Vaginal reconstruction with vertically oriented rectus abdominus myocutaneous (VRAM) flap following APR for locally advanced rectal cancer.
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Female↗
Biomedical subjects
D Segre
Publications and source records attributed to D Segre.
Local excision of rectal polyp: indications and techniques.
The local excision of a rectal polyp is often wrongly considered to be a minor surgical procedure. In reality, the malignant potential of adenomas and the not-infrequent presence of cancer in larger polyps, require, for their removal, an oncologically correct operation with strict indication and accurate execution. Despite an increasing inclination to extend the indications of endoscopic polypectomies to polyps of larger size and villous configuration, the local surgical approach remains the preferred treatment in most cases. Here the indications and the results of different surgical techniques proposed for the local excision of a rectal polyp are reported. Among these procedures, transanal endoscopic microsurgery is gaining a primary role in many circumstances.
Adenoma, Villous↗
Antibodies with idiotypic and anti-idiotypic reactivity (epibodies) in conventional immune responses to dinitrophenylated carriers.
A number of monoclonal antibodies were derived from the spleen cells of dinitropheryl (DNP)-immunized mice. Both T-dependent and T-independent carriers were used, and the intensity and length of immunization were varied. It was found that some of the antibodies had only idiotypic (Ab1) reactivity, while others had both idiotypic (Ab1) and anti-idiotypic (Ab2) reactivity. Among the latter antibodies some molecules reacted specifically with DNP and with the combining site of anti-DNP antibodies (epibodies), while others bound DNP and anti-DNP Abs as well as a variety of unrelated antigens (polyreactive antibodies). The proportion of the three types of antibodies (antigen-specific, epibodies and polyreactive antibodies) varied with the nature of the carrier, the intensity of the immunization, and the length of the immunization process. Further characterization of the epibodies, which were predominant in the secondary response to DNP-keyhole limpet haemocyanin (KLH), showed that both Ab1 and Ab2 reactivities were inhibited by both soluble ligands (DNP and anti-DNP), indicating that the specific combining site of the monoclonal antibodies (mAbs) (and/or of the rabbit anti-DNP antibody in the case of Ab2) was involved in both activities. Both Ab1 and Ab2 reactivities were removed by absorption of the mAbs with either immobilized DNP or immobilized rabbit anti-DNP. The mAbs were capable of binding themselves as well as to other mAbs with the same characteristics. The affinity constants of several mAbs for both the DNP and anti-DNP ligands were determined.
Animals↗
Graded Autocatalysis Replication Domain (GARD): kinetic analysis of self-replication in mutually catalytic sets.
A Graded Autocatalysis Replication Domain (GARD) model is proposed, which provides a rigorous kinetic analysis of simple chemical sets that manifest mutual catalysis. It is shown that catalytic closure can sustain self replication up to a critical dilution rate, lambda c, related to the graded extent of mutual catalysis. We explore the behavior of vesicles containing GARD species whose mutual catalysis is governed by a previously published statistical distribution. In the population thus generated, some GARD vesicles display a significantly higher replication efficiency than most others. GARD thus represents a simple model for primordial chemical selection of mutually catalytic sets.
Catalysis↗
[Laparoscopy: access with open versus closed technique].
Pneumoperitoneum in diagnostic or therapeutic laparoscopy can be achieved by an open or a closed technique. The authors, on the basis of their experience, compare both techniques, concluding that open method is safer, because of the lack of major complications observed in the closed method and with only few minor complications.
Cholecystectomy, Laparoscopic↗
[Perforated endometriosis of the sigmoid. Report of a case].
