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A Zerbi

Publications and source records attributed to A Zerbi.

At least 37 records · Page 2Linked to original sources
PubMed1997

Evaluation of UICC TNM classification for pancreatic cancer. A study of 228 patients.

CONCLUSION: A different stage grouping of TNM factors can improve the predictivity of the UICC TNM classification for pancreatic cancer. Nevertheless, the Japanese Pancreas Society (JPS) classification maintains a higher prognostic value. BACKGROUND: The use of a reliable staging classification facilitates the evaluation of anticancer treatments and the correct management of patients. The aim of the present study was to evaluate the prognostic value of three modified UICC TNM classifications, obtained by different stage grouping of the UICC TNM factors, comparing their predictivity to the standard UICC and the JPS classifications. METHODS: Clinical material consisted of 228 patients who underwent resection for pancreatic cancer. The reliability of the classifications was analyzed by the following methods: univariate analysis of stage survival curves; multivariate analysis of each classification after adjusting for grading and radicality; and correlation between the patients' distribution in the stages of each classification and in survival classes. RESULTS: The following modified UICC classification allowed a better differentiation of stage II and III survival (P = 0.08) than standard UICC (P = 0.74): stage I: T1N0M0; stage II: T1N1M0/T2N0M0: stage III: T2N1M0/T3 any NM0; stage IV: M1. The JPS classification better discriminated between the different stages (P < 0.001). All classifications had an independent prognostic value by multivariate analysis. The correlation between stages and survival classes was higher for the JPS classification than either UICC TNM classification or the modified UICC classifications.

Adenocarcinoma↗
PubMed1997

Color Doppler imaging in the assessment of vascular involvement by pancreatic carcinoma.

OBJECTIVE: The aim of our study was to assess the accuracy of color Doppler imaging in diagnosing the involvement of peripancreatic vessels by pancreatic carcinoma. SUBJECTS AND METHODS: We prospectively evaluated the color Doppler images of 61 patients with pancreatic carcinoma. Our evaluations occurred before surgery and focused on vascular involvement. Absence of contact or a short contiguity (< or = 2 cm) between tumors and peripancreatic vessels was considered to be a sign of resectability on color Doppler imaging; a long contiguity (> 2 cm), compression, encasement, or thrombosis was considered to be a sign of unresectability. In all patients, the sonographic diagnosis was compared with the surgical results. RESULTS: With color Doppler imaging, we detected signs of vascular involvement in 26 of 33 patients in whom vascular involvement was found at surgery. We detected no vascular involvement in 25 of 28 patients in whom no vascular involvement was found at surgery. No false-positive diagnoses occurred when vascular encasement was revealed by color Doppler imaging. For diagnosis of vascular involvement, the sensitivity, specificity, and overall accuracy of color Doppler imaging were 79%, 89%, and 84%, respectively; positive and negative predictive values were 89% and 79%, respectively. CONCLUSION: Color Doppler imaging is a sensitive and highly specific technique in assessing vascular involvement by pancreatic cancer when absence of contact or vascular encasement is seen. When vascular encasement is detected by color Doppler imaging, a definitive diagnosis of unresectability can be made, and further diagnostic procedures can be avoided. When sonography is used in the initial evaluation of pancreatic cancer, color Doppler imaging can improve the selection of patients for further diagnostic examinations or surgical exploration.

Aged↗
PubMed1996

Pancreatic adenocarcinoma: assessment of vascular invasion with high-field MR imaging and a phased-array coil.

OBJECTIVE: We performed this study to determine the value of MR imaging for assessing vascular invasion in preoperative staging of pancreatic carcinoma. SUBJECTS AND METHODS: In 73 consecutive patients with an established diagnosis of pancreatic duct adenocarcinoma, spin-echo T1-weighted and breath-hold multiplanar gradient-recalled (MPGR) images were obtained at 1.5 T with a phased-array coil before and after bolus injection of gadopentetate dimeglumine. Major peripancreatic vessels were evaluated for contiguity with tumor and tumor encasement. All patients subsequently underwent surgery. Results of unenhanced and enhanced MR imaging studies were compared with the histologic findings in the resected specimens of 49 tumors and with the surgical findings of 24 nonresected tumors. RESULTS: In 39 patients, tumor contiguity with adjacent vessels was found at pathologic examination. Of the remaining 34 patients, 10 had vascular encasement by tumor seen on pathologic examination of the resected specimen; the other 24 had unresectable tumors encasing adjacent vessels at surgical evaluation. In the assessment of vascular tumor contiguity, the accuracy was 85% for unenhanced spin-echo T1-weighted imaging, 87% for enhanced spin-echo T1-weighted imaging, 67% for unenhanced MPGR imaging, and 69% for enhanced MPGR imaging. In the assessment of vascular tumor encasement, the accuracy was 91% for unenhanced spin-echo T1-weighted imaging, 94% for enhanced spin-echo T1-weighted imaging, 74% for unenhanced MPGR imaging, and 76% for enhanced MPGR imaging. CONCLUSION: MR imaging is helpful for preoperative assessment of vascular involvement caused by pancreatic carcinoma. For this purpose, unenhanced and enhanced spin-echo T1-weighted images seem to be more accurate than images obtained with other pulse sequences.

Abdomen↗
PubMed1995

Comparison between pylorus-preserving and Whipple pancreatoduodenectomy.

