Obstruction of the main pancreatic duct with secondary upstream ductal hypertension is one cause of pain in patients with pancreatic cancer. Pancreatic endoscopic stenting and decompression of the pancreatic duct have been effective in the treatment of pain secondary to chronic calcifying pancreatitis and in one case of pancreatic cancer. We describe eight patients with unresectable cancer of the pancreatic head associated with upstream dilatation of the pancreatic duct and severe pancreatic "obstructive"-type pain (correlation with meals and pain radiation to the back) in which a pancreatic stent was inserted across the neoplastic stricture. No mortality was associated with the procedure. All patients but one were free of pain within 48 hours after endoscopic pancreatic stenting, and all discontinued narcotics. Mean survival time was 165.5 days (range, 26 to 575 days). Six patients were still without symptoms, whereas two had a painful relapse a few days before death. No clinical evidence of pancreatic clogged stent was observed during follow-up. Endoscopic pancreatic drainage is a safe and effective way of controlling cancer pain in selected cases and should be considered as a further therapeutic option in these patients.

Aged↗

PubMedDate not supplied

Preoperative parenteral nutrition in the high risk surgical patient.

In order to assess the significance of malnutrition in determining surgical complications and the possibility of their reduction by preoperative nutritional support (PNS), a randomized controlled trial is being performed at our institution. The results relative to 100 patients who underwent major surgery for gastrointestinal disease, are presented here. In the treatment group 49 patients received 30 kcal/kg/day and 200 mg/kg/day of nitrogen for at least 7 days in the immediate preoperative period (nine patients were excluded from this group due to early surgery--seven cases; or refusal to accept PNS--two cases. Data analysis with their inclusion or exclusion showed similar results.) Fifty-one patients constituted the control group. The observed septic complication rate was, respectively, 30 and 35.3% (p:NS). When the analysis was restricted to the patients with abnormal instant nutritional assessment (INA), as defined by Seltzer et al (serum albumin less than 3.5 g/dl and/or total lymphocyte count less than 1500 cells/mm3), a statistically significant difference was observed in the incidence of sepsis between the two subgroups (21% vs 53.3%, p less than 0.05). Analogous results were obtained from the patients who underwent gastrectomy for gastric cancer: 16.7% of septic complications in the malnourished treated patients and 100% in the malnourished control ones (p less than 0.05). The occurrence of serious sepsis (sepsis score greater than or equal to 10, according to the scoring system developed by Elebute and Stoner) in the malnourished subgroups was 5.2% and 26.7%, respectively, (p = 0.09). The postoperative mortality rate was not significantly changed by the PNS (reduction from 3.9% to 2.5%, p:NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Trials as Topic↗

PubMedDate not supplied

Insulin adsorption to three-liter ethylen vinyl acetate bags during 24-hour infusion.

Insulin adsorption to ethylen vinyl acetate, 3-liter bags injected with 10 insulin units, during 24-hr infusion has been studied. Three different infusions systems (A, B, and C) were tested and eight bags for each system were used. An elevated insulin adsorption resulted in each system. The maximal insulin recovery, expressed as percentage of the original theoretical 3333 microIU/ml insulin concentration, was 19.54% (at time 6), 20.93% (at time 4), and 16.95% (at time 22) for system A, B, and C, respectively. "Dismissed insulin amount" after 24-hr infusion was 1590 +/- 279.5 microIU, 1505.8 +/- 430.5 microIU, and 1253.3 +/- 369.8 microIU for system A, B, and C, respectively. Comparison of insulin concentration values at different times revealed significant differences only at time 18 (if compared with times 0,2.4,6,8,12,14,16) ant at time 20 (if compared with time 4,6,8,10) for system A, and at time 4 (if compared with time 12,14,16,18,20,22,24) for system B. We conclude that a constant but low insulin delivery can be achieved using 3-liter EVA systems and a 24-hr infusion.

Adsorption↗

PubMedDate not supplied

Structured versus long-chain triglycerides: a safety, tolerance, and efficacy randomized study in colorectal surgical patients.

