Biomedical subjects

A Peracchia

Publications and source records attributed to A Peracchia.

At least 19 recordsLinked to original sources

PubMed1995

Lack of allelic loss at the multiple endocrine neoplasia type 1 (MEN-1) gene locus in a pancreatic ductal (non-endocrine) adenocarcinoma of a patient with the MEN-1 syndrome.

The gene responsible for multiple endocrine neoplasia type I (MEN-1) syndrome has been mapped to chromosome 11q13. It appears to function as a tumour-suppressor gene analogous to that for retinoblastoma and allelic losses involving the wild-type of the MEN-1 allele have been found in parathyroid and pancreatic endocrine tumours of MEN-1 patients. No genetic information has been provided so far on non-endocrine malignancies that may occur in MEN-1 patients. A case of exocrine pancreatic adenocarcinoma presenting as the terminal event in a woman with a long standing history of MEN-1 syndrome and multiple endocrine tumours of the pancreas was investigated for possible allelic losses at the MEN-1 gene locus using restriction fragment length polymorphisms (RFLPs) closely linked to the MEN-1 gene and polymerase chain reaction (PCR) for D11S533 locus. No allelic losses were found in tumour tissue with two informative RFLPs (D11S97, D11S146) or with PCR analysis. These findings suggest that the MEN-1 gene does not confer a predisposition to develop tumours other than those that typify the syndrome.

Adenocarcinoma↗

PubMed1995

Esophageal achalasia: laparoscopic versus conventional open Heller-Dor operation.

BACKGROUND: The laparoscopic treatment of esophageal achalasia has recently been introduced, and the occasional reports in the literature seem to indicate considerable advantages for patients in terms of surgical trauma, postoperative discomfort, and appearance. As yet, however, no studies have directly analyzed the benefits and shortcomings of the new surgical technique by comparison with the conventional open procedure. The objective of our study was to review recent experience with the laparoscopic Heller-Dor operation (LAP-HD) at the Department of Surgery of Padua University and compare it with the traditional open Heller-Dor procedure (OPEN-HD) to assess early effectiveness in patients with primary esophageal achalasia. PATIENTS AND METHODS: The records of 17 patients who had LAP-HD and a matched group of 17 patients who had OPEN-HD were retrospectively reviewed. The duration of procedures, morbidity, several aspects of the postoperative course, and hospital costs were recorded and compared. Results of clinical follow-up and of manometric and pH-monitoring studies performed 6 months postoperatively were also evaluated in both patient groups. RESULTS: LAP-HD took longer than OPEN-HD (mean 178 versus 125 minutes). There was no mortality or major morbidity in either group. Postoperative pain and ileus and need for IV nutrition lasted a shorter time for LAP-HD patients (P < 0.0001). Consequently, the median postoperative hospital stay and the median interval before returning to normal activity were also shorter (4 and 14 days for the LAP-HD group versus 10 and 30 days for the OPEN-HD group, P < 0.0001). During follow-up, dysphagia recurred in 1 patient of the LAP-HD group and gastroesophageal reflux was registered in 1 patient of the OPEN-HD group. Lower esophageal sphincter pressure decreased significantly after both procedures. CONCLUSIONS: Laparoscopic management of achalasia leads to short-term results comparable to those of the well-established open technique. In view of the less severe surgical trauma and lower hospital cost, the laparoscopic approach is preferable, but long-term studies are needed.

Adult↗

PubMed1995

Laparoscopic approach to esophageal achalasia.

Certain technical details are considered important to ease the laparoscopic performance of a Heller myotomy combined with a Dor antireflux procedure for esophageal achalasia. A special emphasis is given to intraoperative esophagoscopy combined with a mild balloon distension of the esophagogastric junction. These maneuvers prove helpful in identifying the esophagogastric region, easing the myotomy, and controlling its completeness.

Adolescent↗

PubMed1995

Efficacy of octreotide in the prevention of pancreatic fistula after elective pancreatic resections: a prospective, controlled, randomized clinical trial.

