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A Vignali

Publications and source records attributed to A Vignali.

35 records · Page 2Linked to original sources
PubMed1995

Surgery in the very old patient: evaluation of factors linked to postoperative morbidity and mortality.

One hundred and sixty-seven patients over 79 years of age were studied prospectively in our Emergency Surgery Department in order to evaluate their outcome, and the possible existence of factors linked to morbidity and mortality. The most common indications for surgery were gallstones (22.1%), hernias (14.9%), colo-rectal cancer (13.7%), peptic ulcer (6.5%), gastric cancer (5.9%) and ischemic or hemorrhagic vascular diseases (13.1%). Emergency surgery was performed in 93 (55.6%) patients. Forty-nine patients (29.3%) developed 83 postoperative complications. The risk of morbidity was statistically higher in patients who had more than two associated diseases (p < 0.05) and received blood transfusions (p < 0.01). The mortality rate was 16.1%, and was significantly related to ASA scores > or = 4 (p < 0.001) and a high degree of intraoperative bacterial contamination (Classes III-IV) (p < 0.05). Compared to elective surgery emergency operations had a higher morbidity (33.3% vs 24.3%) and mortality (21.5% vs 9.4%), but the difference was not significant. Mortality/morbidity ratio was significantly higher in emergency, as compared to elective surgery (64.5% vs 38.8%, p < 0.001).

Aged↗
PubMed1995

Benefits of early postoperative enteral feeding in cancer patients.

OBJECTIVE: To evaluate the effect of the early postoperative administration of an enriched enteral diet in cancer patients. DESIGN: Randomised controlled study. SETTING: Surgical intensive care unit of a university hospital. PATIENTS: 77 consecutive patients undergoing curative surgery for gastric or pancreatic cancer. INTERVENTIONS: Patients were randomised into 3 groups to receive: a standard enteral formula (n=24); the same formula enriched with arginine, RNA, and omega-3 fatty acids (n = 26), isonitrogen isocaloric total parenteral nutrition (n = 27). Enteral nutrition was started within 12 h following surgery. Infusion rate was progressively increased reaching the full regimen on postoperative day (POD) 4. On admission and on POD 1 and 8, the following measurements were performed: serum level of total iron-binding capacity, albumin, prealbumin, retinol-binding protein (RBP), and cholinesterase. Delayed hypersensitivity response (DHR), IgG, IgM, IgA, lymphocyte subsets. and monocyte phagocytosis ability were also evaluated. Bioelectrical impedance analysis was performed preoperatively and on POD 2, 7, and 11. The rate and severity of postoperative infections and the length of hospital stay were evaluated. RESULTS: In all patients, a significant drop of nutritional and immunologic parameters was observed on POD 1. A significant increase of prealbumin (p<0.02), RBP (p<0.005), monocyte phagocytosis ability (p<0.001), and DHR (p<0.005) was found on POD 8 only in the group fed with the enriched diet. A significant reduction of severity of postoperative infections and length of postoperative stay was found in the group with the enriched diet compared to the other groups. CONCLUSIONS: These data are suggestive of an improvement of the nutritional and immunologic status and clinical outcome in cancer patients who receive an enriched enteral diet in the early postoperative course.

Aged↗
PubMed1995

Impact of a programme of autologous blood donation on the incidence of infection in patients with colorectal cancer.

OBJECTIVE: To assess the effects of both autologous and homologous blood transfusion on the incidence of infective complications after elective operations for colorectal cancer. DESIGN: Prospective open study. SETTING: University hospital, Italy. INTERVENTIONS: Recording of variables known to influence the development of infection. MAIN OUTCOME MEASURES: Infective morbidity and mortality. RESULTS: Fifty-three patients (33%) deposited their own blood. Eighty-six of the 161 (53%) patients were transfused, 36 were given autologous blood, 48 homologous blood and 2 both autologous and homologous blood. These two were excluded from the analysis. Infective complications developed in 28 patients (17%), of which 7/75 (9%) were in patients who had not been transfused, 5/56 (14%) in patients given autologous transfusion, and 16/48 (33%) in patients given homologous transfusions (p < 0.001). Multivariate analysis identified homologous blood transfusion as the only variable significantly associated with the development of postoperative infective complications. No patient died. CONCLUSION: Transfusion of autologous blood was associated with significantly fewer postoperative infective complications than transfusion of homologous blood or no blood transfusion.