The term endometriosis means the presence in an ectopic site of normal functioning endometrial tissue, the ectopic endometrial tissue, as the normal uterine mucosa, undergo hormonal stimulation and follow the proliferative and functional changes along the menstrual course; this evolution, characterize the clinical story of patients affected by endometriosis. Endometriosis is considered to be one of the most common gynecologic disorders, occurring in about 10% of women in fertile age. An involvement of adjacent organs such as the pelvic colon and rectum by endometriosis is not uncommon and may cause symptoms difficult to distinguish from malignant or inflammatory disease located in the pelvic region. The purpose of the following case report is to elucidate certain diagnostic and therapeutic problems of a disease concerning both the surgeon and gynecologists. Our case concerns a 44 year old patient with two children and a negative previous clinical gynecological history; the patients reports the occurrence in the last two years of alterations of colic evacuation consisting in a period of constipation lasting 5-7 days. The patient reached us in emergency with a sub-occlusive state that has lasted for 5 days, in the last 12 hours the appearance of a violent trafictive pain referred to the lower abdomen configure the clinical picture of a acute abdomen. The patient underwent surgery and the laparotomy demonstrated the presence of a perforated tumours located at the recto-sigmoid junction. We proceed to perform an Hartman's resection and a right ovariectomy.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Behavior of the idiotypic network in conventional immune responses. III. Detection and enumeration of cells producing idiotypic and anti-idiotypic antibodies by a spot ELISA technique.
The idiotypic (Ab1) and anti-idiotypic (Ab2) responses of spleen cells of mice immunized with DNP-Ficoll were assayed with the spot ELISA technique in wells coated with DNP-BSA or with affinity-purified rabbit anti-DNP antibodies, respectively. In agreement with results previously obtained with the hemolytic plaque technique, large numbers of Ab1 and Ab2 ELISA spots were found. The cytokinetics of the Ab1 and Ab2 responses were very similar and the peak responses occurred simultaneously. The isotypes of Abs1 and Abs2 were also similar. Both responses were specifically inhibited by soluble DNP-lysine. Similar results were obtained with spleen cells from mice immunized with the T-dependent antigen DNP-KLH and with the T-independent antigen fluorescein-Ficoll. In contrast, no Ab2 response was detected when spleen cells from mice immunized with ovalbumin were assayed, probably because the affinity-purified rabbit anti-ovalbumin antibodies used to coat the wells for the Ab2 assay contained molecules of several specificities, corresponding to the several epitopes of the ovalbumin molecule. The many similarities between the Ab1 and Ab2 responses to the haptens suggest that they reflected two different reactivities of the same antibody molecules.
Animals↗
[Hemorrhagic necrotic acute pancreatitis: analysis of our case series in the light of the most recent diagnostic and therapeutic criteria].
During the period between 1-1-1979 and 30-9-1992, 43 cases of hemorrhagic necrotic acute pancreatitis were referred to the authors' attention. Six patients were not operated, 12 underwent emergency surgery and laparotomy was postponed in 25 cases. The introduction of sophisticated diagnostic methods, such as Eco, CT, ERCP, intensive medical therapy and postoperative NPT have allowed a more rational surgical approach in terms of timing and extent to be adopted, operating on patients who are metabolically more stable. NPT is a useful tool in the latter postoperative stage. In the series of patients undergoing emergency laparotomy there was a mortality rate of 66%. The mortality rate fell to 16% in those patients in whom surgery was postponed.
Acute Disease↗
Behavior of the idiotypic network in conventional immune responses. I. Kinetics of idiotypic and anti-idiotypic antibodies following immunization with T-independent and T-dependent antigens.
