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At least 73 records · Page 4Linked to original sources
PubMedDate not supplied

[Local excision of rectal tumors].

Local excision is a suitable approach for treating sessile adenomas and early adenocarcinomas of the rectum. The indication for transmural rectal carcinomas (T2 and T3) is a matter of debate and no randomized studies have been reported to date. The early and long-term results of a consecutive series of 160 patients who underwent local excision in our departments are reported. Sixty-three patients (39%) had adenoma and 97 patients (61%) carcinoma. Forty-seven patients with carcinoma (48%) received adjuvant therapy. Postoperative complications occurred in 25 patients (15%). The complication rates were 13% (8/63) for adenomas and 18% (17/97) for carcinomas. Only 1 patient died during the postoperative period as a result of unrelated causes. The overall local recurrence rates were 3% and 24%, respectively. Among the adenocarcinomas recurrence was related to staging, tumour clearance at the resection margins and use of chemo- and radiotherapy. No recurrences were reported among the T2 patients submitted to neoadjuvant treatment. A difference versus radical surgery was observed for T3 patients only. Local excision and transanal endoscopic microsurgery in particular is worthwhile in adenomas and T1 carcinomas of the rectum. Patients with T2 tumors should be treated with preoperative chemo- and radiotherapy. Patients with T3 tumors should be treated with transanal endoscopic microsurgery for palliative purposes only.

Adenocarcinoma↗
PubMedDate not supplied

[Laparoscopic cholecystectomy. The beginning of a new era].

An important breakthrough in the field of general surgery, laparoscopic cholecystectomy (LC) offers significant advantages for patients. Major reasons for the rapid worldwide acceptance of this new surgical procedure is that patients experience reduced postoperative pain, ileus is virtually abolished, and the patient is able to leave the hospital the following day without a major abdominal scar. This appears to respond to patients' desire for less invasive approaches to the treatment of gallstone disease. LC is thus becoming the treatment of choice for symptomatic gallbladder disease. Its rapidly growing popularity is evident in Italy where many centers are offering LC routinely, in alternative to open cholecystectomy. A critical appraisal of this new technology is necessary, in light of recent data from centers presenting results and complications of large series of LCs. Adequate training of surgeons who will perform LC is also becoming a major concern. In this review the authors describe patient evaluation and selection for LC. Effective therapeutic strategies are illustrated, including the central, but nevertheless controversial role of endoscopic retrograde cholangiopancreatography (ERCP) as an approach to common bile duct lithiasis. Currently, LC should be performed in centers with the availability of an endoscopist with expertise in ERCP. Following the success of LC, other minimally invasive techniques will evolve in various surgical specialties. New generations of surgeons will thus have to familiarize with these emerging techniques while maintaining a critical attitude of evaluation.

Cholecystectomy↗
PubMed1991

[Biologic response modifiers in the treatment of solid tumors].

This study concerns the clinical applications in Oncology of Biologic Response Modifiers; the authors focus the results reached in neoplasms, such as renal cell carcinoma or melanoma, whose sensitivity to this treatment has been proved. Prospective studies, published in 1990 have been reviewed, considering only those in which route and rate of response (complete and partial) were clearly specified. At present clinical efficacy concerning this topic is controversial and it probably depends on different reasons: immunogenicity of cancer, variable route of administration, lack of predictors. It should be stressed that more in depth studies about cancer immunology are required; a wide spread of immunotherapy will be feasible only by improving therapeutic strategies and limiting adverse effects of this treatment.

Adjuvants, Immunologic↗
PubMed1990

[Indications and limitations of the surgical treatment of portal hypertension].

The authors report a review of the literature and describe their personal experience with treating esophageal varices; all types of surgical approaches (selective and total shunts, esophageal transection) are examined and compared to the results obtained with non surgical treatment (particularly endoscopic sclerotherapy). Indications and results of surgical treatment are discussed from three definitive viewpoints: prevention of first bleeding or prophylactic treatment, control of acute bleeding or emergency treatment and prevention of rebleeding or elective treatment.

Esophageal and Gastric Varices↗
PubMed1989

Pylorus-preserving total pancreatectomy and segmental pancreas autotransplantation.

12 patients affected by periampullary neoplasms underwent surgery consisting of modified pylorus-preserving total pancreatectomy. In 8 of these patients, a segmental pancreas autotransplantation was performed by anastomosing the splenic to the femoral vessels in the Scarpa's triangle. The pancreas was treated by irradiation to inhibit the exocrine function. Gastric emptying was studied in 9 survivors by upper gastrointestinal barium series. In 6 patients gastric emptying and pyloric function were also evaluated by radionuclide studies. In 3 patients the transplanted pancreas had to be removed within the second postoperative week because of graft thrombosis, infection or hemorrhage. In a mean follow-up of 16 months (range: 6-20 months) the remaining 5 transplants showed a good endocrine activity until the beginning of antiblastic treatment for hepatic metastasis (3 cases), pancreatic fibrosis (1 case) or the patient's death (2 case). At present no graft is still functioning.

Adult↗
PubMedDate not supplied

Local excision of rectal tumours with transanal endoscopic microsurgery.