Adult↗
PubMed1992

Association between perioperative blood transfusion and postoperative infection in patients having elective operations for gastrointestinal cancer.

OBJECTIVE: To assess the effect of blood transfusion on the development of infection after elective operations for gastrointestinal and pancreatic cancer. DESIGN: Prospective open study. SUBJECTS: 285 consecutive patients admitted with gastric, colorectal, and pancreatic cancer, 215 of whom were suitable for the study. MAIN OUTCOME MEASURES: Sex, age, total iron binding capacity, measurement of haemoglobin and serum albumin concentration, assessment of immune response by delayed hypersensitivity skin test, and weight loss were recorded, as were duration of operation, operative blood loss, and pathological TNM stage of the disease. RESULTS: Sixty patients (28%) developed infections postoperatively. Univariate analysis showed that the development of infection was significantly associated with the amount of blood transfused (p < 0.001), operative blood loss (p < 0.05), and length of operation (p < 0.01), but not weight loss (p = 0.07) or delayed hypersensitivity response (p = 0.08). Multiple logistic analysis showed that blood transfusion was a significant independent variable only when more than 1,000 ml were transfused (odds ratio 6.5, p < 0.05). CONCLUSION: Transfusion of more than 1,000 ml of blood is an independent risk factor in the development of infection postoperatively in patients undergoing operations for gastrointestinal cancer.

Adult↗
PubMed1991

[Lymph node localization of gastrinoma. Diagnosis and treatment].

The case of a 48-year old woman with a lymph node localization of gastrinoma is reported. The preoperative workup (US-scan, TC-scan and NMR) made it possible to detect and localize the lesion. A conservative surgical approach was decided according to the latest literature reports which showed a favourable course in patients with lymph node gastrinoma. Surgical resection has been accomplished. The patient's hormone level was normal at one-year follow-up.

Female↗
PubMedDate not supplied

Immunonutrition in gastric cancer surgical patients.

The aim of this study was to evaluate the potential advantages of perioperative versus postoperative administration of an enteral immune-enhancing diet on host defense and protein metabolism. Thirty subjects, candidates for gastrectomy for cancer, were randomly allocated into two groups. The first group (n = 15) received an enteral formula enriched with arginine, omega-3 fatty acids, and RNA 7 d before and 7 d after surgery; the second group (n = 15) received the same diet but only 7 d after surgery. Postoperative immune and inflammatory responses were investigated by phagocytosis ability of polymorphonuclear cells, interleukin-2 receptors (IL-2R), lymphocyte subsets, interleukin-6 (IL-6), and delayed hypersensitivity response (DHR). Prealbumin (PA), retinol binding protein, albumin, and transferrin were determined as protein synthesis indicators. Perioperative immunonutrition prevented the early postoperative impairment of phagocytosis, DHR, total number of lymphocytes, and CD4/CD8 ratio (P < 0.05 versus postoperative group). The IL-2R levels were significantly higher in the perioperative group (P < 0.05 versus postoperative on postoperative day [POD] 4 and 8). Perioperative group also showed lower levels of IL-6 (P < 0.05 versus postoperative on POD 1, 4, and 8) and higher levels of PA (P = 0.04 versus postoperative on POD 8). The perioperative administration of immunonutrition ameliorated the host defense mechanisms, controlled the inflammatory response, and improved the synthesis of short half-life constitutive proteins.

Adenocarcinoma↗
PubMedDate not supplied

A prospective, randomized clinical trial on perioperative feeding with an arginine-, omega-3 fatty acid-, and RNA-enriched enteral diet: effect on host response and nutritional status.

