4 pg/mL (range 12-146). Significantly increased serum gastrin concentrations, which returned to normal after surgery, were detected only in patients with well-differentiated cancer (74.2+/-28.3 pg/mL; moderately differentiated, 52.1+/-23.8; poorly differentiated, 29.9+/-12.3, p=0.02). The prognosis was unrelated to serum gastrin level; instead, tumor stage, preoperative CEA value, and degree of differentiation affected patient survival. CONCLUSIONS: This study showed that the serum gastrin concentration is not an appropriate clinical oncogenic factor. Although occurring only in well-differentiated tumors, serum gastrin is unrelated to the prognosis of patients with colorectal cancer.
The effect of octreotide on splanchnic haemodynamics was investigated in 25 domestic pigs by mean of US-colordoppler. In a blind-operator design the superior mesenteric artery (SMA) blood flow was evaluated before and after i.m. injection of 5, 10, 20, 25 micrograms/kg or of an equivalent volume of saline solution. Seven serial measurements were taken every 10 min in each pig excluding the higher and the lower values. The administration of 5 and 10 micrograms/kg determined a rapid and stable (3 hours) decrease of the SMA blood flow (6 and 8.5% respectively) (p < 0.05). The blood flow decreased by 27-29% (p < 0.001) in response to the administration of 20 and 25 micrograms/kg respectively. The reduction started 30 min after injection and the blood flow remained lower than basal for up to 5 hours. Because of the mean standard error of US blood flow assessment is 10% due to the interobserver and intraobserver variations, we considered statistically significant only the reduction occurred after the administration of 20 or 25 micrograms/kg. Authors findings suggest that high dose of octreotide is effective in reducing the splanchnic haemodynamics in the pig. Such animal can be used in experimental setting planed to assess the effect of splanchnic blood flow reduction.
Records of 8 patients undergoing repeated operation for isolated hepatic metastasis were reviewed for operative morbidity and mortality, survival, disease-free survival. The mean interval between the initial colon operation and first hepatic resection and that between the first and the second hepatic operation were calculated. Both were found to be correlated with survival of these patients. Repeat hepatic operation for recurrent colorectal metastasis to the liver yields comparable results to first hepatic resections in terms of operative mortality and morbidity, survival, disease-free survival. Repeated hepatic operation is the most successful for of treatment for isolated recurrent colorectal metastasis.
Preoperative symptoms have been found to persist in up to 30% of patients after open cholecystectomy. No data exists about the influence of laparoscopic cholecystectomy on symptoms. A group of 109 elective patients who had undergone at least 12 months previously laparoscopic cholecystectomy were retrospectively studied. Pre- and postoperative symptoms were compared and patients satisfaction graded from 1 (excellent) to 5 (worst). More than two symptoms were present preoperatively in all patients. Postoperatively 75 patients were absolutely symptomless. 9 patients complained of only one symptom, and 25 patients continued to have two or more symptoms. The mean time to return to full activity did not correlate with the number of postoperative symptoms. Most patients (75) considered the procedure completely successful while only 6 were no better off postoperatively. The incidence of symptoms after laparoscopic and laparotomic cholecystectomy is similar. The patients should be advised that the presence of preoperative symptoms are not necessarily caused by gallstones and that cholecystectomy might be followed by the persistence of symptoms.
The clinical findings and surgical management of a 58 years old woman with a large lipoma of the thigh are reported. Giant lipomas of the thigh, infrequently observed, are of interest because causing functional limitation and lymphedema, due to their tendency to recur after surgical removal and their potential hazard of malignant transformation. Specific diagnostic tools are discussed. Surgical excision is the first-choice treatment of a giant lipoma of the thigh.
The autotransplant of the left lobe of the pancreas in the latero-cervical region has been successfully performed in 38 adult beagles with a mean cold ischemia time of 52 minutes. Juice volume and amylase, protein and bicarbonate outputs were resumed postoperatively as soon as 6 hours. A single case of thrombosis of the mesenteric vein occurred; all other pancreatic grafts showed good histological vitality at 30 days. This procedure of autografting is proposed as a valid experimental model for the pathophysiologic study of acute pancreatitis.
Age and clinical presentation as acute cholecystitis have widely been found to be predictors of outcome after cholecystectomy. Recently, male gender has been cited in several studies as a possible prognostic factor. A single Institution cholecystectomy registry (3.047 cases between 1959-1997) comprising 966 (31.7%) men and 2.81 (68.3%) women was retrospectively analysed. Men experienced significantly higher rate of major complications (5.3% vs 3.2%; p < 0.01) and mortality (1.55% vs 0.62%; p < 0.03). By logistic regression analysis, it was found that male gender, acute cholecystitis, respiratory and cardiovascular system disease were significantly related to postoperative morbidity. Age older than 65 years, male gender, respiratory and cardiovascular diseases were factors negatively affecting operative mortality.