Search PubMed⌕ Search

Biomedical subjects

R Coppola

Publications and source records attributed to R Coppola.

187 records · Page 11Linked to original sources
PubMedDate not supplied

Early graft failure after heart transplantation: management by extracorporeal circulatory assist and retransplantation.

Early graft failure represents a serious complication after orthotopic heart transplantation. Various modes of extracorporeal mechanical circulatory assistance, however, allow for "bridging" to heart retransplantation in these instances. We report a case of bridging to heart transplantation by means of intraaortic balloon counterpulsation. After transplantation a right ventricular assist device was required because of early graft failure while the intraaortic balloon pump was left in place. A retransplantation was successful, and 13 months after the operation the patient is in New York Heart Association functional class I. The cause of early graft failure, especially the tendency toward failure of the right ventricle, is not well understood and seems to be multifactorial, which suggests that an elevated pulmonary vascular resistance in the recipient possibly represents a considerable risk factor. Bridging to heart retransplantation with the use of extracorporeal blood pumps can be performed effectively.

Assisted Circulation↗
PubMedDate not supplied

[Prognostic factors in local-regional recurrences of colorectal neoplasms].

PURPOSE: The aim of this study was to evaluate, in a group of patients suffering of colo-rectal cancer, the influence on local recurrence of some clinical and anatomo-pathological variables. METHODS: The study was limited to 833 patients who underwent potentially curative resection and have been followed for at least two years. All patients were evaluated every six months for the first three years and yearly thereafter by means of clinical, laboratory, endoscopic and radiological investigations. Recurrence was observed in 78 patients (9.4%); 19 of these had evidence of distal failure simultaneously (2.2%). The incidence was 2.4% and 17.7% in the carcinoma of the colon and rectum respectively. Median time of recurrence was 16 +/- 11 months; 75% presents within 23 months from operation. Chi-square test was used to relate incidence of recurrence to clinical and anatomo-pathological factors and then a multivariate logistic regression analysis was used to evaluate the most significant variables. RESULTS: Univariate analysis reveals a significant relationship between recurrence and age under 50 years (p = 0.01), presence of preoperative complication (p = 0.01), stage (p = 0.01), site (p = 0.000) of primary tumor and lymph-nodal involvement (p = 0.0002). No statistically significant difference was found between recurrence and tumor wall infiltration, number of lymph nodes involved, grading and morphology of primary tumor. Multivariate logistic regression analysis confirmed these results except for preoperative complication (p = 0.9). CONCLUSIONS: Authors believe that selection of patients to undergo adjuvant therapies is improved by identification of high-risk patients.

Age Factors↗
PubMedDate not supplied

Pancreatic resection for periampullary cancer in elderly patients.

BACKGROUND/AIMS: Major abdominal surgery in elderly patients has traditionally been thought to carry a high operative risk. Recent data, however, have suggested that with proper selection, elderly patients can withstand pancreatic resection. METHODOLOGY: The medical records of 102 patients who underwent pancreatic resection for pancreatic or periampullary tumors were retrospectively reviewed. Twenty-nine patients were aged 70 years or older (mean age: 74 years) and 73 patients were younger (mean age: 56 years). Concomitant comorbid conditions were evaluated in the patients of both groups, and no significant differences were identified. A pancreaticoduodenectomy was performed in 81 cases and a total pancreatectomy in 21. RESULTS: The operative mortality rate was 0% in the older patients and 6.8% in the younger patients. Major complications occurred in 28% of the patients. There were no significant differences in morbidity among the two age groups. The overall actuarial survival curves showed similar trends in both groups. CONCLUSIONS: With appropriate preoperative selection, pancreatic resection can be performed with low operative risk in elderly patients. Chronological age alone should not be considered an absolute contraindication for pancreatic resection.

Adult↗