BACKGROUND: The use of immune-enhancing enteral diets in the postoperative period has given contrasting results. The purpose of this prospective, randomized, double-blinded clinical study was to evaluate the effect of immunonutrition given perioperatively on cytokine release and nutritional parameters. METHODS: Patients with cancer of the stomach or colo-rectum were eligible. Subjects consumed 1 L/d of either a control enteral formula (n = 25; control group) or a formula supplemented with arginine, omega-3 fatty acids, and RNA (n = 25; verum group) for 1 week before surgery. Both formulas were given by mouth. Six hours after the operation, jejunal infusion with the same diets was started and maintained for 7 days. Blood was drawn at different time points to assess albumin, prealbumin (PA), transferrin, cholinesterase activity, retinol binding protein (RBP), interleukin-2 receptors alpha (IL-2Ralpha), IL-6, and IL-1 soluble receptors (IL-1RII). The composite score of delayed hypersensitivity response (DHR) to skin test also was determined (the higher the score, the lower the immune response). RESULTS: During the 7 days of presurgical feeding, none of the above parameters changed in either group. Eight days after operation, in the control group, the concentration of PA and RBP was lower than in the verum group (0.18 vs 0.26 g/L for PA and 30.5 vs 38.7 mg/L for RBP; p < .05). IL-2Ralpha concentration was 507 pg/mL in the verum group vs 238 pg/mL in the control group (p < .001), whereas IL-6 and IL-1RII were higher in the control group than in the verum group (104 vs 49 and 328 vs 183 pg/mL, respectively; p < .01). The DHR score was 0.68 in the control group vs 0.42 in the verum group (p < .05). CONCLUSIONS: Perioperative feeding with a supplemented enteral diet modulates cytokine production and enhances cell-mediated immunity and the synthesis of short half-life proteins.

Adolescent↗
PubMedDate not supplied

[Colorectal laparoscopic surgery. Single center experience with 599 cancer patients].

PURPOSE: To analyze the results of laparoscopic colectomy for cancer of colon and rectum on early outcome. METHODS: Fifty hundred and ninety-nine consecutive unselected patients who underwent laparoscopic colectomy for cancer of the colon or rectum between January 1998 and December 2004 in a single Institution were prospectively evaluated. Tumor classification was by TNM stage. Patients were monitored for postoperative complications for 30 days after surgery. Follow-up was done by direct patient contact. RESULTS: Mean (SD) age was 65.8 (11.7) years. Mean (SD) ASA score was 2.0 (0.5). The following operations were performed: 248 left colectomies, 131 right colectomies, 26 sigmoid resections, 164 rectal resections, 21 abdominoperineal resections (Miles operation) and 9 total colectomies. Conversion rate was 7.2% (43/599 pts). The overall morbidity rate was 23.3% (143/599 pts). The mortality rate was 0.3% (2/599 pts). Anastomotic leak occurred in 45/599 (7.3%) patients. Re-operation rate was 4.6% (26/599 pts). Mean (SD) length of stay was 9.9 (5.8) days. The mean number (SD) of lymphnodes intraoperatively collected was 16.7 (9.8). Median (range) time of follow-up period was 20.2 months (6-68). One port-site metastasis was found at 18 months after surgery. Overall 5-years survival was 81%. Local recurrence rate in patients who underwent TME of the rectum was 4.4%. CONCLUSION: Laparoscopic colectomies is safe and effective in the treatment of colon and rectal cancer.

Aged↗
PubMedDate not supplied

Lack of improvement of prognostic performance of weight loss when combined with other parameters.

This prospective study was designed to evaluate the ability of single and combined prognostic parameters in predicting postoperative infections in cancer surgical patients. The evaluation was based on multiple logistic analysis and receiver operating characteristic (ROC) curve analysis. The Younden's index (YI) was used to select threshold values of the parameters. This analysis was applied in 398 patients undergoing curative elective surgery for gastric, colorectal, or pancreatic cancer. At admission, the percentage of body weight loss, serum albumin, total lymphocyte count, total iron-binding capacity, and serum cholinesterase activity were evaluated. In all patients, the type and rate of postoperative infection were recorded. Multiple logistic analysis showed weight loss as the most predictive variable (p = 0.02), when taken individually. Its best cutoff value was 10% (YI = 1.27, p = 0.00001, ROC area = 0.62). When serum albumin was added as the second-best variable, with a threshold of 35 g/L, the combined YI was 1.27, and the ROC area was 0.65 (p NS vs. weight loss). Total lymphocyte count dichotomized at 2200 million/L was the third variable added to weight loss and serum albumin (YI = 1.31, ROC area = 0.59). In conclusion, weight loss split at 10% appears as the only index with a moderate prognostic performance that is worth evaluating in the preoperative nutrition assessment. A nonsignificant improvement of predictive ability was obtained by the combination of serum albumin, total lymphocyte count, total iron-binding capacity, or serum cholinesterase activity.

