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Biomedical subjects

G Costamagna

Publications and source records attributed to G Costamagna.

At least 73 records · Page 4Linked to original sources
PubMed1997

Endoscopic mechanical lithotripsy of difficult common bile duct stones.

BACKGROUND: Mechanical lithotripsy for the management of difficult common bile duct stones has sometimes yielded conflicting results. METHODS: A series of 162 consecutive patients who underwent mechanical lithotripsy was evaluated retrospectively and a large number of variables tested for their association with successful outcome. RESULTS: The procedure was safe (morbidity rate 1.8 per cent) and effective (84.0 per cent stone clearance rate). Univariate and multivariate analysis showed that stone size was the only outcome predictor (mean(s.d.) diameter of grasped versus non-grasped stones 21.7 (6.7) versus 28.3(10.4) mm; F = 10.72, 98 d.f., P = 0.002). The cumulative probability of bile duct clearance ranged from over 90 per cent for stones with a diameter less than 10 mm to 68 per cent for those greater than 28 mm in diameter (P < 0.02). CONCLUSION: Patients at high risk of lithotripsy failure (stone diameter of 28 mm or more) might more wisely undergo surgery or other non-surgical procedures, such as extracorporeal shock-wave lithotripsy or long-term biliary stenting.

Adult↗
PubMed1996

Endoscopic treatment of chronic idiopathic pancreatitis in children.

The purpose of this study was to analyze the preliminary results obtained with endoscopic treatment of children with chronic idiopathic pancreatitis. The disease appears to be caused by a deficit of pancreatic stabilizing proteins that leads to precipitation of solutes contained in the pancreatic secretions; these precipitates are the cause of inflammation. The possible role of a congenital malformation in the pathogenesis of this disease is being regarded with increasing scepticism. Between October 1991 and April 1994, five cases of chronic pancreatitis were referred to the Division of Pediatric Surgery of the Policlinico "A. Gemelli" of Rome. The age range of the patients (3 boys, 2 girls) was 3 to 14 years (mean, 10.8 years); all had a history of acute attacks and had blood chemistry findings compatible with pancreatitis. None of the patients' families had a history of pancreatic disease. All diagnoses were confirmed by endoscopic retrograde cholangiopancreatography, and the disease was staged according to the criteria of Cremer et al. Endoscopic pancreatic sphincterotomy, with or without removal of calculi, was performed in four cases (2 in the authors' hospital, 2 in another institution). Three of the children have had no further symptoms (mean follow-up period, 20 months), and their growth and weight gain have been normal. The fourth child, a 3-year-old girl, has had two episodes of pain since treatment. These attacks, both of which subsided spontaneously, probably were caused by the passage of protein plugs through the sphincterotomy. The fifth patient received no treatment because she had remained asymptomatic since the first examination (28 months ago). The short-term effects observed in these children indicate that endoscopic treatment of chronic idiopathic pancreatitis is associated with a high rate of success with respect to pain control. Because of the short follow-up, the effects on endocrine and exocrine function have not been assessed. No deaths or complications occurred. Conservative treatment of this type can be repeated if pain recurs, an important factor given the chronic nature and early onset of this disease, and it does not preclude the possibility of subsequent surgery. The authors' experience indicates that this approach should be considered the initial treatment of choice for children with chronic pancreatitis.

Child↗
PubMed1996

Massive haemobilia after percutaneous liver biopsy in a patient with POEMS syndrome successfully treated by arterial embolization.

A 65-year-old woman with POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and skin changes) developed severe upper right quadrant colic with jaundice, massive haematemesis and melaena following an apparently uncomplicated percutaneous liver biopsy performed for suspected liver involvement. Symptom onset occurred about 18 hours after the procedure. Haemobilia was diagnosed on endoscopic retrograde cholangiopancreatography. An arteriovenous fistula in the third hepatic segment was demonstrated by transfemoral arteriography and successfully embolized using Gelfoam pledgets mixed with Ivalon fragments. A review of percutaneous liver biopsy related haemobilia is presented.

Aged↗
PubMed1996

Role of intraluminal brachytherapy in extrahepatic bile duct and pancreatic cancers: is it just for palliation?

PURPOSE: To evaluate intraluminal brachytherapy (ILBT) in patients with extrahepatic bile duct or pancreatic cancers. MATERIALS AND METHODS: Thirty-one patients (aged 33-87 years) with unresectable extrahepatic bile duct (n = 18) or pancreatic (n = 13) cancer received ILBT exclusively or as part of a definitive treatment regimen. ILBT was performed with transhepatic percutaneous drainage in four patients and with endoscopic retrograde cholangiopancreatography in 27. Fourteen patients with no metastases, an Eastern Cooperative Oncology Group performance score of < or = 2, and good hematologic parameters received combined modality treatment: 30-Gy ILBT and 45-Gy external-beam radiation therapy with continuous infusion of fluorouracil. Seventeen patients underwent 50-Gy ILBT alone for palliation. RESULTS: No direct treatment-related acute toxic reactions were seen. Three patients had cholangitis early in the study. Three patients had late gastrointestinal bleeding. Jaundice was palliated in all patients (n = 29); pain, in 11 of 13 patients. The survival rate in patients with extrahepatic bile duct cancer was 62% (five of eight) at 2 years for combined modality treatment. No patient with pancreatic cancer lived for longer than 2 years. CONCLUSION: ILBT is an effective palliative treatment of unresectable extrahepatic bile duct and pancreatic cancers. Results suggest a possible "curative" role in specific clinical settings when properly integrated with other treatments.

