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Biomedical subjects

E Forni

Publications and source records attributed to E Forni.

At least 19 recordsLinked to original sources
PubMed2002

[Radical surgical treatment of gastric cancer. Personal experience].

After surgical therapy the survival outcome of gastric cancer is still poor. Early diagnosis and radical surgery are the two most important means to improve the prognosis. Radical surgery must include all lymph nodes embryologically related to stomach. The aim of this study was to verify whether an aggressive surgical strategy can increase postoperative survival rate. In the period 1990-1994 eighty two patients with gastric cancer were operated on. The M:F ratio was 1.6:1 and the mean age was 65.3 years (range 23-89). Palliative operations (6 gastroenterostomy) were performed in 7.3% of cases. In the other patients, 36 total gastrectomies (43.9%), 8 total gastrectomies extended to spleen, pancreas and colon (9.7%), 32 distal subtotal gastrectomies (39.1%) were performed. Gastric exeresis was always associated with lymph node dissection extended to level I and II (R2). In some cases level III and IV lymphadenectomy (R3) was performed according to Maruyama-Mishima technique. There were no intraoperative deaths. The operative mortality was 13.6% for total gastrectomies and 3.1% for subtotal gastrectomies. Postoperative complications occurred in 15.9% of total gastrectomies (3 anastomotic fistula, 2 wound infection, 1 subphrenic abscess, 1 melena) and in 3.1% of subtotal gastrectomies (1 sepsis). Stage III and IV cancers represented 74.4% of all cases (stage IIIA 19.6%, IIIB 21.9%, IV 32.9%). Metastatic lymph node involvement (N2+) affected 53.1% of T3 and 88.2% of T4 cancers. The mean survival rate of patients subjected to gastroenterostomy was 6 months. The 2-year survival for total gastrectomies was 42%, for subtotal gastrectomies 28.1%. In our experience, wide removal of lymph nodes and total or extended gastrectomies were performed without any increase of mortality and morbidity. In advanced stages, a wider exeresis increased survival and prevented local recurrence.

Adenocarcinoma↗
PubMed2002

[Extended lymphadenectomy for carcinoma of pancreatic head. Personal experience].

Long-term survival in patients with cancer of the pancreatic head is disappointing. Surgery is the only curative therapy. Unfortunately the prognosis of patients resected (10-15%) is extremely poor due to loco-regional cancer recurrence (50%). Lymphatic and perineural invasion might account for local recurrence. Japanese studies reported the importance of an extended lymphadenectomy during the classic Whipple exeresis (40% of patients present lymph node metastases). During the period 1996-2000 at our Institution 20 patients (14 M, 6 F, mean age 62.4 years) with pancreatic head cancer (17 adenocarcinoma, 1 lymphoma, 2 carcinoma) underwent Whipple's exeresis with a regional (peripancreatic or R1) and juxta-regional (para-aortic or R2) lymphadenectomy according to Ishikawa technique. R1 nodes consisted of lymph nodes at the pylorus, superior head, common bile duct, anterior pancreaticoduodenal region, inferior head and superior mesenteric vessels. R2 nodes consisted of lymph nodes at the superior body, inferior body, mid colic region, common hepatic duct, coeliac truncus and para-aortic region. This wide dissection was quite easy also in patients with a serious cholestatic disease. Intraoperative mortality was 0%. Operative mortality was 5%. Postoperative complications (20%) were 1 sepsis, 1 hepato-renal syndrome with hepatic coma, 1 mechanical intestinal obstruction, 1 wound infection. Eight patients (40%) died in 6 months in average (neoplastic recurrence 40%). Notwithstanding the advanced disease (stage III 50%; N1+ 50%), twelve patients (60%) have a mean postoperative survival rate of 18.5 (range 1-48) months without neoplastic recurrence. Tumour diameter was less than 4 cm in 83.3% of cases. An earlier diagnosis (with tumour diameter < 4 cm) can improve pancreatic head cancer prognosis. A wide surgical exeresis with a R2 lymph nodes clearance together with surrounding connective and nervous tissue can remove micrometastases with a better control local recurrence.

