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Biomedical subjects

P Granone

Publications and source records attributed to P Granone.

47 records · Page 3Linked to original sources
PubMedDate not supplied

Sutureless cholecystojejunostomy in pigs using an absorbable intraluminal stent and fibrin glue.

The absence of foreign bodies in sutureless anastomoses provides faster healing. The first sutureless cholecystojejunostomies were reported by Murphy in 1892. The common bile duct was tied and 11 cholecystojejunostomies plus 12 jejunojejunostomies were performed in 12 Landrace pigs employing sliding absorbable intraluminal nontoxic stents (SAINTs) and fibrin glue. One cholecystojejunostomy was not performed owing to a gallbladder morphologic anomaly. Three animals died of problems unrelated to the SAINT-glue anastomoses. Of the 18 anastomoses in the 9 remaining animals, all were patent at the verification times of 14, 30, 120, and 480 days. Morphologically,there was greater edema and reduced height of the glandular epithelium in the 30-day CJs when compared to the jejunojejunal anastomoses. Results indicate that the sutureless SAINT-fibrin glue procedure is quite versatile and may be utilized for cholecystoenteric anastomoses.

Anastomosis, Surgical↗
PubMedDate not supplied

Sliding, absorbable, reinforced ring and an axially driven stent placement device for sutureless fibrin glue gastrointestinal anastomosis.

Reduced blood flow of from 43 to 71% has been reported in sutured and stapled anastomoses. The sutureless sliding, absorbable, intraluminal, nontoxic stent (SAINT)-fibrin glue anastomotic method, which clamps the stump margins between 2 dissolving surfaces, includes only two stages of temporary compression (about 6 min total using 4 IU/mL thrombin) during the glue application in order to promote vascularization. A SAINT placement device (SAINT-PD) was introduced to facilitate low rectal anastomoses. Morphohistologic results from limited trials using fibrin glue with an untied sutureless stapler technique and a prototype non-gear-driven SAINT-PD, neither having the two dissolvable clamping surfaces of the SAINT, showed a 29 and 25% incidence of intraluminal tissue ridges, respectively. Since these tissue ridges could result in subclinical dilatation or frank stenosis, and the more extensive SAINT trials had an 8% incidence of tissue ridges, redesign of the SAINT-PD was undertaken. Consequently, to improve the anastomotic quality of the SAINT-PD, the sliding absorbable reinforced ring (sucrose base) acting as the second dissolvable surface for the SAINT-PD and a new axially controlled geared SAINT-PD design are described.

Anastomosis, Surgical↗
PubMedDate not supplied

Biological characterization of central and peripheral primary non small cell lung cancers (NSCLC).

BACKGROUND: Non Small Cell Lung Carcinomas (NSCLC) comprise 90% of all lung carcinomas. Studies have demonstrated a preferential central (bronchus-derived) localization for squamous cells, whereas adenocarcinomas are frequently peripheral (bronchiolo-alveolus derived). It has been suggested that exposure to carcinogenic insults including cigarette smoke, may induce different types of tumors in different locations. MATERIALS AND METHODS: Forty one NSCLC patients staged according to WHO and TNM were considered for localization and biological parameters (p53 expression, cell ploidy and S-phase). RESULTS: p53 overexpression was found more frequently in central than in peripheral tumors (69% vs 39%) (p = 0.074). Central tumors were more aneuploid (69%) than peripheral ones (46%) (p = 0.03) No difference in smoking habit was observed in the two groups. CONCLUSIONS: Our results suggest that there is no apparent biological difference between these two groups of NSCLCs, and that the smoking does not play a role in either histotype determination or biological behavior.

Adenocarcinoma↗
PubMedDate not supplied

[The prognostic role of anatomo-pathological factors in colorectal cancer: an univariate analysis].

An univariate analysis of pathologic data of 987 patients with primary colorectal carcinoma treated over a period of 22 years was performed. Six variables such as tumor site, histologic type, depth of invasion, nodal involvement, distant metastases, histologic grade and tumor stage were tested for their prognostic value. 5-year survival rate was investigated. Patients with tumors in the left colon and rectum have shown a better prognosis than patients with tumors in the right colon (53-51% vs. 38% p = 0.0007). As regard histologic type non significant differences between mucinous and non-mucinous carcinoma was observed (44% vs 48% respectively p = 0.4). The depth of tumor invasion was an important prognostic factor; according to tumor infiltration patients can be divided in four groups (T1, T2, T3, T4) with 5-year survival rates of 80%, 74%, 39% and 16% respectively (p = 0.0000). Highly significant decrements in survival occurred when lymph node metastases were demonstrable (20% vs. 67% p = 0.0000). Prognosis was still strongly related to histologic grade, with significant difference in survival rates between G1 and G2-G3 tumors (71% vs. 48%-42% p = 0.0000). Finally prognosis was closely related to the stage of spread at the time of diagnosis.

Adenocarcinoma↗
PubMedDate not supplied

[Hartmann's procedure in emergency surgery of the colorectum].