BACKGROUND: A prospective, randomized controlled clinical trial was conducted in 33 Italian surgical departments with the aim of evaluating the efficacy of octreotide in the prevention of pancreatic fistula after elective pancreatic resections. METHODS: Between July 1990 and May 1992, 278 patients were enrolled in the study. Fifty-four dropped out because of unresectable disease and six were excluded because of protocol violation; the remaining 218 were randomly assigned to the octreotide group (n = 111) or to the placebo group (n = 107). There were 131 men and 87 women with a mean age of 58.2 +/- 11.7 yrs. Pancreaticoduodenectomy was the most common operation performed (n = 143), sixty-four percent of patients had a pancreatic or periampullary cancer; chronic pancreatitis accounted for 8.2% of cases. RESULTS: Mortality rate was 6.9%. A pancreatic fistula occurred in 31 patients (14.2%), 9% in the octreotide group and 19.6% in the placebo group (p < 0.05). Morbidity rate was significantly lower in the octreotide (21.6%) than in the placebo group (36.4%) (p < 0.05). When specific pancreatic complications were grouped together and evaluated, they occurred less frequently in the treated (15.3%) than in the placebo group (29.9%) (p < 0.05). CONCLUSIONS: Octreotide was able to reduce significantly the incidence of pancreatic fistula after elective pancreatic resections.

Aged↗

PubMed1995

Laparoscopic Heller-Dor operation for the treatment of oesophageal achalasia: technique and early results.

From January 1992 to December 1994, a laparoscopic oesophageal myotomy combined with Dor fundoplication was performed in 33 patients with oesophageal achalasia. Intraoperative endoscopic balloon distension of the cardia proved useful to identify the oesophagogastric junction, ease the myotomy, and control its completeness. There was no operative mortality. A mucosal tear not requiring conversion occurred in three patients who had previously undergone pneumatic endoscopic dilations of the cardia. The early clinical and functional results show the effectiveness of the operation.

Adolescent↗

PubMed1995

Surgical management of benign stricture from reflux oesophagitis.

From January 1976 to December 1994, out of 605 patients with reflux oesophagitis, 166 (27.4%) presented with an oesophageal stricture, and 68 of these (40.9%) underwent surgical therapy. Thirteen of the 68 patients (19.1%) had an associated Barrett's oesophagus. Oesophageal manometry revealed scleroderma in nine individuals (13.2%). The stricture was undilatable in 11 patients (16.1%) observed before 1985. An oesophageal-sparing operation was performed in the majority of patients: fundoplication (n = 39), Collis gastroplasty plus fundoplication (n = 10), and total duodenal diversion (n = 4). Oesophageal resection was performed in 15 patients (22%); 12 of these individuals were operated on before 1985. The mortality rate was 4.4%: two patients died of necrosis of the interposed colon and one of acute pancreatitis. The average follow-up time was 27 months (8-136). Oesophageal-sparing procedures significantly reduced the need for further endoscopic dilatation (P < 0.001). Standard fundoplication was successful in 30 out of 39 patients (77%). Reasons for a failed fundoplication were a long, hard stricture, an ineffective partial wrap in patients with unrecognized short oesophagus, or underlying scleroderma. Regression of Barrett's mucosa was not recorded with any of the conservative surgical procedures.

Adolescent↗

PubMed1995

Therapeutic options for cancer of the hypopharynx and cervical oesophagus.

Between 1980 and 1990, 291 patients with a cancer in the cervical area of the oesophagus were admitted to our Department: in 187 the cancer was located mainly in the cervical region, 76 in the hypopharynx and 28 had a tumour that had spread to the cervical oesophageal region following laryngectomy. Most tumours of the hypopharynx involved the cervical oesophagus when it was often difficult to define the site of origin. 153 patients (53%) underwent surgical resection which included a modified neck dissection followed by different kinds of reconstruction. 96 patients underwent pharyngogastric anastomosis. Twenty anastomotic leaks (23%) were recorded including both those clinically evident and asymptomatic ones detected radiologically. Moreover, segmental proximal necrosis was seen in ten patients. Hospital mortality rate after pharyngogastric anastomosis was 14.7% (14/95). Colon interposition was used in 11 patients. Two anastomotic leaks and two partial necroses were observed. Hospital mortality was 18% (2/11). Eighteen patients underwent laryngopharyngectomy and cervical oesophagectomy with reconstruction performed by means of revascularized jejunal loop. One anastomotic leak was observed and hospital mortality was nil in these cases. Twenty-four patients underwent total oesophagectomy with larynx preservation when the cancer was located at least 2 cm below the upper oesophageal sphincter. Five anastomotic leaks and two partial necroses occurred and hospital mortality was 8.3% (2/24) in these patients. The remaining five patients operated on underwent miscellaneous surgical procedures with one postoperative death. Overall survival for resections considered curative was 21%:37% for hypopharyngeal and 18% for cervical cancers respectively, while it was nil at three years after palliative resection and total oesophagectomy with larynx preservation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1995

Surgical therapy of esophageal leiomyoma.

