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Biomedical subjects

G Giraudo

Publications and source records attributed to G Giraudo.

At least 19 recordsLinked to original sources
PubMed2002

Abdominal wall recurrences after colorectal resection for cancer: results of the Italian registry of laparoscopic colorectal surgery.

PURPOSE: The purpose of the present study was to evaluate prospectively the abdominal wall recurrence rate after laparoscopic resection for colorectal cancer, to analyze the impact of the learning curve on abdominal wall recurrence, and to assess the outcome of those patients. METHODS: The Italian Registry of Laparoscopic Colorectal Surgery database was analyzed to obtain data on cancer patients with abdominal wall recurrence, concomitant local or distant metastases, and interval between initial surgery and diagnosis of trocar site or minilaparotomy recurrences. The records of the initial procedures and the technique of specimen removal were reviewed. RESULTS: From January 1992 to July 2000, 2,583 patients (1,753 cases of carcinomas and 830 cases of benign diseases) were recorded. The malignant lesions were located on the right colon in 19 percent, the left colon in 48.8 percent, and rectum in 32.2 percent. Sixteen patients with histologic evidence of colorectal adenocarcinoma recurrences at the abdominal wall were observed (0.9 percent). Ten patients presented an advanced stage (III for 7 patients and IV for 3 patients). Eleven cases occurred during the learning curve period (the first 50 consecutive cases). The median survival time after abdominal wall recurrence diagnosis was 16 (range, 12-60) months. By July 2000 only two patients were alive. CONCLUSIONS: The results of the Italian prospective Registry of Laparoscopic Colorectal Surgery confirm that the incidence of abdominal wall recurrences is similar to that reported in open studies (<1 percent). Most abdominal wall recurrences occurred in the learning curve period, suggesting that surgical experience may play a role in the development of this outcome. The prognosis of these patients is very poor.

Abdominal Muscles↗
PubMed2002

Does adrenal mass size really affect safety and effectiveness of laparoscopic adrenalectomy?

OBJECTIVES: To evaluate the effectiveness and safety of laparoscopic adrenalectomy with regard to adrenal mass size, as well as to consider its clinical and pathologic patterns. Laparoscopy is today considered the first-choice treatment of many adrenal diseases, although its use is still controversial for large adrenal masses and incidentally found adrenal cortical carcinoma. METHODS: A total of 125 patients underwent lateral transperitoneal laparoscopic adrenalectomy. The indications were either functioning or nonfunctioning adrenal masses, without any radiologic evidence of involvement of the surrounding structures. The correlation between the size and the operative times, estimated blood loss, incidence of intraoperative and postoperative complications, and length of hospital stay were studied with Pearson's correlation coefficient, Fisher's exact test, and the chi-square test. The analysis of variance test was used to evaluate any possible correlation between the size and clinicopathologic features and the results. RESULTS: A slight correlation was observed between the size and operative time (P = 0.004), but no correlation was observed between the size and the other parameters. Statistical analysis showed a significant correlation between the clinicopathologic patterns (nonfunctioning benign adrenal masses, Conn's adenoma, Cushing's adenoma, pheochromocytoma, adrenal cortical cancer, and other tumor metastasis) and the operative time (P = 0.011), but not with the other parameters. CONCLUSIONS: Laparoscopic adrenalectomy is also effective and safe for large lesions. The results of our series confirms that the risk of encountering an incidental adrenal cortical cancer is significantly increased for large lesions, and therefore, in these cases, additional attention is required to observe oncologic surgical principles.

Adolescent↗
PubMed2001

Gasless laparoscopy could avoid alterations in hepatic function.