BACKGROUND: After trauma or surgery, researchers have suggested that medium-chain triglycerides have metabolic advantages, although they are toxic in large doses. To try to reduce this potential toxicity, structured lipids, which provide a higher oxidation rate, faster clearance from blood, improved nitrogen balance, and less accumulation in the reticuloendothelial system, could be used. Therefore, we evaluated, through a blind randomized study, the safety, tolerance, and efficacy of structured triglycerides, compared with long-chain triglycerides (LCT), in patients undergoing colorectal surgery. METHODS: Nineteen patients were randomized to receive long-chain or structured triglycerides as a lipid source. They received the same amount of calories (27.2/kg/d), glucose (4 g/kg/d), protein (0.2 g/kg/d), and lipids (11.2 kcal/kg/d). Patients were evaluated during and after the treatment for clinical and laboratory variables, daily and cumulative nitrogen balance, urinary excretion of 3-methyl-histidine, and urinary 3-methylhistidine/creatinine ratio. RESULTS: No adverse effect that required the interruption of the treatment was observed. Triglyceride levels and clinical and laboratory variables were similar in the two groups. A predominantly positive nitrogen balance was observed from day 2 until day 5 in the LCT group and from day 1 until day 4 in the structured triglycerides group. The cumulative nitrogen balance (in grams) for days 1 to 3 was 9.7+/-5.2 in the experimental group and 4.4+/-11.8 in the control group (p = .2). For days 1 to 5 it was 10.7+/-10.5 and 6.5+/-17.9 (p = .05), respectively. The excretion of 3-methylhistidine was higher in the control group but decreased in the following days and was similar to the experimental group on day 5. CONCLUSIONS: This study represents the first report in which structured triglycerides are administered in postoperative patients to evaluate safety, tolerance, and efficacy. It suggests that Fe73403 is safe, well tolerated, and efficacious in terms of nitrogen balance when compared with LCT emulsion.

Colitis, Ulcerative↗

PubMedDate not supplied

Survival in early gastric cancer: multivariate analysis on 72 consecutive cases.

BACKGROUND/AIMS: Few reports from the Western hemisphere have investigated the impact of pathological features and surgical modalities on the prognosis of patients affected by early gastric cancer (EGC). In particular, the extent of lymphadenectomy (limited vs. extended) and the type of gastric resection (subtotal vs. total) remain controversial issues in the management of EGC. The aim of this study was to identify factors influencing prognosis in patients affected by EGC. METHODOLOGY: Hospital records and pathological specimens of 72 patients with EGC undergoing resective surgery during the period 1981-1995 were retrospectively reviewed. Patient status was determined by follow-up examination or by telephone contact. Univariate and multivariate analysis was used to calculate the 5-year survival probabilities with respect to the following variables: age (< or = 65, > 65), sex, depth of invasion (mucosal, submucosal) tumor location (upper, middle and lower third), gross appearance (type I, type II and type III), size (< or = 1.5 cm, > 1.5 cm), presence or absence of lymph node metastasis, histological type (intestinal, diffuse), extent of lymphadenectomy (limited or extended), and type of gastrectomy (total or distal subtotal). Survival was the outcome variable studied. RESULTS: Multivariate logistic regression analysis showed that age, nodal involvement and depth of invasion were independently associated with poor survival. CONCLUSIONS: Results showed a significant dominance of host- and tumor-related factors over the type of surgical procedure on prognosis of EGC patients.

Adult↗

PubMedDate not supplied

[Carcinoid neoplasms: report of 5 personal cases].

The authors report 5 cases of carcinoid tumor differently located. The typical carcinoid syndrome has been observed only in one case, presenting with high levels of urinary serotonin and 5-OH-HIAA. The remnant patients were completely asymptomatic and the correct diagnosis was obtained only by histologic examination of the surgical specimen. On the basis of their experience and of the literature, the authors evaluate the current diagnostic and therapeutic options for these neoplasms. The indication for surgical treatment, even in cases with local or distant metastases, is emphasized.

Aged↗

PubMedDate not supplied

[Analysis of growth, phenotype and cytotoxic activity of tumor infiltrating lymphocytes expanded in vitro with interleukin-2 and interleukin-4: preliminary results].

Tumor infiltrating lymphocytes (TIL) play an important role in the host immune response to cancer. When these cells are reinfused into cancer patients after in vitro expansion with lymphokines such as interleukin 2 (rIL-2), they often induce regression of tumor metastases. We obtained TIL of enzymatic digestion of 7 human solid tumors and then cultured them with rIL-2 and interleukin 4 (IL-4) at different concentrations for about 36 days. Immunophenotypic analysis was performed at the end of the second and fourth week; cytotoxic activity against autologous and heterologous targets was assessed on the 30th day of culture. The best lymphocytic growth was observed when we used rIL-2 and IL-4 for the first two weeks of culturing and then continued with rIL-2 alone. CD3 and CD56 cells formed the majority of TIL in all cultures. In 4 cases CD4 cells predominated at the initial stage of culturing, with CD8 cells gradually increasing and finally inverting the CD4/CD8 ratio. Autologous cytotoxicity (3/4 cases) appeared to be better in those patients in whom the CD4/CD8 ratio was inverted. These data enable identification of the combination of lymphokines that will will best provide expansion of live TIL active against tumoral cells. This procedure must be followed before in vivo reinfusion of expanded lymphocytes is carried out.

