Biomedical subjects
Publications and source records attributed to F Crucitti.
In 1983, Shepherd and Lee described the solitary necrotic nodule of the liver, an uncommon non-malignant lesion with a characteristic histological appearance. This nodule can often be misinterpreted as a necrotic secondary tumour. Limited liver resection can make differential diagnosis and cure the lesion.
The authors report their experience with 463 tension free hernioplasty procedures for inguinal and femoral hernias. The surgical technique included the insertion of both a polypropylene plug and a polypropylene mesh, and was carried out mostly in local anesthesia (84.2%) using bupivacaine 0.25% for ileoinguinal and ileohypogastric blockage and mepivacaine 0.5% for local infiltration. There was no major intraoperative complication; local postoperative complications were rare (10%) and easily managed; postoperative pain was frequently observed (66%), though mild and transient; resumption of working activity occurred within a month in 96.6% of cases; there were only 3 post-operative recurrences (respectively, at 1, 6 and 12 months). The authors conclude that the tension free hernioplasty is a simple, rapid, low-cost and effective technique, easily performed under local anesthesia.
BACKGROUND/AIMS: The surgical treatment of pancreatic carcinoma, and particularly the decision to resect locally advanced non-metastatic cancer is extremely controversial. The aim of this study is to report our experience in extensive pancreatectomy and draw conclusions regarding its effectiveness in treating locally advanced pancreatic cancer. METHODOLOGY: In our Department of Surgery, 12 patients underwent pancreatic resective surgery extended to the portal vein (6 cases), to the superior mesenteric vein (1 case) or to other peripancreatic organs (5 cases). RESULTS: The procedure was considered curative in 7 cases. The mortality rate was 16.6% and the morbidity 25%. Four out of the five patients who had undergone vascular resection and had not died in the postoperative period survived for more than 12 months, while the 5 cases in whom the resection was extended to other organs survived from 9 to 93 months. In all cases, the quality of life was satisfactory until tumor recurrence, which occurred in 8 cases (66.7%). Two of the cases with vascular resection are still alive after 17 and 22 months. CONCLUSIONS: In all of these 12 cases, we were forced to perform "extensive" resective surgery, which was apparently curative, although we were not able to prevent recurrence in a high percentage of cases. Moreover, aggressive surgery seems justified in particular histotypes, such as in the carcinoid case reported in our study; debulking enhances the effectiveness of chemotherapy and permits relief of the endocrine symptoms eventually induced by the tumor.
Local recurrence affects approximately 50% of patients undergoing surgery for pancreatic adenocarcinoma. To lower the incidence of locoregional recurrence, the combination with surgery of adjuvant radiotherapy has been proposed. The latter is based on external radiotherapy (ERT), intraoperative radiotherapy (IORT) or their combination. To evaluate the impact on local control and survival, results achieved in a a group of patients undergoing surgical resection and combined adjuvant radiotherapy, are analyzed. 17 patients with adenocarcinoma of the exocrine pancreas were treated with a therapeutic protocol based on pancreatectomy and intraoperative radiotherapy (IORT) to the tumor bed (10 Gy) followed by postoperative radiotherapy (50 Gy); 9 patients underwent also preoperative radiotherapy (5 Gy) to the pancreas and liver. With a median follow-up of 45 months, in 3 patients (17.6%) local recurrence was observed while 12 patients (70.6%) showed liver metastases or peritoneal spread. Median survival was 17.5 months and actuarial survival at 2 and 5 years was 41.2% and 11.2%, respectively. As compared to a moderate local control, the prognosis of patients undergoing surgical resection remained disappointing. Thus, the effort of improving results with new therapeutic modalities as preoperative radiochemotherapy and adjuvant chemotherapy, seems justified.