Adult↗
PubMed1995

Intraluminal brachytherapy in the treatment of pancreas and bile duct carcinoma.

PURPOSE: A new method of palliation of malignant obstructive jaundice is presented. METHODS AND MATERIALS: Twelve patients with carcinoma of the extrahepatic bile ducts (EHBD-five patients) or pancreatic head (PH-seven patients) received radiation therapy between 1988 and 1991. Percutaneous transhepatic biliary drainage was performed in four EHBD patients and an endoprosthesis was placed during endoscopic retrograde cholangiopancreatography (ERCP) in the other eight patients. All 12 received intraluminal brachytherapy (ILBT): 20-50 Gy calculated at 1 cm from the Iridium-192 (192Ir) wire. In four PH patients the source was placed in the duct of Wirsung; in the other eight patients ILBT was performed via the common bile duct. Five of the seven PH patients and one of the five EHBD patients received External Beam Radiation Therapy (EBRT): 26-50 Gy, alone or with concomitant 5-Fluorouracil (5-FU). RESULTS: Cholangitis occurred in six patients. Three PH patients treated with EBRT+ILBT developed gastrointestinal toxicities. With a minimum follow-up of 18 months, median survival times were 14 months (EHBD) and 11.5 months (PH); one of the seven PH patients is alive (29 months) and two of the EHBD patients are alive (18 and 43 months). All patients had satisfactory control of jaundice. CONCLUSIONS: The results in the EHBD patients suggest that the addition of ILBT after biliary drainage prolongs survival. Further experience is necessary to determine whether ILBT in the common bile duct and/or in the duct of Wirsung may be, in PH patients, an alternative boost technique to Interstitial Brachy-therapy (IBT) or Intraoperative Electron Beam Radiation Therapy (IOEBRT).

Aged↗
PubMed1995

Pancreatic juice 90K and serum CA 19-9 combined determination can discriminate between pancreatic cancer and chronic pancreatitis.

OBJECTIVES: Differential diagnosis of pancreatic cancer versus chronic pancreatitis may be difficult. The aim of this study is to determine whether a group of tumor-associated antigens could differentiate between the two pathologies. METHODS: CA 19-9, TAG-72, CAR-3, and a newly discovered antigen termed "90K" were determined in the serum and in the pancreatic juice of 19 patients with pancreatic cancer, 20 patients with chronic pancreatitis, and seven controls with lithiasis of extrapancreatic bile ducts. RESULTS: The serum antigen levels of all three markers except 90K were significantly higher in pancreatic cancer than in chronic pancreatitis. High correlations were found between serum CA 19-9 and both TAG-72 and CAR-3. 90K did not correlate with other markers. In pancreatic juice, only 90K values were significantly higher in chronic pancreatitis than in pancreatic cancer, and only 90K and CA 19-9 were significantly correlated. At the stepwise discriminant analysis, serum CA 19-9 and pancreatic juice 90K had independent diagnostic roles. Used in combination, they correctly identified 84.2% of pancreatic cancer and 90% of chronic pancreatitis. CONCLUSIONS: These data suggest that pancreatic juice 90K and serum CA 19-9 can discriminate between chronic pancreatitis and pancreatic cancer. The data further support the complementary use of tumor-associated antigens along with other diagnostic tools.

Antigens, Neoplasm↗
PubMed1995

[Results of endoscopic biliary drainage in primary tumors of the common bile duct (cholangiocarcinoma)].

Endoscopic drainage is an effective therapy for palliation of patients with bile duct carcinoma. From November 1987 to November 1994 112 patients with cholangiocarcinoma were observed. The success rate of the procedure was 94.5%. The biliary drainage was successful in 99% of patients (in 4% of patients the complete biliary drainage was obtained with the aid of a transhepatically inserted guide-wire with the "rendez-vous" procedure). In 15 patients an intraluminal radiation therapy with Iridium-192 was associated. The morbility was 13% and the 30-days mortality 11%. A surgical operation was performed in 26% of patients with radical intent. The mean survival time in patients treated only endoscopically was 208 days for patients with lesions of the distal and middle third of the bile duct and 281 days for patients with hilar cholangiocarcinoma. In patients with intraluminal radiation therapy the mean survival time was 357 days, with a significative difference with the only endoscopically treated group (357 vs 238 days, p < 0.05). We conclude that endoscopic drainage is a safe and effective management for patients with cholangiocarcinoma and it does not preclude definitive surgical treatment in appropriate candidate.

Adult↗
PubMed1991

Carcinoma of the pancreas: a personal experience with 100 cases.