Adenocarcinoma↗
PubMed2001

Prediction of the impact of logging activities on forest cover: a case-study in the east province of Cameroon.

The objective of this study was to test the value of the concept of the net commercial value of standing timber in predicting the impact of logging activities on forest-cover modifications. A study area was selected in the East province of Cameroon which contains major primary forests and which contributes strongly to national timber production. A Geographic Information System containing ecological and economic variables was used in combination with remote sensing data to define the net commercial value of standing timber in the East province. Taking account of the potential commercial value of standing timber improves our understanding of the spatial determinants of logging activities and of the resulting forest-cover modifications. The occurrence of logging-induced forest-cover modifications increases with the value of forest rent. In one of the study sites, half of the very high rent areas have already been logged. In that site, therefore, it is mostly the low rent or marginal forest areas that remain unlogged. This was not the case, however, throughout the study area as shown by the observations at another site.

Cameroon↗
PubMed2000

Alcohol carousel and children's school drawings as part of a community educational strategy.

Within a community action research program, messages for the community population can be conveyed through already existing channels (newspapers, magazines, TV, radio) or special tools can be created. As part of the Rifredi Health District (16,900 inhabitants), Florence, Italy, Community Alcohol Action Research Project, 5,500 alcohol carousels (translated and adapted from the Stockholm carousel) were distributed during 1996 in the project's area where they were freely available. Two samples, one of a consumers' association (response rate 26%) and the other of school parents, employed a questionnaire. A few local key people underwent a qualitative interview. In all circumstances the carousel proved to be understandable, useful, and able to elicit discussions about alcohol issues. In 1996-97, after a 2-year training program in communication skills and alcohol prevention, 13 teachers in local preschools, elementary schools, and middle schools planned and implemented a health education program on the issues of alcohol and food. One outcome was nine drawings produced by the school children. The drawings were exhibited in some schools and supermarkets, and were hung in city buses.

Adult↗
PubMed1998

[Surgical therapy of metabolic liver diseases (glycogenosis, hypercholesterolemia)].

Up-to-date, most patients with serious chronic hepatic disease are best treated by liver transplantation. It has been confirmed the striking benefit of liver transplantation also for patients with glycogen storage disease or homozygous familial hypercholesterolemia who were refractory to medical treatment. Nevertheless, the advantage of achieving palliation without transplantation, thereby avoiding the need for chronic immunosuppression, is obvious. With reference to the mentioned above diseases, end-to-side portacaval shunt was used. A favourable effect was noted on body growth and a number of metabolic abnormalities. Hepatic failure did not occur, although in a few patients blood ammonia concentrations and serum alkaline phosphatase levels increased relative to preoperative values. To avoid an incomplete palliation provided by portacaval shunt, appropriate case selection is a problem. The Authors report their personal experience with portacaval shunt for the treatment of glycogenosis and familial hypercholesterolemia.

Adolescent↗
PubMed1996

Purification, partial characterisation and mode of action of enterococcin EFS2, an antilisterial bacteriocin produced by a strain of Enterococcus faecalis isolated from a cheese.

Enterococcus faecalis strain EFS2, isolated from the surface of a traditional cheese, produced a bacteriocin active against Gram-positive bacteria including Listeria spp. and some Staphylococcus aureus strains. The bacteriocin, named enterococcin EFS2, has been purified to homogeneity by ammonium sulphate precipitation and reversed-phase high performance liquid chromatography (RP-HPLC). The molecular weight was determined by mass spectrometry to be 7149.6. The amino acid composition of enterococcin EFS2 revealed that it contained 67 amino acid residues and had a blocked amino-terminal end. Enterococcin EFS2 induced viability loss, efflux of K+ ions and ATP, and cell lysis. Kinetic study of bactericidal activity of enterococcin EFS2 on Listeria innocua strain LIN11 indicated slower cell destruction than by nisin. At pH 7.0, the activity of enterococcin EFS2 was the highest at 35 degrees C and was lost at 15 degrees C. The bacteriocin was more active against L. innocua strain LIN11 in broth adjusted to pH 6.0, 7.0 and 8.0 than to pH 4.5 at 30 degrees C.