The authors report their experience with Hartmann procedure. 28 patients were treated: 21 males and 7 females. The mean age was 58 years. Perforative diverticulitis was the commonest indication (14 patients), followed by carcinoma (11 patients). Miscellaneous causes accounted for 3 patients. This procedure was primarily performed as an emergency operation (71%). One patient died post-operatively (3.5%); post-operative morbidity was 10.7%. A second operation was not planned if the first operation had been performed for palliation of metastatic or locally advanced cancer (7 patients). Restoration of colonic continuity was achieved successfully in 14 patients with no mortality and morbidity. According to their experience, authors believe Hartmann procedure to be the most suitable operation facing a left colon emergency. It is usually easy to perform and well tolerated by poor risk patients.

Anastomosis, Surgical↗
PubMedDate not supplied

Therapeutic and prognostic problems in lung cancer with mediastinal lymph node involvement.

From January 1st, 1978 to 31st December, 1981, 28 patients with lung cancer and mediastinal lymph node metastases, underwent surgery. In four patients, only exploration was performed, in five patients, an incomplete resection and in 19 patients, a complete resection (resectability rate 86%). In the first two groups of patients, survival never exceeded two years. In the 'complete resection' group, 78% of the patients survived for one year, 61% for two years and 47% for three years. Patients with adenocarcinoma had a higher three year survival rate than those with squamous cell carcinoma (60% vs. 37%). No 30-day mortality was observed. All patients were treated postoperatively with MACC + BCG. The prognosis of lung cancer classified as N2 is strongly influenced by a series of factors some of which are included in the TNM system. In any case, it would still appear that the best treatment for this kind of tumor is radical surgical resection followed by adjuvant radiotherapy and/or multichemotherapy.

Adenocarcinoma↗
PubMedDate not supplied

Surgery of rectal cancer (technical observations).

The evolution of the surgical management of rectal cancer is briefly reviewed. Factors which influence the choice of the surgical procedure relatively to the tumor characteristics, are examined. The role played by preoperative staging as the basis of a correct therapeutic approach is underlined. Most common surgical procedures in rectal cancer treatment are reported, and emphasis is put on aspects of particular interest for radiodiagnosticians and radiotherapists.

Humans↗
PubMedDate not supplied

Prosthetic reconstruction of the chest wall.

Since January 1987, in a consecutive series of 56 resections of the chest-wall for cancer, the wall defect was repaired by a prosthetic implant on 14 occasions (10 silastic sheeting, 4 goretex soft tissue patch). Indications for thoracic wall resection were: T3 primary lung cancers (7 cases), local recurrences after breast cancer surgery (5 cases), primary and metastatic neoplasms arising in the chest-wall (2 cases). No rejection was reported nor episodes of flail chest or respiratory disorders. No major complications occurred in patients who underwent postoperative radiotherapy; only 1 case of persistent seroma was observed. Followup ranges from 3 to 37 months. In no case was a local recurrence of tumor observed. Cosmetic results were considered from acceptable to good in all patients. In every case a total control of pain symptoms was achieved. There were 6 deaths at a mean interval of 22 months from operation (4 lung cancers, 1 breast cancer, 1 osteosarcoma), all due to metastatic spread of the disease.

Breast Neoplasms↗
PubMedDate not supplied

Intraoperative esophageal manometry in surgical treatment of achalasia: a reappraisal.

BACKGROUND/AIMS: Intraoperative Esophageal Manometry is used during surgery for gastroesophageal reflux disease to obtain a better lower esophageal sphincter pressure, or during the Heller procedure for achalasia to verify the myotomy. The effectiveness of this manometry is not explicit. MATERIAL AND METHODS: From 1977 to 1987, 58 patients underwent surgery for achalasia at our Institution. A transabdominal Heller's myotomy and a modified Dor's anterior fundoplication were performed in all cases. During the operation, Lower Esophageal Sphincter Pressure was measured in 38 patients (A group) to verify the completeness of the càr-diomyotomy; the fundoplication-induced pressure increase was also recorded. Twenty patients (B group) underwent surgery without intraoperative manometry. Forty-six patients (30 of A group and 16 of B group) were followed up for 24 to 120 months (median 68 months) by means of a clinical questionnaire, barium meal, manometry and 24-hour esophageal pH monitoring. RESULTS: In 21 cases, intraoperative manometry showed the completeness of the myotomy at the first record, while in the remaining 17 it revealed the persistence of a High Pressure Zone; in these, a more accurate incision of the muscle layers on the anterior surface of the esophagus was subsequently performed up to a complete abolition of the HPZ. Long-term results were excellent or good in 27 (90%) patients of A group and in 9 (56%) patients of B group. Dysphagia and gastro-esophageal reflux were the commonest findings in patients with poor results. CONCLUSION: The usefulness of intraoperative manometry in the surgical treatment of achalasia is emphasized and some technical details are reported.

Adult↗
PubMedDate not supplied

Surgical management of pulmonary tuberculosis.

Surgery for pulmonary tubercolosis (PTB) is now the second place treatment. Among the surgical indications the most debated is the multi-drug resistance of a focal pulmonary tuberculous disease. Other indications are: bronchiectasis, hemoptysis and the presence of a broncho-pleural fistula. Pulmonary Aspergilloma is a frequent indication for surgery; it is commonly a PTB sequela and causes severe complications. The presence of an unknown pulmonary mass or nodule is a surgical criterion because it might signal a cancer. Surgery therefore now constitutes a valid option for the treatment of clinical patterns of PTB unresponsive to medical treatment in severe, potentially fatal clinical conditions.

Aspergillosis↗