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Biomedical subjects

G E Gerunda

Publications and source records attributed to G E Gerunda.

At least 37 records · Page 2Linked to original sources
PubMed1994

Implication of laparoscopy and peritoneal cytology in the staging of early pancreatic cancer.

Staging of pancreatic cancer still represents a challenge for surgeons involved in this field. Diagnostic methods of radiological imaging used routinely (CT, NMR, angiography) may understage this neoplasm. In fact, the presence of peritoneal or subglissonian hepatic micrometastases (< 2 cm) is a frequent surprise at laparotomy and forces the surgeon to use a palliative procedure. Actually this policy has not to be followed because the possibility to perform non-surgical palliation of jaundice or pain respectively by percutaneous radiological stent insertion and celiac alcoholization. In this viewpoint, preoperative staging has acquired an important role for a correct treatment, be it surgical or medical. Laparoscopy allows it to overcome the understaging produced by the more common diagnostic means, with the possibility to view directly the celomatic space and the surface of the abdominal viscera; moreover, during this procedure it is possible to perform a peritoneal washing to obtain other information about the cancer stage. In our experience, 56 patients were judged as resectable by radiologic methods; 31 were excluded from surgery by laparoscopy; 10 of the remaining 25 cases were submitted to radical resection. The operative resectability rate resulted in 40%, against 18% in cases where we submitted to surgery all the patients. Seven patients underwent peritoneal washing, always with a negative result; all were submitted to surgery and radically resected. In our opinion, laparoscopy and peritoneal washing represent useful tools in the staging of patients affected by pancreatic cancer.

Ascitic Fluid↗
PubMed1994

Pancreatic cancer and retroperitoneal neural tissue invasion. Its implication for survival following radical surgery.

To analyze the implication of retroperitoneal perineural lymphatic infiltration (rpli) for the survival of patients affected by exocrine pancreatic cancer, we considered 17 cases which underwent radical resection at our Institute from 1980 to 1993. Histology of specimens showed an rpli in 15 cases, without any correlation between this anatomopathologic aspect and the neoplasm size or the presence of lymph node metastases. The 2 patients without rpli are both alive and have been free from disease during a follow-up period of more than 5 years. In the group of 15 patients with positive rpli, 3 (21.4%) have remained free from disease (2 alive and 1 dead for other reason). Eleven remained with disease (1 is alive and 10 have died). One died in the postoperative period and could not be included in the evaluation. These observations have led the surgeon to consider the necessity, during resection, of an accurate dissection not only of the regional lymph nodes but also of the retropancreatic tissue and the neural structures present in this area. This approach may lead to a more correct staging of the neoplasia, a better radical surgery and perhaps a longer survival. Moreover it may represent an important marker for an adjuvant protocol of chemotherapy and/or radiotherapy.

Duodenum↗
PubMed1994

[The role of laparoscopy and peritoneal cytology in the preoperative staging of pancreatic carcinoma].

The staging of pancreatic cancer still represents a challenge for surgeons involved in this field; radiological diagnostic methods used routinely (CT, NMR, angiography) may under-estimate this neoplasm; in fact, the presence of peritoneal or subglissonian hepatic micrometastasis (< 2 cm) is a frequent surprise at laparotomy and force the surgeon to undertake a palliative procedure. This policy need not be followed because it is possible to perform non-surgical palliation of jaundice or pain respectively by percutaneous radiological stent insertion and coeliac alcoholisation. Pre-operative staging thus acquires an important role in the correct treatment, surgical or medical. Laparoscopy allows us to overcome the understaging of the more common diagnostic methods and view directly the coelomatic space and the surface of the abdominal viscera; moreover during this procedure it is possible to perform a peritoneal wash to obtain other information on the cancer stage. We judged 56 patients by radiological diagnosis; 31 were excluded from surgery by laparoscopy; 10 of the other 25 cases were submitted to radical resection. The resectability operative rate was 40%, compared with 18% if we had submitted patients to surgery. Several patients underwent peritoneal wash, always with negative results; all were submitted to surgery and radically resected. In our opinion, laparoscopy and peritoneal wash represent useful tools in the staging of patients affected with pancreatic cancer.

Biopsy↗
PubMed1994

CCL4-induced liver cirrhosis and hepatocellular carcinoma in rats: relationship to plasma zinc, copper and estradiol levels.

A number of biochemical events accompany the development of chronic liver disease and its evolution into hepatic cancer. Low plasma zinc and high plasma copper levels have been observed in individuals with advanced hepatocellular liver disease. Moreover, many investigators have demonstrated an increase in serum estradiol levels in individuals with chronic liver disease and hepatocellular carcinoma (HCC). In the present study, the relationship between these biochemical events and HCC was investigated in an animal model. Specifically, carbon tetrachloride (CCL4) was administered intragastrically to 20 female Sprague Dawley rats for 30 weeks. All 20 animals developed cirrhosis. Six (30%) developed HCC. Significantly higher serum estradiol, zinc and copper levels were observed in the rats developing HCC as compared with those with cirrhosis alone (P < or = 0.05, 0.01 and 0.001, respectively). A trend toward increased serum levels of progesterone, ALT and total bilirubin (0.1 > or = P < or = 0.05) was found in the animals developing HCC. No differences in serum testosterone and alkaline phosphatase levels were noted between animals with and without HCC. These studies demonstrate that in animals with experimental CCL4-induced cirrhosis and HCC serum levels of estradiol, zinc and copper are increased, as is the case in man.

