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L Gennari

Publications and source records attributed to L Gennari.

173 records · Page 10Linked to original sources
PubMedDate not supplied

Cavitron Ultrasonic Surgical Aspirator (CUSA) in liver resection.

At the Istituto Nazionale Tumori of Milan, the Cavitron Ultrasonic Surgical Aspirator (CUSA) was employed to perform hepatic resections in 34 patients with primary or secondary liver tumors. The use of CUSA has proved to be very efficient and safe. In lobectomies and extended lobectomies average bleeding was 685 cc with a mean resection time of 28 minutes. In segmentectomies, average bleeding was 540 cc with a mean resection time of 22 minutes. Comparing these data with those we previously obtained in hepatic resections using traditional methods (digitoclasia), it appears that despite overall operative times suffering no significant variation, a considerable reduction in bleeding was obtained, together with a notable fall in post-operative complications.

Adolescent↗
PubMedDate not supplied

[Adjuvant chemotherapy of colorectal carcinoma].

Clinical studies on adjuvant chemotherapy in colorectal cancer started 30 years ago, but some proof of its effectiveness did not come until recently. Only randomized prospective studies can provide definite evidence in this regard. Obviously, the potential value of an effective adjuvant treatment for a frequent disease such as colorectal cancer is enormous. Randomized studies had failed to provide evidence in favour of adjuvant chemotherapy in colon cancer until a recently reported study on 5-fluorouracil and levamisole. As of today, the latter regimen may be considered as the reference one for adjuvant chemotherapy in Dukes C colon cancer. In rectal cancer some studies displayed statistically significant results in favour of adjuvant chemotherapy: however, sufficient data are still unavailable to support adjuvant chemotherapy as standard treatment. On the contrary, postoperative radiotherapy is definitely effective in decreasing local relapses. Studies are underway on the combination of chemotherapy and radiotherapy in rectal cancer. In addition to systemic chemotherapy, portal infusion of cytotoxic drugs has been tested in colorectal cancer. Controlled studies are underway, but available results would not seem to support regional treatment. Recent improvement in the chemotherapy of advanced colorectal cancer has probably occurred through the pharmacologic modulation of 5-fluorouracil by leucovorin. If this will be confirmed, one will be able to resort to more effective multidrug regimens than those tested so far and an improvement in adjuvant chemotherapy may be anticipated too.

Antineoplastic Combined Chemotherapy Protocols↗
PubMedDate not supplied

Comparison of nutritional status after total or subtotal gastrectomy.

Forty-four disease-free patients were evaluated a mean of three years after total gastrectomy (TG) or subtotal gastrectomy (SG) for cancer. The investigation encompassed nutritional assessment by standard anthropometric and biochemical indices; evaluation of the nutritional intake based on 24 h recall and of appetite status on a visual analogue scale; and anamnestic analysis of postcibal symptoms and syndromes. Body weight had declined progressively until the 15th postoperative month after both TG and SG. Weight loss, as well as the general nutritional status index (actual body weight/usual body weight +/- actual body weight/desirable body weight + measured arm muscle circumference/reference arm muscle circumference x 33), had dropped more significantly in patients undergoing TG than those having SG (p less than 0.05). The principal body compartment change was observed in the fat content which was severely depleted, whereas the somatic proteins were relatively spared and the visceral proteins and remaining biochemical variables were in the normal range. Protein intake was not significantly different in the two groups, but caloric intake was significantly lower and the number of meals significantly higher after TG (p less than 0.05). These data suggest that malnutrition after TG is relatively mild and that this operation causes only a limited impairment of the nutritional state, and spares most of the nutritional variables of clinical interest in comparison with SG. These findings argue in favor of TG when clinically indicated without excessive concern about postoperative nutrition.

Adult↗
PubMedDate not supplied

Prognostic factors for survival and disease-free survival in hepatic metastases from colorectal cancer treated by resection.