BACKGROUND: In a previous clinical study, we showed that the duration and level of pneumoperitoneum are responsible for changes in hepatic function during laparoscopic procedures. These findings encouraged us to evaluate hepatic function during laparoscopy with and without carbon dioxide (CO(2)) pneumoperitoneum in a clinical setting. METHODS: We performed 63 laparoscopic cholecystectomies and 30 non-hepatobiliary laparoscopic procedures in 93 consecutive patients with normal preoperative liver function tests. The anesthesiologic protocol was uniform, using drugs at low hepatic metabolism. We performed laparoscopic cholecystectomies in 43 patients with a pneumoperitoneum; in the remaining 20, we used a gasless technique. We randomized the 43 laparoscopic cholecystectomies into 23 performed with pneumoperitoneum at 14 mmHg and 20 performed at 10 mmHg. All non-hepatobiliary laparoscopic procedures were performed with a pneumoperitoneum of 14 mmHg. The postoperative serologic levels of AST, ALT, and bilirubin, and the prothrombin time were measured at 6, 24, 48, and 72 h. The alterations in the serologic hepatic tests were then related to the type of procedure, its duration, and the level of pneumoperitoneum. RESULTS: The study group was comprised of 93 patients, 39 male and 54 female, with a mean age of 50.5 years (range, 15-74). There were no deaths. There was no morbidity in the pneumoperitoneum group, but there was one case of accidental omental injury during the placement of the abdominal, wall retractor in the gasless group. All patients had postoperative changes in serologic hepatic tests. Slow return to normality occurred 48 or 72 h after the operation. The increase in AST and ALT was statistically significant and correlated to the level and duration of pneumoperitoneum. The serologic change in the gasless group were significantly lower than in the laparoscopic cholecystectomy group with pneumoperitoneum at 14 mmHg. There was no statistically significant difference between the gasless group and the laparoscopic cholecystectomy group with pneumoperitoneum at 10 mmHg. There was a statistically the significant increase in the non-hepatobiliary laparoscopy group over the gasless group, despite the absence of hepatobiliary injuries in the first group. No symptoms were related to these serologic hepatic changes. CONCLUSIONS: The gasless technique causes smaller alterations in serological hepatic parameters than pneumoperitoneum at 14 mmHg. By contrast, the gasless technique and low-pressure pneumoperitoneum have the same effect on hepatic function. Therefore, the use of a subcutaneous abdominal wall retractor combined with a low-pressure pneumoperitoneum is recommended for patients with severe hepatic failure. Transaminases

Adolescent↗
PubMed2001

Human CD38 and its ligand CD31 define a unique lamina propria T lymphocyte signaling pathway.

CD38, a nonlineage-restricted surface glycoprotein, is an ecto-enzyme (ADP ribosyl cyclase/cADPR hydrolase/EC 3.2.2.6) that regulates cytoplasmic Ca2+ and cell-cell interactions. The molecule also delivers trans-membrane signals, despite a structural ineptitude to the scope. To reconcile these issues in a unitarian model, we compared the effects of CD38 signaling in circulating and residential T lymphocytes, the latter represented by those colonizing the intestinal lamina propria. Results are as follows: 1) LP T cells express an enzymatically active form of CD38, characterized by a modified ratio between cyclase and hydrolase functions; 2) LP T cells do not mobilize Ca2+ upon CD38 ligation, as seen in PB T cells (this condition is due to a lack in activation of PLC- g, constantly observed in PB T lymphocytes); 3) The early steps of CD38 signaling involve activation of lck, syk, and LAT; 4) Late events include synthesis and release of IL-2, IL-4, IL-5, IL-10, IFN-g and GM-CSF; 5) The uniqueness of the CD38 pathway in LP T cells is not caused by impaired interactions with the CD31 ligand. The differences observed concern the signaling machinery that CD38 exploits for its own use and not the interplay with its ligand.

ADP-ribosyl Cyclase↗
PubMed2001

Transperitoneal laparoscopic adrenalectomy: experience in 72 procedures.

PURPOSE: To evaluate the safety and effectiveness of transperitoneal laparoscopic adrenalectomy for a variety of adrenal diseases. PATIENTS AND METHODS: Seventy-two patients underwent laparoscopic adrenalectomy from January 1995 until March 1999. The indications for the treatment were limited to either functioning or nonfunctioning adrenal masses without radiologic evidence of involvement of the surrounding tissues. The indication for bilateral adrenalectomy was Cushing's disease after the failure of other therapies or Cushing's syndrome secondary to ectopic ACTH secretion without the discovery of a primary neoplasm. RESULTS: Thirty-five of the adrenalectomies were performed on the left side and 33 on the right side, and 4 were performed bilaterally. The right-sided procedures required a mean operating time of 130 minutes (range 85-200 minutes), the left-sided procedures required a mean operating time of 140 minutes (range 95-200 minutes), and the bilateral procedures required a mean operating time of 240 minutes (range 210-290 minutes). A conversion from laparoscopy to laparotomy was necessary for 3 patients (4%). Intraoperative complications were reported in 6 patients (8%). Postoperative complications likewise occurred in six patients. CONCLUSIONS: These procedures proved to be safe and able to remove the majority of either functioning or nonfunctioning benign adrenal masses. Some controversy remains regarding the safety of laparoscopic adrenalectomy for large lesions and the safety of bilateral laparoscopic adrenalectomy because of bleeding risks, anesthetic risks, and long operative times. The effectiveness of laparoscopic adrenalectomy for nonfunctioning adrenal masses with histologic findings of carcinoma has not yet been proved.