Animals↗
PubMed1993

Effect of ursodeoxycholic acid administration on bile duct proliferation and cholestasis in bile duct ligated rat.

The origin, mechanism, and significance of the bile duct proliferation (BDP) associated with cholestasis remain unexplained. This study examined the effect of oral administration of ursodeoxycholic acid (UDCA) on both BDP and cholestasis in the rat. After bile duct ligation, male Sprague-Dawley rats were treated for 30 days with either UDCA (5 mg/day) (group A) or saline solution (group B). Animals were sacrificed at day 30. The serum activity of aminotransferase (ALT, AST), alkaline phosphatase, and gamma-glutamyltransferase (GGT) was significantly lower (P < 0.01) in the UDCA-treated rats. Total serum bilirubin and total serum bile acids were lower (P < 0.001) in group A. Moreover, the control of BA in bile was reduced also (P < 0.02). Conversely, serum cholesterol levels were not different between the two groups. Histological examination showed that the number of ductular cells in the portal areas was significantly (P < 0.001) reduced in UDCA-treated as compared to saline-treated rats. The replication activity, assessed as the number of bromodeoxyuridine-positive cells, was also significantly lower in treated animals (33 +/- 11 vs 64 +/- 22 per 1000 cells; P < 0.001). Lobular bile ductules were three times larger in group B, and extrahepatic duct measurements confirmed this increase in size of the larger biliary ducts (P < 0.001). These findings demonstrate that UDCA reduces BDP in response to BD ligation. Although the mechanism(s) of this effect is still hypothetical, UDCA may reduce the level of irritating bile salts such as chenodeoxycholic acid and lithocolate and increase periductular bile acid recirculation.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

Sex hormones and trace elements in rat CCL4-induced cirrhosis and hepatocellular carcinoma.

Several biochemical events accompany and mediate the development of chronic liver disease and its evolution into cancer. Low plasma zinc and high copper levels have been observed in various liver diseases, such as liver cirrhosis and viral hepatitis, while increased oestradiol levels have been documented in chronic liver damage and hepatocellular carcinoma. We administered CCL4 intragastrically to 10 female Sprague Dawley rats for 30 weeks. All animals developed cirrhosis and four also developed hepatocellular carcinoma. Plasma levels of zinc, copper and oestradiol were significantly higher in the latter group than in animals with simple cirrhosis. Progesterone, AST and bilirubin showed a trend toward significant differences whereas testosterone and ALP levels were unchanged. These findings add to the evidence that sex hormones and trace elements are involved in the process of the development of chronic liver damage and carcinogenesis.

Alkaline Phosphatase↗
PubMed1990

Selective variceal decompression and its role relative to other therapies.

Seventy patients, selected from 265 patients with proved variceal bleeding, underwent a distal splenorenal shunt (DSRS) procedure with or without splenopancreatic disconnection (SPD). Alcoholic cirrhosis was the cause of portal hypertension in 57% of the patients. The operative mortality was 13% (Child's classes A and B 2%, class C 66%). Despite fewer varices in all of the patients, variceal rebleeding and death occurred in one patient (2%). Late portal perfusion was observed in 91% of the patients, with worsening in 23%, compared with the preoperative study. Persistent hepatocyte necrosis and incomplete SPD were the most significant prognostic factors for decreased perfusion (presence and absence of necrosis, 38% and 12%, respectively; DSRS and DSRS with SPD, 43% and 12%, respectively). SPD also decreased ongoing hepatocyte damage. Post-shunt encephalopathy was clinically evident in 7% of the patients, but after electroencephalographic evaluation, it increased to 24.6%. Significant factors in its development included decreased portal perfusion (62% versus 14%), active hepatitis (48% versus 17%), and incomplete SPD (43% versus 14%). The higher late liver-related mortality was associated with a lack of or decreased portal perfusion and the absence of SPD.

Esophageal and Gastric Varices↗
PubMed1989

The role of the leukocyte adherence inhibition (LAI), CA 19-9, and tissue polypeptide antigen (TPA) tests in the diagnosis of pancreatic cancer.