One hundred patients with pancreatic cancer were evaluated between March 1981 and December 1989. This study showed that 61 were not candidates for definitive surgery because of nonoperability (28 patients) or nonresectability (33 patients). An additional 25 patients had cancers that were unresectable because of metastases (13 patients) or local spread of disease (12 patients) discovered at laparotomy. Fourteen patients had resectable cancers. Ten were treated by total pancreatectomy, three by distal pancreatectomy and one by pancreatoduodenectomy (Whipple). There were two operative mortalities. The median patient survival time was 20.5 months. Two patients survived 5 years. Five patients are alive at 3, 14, 18, and 47 months. Palliative surgical procedures performed in 18 patients included 10 biliary bypasses, 9 gastrojejunostomies, and 6 T-tube placements. This was associated with an operative mortality rate of 11%. The median survival time was 5 months. Other palliative measures included endoscopic placement of biliary and pancreatic stents (47 patients, 2.7% mortality rate), endoluminal radiation therapy, interstitial radiation therapy and external beam radiation therapy. The median survival time of patients so treated was 4.5 months.

Adult↗
PubMed1989

Value of ERCP in the diagnosis and management of pre- and postoperative biliary complications in hydatid disease of the liver.

Twenty-nine patients with symptomatic hydatid disease of the liver were evaluated preoperatively by endoscopic retrograde cholangiopancreatography (ERCP) in the years 1982-1987. In the same period, 6 patients who previously underwent surgery for the parasitic disease also underwent ERCP because of postoperative symptoms of biliary obstruction. Findings at ERCP excluded biliary tract involvement in 11 cases. Positive findings were shown in 24 patients, including compression of the bile ducts in 4, small cysto-biliary communications in 5, intrabiliary rupture in 9, residual hydatid material in the common bile duct, and sclerosing cholangitis in 3. Endoscopic removal of migrated hydatid debris was achieved in 8 patients, avoiding reoperation in 4.

Adult↗
PubMed1989

[Use of central venous catheters implanted subcutaneously in children with neoplasms].

The use of totally implantable right atrial catheters was evaluated in pediatric oncology patients. From September 15, 1987 to March 31, 1989, 26 catheters were inserted in patients (1 year to 20 years of age) with the following diagnosis: acute leukemia (6), osteosarcoma (5), lymphoma (4), central nervous system tumors (6), osteosarcoma (5), lymphoma (4), central nervous system tumors (6) and other solid tumors (5). Total number of catheter days was 5,475. The catheters were maintained for a mean of 210 days (range 10-534). Complications included: documented local infection in 1 patient, successfully treated with antibiotics without removing the catheter and transient obstructions resolved with injection of heparin or urokinase in other children. The use of these right atrial catheters has been widely accepted by patients and families as well as by the health team. Complications have been minimal. Our experience confirms that these catheters contribute to improving quality of life in pediatric patients with neoplasms.

Adolescent↗
PubMed1987

[Hemobilia: comparison of diagnostic technics. Considerations on 14 patients].

Fourteen cases of hemobilia of traumatic (six), vascular (six) or neoplastic (two) origin were reviewed. Eleven patients obtained correct diagnosis only be integration of at least two diagnostic procedures out of Ultrasonography, Computed Tomography, arteriography and cholangiography. Although US and CT are extremely useful as screening procedures, correct diagnosis should be only possible by integration of more diagnostic technics. Arterial embolization represents a successful alternative to surgical intervention; moreover US may also be helpful for follow-up of treated patients.

Cholangiography↗
PubMed1987

Juxtapapillary choledochoduodenal fistula. Diagnosis and treatment in 19 cases.

Nineteen patients with distal juxtapapillary choledochoduodenal fistula diagnosed by endoscopic retrograde cholangiopancreatography are reported. Eighty-four percent of the patients had undergone previous operations on the biliary tract. Fistula appears to be mostly secondary to common bile duct exploration with rigid probes or to a technical mistake in performing sphincteroplasty. Spontaneous fistula secondary to the passage of a stone into the duodenal lumen may also occur. Common duct stones were responsible for the symptoms in most cases (70%). Endoscopic sphincterotomy showed good results in cholecystectomized patients with stones. Surgery directed to the fistula or biliary by-pass are not recommended. Uncomplicated fistula probably does not require treatment.

Adult↗
PubMed1983

Post-gravidic Budd-Chiari syndrome treated by mesocaval H-graft shunt.

A new case of Budd-Chiari syndrome following pregnancy is reported. The patient, shortly after her second normal delivery, showed clinical evidence of hepatic venous outflow impairment. The diagnosis of Budd-Chiari syndrome was supported by angiographic studies, computed tomography, liver scanning and histology. Because of the poor results reported in the literature following medical treatment, portosystemic shunting was considered. At laparotomy, due to the huge caudate lobe hypertrophy, a mesocaval H-graft shunt was performed, using a 10 mm woven Impraflex graft. The patient is well, with normal liver function tests, 24 months following the procedure.

Adult↗