The prognostic factors of 219 patients submitted to Ro hepatic resection for colorectal metastases have been statistically analyzed. The overall 5-year actuarial survival rate was 24% and the 5-year disease-free survival rate was 18%. At univariate analysis four variables resulted significant: 1) The stage of primary colorectal cancer: if the meserentic lymph nodes were metastatic (Dukes C) or uninvolved (Dukes B) 5-year survival was respectively 16 and 38% (p < 0.001). 2) The percentage of hepatic replacement: the 5-year survival rate of patients with H1 (< 25%), H2 (25-50%) and H3 (> 50%) was 27, 16 and 8% respectively (p < 0.001). 3) The number of metastases: the 5-year survival of patients with 1, 2-3, > 3 hepatic nodules was 29, 21 and 17% respectively (p < 0.05). 4) The extent of surgical resection: 5-year survival after minor and major resection was 28 and 18% respectively (p < 0.05). At multivariate analysis only stage of primary and percentage of hepatic replacement retained statistical significance. In 60% of 154 patients with recurrent disease the liver was again involved.

Analysis of Variance↗
PubMedDate not supplied

[Study on diagnostic and therapeutic behavior in tumors of the medial-lower third of the rectum in 2 Italian regions].

The authors report about a survey on the behaviour of 51 departments of surgery in Lazio and Lombardia as to diagnosis, staging and therapy of carcinoma of the medium-lower one-third of the rectum. A set of 722 patients treated in 1993 was considered. A questionnaire was distributed and answers collected about the staging protocols, the therapeutic choices and some details of surgical technique as the ligation of the lower mesenteric artery or the extent of the lymphadenectomy. The results indicate some stable trends as to preoperative study (digital examination and fibre optic endoscopy in almost all cases) and as to the choice of the technique of anastomosis (43.1% of termino-terminal stapled anastomosis). Intrarectal ultrasound gains consensus but is still not much diffuse (18.6% of cases). Almost all of the participating Institutions agreed in joining further prospective studies.

Endoscopy↗
PubMedDate not supplied

[Liver metastasis. Clinico-pathological prognostic factors in metastasis from colorectal cancer].

Hepatic Metastases (HM) from colorectal cancer represents one of the main problems of oncologic treatment: from 80 to 90 percent of patients undergo chemotherapy and a minority hepatic resection. The natural history of patients with unresectable HM has been recently investigated by uni and multivariate analyses; the percentage of hepatic replacement, the stage and grade of primary colorectal tumours, alkaline phosphatase and the presence of extrahepatic disease proved to be the most important independent prognostic factors. Albumin and carcino-embryonic antigen (CEA) levels, age and weight loss of patients were also prognostic. The groups of patients with more favourable factors had a median survival ranging from 21 to 35 months, in contrast to a median survival of 4 to 8 months for those with adverse factors. The outcome of more than 3400 patients submitted to hepatic resection, has been investigated. At multivariate analysis twelve variables resulted independently related to prognosis: stage of primary tumour, extent of liver involvement and presence of extrahepatic metastases were considered to be the most important. The knowledge of prognostic factors is extremely important in selecting patients candidated to various treatments, to interpret the results and to plan new therapeutic strategies.

Colorectal Neoplasms↗
PubMedDate not supplied

[Liver metastasis: therapeutic strategy].

The liver is one of the most frequent sites of metastatic growth, in particular from digestive malignancies (DM). The first goal is to reduce the incidence of metastases. Adjuvant systemic chemotherapies have been demonstrated to reduce the recurrence rate and to improve survival in Dukes C colon cancer. Fluorouracil is the pivot of adjuvant treatment modulated by Leucovorin or Levamisol. A short postoperative administration of fluorouracil by intraportal route has been tested, but the results are controversial. Adjuvant treatments for different DM are under investigation. When hepatic metastases are clinically evident, therapeutic decisions depend on several factors: site and nature of primary, extent of hepatic and extrahepatic disease, patient characteristics, efficacy of treatments. A staging system should be adopted to allow a rational approach. In selected cases a locoregional treatment can achieve consistent results. Hepatic Intrarterial Chemotherapy (HIAC) for colorectal metastases achieves objective responses in more than 50% of patients. Survival seems positively affected. When feasible, Ro hepatic resection is the most effective treatment, five-year survival rate being about 30% when metastases are from colorectal cancer. Since the liver is the most frequent site of recurrence after resection, repeat resection have been successfully performed.

Humans↗