Adolescent↗
PubMed2000

Solitary fibrous tumour of the adrenal gland associated with pregnancy.

Solitary fibrous tumour (SFT), first described as a pleural lesion, has been reported in several extrathoracic sites over the past 10 years. We describe a SFT of the left adrenal gland incidentally discovered in a 23-year-old, 22-week pregnant woman and characterised by a rapid growth during the third trimester of pregnancy. Elevated serum and urinary levels of cortisol and elevated blood levels of delta 4 androstendione and 17-OH progesterone were observed. After spontaneous delivery, the patient underwent laparoscopic resectioning of the mass and of the left adrenal gland from which the tumour was apparently originating. The kidney was not involved, and no other abdominal tumours were found. Histological and immunohistochemical features were typical of SFT of pleura and other locations. Only one case of adrenal SFT is on record, and the adrenal gland is to be added to the long list of extrathoracic locations of SFT. The association with pregnancy was a previously unrecognised event in SFT. The focal expression of progesterone receptors in the tumour cells may be related to pregnancy. This observation prompted an analysis of steroid hormone receptors in SFT of classical sites (pleura). Two of five cases had focal progesterone receptors too, a finding which deserves further investigations in a much larger series of SFTs.

Adrenal Gland Neoplasms↗
PubMed2000

Education as a clinical tool for self-dialysis.

Therapeutic compliance and patient education are presently considered crucial parts of end-stage renal disease (ESRD) therapy. In the center where Italian home and self-care dialysis treatment started, an education program was designed as multi-step pathway--following patients from chronic renal failure to dialysis and eventual graft--employing lessons, booklets, and books. Each step was validated in various subsets of patients. Lessons involved two hours of informal discussion on the main aspects of ESRD and renal replacement therapy (RRT); booklets were created from tape recordings of the lessons. Patient participation was good, with 28 of 33 patients on charge in the center for 6 months or more taking part in more than one lesson in 1999. In 16 of 16 patients who answered a questionnaire after two lessons, expressed opinion was "good" to "fair." All asked for further material. With regard to books, 500 copies of the book What does dialysis mean? were given out in the region; this book was validated in 22 patients on peritoneal dialysis (PD) and 18 on hemodialysis (HD). It helped patients to accept dialysis in 65% of cases and to comprehend it in 90%. Four thousand copies of the book Stories, containing 18 interviews on transplantation, were printed, and this book was validated in 21 patients on self-care and 35 on hospital dialysis (potential candidates for graft). Of 56 patients, 53 asked for further material; 19 changed their initial opinion (10 choose transplantation, despite initial skepticism; 9 put off transplantation, despite initial acceptance). On a local scale, the program led 12 of 18 new patients, who followed at least part of the program, to choose self-dialysis (PD, home, and self-care dialysis).

Adult↗
PubMed2000

Laparoscopic cholecystectomy in cirrhosis: contraindication or privileged indication?

Until recently, cirrhosis has been considered to be an absolute or relative contraindication of laparoscopic cholecystectomy. An evaluation of benefits and risks of laparoscopic cholecystectomy in the treatment of gall bladder lithiasis in cirrhotic patients is presented. Thirty-three consecutive laparoscopic cholecystectomies in patients with cirrhosis were performed between March 1990 and March 1997. During the same period, no open cholecystectomy was performed in patients with cirrhosis. There was no morbidity or mortality; the conversion rate was 6% (2/33). No patient received blood transfusion, and the mean hospital stay was 2.8 days. These results favorably compare with the results of open cholecystectomy. Specific advantages of laparoscopic cholecystectomy in patients with cirrhosis include the absence of wound infection and a lower rate of postoperative hepatic failure. Finally, laparoscopic surgery reduces the risk of viral contamination (the hepatitis B virus, the hepatitis C virus, or the human immunodeficiency virus) of the surgical staff.

Adult↗
PubMed1999

Endoscopic palliative treatment of advanced pancreatic cancer: thoracoscopic splanchnicectomy and laparoscopic gastrojejunostomy.