Amino Acids↗
PubMed1995

Bench surgery and liver autotransplantation. Personal experience and technical considerations.

Advances in hepatic transplantation have opened the possibility of bench surgery for liver disease. Thus, nonconventional methods such as the ex vivo approach (bench procedure) or the in vivo ex situ preserved liver surgery have been performed in selected cases. These methods have been confined to situations and tumour stages otherwise deemed untreatable, or to situations where resection may not be sufficiently radical. To date, primary liver tumours (hepatocellular, cholangiocellular) and colo-rectal metastases are considered to be suitable conditions. The technique used is that of liver grafting. Hypothermic liver perfusion (U.W., 4 degrees C) and pump-driven veno-venous bypass from portal vein and inferior vena cava to the superior vena cava are performed. The principal aim of bench surgery is to avoid the unnecessary removal of a large amount of normal parenchyma. Resection lines follow the segmental structure of the liver. Sometimes, an atypical hepatectomy with a parenchymal exeresis "à la demande" is required. Authors' experience with four patients undergoing ex vivo operation of the liver (three patients) or surgery on an ex situ hypothermic perfused liver (one patient) is reported. The patients had liver metastases from colonic carcinoma (1 M, 2 F) and from renal carcinoma (1 M). Major hepatic resections were performed. One patient (M) died from neoplastic intestinal recurrence after 16 months. Two patients (F) died after 24 and 9 days for sepsis and pulmonary embolism. One patient (M) died intraoperatively from a massive retroperitoneal bleeding. Being able to remove otherwise unresectable hepatic neoplasms is a worthy objective. In the presence of diffuse chemoresistant colo-rectal hepatic metastases, liver bench surgery is a promising therapeutic hope. At the basis of a good hepatic function there are a correct organ preservation, a perfect bench surgical technique with respect for vascularization and biliary drainage of the hepatic remnant, and an accurate hemostasis of the resection surface.

Female↗
PubMed1994

[Pyogenic liver abscess: a caseload contribution].

Pyogenic hepatic abscesses have been recognized since the time of Hippocrates, but an understanding of their etiology, bacteriology, diagnosis and treatment is an event of the twentieth century. Fortunately mortality rate has declined due to improvements in diagnosis, intensive care, medical and surgical management. In particular, the use of CT and ultrasound scanning has reduced the incidence of unrecognized and therefore untreated liver abscesses. Considering nine patients operated on for liver abscess, the Authors affirm that laparotomic surgical drainage is still the most effective therapy in the majority of cases.

Adult↗
PubMed1994

[What future for clinical xenograft of the liver?].

In the cyclosporine era liver orthotopic allotransplantation has shown to be very effective in the treatment of many end-stage liver diseases. Currently, the major limitation in clinical transplantation is the shortage of donor organs unlikely solvable by alternative policies or approaches such as living donors and artificial organs. Animals have been considered as an alternative source of organs offering the following advantages: availability of a predictable and ready supply of donor organs, opportunity to practice transplantation as an elective procedure, possibility to match the size of the graft recipient. However, immunologic barriers are thought to make xenotransplantation impractical between widely divergent (discordant) species. Hyperacute xenograft rejection, in fact, consists of an immediate, diffuse intravascular coagulopathy followed by an aggressive cellular reaction. Recipient preformed natural antibodies and complement are involved in the humoral phase of hyperacute rejection. The violence of this reaction depends on the titer of natural antibodies and on the divergency of the species involved. Species more closely related (concordant) exhibit a less aggressive reaction characterized by an acute cellular rejection. Hepatic allografts and xenografts, though, are unusually resistant to humoral injury and undergo a combination of both humoral and cellular rejection. Preliminary studies have demonstrated a prolonged reduction in natural antibodies accomplished by plasmapheresis and cyclophosphamide combined treatment. Furthermore, new therapeutic agents such as FK 506, rapamycin and deoxyspergualin may find widespread application in clinical transplantation. FK 506 has shown to possess a remarkable efficacy in reversing refractory hepatic allograft rejection as well as ability to inhibit humorally mediated immunity.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

[Hepatic carcinoma in cirrhosis. Segmental liver resections].