Transanal Endoscopic Microsurgery (TEM) is a novel technique, first introduced by Buess and coworkers in 1983 for the treatment of large sessile polyps of the rectum. Due to the excellent results the indication was then extended also for the removal of low risk early adenocarcinomas (pT1, G1-G2). TEM allows, by using an operative proctoscope of an outside diameter of only 4 cm., all the conventional surgical manoeuvers within the rectal lumen, up to 20 cm. from the anal verge. The Authors report a consecutive series of 53 patients submitted to TEM over a 37 month period; apart from 7 patients excluded for different reasons, postoperative diagnosis showed 30 adenocarcinomas (65.2%), 15 adenomas (32.6%) and 1 epidermoidal carcinoma (2.2%). The low recurrence rate observed both for adenomas (0%) and pT1 adenocarcinomas (9%) coupled with the optimum vision allowed by the 6-fold magnified stereoscopic view, make this technique the method of choice for selected patients with these kind of pathologies.

Adenoma↗
PubMedDate not supplied

[Unusual location of hydatid cysts: clinical and therapeutic aspects].

Among patients treated for hydatidosis, unusual sites are observed in 5-30% of cases, with highest rates in endemic areas; on these basis during the diagnostic work up of masses arising from peritoneum, spleen, mediastinum, kidney and muscle, this possibility should be always taken into account. In fact, only a preoperative diagnosis allows a correct therapeutic approach, especially when synchronous lesions coexist. In this paper the Authors report their experience in the treatment of 66 (5.2%) hydatid cysts developed in unusual sites, out of 1275 patients treated for hydatidosis from 1949 to 1993. They discuss the main pathogenetic and clinical features as well as the therapeutic management of these atypical lesions.

Echinococcosis↗
PubMed1994

[Gastric angiodysplasia: a rare cause of bleeding from the upper digestive tract].

Two cases of bleeding gastric angiodysplasia treated with a different approach, on the basis of the endoscopic features, are reported. Arteriovenous malformations may arise from any site of the digestive tract: gastric angiodysplasia represents one of the less frequent localizations, causing 2-5% of upper gastrointestinal bleeding. Several diagnostic tools are currently available and the choice of the most appropriate therapeutic strategy depends on many features: site and number of the lesions, patient's hemodynamic conditions, endoscopic skill. Surgery is preferred only when multiple and disseminated lesions within the gastric wall occur or when endoscopic approach fails.

Angiodysplasia↗
PubMed1994

[Papillomatous lesions of the biliary tract].

Biliary papillomatosis is a rare entity, characterized by single or multiple lesions arising from the biliary epithelium, leading to relapsing attacks of obstructive jaundice and cholangitis. Usually considered a benign disease, progression to malignancy has though been reported. In this paper the case of a 72 year old patient, with a single papilloma of the left hepatic duct treated by left hepatectomy, is discussed. The main histological, clinical and therapeutic aspects of this unusual pathology are then examined, with a complete review of the Literature.

Aged↗
PubMed1993

The importance of heterogeneity and of multiple site sampling in the prospective determination of deoxyribonucleic acid flow cytometry.

Multiple fresh specimens from 59 nonsmall cell carcinomas of the lung, 38 carcinomas of the gastric tract and 55 carcinomas of the colon and rectum were analyzed by deoxyribonucleic acid (DNA) flow cytometry (FC) after radical resection to evaluate tumor ploidy as an independent prognostic factor. The minimum follow-up period was five years (range of five to ten years). Aneuploidy was observed in 98.0 percent of carcinomas of the lung, in 70.9 percent of carcinomas of the colon and rectum and in 63.1 percent of carcinomas of the gastric tract. FC DNA heterogeneity, in terms of different number of DNA stem lines or different DNA indices between core and periphery, or both, was found in 50.0 percent of carcinomas of the lung, 47.0 percent of carcinomas of the colon and rectum and in 34.5 percent of carcinomas of the gastric tract. A diploid pattern was more frequently observed in less advanced stages of the gastrointestinal tract. By univariate analysis (Kaplan-Meier), patients with carcinoma of the lung with hypodiploid or hypertetraploid peaks, or both, and aneuploid gastric tumors had poorer prognosis. These differences were only marginally significant. Cox analysis demonstrated that the single most important prognostic variable for predicting the overall survival rate was the stage of disease. Tumor DNA content can be considered a marker of advanced stages, particularly in tumors of the gastrointestinal tract, but there is no evidence that it is an independent prognostic variable able to predict long term survival in patients who have been radically resected.

Adenocarcinoma↗
PubMedDate not supplied

[Localized fibroma: a rare tumor of pleural origin].

Localized fibroma represents a rare entity arising from the pleura. Currently its histogenesis and clinical behaviour are still controversial. A case of a 64-year-old male is here presented; clinical and histopathological features are then discussed on the basis of a review of the Literature. At present, an en-bloc resection of the tumor, including wide margins of the surrounding lung tissue, seems to be the most appropriate surgical choice.

Adult↗
PubMedDate not supplied

The role of surgery in the treatment of primary gastric lymphoma.