BACKGROUND: Surgical enucleation is the treatment of choice in selected patients with esophageal leiomyoma. The video-thoracoscopic approach can potentially cause less patient discomfort postoperatively and reduce the hospital stay and recovery period. STUDY DESIGN: A retrospective evaluation of 66 patients who underwent surgical therapy for esophageal leiomyoma over a 27-year period was done. The main symptoms were dysphagia in 35 (53 percent) patients, heartburn or regurgitation, or both, in 11 (17 percent) patients, and retrosternal pain in ten (15 percent) patients. Associated esophageal disorders were found in 19 patients (some patients had more than one disorder): hiatal hernia in 15 (23 percent), epiphrenic diverticulum in four (6 percent), and achalasia in three (5 percent). The operation consisted of leiomyoma enucleation in 63 patients, and esophageal resection in three. In six patients, the enucleation was successfully performed by video-thoracoscopy combined with intraoperative esophagoscopy. The muscle layer of the esophagus was approximated in the majority of the patients after tumor enucleation. RESULTS: There was no operative mortality. The incidence of intraoperative esophageal perforation was greater in patients who had previously undergone endoscopic biopsy (p < 0.01). In one patient, a pseudodiverticulum developed after thoracoscopic enucleation, requiring reoperation with approximation of the muscle layer for relief of dysphagia. The length of hospital stay was shorter in patients undergoing the video-assisted operation (p < 0.05). The median follow-up period was 53 months (range, 12 to 248 months). No recurrence of leiomyoma was observed. Overall, seven (11 percent) patients complained of heartburn or epigastric pain, or both, which was responsive to antisecretory drugs, but only three had such symptoms induced by the operation. In two patients the symptoms appeared after combined treatment of an epiphrenic diverticulum, and in one patient after simple leiomyoma enucleation. CONCLUSIONS: Enucleation of esophageal leiomyoma is a safe and effective operation. The video-thoracoscopic approach combined with intraoperative esophagoscopy allows performance of this procedure with the added advantage of shortening hospital stay. The muscle layer of the esophagus should be approximated to avoid decreasing the propulsive activity of the esophageal body. This may improve the long-term outcome of the operation by preserving the acid-clearing mechanism of the esophagus and reducing the incidence of postoperative reflux esophagitis.

Adult↗

PubMed1995

Laparoscopic cholecystectomy and endoscopic sphincterotomy under a single anesthetic: a case report.

Several options have been described for the management of unsuspected common bile duct stones diagnosed for the first time by transcystic cholangiography during laparoscopic surgery. These include immediate conversion to open laparotomy and formal common bile duct exploration, laparoscopic bile duct exploration, or postoperative biliary endoscopy (i.e., ERCP with sphincterotomy and stone extraction). Herein we describe a fourth option which allows the surgeon to manage both cholelithiasis and choledocholithiasis at the time of laparoscopic intervention: endoscopic sphincterotomy performed immediately after laparoscopic cholecystectomy under one anesthetic. This option seems the most logical when the surgeon wishes to preserve the minimally invasive approach.

Anesthetics↗

PubMed1994

Self-expanding esophageal prosthesis. Effective palliation for inoperable carcinoma of the cervical esophagus.

Whether to palliate dysphagia in patients with inoperable cancer of the cervical esophagus is a debatable issue. We report herein a patient who underwent definitive chemoradiotherapy for cancer of the cervical esophagus, with early recurrence of dysphagia 1 month after the end of the treatment. No salvage surgery was attempted due to the poor general conditions and to the residual effects of the radiotherapy in the neck. Endoscopically, the upper esophageal sphincter (UES) was located 17 cm from the incisors, and the cranial margin of an infiltrating stricture was just 1 cm below the sphincter. After endoscopic dilatation, a self-expanding esophageal prosthesis (Ultraflex, Microvasive, USA) was placed under endoscopic and radiologic control with the cranial margin at the level of the UES. The patient promptly resumed oral feeding and 2 months later he is still on unrestricted diet.

Carcinoma, Squamous Cell↗

PubMed1994

[Adenocarcinoma in Barrett's esophagus: long-term results of curative resection].

Between 1980 and 1993, out of 635 patients presenting with an adenocarcinoma of the esophagogastric junction, 74 (11.7%) had a neoplasm arising from a columnar specialized epithelium lining the distal esophagus. Fifty of these patients (68%) underwent a curative (R0) resection. 36 patients (72%) were in stage 0, I or II, and the 5-year actuarial survival rate was 44%. The survival rate dropped to 13% when nodal metastases were present. We conclude that the long-lasting symptoms during the pre-neoplastic phase, and a closer endoscopic surveillance allow a early diagnosis of Barrett adenocarcinoma. Surgical therapy must be radical in these patients in order to improve prognosis.