Liver cirrhosis is frequently complicated by the onset of an hepatocellular carcinoma. An accurate monitoring of the cirrhotic patient often assures an early diagnosis, so that an hepatic resection is still possible. Hepatectomy has been accepted as the only chance of cure, but selection of the appropriate extent of surgery has to be made taking into account both the risk of postoperative hepatic failure and oncologic needs. Intraoperative sonography and intermittent hepatic vascular clamping lead to a safer liver resection, while the postoperative course is improved by monitoring the hepatic function and preventing sepsis. In the period November 1973-March 1991, 34 hepatic segmentectomies (unisegmentectomy 47%, bisegmentectomy 38.3%) were performed in our Service in cirrhotic patients with hepatocellular carcinoma. The clinical stage was defined using a modified Child-Bismuth's grading (A 67.6%, B 32.4%). In the majority of cases (53%), tumors were less than 5 cm in diameter. Perioperative blood loss was less than 1,500 ml and fresh frozen plasma was preferred for volume substitution. The operative (one month) mortality rate was 20.5%. Postoperative complications occurred in 45% of cases. The mean survival rate was 14 months. The above results suggest early detection and curative resection as the best way to improve long term prognosis. Segmentectomy achieves a good balance between liver function preservation and radical exeresis. Postoperative intensive care is needed to prevent complications which might lead to hepatic failure.

Carcinoma, Hepatocellular↗
PubMed1992

[The diagnostic elements and therapy principles in thyroid cancer: the Pavia experience 100 years after Bottini].

The diagnostic and operative management of thyroid cancer is controversial as the nature of the disease is heterogeneous in its growth rate, pattern of spread, and histological type. Therefore, surgery must be extensive enough to minimize the chances of recurrence and death. In the period 1962-1989, 159 thyroid cancers were observed. According to the histological type, 61 total thyroidectomies, 34 hemithyroidectomies with isthmusectomy, and 29 subtotal thyroidectomies were performed. Cervical lymph node dissection was performed in 55 patients. The 10-year postoperative survival rate was 70.59% with lymphadenectomy and 65.71% without lymphadenectomy.

Female↗
PubMed1991

Preventing relapses of breast cancer with modified radical mastectomy.

Better prevention and early detection have improved the percentage of early cancers among all the treated breast tumors to about 40%. After the first demonstration in Milan in 1981 that even conservative surgery can effectively prevent tumor relapses, radical and modified radical mastectomy was compared in 136 and 127 women, respectively. The groups were well stratified as regards age, menopause, T- and N-status. No difference was found in 10-yr survival (58.8 and 59.8%, respectively) or local relapses (9.5 and 10%, respectively) or general relapses. The median disease-free survival was 10 yr in both groups. The results suggest that in T1-T2a, N0-N1b M0 unilateral breast cancer relapses are prevented as effectively with modified radical as with radical mastectomy.

Adult↗
PubMed1990

[A modification of the Sweet-Allen simple reconstruction technique after total gastrectomy].

The Authors report their personal modification of Sweet-Allen's esophago-jejunal reconstruction after total gastrectomy. In their opinion, it enables to combine the advantages of the omega-shaped loop (easier and faster surgical technique, reduced postoperative morbidity) with those typical of the Roux-en-Y loop, that is complete elimination of biliary reflux, leading to better long term functional outcome and quality of life for the totally gastrectomized patient.

Anastomosis, Roux-en-Y↗
PubMed1989

The potential malignancy of eccrine spiradenoma.

Eccrine spiradenoma is a rare, usually benign tumor, originating from cutaneous sweat glands. Its clinical and histologic diagnosis can be difficult at times, especially when malignant features are present. Proper management requires radical surgical excision. Two cases of spiradenoma are reported, one of which highly malignant with diffuse pulmonary metastases leading to the patient's death in spite of repeated radical surgery.

Adenoma, Sweat Gland↗