A minimal requirement in investigations of the behavior of the idiotypic network during immunization is the ability to quantitate both the idiotypic (Ab1) and anti-idiotypic (Ab2) responses. Quantitation of Ab2 in serum is complicated by the simultaneous presence of Ab1, so that Ab1-Ab2 immune complexes escape detection. In contrast, immune complexes should not complicate the enumeration of Ab2-producing lymphocytes in a hemolytic plaque assay. This study utilizes a procedure that allows detection of Ab2-producing cells in such an assay. The procedure relies upon the insertion of the appropriate antibody (Ab1) into the membrane of indicator SRBC through a covalently attached dipalmitoyl phosphatidylethanolamine (DPPE) tail. When the Ab2 response following murine immunization with DNP-Ficoll was analyzed using such an assay, peak plaque-forming cell (PFC) numbers were found to coincide with peak Ab1 PFC numbers in both the primary and secondary response. In addition, this Ab2 response was found to be T independent. The murine immune response to DNP-HGG demonstrated a peak Ab2 PFC response which followed the peak Ab1 PFC response after both primary and secondary immunization. This Ab2 response appeared to be T dependent. The secondary responses to both DNP-Ficoll and DNP-HGG showed increased levels of Ab2 PFC and decreased levels of Ab1 PFC in comparison to the primary responses to the same antigens, suggesting that immunoregulation may occur within these idiotypic networks.
Animals↗
Behavior of the idiotypic network in conventional immune responses. II. Affinity and heterogeneity of idiotypic and anti-idiotypic antibodies following immunization with T-independent and T-dependent antigens.
The relative affinity and heterogeneity of affinity of idiotypic and anti-idiotypic antibodies in mice immunized with the T-independent antigen DNP-Ficoll and the T-dependent antigen DNP-HGG were measured by a plaque inhibition assay. Idiotypic plaque-forming cells (PFC) were detected by a conventional assay utilizing DNP-coated SRBC. Anti-idiotypic PFC were detected with SRBC coated with affinity-purified anti-DNP antibody of rabbit origin. It was found that both idiotypic and anti-idiotypic antibodies elicited by immunization with the T-independent antigen had lower affinity and were less heterogeneous than the corresponding antibodies originating in mice immunized with the T-dependent antigen. In addition, the affinity and heterogeneity values of the idiotypic antibodies were correlated with the affinity and heterogeneity values of the anti-idiotypic antibodies from the same mice. This finding indicates that idiotypic and anti-idiotypic antibodies mutually regulate each other, thus pointing to internal immunoregulatory effects of the idiotypic network with respect to these parameters.
Animals↗
Clinical, laboratory and radiographic features in early rheumatoid arthritis.
We evaluated disease status in relation to age, sex and disease duration using some short term indices of disease activity, laboratory tests, and radiological features in 315 patients with rheumatoid arthritis of duration varying from 3 to 36 months (mean 12 months). No differences were observed among various age groups in disease duration, female/male ratio, incidence of radiologic lesions and other indices of disease process. Some clinical markers of the disease process such as involvement of the flexor tendons of the hands and Ritchie's index (score greater than 9) were significantly more frequent in the women (p less than 0.0013 and p less than 0.04, respectively). In the patients with disease of recent onset women were slightly more numerous (56%) than men; however, in those with disease duration of 36 months there were significantly more women (72%) (p less than 0.039), suggesting a greater tendency to chronic disease in this sex. Radiological lesions of the small joints of the hands, feet, and/or wrists were found in 37% of the cases with disease duration of up to 4 months and in 91% at 36 months (p less than 0.0001). The lesions were associated significantly more frequently with Ritchie index (p less than 0.02) and with laboratory indices of inflammatory activity (erythrocyte sedimentation rate greater than or equal to 25 mm/h) (p less than 0.001) and immune response (latex test greater than or equal to 80) (p less than 0.0001). Logistic regression analysis showed that the duration of illness is the most important factor correlating with radiologic lesions.
Adolescent↗
Detection and enumeration of immunoglobulin secreting cells.
