Biomedical subjects

A Ruzzenente

Publications and source records attributed to A Ruzzenente.

10 recordsLinked to original sources

PubMed2006

Laparoscopic hepatic resection.

BACKGROUND: Although laparoscopy in general surgery is increasingly being performed, only recently has liver surgery been performed with laparoscopy. We critically review our experience with laparoscopic liver resections. METHODS: From January 2000 to April 2004, we performed laparoscopic hepatic resection in 16 patients with 18 hepatic lesions. Nine lesions were benign in seven patients (five hydatid cysts, three hemangiomas, and one simple cyst), five were malignant in five patients (five hepatocarcinoma), and four patients had an uncertain preoperative diagnosis (one suspected hemangioma and three suspected adenomas). The mean lesion size was 5.2 cm (range, 1-12). Twelve lesions were located in the left lobe, three were in segment VI, one was in segment V, one was in segment IV, and one was in the subcapsular part of segment VIII. RESULTS: The conversion rate was 6.2%; intraoperative bleeding requiring blood transfusions occurred in two patients. Mean operative time was 120 min. Mean hospital stay was 4 days (range, 2-7). There were no major postoperative complications and no mortality. CONCLUSIONS: Hepatic resection with laparoscopy is feasible in malignant and benign hepatic lesions located in the left lobe and anterior inferior right lobe segments (IV, V, and VI). Results are similar to those of the open surgical technique in carefully selected cases, although studies with large numbers of patients are necessary to drawn definite conclusions.

Adult↗

PubMed2005

[Long-term results of neoadjuvant radiochemotherapy in squamous carcinoma of the thoracic esophagus].

AIM: Surgery is considered the mainstay of therapy for clinically resectable esophageal cancer, even though neoadjuvant treatments are frequently added. The aim of this study was to analyse our experience on neoadjuvant treatment of squamous cell carcinoma of the thoracic esophagus with special reference to long-term RESULTS METHODS: The results of 66 patients who underwent neoadjuvant chemo-radiotherapy for squamous cell carcinoma of the thoracic esophagus at the 1(st) Division of General Surgery, University of Verona, from February 1995 to December 2002 were analysed statistically. The median follow-up period for the surviving patients was 65.3 months. RESULTS: The induction treatment was completed in 93.9% of cases, with a null treatment related mortality and a complication rate of 34.8%. Sixty-one out of the 66 patients (92.4%) underwent resection with a R0-resection rate of 83.9%. A major pathological response (responders) was gained in 42.6% of the cases, with a complete response (pTONO) observed in 29.5% of the cases. Overall 5-year survival for the 66 patients was 30%, while the 5-year survival rate raised to 43% in R0-patients. A better long-term survival was observed for responders with respect to ''non-responders'' with a 5-year survival rate of 70% and 13%, respectively (P<0.001). CONCLUSIONS: This neoadjuvant protocol regimen represents a feasible treatment with an acceptable morbidity. The tumor efficacy in term of pathological responses was similar to literature RESULTS: An high rate of R0-resections was achieved with a possibility of cure limited to this group of patients. A better long-term survival was observed in patients with major pathological responses.

Adult↗

PubMed2004

[Surgical treatment of gasto-esophageal junction adenocarcinoma: long-term results of a single Italian centre].

OBJECTIVE: The present study analysed the experience of a single Italian institution in the treatment of gastro-esophageal junction (GEJ) adenocarcinoma with the aim of assessing the long-term outcome after surgical resection. METHODS: The results of 132 patients who underwent resection with curative intent for GEJ adenocarcinoma at the First Division of General Surgery, University of Verona, from January 1988 to February 2004, were analysed statistically with special reference to Siewert type. The median follow-up period for the surviving patients was 37 months. RESULTS: Long-term survival was limited to patients who underwent RO resections (88.6%) with a 5-year survival rate of 28%. Univariate analysis showed Rp, T and pN categories to be significant prognostic factors (P<0.001), with chance of cure limited to patients with less than 6 involved lymph nodes. At multivariate analysis, R category and lymph node involvement were the most important prognostic factors while pT category lost the significance shown at univariate analysis (P=0.082). Siewert classification did not show any prognostic significance (P=0.969), but the mode of recurrence differed for the three Siewert types: in type I tumors, the majority of relapses were haematogenous (67%), while they were prevalently intra-abdominal in type III (65%) with a high rate of peritoneal carcinosis (26%). CONCLUSIONS: The long-term prognosis for GEJ cancer remains poor, independently from Siewert type, with cure limited to patients with less than 6 involved lymph nodes.