Adenocarcinoma↗

PubMedDate not supplied

Adenocarcinoma of the small intestine.

We examined eight patients with adenocarcinoma of the small intestine: four were localized in the duodenum and four in the jejunum. We performed six curative resections: two pancreatoduodenectomy, two total pancreatectomy and two jejunal resections; in two cases, only by-pass was performed. Three patients who were resected are alive after more than five years; the other patients died between nine and forty-one months after surgery. The evaluation of the data from our experience and from literature shows that the consistently negative results are related to a delay in diagnosis and therapy.

Adenocarcinoma↗

PubMedDate not supplied

Primary hyperparathyroidism. Our experience.

We report our experience in the clinical presentation and management of 12 patients with primary hyperparathyroidism, who underwent successful surgery. Comparing our results with those previously reported in the literature, we have attempted to correlate the kind of parathyroid lesion, the magnitude of hypercalcemia and PTH increase, and clinical symptoms. Often these relationships are intriguing; we have tried to classify our patients describing four groups, according to clinical and humoral findings: 1) patients with very mild hypercalcemia and aspecific symptoms; 2) patients with a finding of recurrent hypercalcemia and prevalent renal involvement; 3) patients with severe hypercalcemia, plurisystemic involvement and general decay; 4) patients with medical emergencies. Finally, some considerations on rare histological pictures (hyperfunctioning carcinoma, oxyphil cell adenoma) are reported.

Adenoma↗

PubMedDate not supplied

Surgical treatment of hepatocellular carcinoma.

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Carcinoma, Hepatocellular↗

PubMedDate not supplied

Stomach cancer: a study of 117 consecutive resected cases and results of R2-R3 gastrectomy.

In a consecutive series of 175 patients with gastric carcinoma, 66.8% underwent gastric resection: 74 total gastrectomies with R3 lymphadenectomy and 43 distal subtotal gastrectomies with R2 lymphadenectomy were performed. 73% (86 cases) of resective procedures proved to be "absolute curative" according to Japanese criteria (JRSGC). Nodal involvement was present in 62 out of 117 resected patients (52.9%): 29.9% N1, 9.4% N2, 13.6% N3; a significant relationship (p = 0.012) between depth of invasion of the gastric wall and lymph node metastases was revealed. The hospital mortality after R2-R3 gastrectomy was 4.2%, major surgical complications occurred in 6.8% of cases. The actuarial 5-year survival after curative resection was 59%. The results suggest that extended lymphadenectomy (R2-R3 gastrectomy) is justified in the surgical treatment of gastric cancer; this procedure can be safely performed and permits "absolute curative" resections in a remarkable percentage of cases.

Actuarial Analysis↗

PubMedDate not supplied

[Use of mechanical staplers in low anterior resection: functional findings].

Twenty-three patients submitted to low stapled anterior resection for rectal carcinoma were studied by clinical questionnaire and manometry in order to assess anorectal function. Results were compared with those obtained from 11 patients submitted to the same procedure by hand suture.

Adult↗

PubMedDate not supplied

[Laparostomy in the treatment of pancreatic abscess. A case report].

Pancreatic abscess is a major cause of death from acute pancreatitis; its reported frequency is between 1.7 and 25 per cent of all patients presenting with acute pancreatitis. The mortality varies between 13 and 54 per cent. Despite apparently adequate initial surgical treatment, the recurrence rate is about 30 per cent. The key to survival in pancreatic abscess is adequate drainage of cavity. Proponents of open treatment claim that it allows better drainage of the viscid content of the pancreatic abscess which often cannot easily pass down a drain. In the present case, following laparotomy for severe intra-abdominal sepsis due to pancreatic abscess, the abdominal cavity was left open to heal by granulation. The procedure permitted early resolution of the septic process. Total parenteral nutritional support resulted in definitive wound healing. We regard laparostomy as a valuable technique in the management of pancreatic abscess; the successful of this technique hinges on expert nursing care and the capability of maintaining complication-free long term parenteral nutrition.

Abscess↗