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D D'Ugo

Publications and source records attributed to D D'Ugo.

32 records · Page 2Linked to original sources
PubMedDate not supplied

Synchronous gastric adenocarcinoma and MALT lymphoma in a patient with H. pylori infection. Could the two neoplasms share a common pathogenesis?

Low-grade primary MALT (mucosa-associated lymphoid tissue) lymphoma of the stomach is a neoplasm with an indolent course and a good prognosis. Patients with this type of neoplasm seem to have a higher risk for other neoplasms. Of interest is the association of gastric MALT lymphoma with gastric adenocarcinoma of intestinal type. We report the case of a patient, with a history of H. pylori-related gastritis, in whom a diagnosis of synchronous gastric adenocarcinoma of intestinal type and low-grade MALT lymphoma, occurring as collision tumors, was made. The stage procedures confirmed the presence of a locally advanced gastric tumor staged as T3 N1. The patient underwent two cycles of neoadjuvant EEP (etoposide, epirubicin, cisplatin) chemotherapy. After 2 months, a R0 total gastrectomy with D2-lymphoadenectomy was successfully performed. The development of simultaneous primary gastric lymphoma and carcinoma is a rare event. The possible coexistence of both tumors should be kept in mind, especially in patients infected with H. pylori, since a possible etiopathogenetic role of this bacterium has been differently postulated for both disease.

Adenocarcinoma↗
PubMedDate not supplied

[Neoadjuvant chemotherapy in gastric carcinoma].

A complete surgical resection currently represents the only curative treatment option for gastric carcinoma, but as regards locally advanced cancer the possibility of local or distant recurrence remains extremely high even following a R0 resection. As far as T3-4/N+ tumors are concerned, unsatisfying results of surgery alone have stressed the need for multimodal treatments: in the recent past adjuvant chemotherapy has represented a common complementary treatment for locally advanced gastric cancer, but conclusive results of most randomized trials did not show a significant impact on long term survival. Literature review shows a growing trend throughout the 90's towards the adoption of a preoperative chemotherapy, initially evaluated as a form of "salvage" palliative treatment for unresectable patients. To date a number of phase II study suggests the efficacy of neo-adjuvant treatment administered to resectable patients with the purpose of inducing tumor downstaging, increasing the rate of R0 resections and controlling recurrencies. From March 1996 the Authors have started a controlled study on neo-adjuvant therapy for locally advanced gastric cancer. Accurate staging and patients selection were based upon immediately preoperative laparoscopy. In this ongoing study, patients are administered two preoperative cycles of EEP chemotherapy (Etoposide, Epirubicin, cis-Platin). Preliminary data have been evaluated on the first 15 cases. Grade I myelosuppression has been observed in 12/15 cases and grade II/III in 3/15 cases; 1 patient died by septic complications. Restaging has not shown progression of the disease in 13/14 cases; a macroscopic response was evidenced in 7/14 patients; 14/14 patients could undergo a successful D2 surgical resection following neo-adjuvant therapy. Pathological staging confirmed tumor downstaging in 7 out of 14 cases; 12/14 patients in this group (85.7%) could benefit a R0 resection. These preliminary data encourage us to proceed in our prospective investigation.

Adenocarcinoma↗
PubMedDate not supplied

[Clinical role of the cytologic study of thyroid nodules].

Indication to surgical treatment for thyroid nodules still represents a relevant clinical dilemma. With this regard, on a consecutive series of 434 thyroidectomies carried out in the last 3 years, the role of Fine Needle Aspiration Biopsy (FNAB) on 139 cases has been statistically evaluated. All cytologic diagnoses have been classified in three subsets: malignant [group 1]; suspect (follicular or Hurtle cell proliferation) [group 2]; benign [group 3]. Our data confirm previous observations about the high specificity of FNAB in case of diagnosis of malignancy (97.6%). On the other hand 51.6% of our cases are included in group 2; only 31.9% of these cases have shown a postoperative diagnosis of malignancy, following a suspect at FNAB. In this study, the sensibility of FNAB has been calculated including among positive results the cytologic diagnoses of group 1 + group 2: the resulting figure of 87.3% weighs the impact of FNAB on our surgical decision process. FNAB plays a crucial role in the management of nodular diseases of the thyroid, even if its overall value is limited by the burden of "suspect" cytologic diagnoses. In our hands, the integration of FNAB results with all relevant clinical data has undoubtedly contributed to increase the portion of thyroidectomies carried out for cancer, from 12.8% of our historical series to 23.2% of the last 3 years.

Humans↗
PubMedDate not supplied

[Clinical significance and prognostic value of tumor maximum diameter in gastric carcinoma].

Maximum tumor diameter (MTD) is considered by many authors as an important prognostic factor in gastric cancer and, in some series, is reported to be strongly correlated with depth of infiltration. Aim of this study was to evaluate the prognostic value of tumor diameter in a monoistitutional series of 153 gastric cancer patients. The Spearman correlation coefficient was also calculated between MTD and other known prognostic factors. For statistical analysis, patients were grouped as follows: MTD 1, < or = 40 mm, and MTD2, > 40 mm. In our series, MTD resulted significantly linked to survival at univariate analysis (p = 0.0001), but multivariate analysis did not evidence MTD as an independent prognostic indicator. The Spearman correlation test documented that MTD2 is strongly correlated with tumor depth (pT), nodal status (pN) and p-stage (p < 0.01) and is a good predictor of locally advanced stage. This retrospective study showed that patients with larger tumor are at an increased risk for tumor advancement and, therefore, MTD could represent a useful parameter for choosing the most appropriate therapeutic strategy.

Humans↗
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

[Ratio of lymph node metastasis in gastric carcinoma after D2 gastrectomy].

The classification of lymph node metastasis in patients with gastric carcinoma is controversial. In the past, all systems used for this disease defined N classification by the location of lymph node metastases relatively to the primary tumor. In the 1997, the UICC and AJCC redefined the pathologic nodal status on the basis of the number of involved nodes rather than their location. More recently, the ratio between the number of metastatic and the total examined lymph nodes has been proposed as a new quantitative staging system. Aim of our study was to clarify the outcome of the ratio of the metastatic lymph nodes (RML) in a monoinstitutional series of 164 patient with primary gastric cancer who underwent gastrectomy with D2 lymph node dissection. Our data showed that ratio of metastatic lymph nodes is a simple, convenient, and reproducible staging system with an ability to predict surgical results and it is an independent prognostic factor after D2-gastrectomy.

Gastrectomy↗
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

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

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↗