Adenocarcinoma↗

PubMed2002

Risk assessment and prediction of rebleeding in bleeding gastroduodenal ulcer.

BACKGROUND AND STUDY AIMS: The aims of this study were to identify risk factors for recurrence of hemorrhage in bleeding gastroduodenal ulcers after endoscopic injection therapy, and to develop a simple and relevant prognostic score which could be used to assess the early risk of recurrence and the residual risk of rebleeding. PATIENTS AND METHODS: A prospective study was conducted from January 1995 to December 1998, in 738 patients who were admitted to our department for acute bleeding peptic ulcer and who underwent endoscopic examination. Ulcers with active bleeding or signs of recent bleeding were treated with injection therapy using epinephrine (1/10,000) and 1% polidocanol. RESULTS: Multivariate analysis revealed that liver cirrhosis, recent surgery, systolic blood pressure below 100 mmHg, hematemesis, Forrest classification, and ulcer size and site were significantly predictive variables for the recurrence of hemorrhage. Among these, Forrest classification was the most important. The overall accuracy of the predictive model was 71% (95% CI = 63 - 79%). The model showed a better sensitivity of 90% for early rebleeding (< 48 hours) than for late rebleeding (> or = 48 hours) where the sensitivity was 65 %. A prognostic score was obtained and patients were classified into four risk classes: very low (VL), low (L), high (H), and very high (VH). The rebleeding rates for the four classes were 0%, 7.9%, 31.8% and 67.9%, and the mortality rates were 5.9%, 8.6%, 13.9% and 35.7%, respectively. The residual risk of rebleeding after 48 hours was 0%, 3.3%, 10.4%, and 14.3% in the VL, L, H and VH classes, respectively. After 5 days the residual risk was under 4% in all classes. CONCLUSIONS: This study demonstrates that the proposed prognostic score, which is easily obtained after emergency endoscopy, is useful in clinical practice because it can identify patients with different levels of rebleeding risk. It can be helpful in patient management and decision making for discharge.

Aged↗

PubMed2002

[Peptic ulcer hemorrhage in the elderly].

BACKGROUND: The aim of this study was to investigate the efficacy of endoscopic injection therapy on the clinical outcome of elderly patients with peptic ulcer bleeding. METHODS: From January 1995 to December 1998, 738 patients with acute peptic ulcer bleeding were observed in the First Division of General Surgery, University of Verona: 359 aged <70 years and 379 =/>70 years. History, clinical and endoscopic findings and outcome were prospectively collected and analyzed comparing old (=/>70 yrs) and young (<70 yrs) patients. Ulcers with active or sign of recent bleeding were submitted to injection therapy using epinephrine and 1% polidocanol. RESULTS: Coexisting diseases were significantly more present in the elderly group except for liver cirrhosis that affected preferentially young patients (12.3 versus 4.0%; p<0.001). Endoscopic treatment was performed in a similar percentage between young and elderly patients (respectively 64.9 e 61.5%) and also the rebleeding rate (14.2 versus 13.2) and the mean duration of hospitalisation were not different. The overall mortality was 12.7% in the elderly group and 8.3% in the young group (p=0.04), whereas mortality after surgery was significantly higher in the young group (respectively 57.1 versus 8.3%; p=0.037). CONCLUSIONS: The clinical and endoscopic features and reebleeding rate were not different between elderly and young patients. Patients aged 70 years or older have a higher number of associated medical diseases except for liver cirrhosis conditions and a highest overall mortality whereas the risk of death after surgery is lower than in the younger group.