DESIGN: Evaluation of thoracoscopic splanchnicectomy and laparoscopic gastrojejunostomy as endoscopic palliative treatment of advanced pancreatic cancer. PATIENTS AND METHODS: Between November 1993 and September 1998 we performed 16 thoracoscopic splanchnicectomies and 6 laparoscopic gastrojejunostomies in patients with an advanced pancreatic cancer admitted to the Department of Surgery of University Hospital Rotterdam-Dijkzigt. These patients either did not achieve adequate pain control with medication or presented serious problems of gastric outlet obstruction, or both. RESULTS: There were fourteen patients (9 men and 5 women) with mean age of 51.8 years (range 28-83), mean BMI of 21.1 (range 17.2-27.2), ASA score I in 2, II in 11, III in 1. We performed 2 left, 2 right and 4 bilateral thoracoscopic splanchnicectomies, 4 laparoscopic gastrojejunostomies and 2 combined endoscopic procedures (bilateral thoracoscopic splanchnicectomy and laparoscopic gastrojejunostomy). The overall average operation ("skin to skin") time was 86 minutes (range 75-100) for bilateral thoracoscopic splanchnicectomies, 63 minutes (range 60-65) for unilateral splanchnicectomies, 88 minutes (range 65-115) for laparoscopic gastrojejunostomies and 190 minutes (range 180-200) for the combined procedure. Blood loss was insignificant with a median of 50 ml (range 30-150). The conversion's rate to open surgery was 4.5%. There were no intraoperative complications. The overall average postoperative mobilization was in 1.9 days (range 1-4) and the overall median postoperative hospital stay was 7 days (range 2-24). There was no mortality at 30 days after endoscopic procedures and the morbidity rate was 21.4%. The postoperative analgesic requirement was considerably reduced with a successful rate was 83.3%. The resolution of gastric outlet obstruction has been complete in all laparoscopic gastrojejunostomies. CONCLUSIONS: Our results show the feasibility and safety of these minimally invasive approaches such as endoscopic palliative treatment of complications of advanced pancreatic cancer.

Adult↗
PubMed1998

Alterations in hepatic function during laparoscopic surgery. An experimental clinical study.

BACKGROUND: Very few studies have been done on the consequences of pneumoperitoneum on hepatic function. At present, there is no consensus on the physiopathological hepatic implications of pneumoperitoneum. The purpose of this clinical study was to evaluate the effects of pneumoperitoneum on hepatic function in 52 patients treated with laparoscopic procedures. METHODS: Thirty-two laparoscopic cholecystectomies and 20 nonhepatobiliary laparoscopic procedures were performed in 52 patients (12 men and 40 women) with a mean age of 44 years (range, 15-74). All patients had normal values on preoperative liver function tests. The anesthesiologic protocol was uniform, with drugs at low hepatic metabolism. The 32 cholecystectomies were randomized into 22 performed with pneumoperitoneum at 14 mmHg and 10 performed at 10 mmHg. All nonhepatobiliary laparoscopic procedures were performed with a pneumoperitoneum of 14 mmHg. The postoperative serologic levels of AST, ALT, bilirubin, and prothrombin time were measured at 6, 24, 48, and 72 h. The serologic changes were related to the procedure, the duration, and the level of pneumoperitoneum. RESULTS: Mortality and morbidity were nil. All 52 patients had a postoperative increase in AST, ALT, bilirubin, and lengthening in prothrombin time. Slow return to normality occurred 48 or 72 h after operation. The increase of AST and ALT was statistically significant and correlated both to the level (10 versus 14 mmHg) and the duration of pneumoperitoneum. CONCLUSIONS: The duration and level of intraabdominal pressure are responsible for changes of hepatic function during laparoscopic procedures. Although no symptom appears in patients with normal hepatic function, patients with severe hepatic failure should probably not be subjected to prolonged laparoscopic procedures.

Adolescent↗
PubMed1997

[The complement system in kidney diseases].

The multifaceted relations between complement system and immune-mediated nephropathies are reviewed. Several conditions in which either the complement activation induces renal damage without hypocomplementemia or hypocomplementemia occurs in the absence of circulating IC are reported as well as disorders in which immune complexes promote hypocomplementemia. The complement system is involved in the clearance of immune complexes, both modifying the immune complex size and favouring the physiologic neutralization by the erythrocyte transport system. In certain pathological conditions the immune complex intrinsic characteristic or genetic abnormalities prevent efficient removal from the blood stream. The purpose of the present review is to summarize these conditions, briefly describing their pathological consequences, and indicate a simple scheme to correctly interpret the biochemical abnormalities of the complement system in nephropathology.