A method is described in which sheep red blood cells (SRBC) are coated with anti-immunoglobulin (Ig) antibodies (Ab) for use in reverse hemolytic plaque assays (RHPA) as follows. The non-complement fixing F(ab')2 fragments of rabbit anti-mouse Ig Ab are derivatized with the N-hydroxysuccinimide ester of palmitate. The hydrophobic palmitate tails spontaneously insert into the SRBC membranes, thus coating the cells with anti-Ig F(ab')2 molecules. The SRBC are lysed by successive additions of mouse Ig, rabbit anti-mouse Ig and complement. When this procedure is carried out in agar gel, Ig-secreting mouse cells produce localized hemolytic areas (plaques). The procedure is more reproducible and more sensitive than RHPA performed with protein A-coated SRBC. In principle, this procedure should be adaptable to the detection of cells secreting any molecule for which specific antibodies are available.
Animals↗
[Our experience in tailoring definitive terminal colostomies and in the follow-up of such patients].
Between January 1983 and July 31, 1988 at the 1st Division of General Surgery of Cuneo S. Croce Hospital, 57 patients (33 m, 24 f) were subjected to abdomino-perineal amputation for rectal A.D.K. A definitive colostomy was fashioned for all patients. Neostoma complications were encountered in 33% of cases. 91% of patients completed the rehabilitative programme and 40% saw satisfactory results as regards the regularisation of the alvus and return to social life.
Adult↗
[Colorectal neoplasms in young patients].
The prognostic factors regarding colon-rectal cancers in the under-40s are examined. A personal series of 15 cases shows that the incidence of tumour recurrence is higher and the disease-free interval shorter than in patients not selected for age and that 5-year survival is much less. These results permit the hypothesis of greater aggressiveness in colorectal cancers in the young, something that justifies the severer prognosis by comparison with the elderly population.
Adult↗
[Acute mesenteric infarct. I. Identification of predisposing factors and definition of the criteria of "cautious clinical monitoring" of the main groups of patients at risk].
On the basis of experience acquired through 11 cases of acute mesenteric infarction personally observed over a 10-year period (1-1-1978-31-12-1987) and on the basis of a review on the literature, the usefulness for the purposes of early diagnosis and consequent early treatment of monitoring the essential, typical biological and clinical parameters of patients at risk of acute mesenteric infarction are reported.
Acute Disease↗
[Acute mesenteric infarct. II. Problems of early diagnosis].
The symptomatology and diagnostic procedure adopted in 11 cases of acute mesenteric infarction are examined. Stress is laid on the importance of early, aetiologically accurate diagnosis for the purpose of instituting profitable treatment. In order to comply with such needs it is essential to perform urgent selective arteriography and/or urgent laparoscopy which only with rare exceptions is carried out even in hospitals that should be better equipped.
Acute Disease↗
[Acute mesenteric infarct. III. Therapeutic problems].
The treatment adopted in 11 cases of acute mesenteric infarction is described: 6 cases involved arterial occlusion due to embolism and 5 arterial occlusion due to thrombosis. Six explorative laparotomies, 4 intestinal resections and one embolectomy of the superior mesenteric artery were carried out. Mortality was 63%. Stress is therefore laid on the need for very early, etiopathogenetic accurate diagnosis so as to commence treatment during the phase of reversible ischaemic intestinal lesion, targeting treatment to the cause of the ischaemia. The problem of the postoperative treatment problem is then discussed with special regard to the treatment of shock, the prevention of recurrences and the short intestine syndrome.
Acute Disease↗
[Anomalies in gastric stump emptying of patients who have undergone resections for duodenal ulcer previously treated with histamine H2 receptor antagonists].
The problem of obstructed emptying of the gastric stump after Billroth II operations in patients previously treated with H2 receptors is discussed. Statistical comparison using the Student's "t" test revealed a significant difference (t = 2.173) between those given and not given H2-antagonists and confirmed the existence of greater postoperative hypotonia in the gastric stumps of the former group. This clinical syndrome demands careful monitoring of the hydroelectrolytic balance and possibly the use of a double naso-gastric and nasojejunal tube as a precaution to ensure the delivery of the jejunal contents to the stomach. The gastrokinetic drugs metoclopramide and domperidone are also beneficial.
Adult↗