Acute Disease↗

PubMed2002

[Esophageal non-variceal hemorrhage: a clinical and epidemiological study].

Aim of this study was to evaluate the incidence of esophageal bleeding in a group of 3741 consecutive patients with acute non variceal upper gastrointestinal hemorrhage observed between January 1990 and January 1999 in the First Division of General Surgery--University of Verona. In 627 patients (16.8%) the source of bleeding was exclusively esophageal; and the most frequent causes of esophageal bleeding were reflux esopagitis (408 cases) and Mallory Weiss syndrome (185 cases). At emergency endoscopy, reflux esophagitis was actively bleeding in 83 cases (20.3%) and these patients presented a significantly higher frequency of cirrhosis and severe esophagitis; moreover a higher percentage of patients with bleeding esophagitis have had recent surgery and/or were hospitalized in an intensive care unit. No death directly related to the bleeding were observed, while ten patients deceased from other causes during the hospitalization. In more than half of the 185 patients affected by Mallory-Weiss syndrome a hiatal hernia was described and 69 (37.3%) were alcoholics with associated cirrhosis in 25 cases. In more than 70% of the cases the bleeding from a mucosal tear followed a vomit episode and the lesions were localized at the gastroesophageal junction. Endoscopic sclerotherapy was performed in 89 patients with active bleeding and hemostasis was initially obtained in all patients; rebleeding occurred in 6 patients (6.7%) who needed a further endoscopic treatment. No patients died during hospitalization. Other causes of esophageal bleeding observed were: Candida esophagitis (19 cases), esophageal malignancy (11 cases), benign polyps (2 cases), angiodysplasia (one case) and one case of aorto-esophageal fistula.

Adult↗

PubMed2000

Bucrylate treatment of bleeding gastric varices: 12 years' experience.

BACKGROUND AND STUDY AIMS: For several years now there has been an increasingly widespread use of a tissue adhesive in the treatment of bleeding gastric varices to achieve rapid, safe control of hemostasis and prevent rebleeding. In this study we report on our experience with the use of Bucrylate (Hystoacryl) for the treatment of gastric varices over a period of more than a decade. PATIENTS AND METHODS: Since 1988, 174 cirrhotic patients with actively bleeding gastric varices have been admitted to our department, where they received emergency treatment with injections of Bucrylate. Any associated nonbleeding esophageal varices were subjected to traditional sclerotherapy in combination with the Bucrylate treatment. The gastric varices were subdivided into four distinct groups according to the method advocated by Sarin in 1989. The patients underwent weekly sclerotherapy sessions until their varices were eradicated, and the follow-up with a mean of 36 months (range 9-90 months) consisted of endoscopy at 3, 6, and 12 months during the first year and then yearly checks to confirm obliteration of the varices. RESULTS: The hemostasis (97.1%), early rebleeding (15.5%), and hospital mortality (19.5%) rates of the patients with bleeding gastric varices, treated with the tissue adhesive, were very similar to those of patients treated for esophageal varices over the same period (98.1%, 13.0%, and 16.4%, respectively). The most frequent cause of death at 30 days was liver failure (76% of cases), followed by hemorrhagic shock (8.8%), and other less frequent causes. Sclerotherapy achieved obliteration rate for gastric varices (70-75%) similar to that for esophageal varices in those patients with portal hypertension due to intrahepatic block (alcoholic and posthepatitis cirrhosis), but a rate of only 32% in the group of patients with prehepatic block (splenoportomesenteric thrombosis), where surgery proved more effective (69%). The medium- and long-term survival rates depended on the stability of the patients' liver conditions, on rapid, effective control of variceal hemostasis, and on complete, lasting obliteration of the gastric varices. CONCLUSIONS: The use of Bucrylate in emergency sclerotherapy achieved results in bleeding gastric varices on a par with those obtained in esophageal varices in cases of alcoholic and posthepatitis cirrhosis. The group of patients with portal hypertension due to prehepatic block (splenoportal thrombosis) showed no benefit from sclerotherapy in terms of obliteration of gastric varices, but benefited from elective surgery. The choice of the obliterating treatment indicated may be facilitated by classifying gastric varices into distinct groups on the basis of anatomicotopographic criteria.