Cholinesterases↗
PubMedDate not supplied

Thymopentin increases the survival of mice after allogeneic blood transfusion, bacterial gavage, and burn injury.

OBJECTIVE: To investigate the effect of blood transfusion on mortality and the incidence of bacterial translocation in mice subjected to thermal burn or bacterial gavage, or both, and to assess the influence of thymopentin on mortality. DESIGN: Randomly controlled experiments. SETTING: University departments of surgery, immunology and nuclear medicine. MATERIAL: 235 Balb/c (H-2d) and C3H/HeJ (H-2k) mice. INTERVENTIONS: 8 groups of 20 mice each received: saline infusion (controls), blood transfusion (BT) alone, 20% burn alone, gavage with 1 x 10(10) Escherichia coli alone, BT and gavage, BT and burn, burn and gavage, or BT, burn, and gavage. A further 3 groups of 10 mice were all gavaged with 111In-biotin labelled E coli and randomised to additional BT and burn, BT alone, or burn alone. 98 mice that had had BT, burn, and gavage, were then randomised to receive thymopentin 0, 0.1, 1, or 5 mg/kg/day for 15 days. The impact of the pretreatment with thymopentin on PGE2 concentration was also evaluated in a separate group of 45 mice that received BT, burn, and gavage; or burn and gavage. MAIN OUTCOME MEASURES: Survival, degree of translocation. RESULTS: The highest mortality (75%) was in the BT, burn, and gavage group. BT alone significantly reduced survival in burned mice, whereas BT alone or associated with gavage had no effect. Thermal injury had the most influence on bacterial translocation, whereas BT did not increase it. Thymopentin significantly improved survival, particularly in the higher doses. The pretreatment with thymopentin significantly reduced PGE2 concentration after BT, burn and gavage. CONCLUSION: Burn injury significantly increased mortality in the presence of immune deficiency caused by BT. Thymopentin reduced mortality, possibly by immunomodulation.

Animals↗
PubMedDate not supplied

Erythropoietic response induced by recombinant human erythropoietin in anemic cancer patients candidate to major abdominal surgery.

BACKGROUND/AIMS: This trial was designed to quantify the production of new red blood cells (RBCs) after treatment with recombinant human erythropoietin (r-HuEPO). MATERIALS AND METHOD: Twenty anemic patients with gastric or colorectal cancer were prospectively studied. The control group (n = 10) underwent surgery without delay. The experimental group (n = 10) received treatment with 500 U/kg of r-HuEPO divided in three doses which were administrated as follows: 300 U/kg 12 days before surgery and 100 U/kg 4 and 8 days later. RESULTS: RBC gain was 210 +/- 75 mL in the experimental group which received treatment. The erythropoietic response was similar after 300 U/kg (59 +/- 36 mL) or 100 U/kg 75 +/- 24 mL). No correlation was found between RBC gain and age (r = 0.18) or baseline levels of erythropoietin (r = 0.08), hemoglobin (r = 0.06), erythrocytes (r = 0.01), reticulocytes (r = 0.01), iron (r = 0.28) and ferritin (r = 0.08). One treated patient in the experimental group was transfused with allogeneic blood (2 units) versus 5 control patients (overall 13 units) (p = 0.06). CONCLUSION: Preoperative treatment with r-HuEPO improved erythropoiesis and reduced allogeneic transfusions in anemic cancer patients. No significant difference in RBC gains was noted between r-HuEPO administration at 300 U/kg and r-HuEPO administration at 100 U/kg. This result suggests a possible dose reduction for future trials.

Adult↗