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Biomedical subjects

R Santoro

Publications and source records attributed to R Santoro.

At least 91 records · Page 5Linked to original sources
PubMedDate not supplied

Diagnostic and surgical features of Klatskin tumors.

AIM OF STUDY: Klatskin tumors are rare and their prognosis is poor. Long term survival can be expected only after a surgical resection, the treatment of choice. The aim of this study is to report our single centre experience and, by literature analysis, to define the role of surgery in the treatment of hilar cholangiocarcinoma. MATERIALS AND METHODS: Between 1990 and 1998, 27 patients affected by Klatskin's tumor were observed. Eight women and seven men (mean age 59 years) underwent surgical resection. Thirteen patients (86%) had curative resection (7 hilar resection (HR), 4 HR combined with partial hepatectomy (PH) and 2 HR + PH with portal vein resection). Two patients (13%) had palliative biliary resection and surgical drainage. RESULTS: One in-hospital death was recorded after a right hepatectomy with portal vein resection (6.6%). Postoperative morbidity rate was 40%. Patients were regularly followed up to date or to death. Ten patients died and 5 survived. The 1-, 2- and 3-year survival rate after curative resection was 84%, 54% and 34%. The median survival was 28.5 months. Lymph node involvement did not show a statistically significant difference on median survival between the positive group and the negative group (26.2 vs 29.8 months), nor did perineural invasion, because of the small number of patients. The 1-, 2-, 3- and 5-year survival rate after isolated hilar resection was 100%, 57.1%, 28.6% and 0. Four out of 6 patients who underwent hilar resection combined with partial hepatectomy are still alive 1, 23, 29, 38 months after resection. Hepatectomy increased mortality (16% vs 0). Palliative biliary resection and surgical drainage were successfully performed in 2 patients with satisfactory results. CONCLUSION: Aggressive surgical treatment of Klatskin tumors can improve patients' survival. Careful preoperative management has to be carried out by a multidisciplinary approach including surgeons, gastroenterologists, radiologists and pathologists. Hepatic resection involving the caudate lobe is often performed in order to obtain microscopic tumor-free margins and curative resection (R0). Biliary drainage and treatment of cholangitis is mandatory before surgery in order to improve surgical outcome. Surgical treatment is characterized by high technical difficulties and better results can be achieved by hepatobiliary surgical teams.

Adult↗
PubMedDate not supplied

[Experience of 10 years with the surgical treatment of lung cancer in elderly patients].

The surgical treatment of lung cancer in elderly patients is correlated with a lot of complications that in most cases are cardiopulmonary type; for this reason, in past times these patients were left out of the surgical treatment. Today, the progress of surgical, diagnostic and anesthetic techniques permit to execute pulmonary resections in patients older than 70 years too. The aim of this study is to evaluate postoperative complications and long-term and long-term survival in patients under and over the age 70. Between January 1990 and June 2000 we have assessed 172 patients with lung neoplasm. We have divided patients in two groups: those younger than 70 years of age (group 1, n = 119) and those older than 70 years of age (group 2, n = 53). Postoperative mortality for group 2 was 7.5% and for group 5.1%. The overall postoperative complication rate for group 2 was 30.2% and for group 1 10.9%. Within group 1 main complications have been of surgical type (61.5%) while in group 2 medical type (cardiopulmonary), with higher frequency in patients ASA 3 or ASA 4. The mortality at 12 months for non-neoplastic causes was 10.2% for group 2 and 2.5% for group 1. On the contrary, the mortality at 12 months for neoplastic causes was 8.2% for group 2 and 6.7% for group 1. We haven't noticed an important correlation between the extension of the resection and the recurrence of disease. The survival at 3 years was 46.5% for group 1 and 41% for group 2 and associated with neoplastic causes.

Aged↗
PubMedDate not supplied

[Resective surgical treatment of exocrine pancreas neoplasms. Retrospective study of 294 cases and review of the literature].

Authors report their own experience on the treatment of pancreatic neoplasms. Two-hundred-ninety-four patients were observed during the years 1959-95. Resectability rate was 18%. Fifty-three patients underwent pancreatic resection: 22 distal pancreatectomies (41.5%), 2 total pancreatectomies (3.7%) and 29 pancreaticoduodenectomies (54.7%) (7 PPPD). Overall morbidity rate was 15.6% with decrease during the years of major postoperative complications. More frequent complications were renal failure (4%), bleeding (1.7%) and acute pancreatitis (5.6%), which was absent during the 1981-95 period. Pancreatic fistula occurred in 5.6%, but in the years 1981-95 only one patient suffered from it (1.8%). During the years 1959-70 operative mortality rate after pancreatic resection was 22.7%, during 1971-80 was 12.5% and during 1981-95 decreased to 4.3%. Patients with stage I tumours survived curative pancreatic resection for about 18.2 months, compared with those with stage II and III tumours, who survived for about 15 and 13 months, respectively. Recent studies have demonstrated a reduction in the morbidity and mortality of pancreatic resections and improvement in the actuarial 5-year survival for patients with resected ductal adenocarcinoma. In the presence of lymphnode metastases, pancreaticoduodenectomy offers good palliation and meaningful survival. In the absence of lymphnode metastases, pancreaticoduodenectomy offers encouraging long-term survival rates and a chance for cure.