Adolescent↗

PubMedDate not supplied

Caval anastomosis in liver transplantation: prospective experience of Verona liver transplantation program.

Caval anastomosis in liver transplantation has been modified to avoid outflow complications. Classic cava replacement is rarely indicated; most liver transplantation teams use a piggy-back (PB) technique. At the start of our liver transplantation program, we opted for a latero-lateral (L-L) caval anastomosis. In our prospective experience, the L-L caval anastamosis was safe and feasible in all 24 adult patients. No vascular complications occurred. Graft and patient survival rates were both 96% at 11 months follow-up.

Adult↗

PubMedDate not supplied

[Acute hemorrhage secondary to gastric ulcer. Results of emergency endoscopic treatment in 775 cases].

The aim of this study was to investigate the effects of endoscopic injection therapy on the clinical outcome of patients with gastric ulcer bleeding. Seven hundred and seventy-five patients with gastric ulcer bleeding were observed over a 10-year period (January 1990 to May 2000) in the First Division of General Surgery of the University of Verona. The prognostic and therapeutic implications of endoscopic treatment of acute severe gastrointestinal bleeding were analyzed on the basis of medical history and clinical and endoscopic findings. The ulcers were classified according to Forrest's classification of bleeding activity. Endoscopic therapy was performed in 500 patients with active bleeding. Haemostasis was initially obtained in all patients except one. Rebleeding occurred in 13%. All these patients were treated endoscopically at the first attempt. Multivariate analysis revealed that recent surgery, ulcer site and Forrest classification independently influenced the recurrence rate. The mortality of the entire cohort studied was 8.1%. Only 31 patients (4%) underwent surgical treatment with a higher mortality compared to unoperated patients (19.3% vs 7.7%). Endoscopic treatment is a safe procedure with a low mortality and cost, and, if successful, substantially reduces the need for emergency surgery.

Acute Disease↗

PubMedDate not supplied

[Acute hemorrhage caused by duodenal ulcer. Results of endoscopic treatment of the first bleeding episode and of recurrences].

BACKGROUND: The aim of this study was to evaluate the impact of immediate endoscopic treatment of bleeding and rebleeding on the clinical outcome of patients with duodenal ulcer hemorrhage. MATERIALS AND METHODS: Between January 1995 and December 1998, 445 patients with bleeding duodenal ulcers were observed in the First Division of General Surgery--University of Verona. All patients, except two who died for hemorrhage before the endoscopic examination, underwent emergency endoscopy within 2 hours from the admission and ulcers with active or sign of recent bleeding were submitted to injection therapy. History, clinical and endoscopic findings, recurrent bleeding and outcome were prospectively collected and analyzed. Recurrent bleeding underwent immediate endoscopic retreatment as first attempt. RESULTS: Endoscopic therapy was performed in 277 patients with active bleeding and hemostasis was initially obtained in all patients except one. Rebleeding occurred in 62 patients (14%) and endoscopic treatment was successful in 85% of first rebleeding and in 58% of the cases with 2 or more rebleeding. Multivariate analysis showed that systolic blood pressure at admission, ulcer size and Forrest classification influenced independently the recurrence rate. The 30 days mortality was 12.2% in the whole series: 35 deaths (9.2%) in the group without recurrence and 19 (30.6%) deaths in the rebleeding group (p = 0.001). Only 22 patients (5%) underwent surgical treatment with a higher mortality compared to not operated patients (36.4% versus 10.9%). CONCLUSIONS: Endoscopic treatment was associated with reductions of the risk of recurrent bleeding and surgery without increasing mortality rate.

Acute Disease↗