Complement System Proteins↗
PubMed1995

Report on intensive treatment of extracapillary glomerulonephritis with focus on crescentic IgA nephropathy.

UNLABELLED: PURPOSE AND DESIGN OF STUDY: In this retrospective analysis the effects of combined treatment with steroid pulses, cyclophosphamide and plasma exchange on six crescentic IgA glomerulonephritis (IgAGN) patients, selected on a histological basis, were examined. The histological criteria included involvement of more than 40% of glomeruli by cellular crescents. The effects of this treatment were compared to those observed in three untreated crescentic IgAGN patients and 12 treated patients who had extracapillary glomerulonephritis of different origins, i.e. ANCA-associated systemic or renal-limited vasculitis. All patients, except the three crescentic untreated IgAGN patients, received the same 2-month treatment according to a standardized protocol: steroid boli 15 mg/kg methylprednisolone for 3 consecutive days by intravenous infusion, followed by prednisone per os (1 mg/kg/day for 4 weeks, 0.75 mg/kg/day for 4 more weeks), cyclophosphamide per os 2.5 mg/kg/day for 8 weeks, and plasma exchange. RESULTS: After this 2-month course of therapy, substantial clinical improvement was observed in both IgAGN and vasculitis patients. However, a second biopsy revealed that florid crescents persisted in IgAGN patients and, unlike the vasculitis group, during the long-term the initial clinical amelioration disappeared in one-half of the treated IgAGN cases. Nevertheless, even in the progressive cases, intensive treatment seemed to substantially delay the onset of dialysis. CONCLUSIONS: Despite some clinical benefits of therapy, short-term reversal of active crescents appears less likely to occur in crescentic IgAGN than in vasculitis-associated crescentic GN. Intensive treatment seems sufficient to arrest, but inadequate to reverse, phlogistic lesions in IgAGN before development of chronic changes.

Adolescent↗
PubMed1991

Classic and perinuclear anti-neutrophil cytoplasm antibodies and antimyeloperoxidase antibodies in rapidly progressive glomerulonephritis.

Classic anti-neutrophil cytoplasm antibodies (cANCA), perinuclear ANCA (pANCA) and antibodies directed against myeloperoxidase (MPO-Ab) were evaluated in 25 patients with either idiopathic or secondary rapidly progressive glomerulonephritis (RPGN). While cANCA were found almost exclusively in Wegener's granulomatosis, pANCA were detectable in several disorders, including microscopic polyarteritis (mPA), but also idiopathic RPGN. MPO-Ab were frequently found in sera from patients with all types of idiopathic but not of secondary RPGN. These results support the hypothesis that some cases of RPGN are early or limited forms of systematic vasculitis. We then looked for the presence of IgA-ANCA in Henoch-Schoenlein purpura (HSP): we found IgA-ANCA with immunoenzymatic assay but not with immunofluorescence in HSP, in primary IgA-GN and in membranous GN as well, thus suggesting the poor specificity of this type of ANCA. The possible pathologic implications of ANCA were examined in vitro. Serum samples from several patients with ANCA were assessed for their capacity to enhance chemiluminescence generation from resting or PMA-stimulated macrophages. Sera from RPGN and mPA patients displaying anti-MPO activity induced granulocytes to enhance the production of oxygen free radicals, thus suggesting a phlogistic effect of MPO-Ab positive sera.

Adult↗
PubMed1985

Acute effects of hemodialysis on erythrocyte sodium fluxes in uremic patients.

The acute effects of both acetate and bicarbonate hemodialysis on erythrocyte transmembrane sodium fluxes were investigated in 15 patients with chronic uremia. We observed a significance (p less than 0.01) stimulation of the Na+,K+ pump in both procedures, with a significant correlation to the amount of fluid removed during hemodialysis (r = 0.56, p less than 0.03). Outward Na+ cotransport fluxes significantly rose (p less than 0.05) after acetate hemodialysis and decreased (p less than 0.05) after bicarbonate hemodialysis. Minor and not significant pre- and posthemodialysis bidirectional changes were observed as regards the intraerythrocyte Na+ and K+ concentration, passive Na+ and K+ permeability, and Na+,Li+ countertransport. Hemodialysis may acutely affect the erythrocyte sodium pump and cotransport fluxes, possibly through the modulation of hormonal factors triggered by the extracellular volume changes.

Acetates↗