Aged↗
PubMedDate not supplied

[Work capacity of housewives with complete laceration of the rotator cuff].

OBJECTIVE: The aim of the this study is to evaluate the work capacity of housewives with full thickness tear of the rotatory cuff (FTTRC). METHODS: Twenty-five subjects have been studied. The FTTRC was located un the right shoulder in 16 cases, in the left shoulder in 5 cases and was bilateral in 4 patients. All patients were female; the average age was 72.4 +/- 4 (range 62-81). The Assessments were made using the Constant Scale, the Groningen Activity Restriction Scale and the Simon's Test. RESULTS: The result of this study confirmed that none of the housewives was able to carry out the houseworks quite independently and with no effort. 16% of the patients did the houseworks with great effort while 84% was helped in making some activities. Help is necessary for the usual housework and heavy domestic works (washing glasses, using vacuum cleaner to clean the floor). Patient's relatives provided help in 76.2% of cases while 23.8% were assisted by maid. Help was occasional in 33.3% of cases, continuous in 52.3% and full in 14.4% of patients. Disability resulting from FTTRC is heavier in subjects where electrical household appliances are not used (p < 0.05) and in subjects who feel deep pain (p < 0.05). The active movements of shoulder, local shoulder pain and level of use of upper limbs do not affect domestic works. CONCLUSIONS: These study showed that FTTRC reduces work capacity of house wives. These disease is more preventing heavy domestic works.

Age Factors↗
PubMedDate not supplied

[Disability and rehabilitation outcome in hemiplegia with global aphasia and neglect].

PURPOSE: Global aphasia and neglect are considered to be the neuropsychological disorders mostly affecting the hemiplegia outcome. The aim of this study is to examine which of the two disorders is making worse the recovery from hemiplegia. METHODS: The study was conduced on 45 patients suffering from hemiplegia: 15 subject with global aphasia, 15 with neglect and 15 without neuropsychological disorders (control group). All patients were subject to rehabilitation treatment. Before and after rehabilitation, the assessment of patients was made using neuropsychological tests, Fugl-Meyer scale and Functional Independence Measure (FIM). At admission, all patients were not self-sufficient. RESULTS: At the end of the rehabilitation period the recovery of motor function was poor in both groups. The damage on limbs motion was severe in 93.4% and marked in 6.6% of both patients with global aphasia and neglect. At discharge, the FIM motor score of patients with global aphasia (44.6 +/- 13) was higher than in those with neglect (37.2 +/- 10) and was not statistically different from control group (51.2 +/- 18) (p = 0.493). The FIM motor score of patients with neglect was significantly lower than control group (p = 0.036). In patients with global aphasia effectiveness was 35.5% and efficiency 0.40 while in patients with neglect effectiveness was 18% and efficiency 0.22. The final disability was lower in patients subject to global aphasia than neglect. CONCLUSIONS: The study showed that neglect limits the recovery from stroke more than global aphasia.e.

Activities of Daily Living↗
PubMedDate not supplied

[The painful hemiplegic shoulder: effects of exercises program according to Bobath].

AIM: To verify whether a shoulder exercises program according to Bobath reduced the shoulder pain in hemiplegic patients. METHODS: We studied a total of 20 patients with pain shoulder. Ten patients are assigned to group R (submitted to rehabilitation) and ten to group R+E (submitted to rehabilitation and shoulder exercises program according to Bobath). Shoulder exercises program was self-performed by the patients after training in occupational rehabilitation unit. The assessment of patients was performed at admission to hospital, at discharge and three months after discharge. Shoulder pain (VAS), shoulder range of motion, disability (FIM), motor function (Fugl-Meyer scale) and spasticity (Ashworth scale) of paretic arm were evaluated in all patients. RESULTS: VAS was similar in both groups at admission and decreased in group R+E at discharge without reaching significant differences (p=0.253). On the contrary, VAS and Shoulder range of motion improved statistically in group R+E (p=0.0001, p<0.04 respectively) after three months. The others variables measured did not change. CONCLUSIONS: This study showed that a shoulder exercises program according to Bobath reduces shoulder pain of patients with hemiplegia if it is performed daily and for a long period of time.

Adult↗
PubMedDate not supplied

[Isolated resection of the caudate lobe in metastasis of colorectal cancer].

The presence of metastatic lesions confined to the caudate lobe (CL or segment I) is quite a rare event. Even more rare is the decision to perform an isolate CL resection. Segmental resection in the liver is justified by the evidence that primary and secondary lesions, in early stage, are confined to the originating segment, and therefore a segmentectomy can be considered for the CL as well. Anatomy of the CL was deeply studied through the years since the surgical approach to this liver segment requires a detailed knowledge of its surgical anatomy and only after 1985 the surgical technique for CL isolate resection was established. We report our experience with 1 case of isolate colo-rectal metastasis confined to the caudate lobe and describe the surgical technique employed.

Adenocarcinoma↗
PubMedDate not supplied

[Epidemiology of measles and its complications in Italy. Personal experience with a hospital case load].

The authors relate and comment on the results of admission for measles in the Hospitals of Chieti and Pescara, in the period between 1974 and 1983. The authors have studied the number of admissions and their duration; moreover, they have evaluated the relationship with the pediatric population of the considered area. They point out the importance of the complications of measles to determine the admission's length to Hospital.

Child↗