Adenocarcinoma↗

PubMed1994

[Thoracoscopic techniques in treatment of esophageal diseases].

Some malignant and benign diseases of the esophagus are generally treated through a thoracotomic approach. While this may be justified in the curative treatment of cancer, thoracotomy may be avoided for benign diseases if good functional results can be obtained through a minimally invasive approach. Long-term results with careful clinical and manometric monitoring of patients operated on for epiphrenic diverticula have to be considered to define the possible role of thoracoscopic approach to this disease since a laparoscopic approach, which includes transhiatal diverticulectomy, myotomy, and fundoplication, seems to have excellent results. As for leiomyomas thoracoscopy represents the first choice approach since it allows a complete removal of the benign tumor with a limited access. In case of malignant diseases, thoracoscopic esophagectomy has in our opinion few indications. Extent of lymphnodal dissection appears to be the major limiting factor of the technique. Moreover, high-risk patients need anyway a double-lumen intubation and a prolonged single-lung ventilation. Modifications of respiratory function after thoracoscopy have to be compared with those occurring after thoracotomy and after transhiatal esophagectomy. Studies on lymphadenectomy and on respiratory physiopathology will help in define a possible role of this approach.

Carcinoma, Squamous Cell↗

PubMed1994

[Limited surgery in cancer of the hypopharynx and cervical esophagus: role of autotransplants of the intestinal loop and skin flaps].

The cervical esophageal region can be involved by several cancer types as primary malignancies of the hypopharynx and cervical esophagus, locally advanced tumors of the larynx and thyroid, and neoplastic recurrence after laryngectomy for cancer. These situations often require complex surgical procedures, and the integrated use of multiple surgical techniques or multistage operations. It is often a limit-type surgery that requires free loop intestinal autotransplants, local and regional skin flaps, and peduncle myocutaneous flaps, and therefore requires specific skill not only in general and thoracic surgery but also in head and neck surgery, plastic surgery and microsurgery. This paper summarizes the experience in the field of cervical esophagus replacement with jejunal free loop autotransplant (23 cases) and cutaneous or myocutaneous flaps (23 cases) at the "Centro Regionale Veneto per le Malattie dell'Esofago" from 1980 to 1993.

Esophageal Neoplasms↗

PubMed1993

Surgical treatment of reflux stricture of the oesophagus.

The choice of surgery in patients with reflux-induced oesophageal stricture remains controversial. From 1976 to 1990, a total of 65 patients underwent fundoplication (36 patients), Collis gastroplasty plus fundoplication (ten), total duodenal diversion (four) and oesophageal resection (15). The postoperative mortality rate was 5 per cent (three patients): necrosis of the colon transplant in two patients and acute pancreatitis in one. The median follow-up was 25 (range 6-120) months. After conservative surgery, the median number of dilatations per patient per year significantly decreased (P < 0.001). Nine patients (25 per cent) complained of persistent or recurrent symptoms after standard fundoplication and six required reoperation. Clinical results were satisfactory in patients who underwent Collis fundoplication, total duodenal diversion and oesophageal resection. It is concluded that the causes of failed fundoplication are irreversible stricture or persistent gastro-oesophageal reflux; the latter may be caused by inefficacy or deterioration of the partial fundoplication wrap. A subtle degree of oesophageal shortening is probably underestimated in such patients and this may explain the better results obtained with the Collis fundoplication. Total duodenal diversion is a good therapeutic option in patients who have undergone previous oesophagogastric surgery. Oesophageal resection should be reserved for patients with tight strictures unresponsive to dilatation or those with scleroderma, multiple previous operations or severe dysplasia in Barrett's oesophagus.

Adolescent↗

PubMed1993

Flow cytometric DNA analysis does not predict the radiochemoresponsiveness of esophageal cancer.