The leukocyte adherence inhibition (LAI) assay measures host cell-mediated tumor immunity. The original test used by Halliday and Miller was modified by substituting tissue extracts with purified tumor antigens (gastrointestinal cancer antigen [GICA]) with the aim of reducing false-positive results in the diagnosis of patients with early pancreatic cancer. By our modified technique, the LAI assay identified four of five pancreatic cancers at an early stage and gave only one false-positive result in 16, showing a sensitivity of 80% and a specificity of 94%. Later stages of the disease responded poorly on the test. These results were significantly better than those by the CA 19-9 and tissue polypeptide antigen (TPA) tests. Should our findings be confirmed in larger material over a longer follow-up period, the LAI test could be proposed as a useful tool in the early diagnosis of pancreatic cancer.

Antigens, Neoplasm↗
PubMed1989

[The L.A.I. test and tumor markers (Ca 19-9 and TPA) in the diagnosis of pancreatic carcinoma].

A particular cell-mediated immune response is tested in this work: the leukocyte adherence inhibition (L.A.I.) in the presence of organ tumor antigens. Forty-two patients suspected of having pancreatic cancer were submitted to the L.A.I. test and Ca 19.9 and TPA determination. The diagnosis of pancreatic cancer was eventually surgically confirmed and staged in 30 patients. The most important features of the L.A.I. test were good specificity (94%) and the ability to diagnose stage I cancers (3/4 cases, 75%), while the other markers are more likely to diagnose more advanced stages. The L.A.I. test seems to be also useful during the follow-up period since its positivity may even be some months previous to the clinical symptoms. During follow-up the L.A.I. test proved useful in supervising the neoplastic disease course from the moment of relapse to advanced clinical symptoms.

Antigens, Neoplasm↗
PubMed1988

Increased proportion of giant platelets and platelet distribution width are better indicators of altered platelet homeostasis than mean platelet volume in liver cirrhosis.

Platelet count, mean platelet volume (MPV), giant platelet percentage, expressed by us as megathrombocytic index (MTI) and platelet distribution width (PDW) have been evaluated in 32 control subjects and in 27 patients suffering from liver cirrhosis (LC) and thrombocytopenia. MTI and PDW were linearly and inversely correlated to platelet count both in controls and patients. MTI and PDW were markedly increased in LC as compared to controls, while MPV was not significantly different. It is concluded that MTI and PDW are good indices of thrombopoietic stimulus both in controls and in CL and better indicators of altered platelet homeostasis than MPV in LC.

Adolescent↗
PubMed1987

Failure of two anti-platelet drugs (indobufen and dipyridamole) to improve thrombocytopenia in liver cirrhosis.

The hypothesis that thrombocytopenia in liver cirrhosis (LC) could be due to platelet activation was investigated. 18 patients with thrombocytopenia and LC have been studied. Circulating beta-thromboglobulin (beta TG) was normal, but appeared elevated when referred to platelet count. However, this may not accurately reflect alpha-granule release because of reduced liver cell function. Intraplatelet beta TG, on the contrary, should not be affected by liver cell function. It was markedly depressed, thus truly suggesting the existence of an exhausted state caused by platelet activation. Thromboxane B2 production was slightly increased. This could be due to a compensatory mechanism, or simply to platelet size, which was slightly increased, too. Anti-platelet therapy failed to improve thrombocytopenia. A platelet activation state seems therefore to be present in LC, but seems not to be the only cause of thrombocytopenia. Platelet factor 4 approximated zero, regardless of platelet count and therapy. This confirms that elevated values of such a protein represent only a laboratory artifact, due to platelet activation in vitro.

Aged↗
PubMed1987

Thrombocytopenia in liver cirrhosis complicated by variceal haemorrhage: lack of increase in platelet count after spleno renal distal shunt.

10 patients with liver cirrhosis (LC) and previous variceal bleeding have been studied. Platelet count was markedly depressed. Giant platelet percentage (MTI) was significantly increased, reflecting bone marrow compensatory hyperactivity. Platelet associated IgG (PAIgG) was elevated. Such elevation, however, was inconstant and did not correlate with platelet count. Beta-thromboglobulin was markedly increased when referred to circulating platelet number, but its level did not accurately reflect platelet activation, because of decreased liver cell function. Platelet Factor 4 was always zero, thus confirming that high values of this protein represent only a laboratory artifact, due to platelet activation in vitro. 5 patients underwent spleno renal distal shunt, which transiently improved hypersplenism only in one case. Despite this, MTI became perfectly normal in all patients, suggesting a decrease in the thrombopoietic stimulus. PAIgG dramatically fell in the two patients with the highest pre-operative values. Since thrombocytopenia persisted, the non-specific nature of PAIgG in LC seems to be further supported.

Adult↗
PubMed1986

[Changes in portal hemodynamics during pharmacologic stimulation: somatostatin vs glypressin].

Sixteen patients with cirrhosis of the liver and a history of haemorrhaging oesophageal varices all given Warren-type splenorenal bypasses were subjected to intraoperative measurement of portal flow and pressure after the administration of Somatostatin and Glypressin. Glypressin was distinctly more effective in producing a significant and long term reduction in portal flow and pressure. Somatostatin made no significant difference to these parameters.

Blood Pressure↗