BACKGROUND: The aim of the study was to analyze the results of surgical treatment in early and advanced primary gastric lymphoma and to evaluate predictive factors for long-term outcome. MATERIAL AND METHODS: A retrospective study of 92 patients resected for primary gastric lymphoma was conducted. Sixty-eight (74%) patients underwent a curative resection 10 (11%) patients had palliative resection and 14 (15%) patients were deemed unresectable: 33 patients (36%) had a stage IE tumor, 12 (13%) stage IIE1, 22 (24%) IIE2 and 25 (27%) stage IVE. RESULTS: Follow-up ranged from 1 to 336 months (means 44 +/- 70 months, median 18 months). Cumulative actuarial 10-year survival rate was 49.1%. Ten-year actuarial survival rates were 78.9% for stage IE and 100% for stage IIE1 whereas 5-years survival rates were 0% for stage IIE2 and 21.7% for stage IVE (P < 0.00001). CONCLUSION: Surgical treatment is the front line therapy for IE and IIE1 stages of primary gastric lymphoma.

Adolescent↗
PubMed1996

Intensive treatment of patients age 60 years and older with de novo acute myeloid leukemia: analysis of prognostic factors.

BACKGROUND: This study aimed to define pre-treatment parameters with prognostic significance in elderly patients with de novo acute myeloid leukemia (AML) who were treated with aggressive regimens. METHODS: We analyzed, retrospectively, the clinical and laboratory features of 159 consecutive patients age >60 years with AML. Ninety-two patients presenting as de novo AML were considered suitable for aggressive chemotherapy according to inclusion criteria not different from those commonly used for younger adults. They belonged to all of the French-American-British classification types except M3, and their median age was 67 years (range: 60-79). Antileukemic treatment consisted of 1 of 3 sequential protocols adopted at the S. Eugenio University Hospital of Rome between 1987 and 1993. The three therapeutic groups were similar in number and presenting characteristics. In addition to arabinosylcytosine, induction schedules included mitoxantrone (Groups I and II) or daunorubicin (Group III), and etoposide (Groups I and III). Once in complete remission (CR), patients were consolidated with two other courses of chemotherapy using reduced dosages of the same drugs given during induction. RESULTS: Induction treatment achieved a 52.2% CR rate, with median remission duration and event free survival (EFS) of 35 and 27 weeks, respectively. Because no significant differences between the results of the three therapeutic groups were observed, all cases were pooled to evaluate the prognostic factors. In univariate analysis, the only presenting characteristic significantly associated with failure of induction treatment was age >67 years (P=0.007). Factors associated with an increased likelihood of shorter remission duration were CD7 expression on leukemic cells (P=0.007) and an abnormal karyotype (P=0.010; those predicting shorter EFS were a chromosomal status other than normal (P=0.002) and detection of CD14 antigen (P=0.008). Logistic regression results identified age and CD14 expression as the variables with independent prognostic impact on CR achievement. In a stepwise proportional hazards general linear model, CD7 and karyotype retained their predictive value regarding remission duration, whereas the karyotypic pattern at diagnosis and CD14 antigen expression were the most important determinants of EFS, with age showing a borderline statistical value. A simple "risk factor score" was developed that would allow for stratification of patients into prognostic groups. CONCLUSIONS: Cytogenetic analysis and immunophenotyping might help to select elderly patients with AML who have little benefit from current therapeutic strategies and with whom new approaches might be experimented.

Acute Disease↗
PubMed1987

Prognostic significance of flow cytometry in lung cancer. A 5-year study.

Flow cytometrically determined cellular DNA content has been measured on specimens from 101 patients affected by lung cancer (40 epidermoid cell carcinoma, 22 adenocarcinoma, 21 large cell carcinoma, 11 small cell carcinoma, and seven undifferentiated carcinoma), and one by mesothelioma. Ninety-eight of 102 (96%) patients with neoplastic disease evidenced the occurrence of at least one cytometrically aneuploid cell subpopulation. Fifty-five of 102 (54%) cases evidenced the occurrence of multiclonality, that is, the presence of more than one aneuploid stem cell line. However, the incidence of multiclonality in lung carcinoma was statistically different in surgical cases (where multiple site sampling from the primary and lymph nodes was possible) in comparison to the nonsurgical ones (e.g., bronchial washing): 48/77 (62%) and six of 24 (25%), respectively. Therefore, only the 77 surgical patients were used for further analysis. The cases were classified according to the DNA index (DI) in the following way: Group A (tumors with one or more stem lines with DI ranging from 1 to 2) and Group B (tumors with at least one stem line with DI less than 1 or greater than 2). A significant correlation has been found between the cytometric ploidy condition so defined (Groups A and B) and the tumor mass doubling time (DT), Group B being associated with fast growing tumors (DT lower than 90 days). A statistically better 12-month survival rate (5-year maximum follow-up) was observed in Group A (88%) in respect to Group B (47%) and is evident in the patient survival time course. A better prognostic indication can be achieved by stratifying the patients according to both the cytometric ploidy condition and the tumor DT. Flow cytometric data can usefully contribute to the prognostic assessment of lung carcinoma provided that representative cellular material is collected by multiple site sampling.

Actuarial Analysis↗