The relationship between the DNA pattern and the responsiveness to chemotherapy or chemoradiotherapy has been evaluated in 30 patients with squamous cell carcinoma of the esophagus. In 24 patients polychemotherapy with cisplatin (100 mg/m2 on day 1) and 5-fluorouracil (1,000 mg/m2/24 h, continuous infusion of 120 h) every 3 weeks, was performed. Six other patients received chemoradiotherapy with cisplatin 80 mg/m2 on day 1 and 18.5 Gy (split course). Before treatment, at least three endoscopic biopsies were taken from each tumor and frozen at -85 degrees C. Five patients were excluded from the evaluation, three because of interrupted treatment and two due to unsuitable biopsy material obtained endoscopically. The response rate to the cytoreductive treatment was 40% (10/25). DNA content was analyzed with flow cytometry. Out of 25 evaluable patients, a diploid and aneuploid tumor was present in 8 (32.0%) and 17 (68.0%) patients, respectively. According to the DNA pattern, a major response was observed in 4 of 8 patients with a diploid tumor and in 6 of 17 patients with an aneuploid tumor (P = 0.5). No relationship between the percentage of cells in the S-phase and the response to the cytoreductive treatment was evident. Although a slightly higher percentage of major responses was found in euploid tumors, there is no evidence that flow-cytometric DNA analysis can be helpful in the selection of patients for chemotherapy or chemoradiotherapy.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1993

Correlation of p53 mutations with epidermal growth factor receptor overexpression and absence of mdm2 amplification in human esophageal carcinomas.

Esophageal carcinomas from 24 patients, most of whom were smokers and consumed alcoholic beverages daily, were analyzed for mutations in exons 5-8 of the p53 tumor suppressor gene. Mutations were identified by polymerase chain reaction amplification and direct sequencing in 12 of 24 (50%) of the samples; almost half of the mutations were at A:T base pairs. Nuclear accumulation of p53 protein, determined by immunohistochemistry with the CM-1 polyclonal antibody, was observed in all cases in which a missense mutation in the p53 gene was detected. None of the 24 carcinomas had amplification of the mdm2 gene, an alternate pathway to p53 loss of function. Alterations involving three other cancer-related genes associated with human esophageal carcinogenesis, c-erbB-1/epidermal growth factor receptor (EGFR), c-myc, and retinoblastoma (Rb), were examined by Southern blot or immunohistochemical analysis in the same sample set to explore the possibility of a link between oncogene activation and loss of tumor suppressor function. While no associations were observed between amplification of the c-myc or EGFR genes and p53 abnormalities, a significant correlation (P < 0.01) was seen between the presence of p53 mutation and EGFR overexpression. Absence of Rb protein, measured immunohistochemically, was observed in four tumors, none of which had aberrations of the p53 gene.

Carcinoma, Squamous Cell↗

PubMed1993

[Primary malignant melanoma of the esophagus. Report of 3 cases and review of the literature].

Primary malignant melanoma of the esophagus is an extremely rare tumour with a fatal prognosis. Only 122 cases have been reported to date in the literature, of which 105 are undoubtedly primary. This study presents three new cases which were surgically treated: two cases underwent subtotal esophageal resection and intrathoracic esophagogastroplasty, and one case underwent total esophageal resection and cervical esophagogastroplasty. The histogenesis, role of immunochemical markers and the therapeutic problems related to malignant esophageal melanoma are discussed in the light of a new review of the literature.

Adult↗

PubMed1992

Primary treatment of esophageal achalasia. Long-term results of myotomy and Dor fundoplication.

From 1976 to 1989, 206 patients referred for primary treatment of esophageal achalasia underwent transabdominal Heller's myotomy and anterior fundoplication according to the Dor technique. In the majority of the patients, the cardia was not mobilized, and the myotomy was extended in length for about 10 cm (8 cm on the esophagus and 2 cm on the stomach). There was no operative mortality. Two patients (0.9%) required reoperation due to bleeding from the myotomy site in one and leakage from the gastrotomy site in the other. One hundred ninety-three patients entered the follow-up study and were followed up from 12 to 144 months (median, 64.5 months). Five patients died during the follow-up of unrelated diseases, and in one patient, an esophageal cancer infiltrating the trachea was discovered 26 months after the operation. Clinical results were excellent or good in 93.8% of the patients, and fair in 2.6%. Disabling dysphagia recurred in seven patients (3.6%), six of whom required pneumatic dilation for relief and one patient who underwent reoperation because of a paraesophageal hiatal hernia. Postoperative roentgenographic studies showed a significant reduction in the mean value of the maximal esophageal diameter. Esophageal manometry showed a significant reduction of lower esophageal sphincter pressure and length over preoperative values. Twenty-four-hour esophageal pH monitoring showed an abnormal acid exposure in seven (8.6%) of 81 patients tested. Of these patients, one had erosive esophagitis on endoscopy. Esophageal transit scintigraphy, performed in 11 patients, showed a significant improvement of transit time in the erect position compared with preoperative values. We concluded that transabdominal esophagomyotomy combined with Dor fundoplication is a safe, effective, and durable procedure in the treatment of esophageal achalasia.

Adolescent↗