Between 1989 and 1993, 62 patients underwent Whipple pancreatoduodenectomy and 75 pylorus-preserving pancreatoduodenectomy (PPPD); 35 patients in the first group and 37 in the second had pancreatic adenocarcinoma while 17 and 21 patients respectively had periampullary adenocarcinoma. The aim of this retrospective study was the comparison of operative outcome, nutritional recovery and survival of patients who underwent these two operations. No significant differences were found between the two groups in operative mortality or morbidity, duration of gastric aspiration and time to start of solid meals. Patients who underwent PPPD had a better nutritional recovery: the increase of both body-weight and serum albumin level at 6 months after discharge was significantly higher for those who had preservation of the whole stomach (P < 0.001 and P < 0.05 respectively). No significant difference in survival was found between the two procedures when patients with pancreatic or periampullary adenocarcinoma were analysed separately.

Adult↗
PubMed1995

A postgraduate teaching course in laparoscopic surgery.

A teaching course in laparoscopic surgery was addressed to 21 young postgraduates as a part of their general surgery program with the aim of making them familiar with the basic principles of laparoscopic surgery. The methodology was based on tutorial teaching and "learning by problems"; the students worked in little groups elaborating check lists, discussing problems, and practising with laparoscopic training devices. Theoretical learning, practical abilities, and efficacy of tutorial teaching were investigated at the end of the course: the participant's understanding of instrument function, mastering of equipment, and solutions to clinical problems were good, as were the efficiency and pleasantness of the didactic method. Tutorial teaching seems to be a valid model for basic training in laparoscopic surgery in a modern medical education program.

Education, Medical, Continuing↗
PubMed1995

[Advances and perspectives in acute pancreatitis].

Biliary aetiology seems related to a number of acute pancreatitis: biliary sludge and dysfunction at the sphincter of Oddi appear to be responsible for most cases pancreatitis previously classified as idiopathic. The presence and extent of necrosis and its overinfection are the two main factors responsible for history and prognosis of acute pancreatitis: CT scan may can correctly recognize them, whereas multiparametric and biohumoral prognosis have lost a lot of their importance. Supportive medical treatment is essential in the early phase of the disease, while antisecretory and antiprotease drugs do not show a clear clinical efficacy. Antibiotics, if active against bacteria usually found in pancreatic infections and able to concentrate in pancreatic tissue, seem to prevent the septic complications of pancreatitis; the role of topical antibiotics and enteral feeding in preventing bacterial translocation needs further evaluation in the future. Early endoscopic treatment is gaining importance for biliary, or suspected biliary, pancreatitis, whereas in selected cases percutaneous drainage is able to deal with septic complications. Surgery remains an effective when infected necrosis are detected and in cases of extended sterile necrosis with organ failure.

Acute Disease↗
PubMed1995

[Computerized tomography versus nuclear magnetic resonance in acute pancreatitis].

The aim of the study was to compare Computed Tomography (CT) and Nuclear Magnetic Resonance (MR) scan's diagnostic reliability in acute pancreatitis (AP). During a 44-month period 21 patients with a clinical and laboratory diagnosis of AP were submitted to CT and MR study. The scans were evaluated according to pancreatitis degree and presence and rate of necrosis. Pancreatitis degree was assessed using Balthazar's grading for CT scans; a similar classification was used for MR scans. Thirteen patients had oedematous pancreatitis and 8 necrotic pancreatitis. Necrosis was diagnosed intraoperatively or in non operated patients with CT scan. MR staging was identical to that of the CT ones except for 2 patients who were grade E at CT and grade D at MR. MR identified necrosis in all 8 patients with necrotic AP whereas CT diagnosed only 5 patients properly since 3 scans were performed without contrast medium infusion because of renal failure. MR proved to be a valid alternative in AP diagnosis: it provide the same diagnostic and prognostic information as CT and does not need contrast infusion, which makes it preferable to CT in the follow-up of severe AP evolution.

Acute Disease↗
PubMed1994

Intraoperative radiation therapy adjuvant to resection in the treatment of pancreatic cancer.

BACKGROUND: Local recurrence is the most frequent site of failure after resection for pancreatic cancer. Tolerance, local control, and survival obtained by the association of resection and intraoperative radiation therapy (IORT) were reported. METHODS: Between June 1985 and March 1993, 90 resections for pancreatic cancer were performed at the authors' institution. For 43 patients, IORT was added to resection (Group 1), whereas the other 47 patients underwent resection alone (Group 2), because of either the unavailability of linear accelerator or the patient's refusal. In Group 1, radiation doses from 12.5 to 20 Gy, with electron beam energies between 6 and 12 MeV, were delivered. Extension of the disease was similar in the two groups of patients: mean diameter of the tumor was 3.2 cm in Group 1 and 3.4 cm in Group 2; percentage of third degree stage disease (International Union Against Cancer classification) was 65.1% in Group 1 and 57.4% in Group 2; and tumor clearance was incomplete in 39.5% of patients in Group 1 and in 34.0% in Group 2. RESULTS: Operative mortality and overall early post-operative complications were respectively 2.3% and 23.2% in Group 1 and 2.1% and 23.4% in Group 2. One-year, 2-year, and 3-year survival rates were respectively 71%, 24%, and 7% in Group 1 and 49%, 16%, and 10% in Group 2 (P was not significant). Median disease free survival was 13 months in Group 1 and 8 months in Group 2 (P was not significant). A local recurrence was detected in 27.0% of patients in Group 1 and in 56.4% of patients in Group 2 (P < 0.01). CONCLUSIONS: The results suggest a better local control in patients with pancreatic cancer undergoing adjuvant IORT.

Adult↗
PubMed1994

Reliability of pancreatic cancer staging classifications.

The prognostic value of UICC and JPS classifications was evaluated in a group of 74 patients undergoing resection for pancreatic carcinoma in the 1982-1992 period. The predictivity of peritoneal cytology and intraoperative liver biopsies was evaluated in a subgroup of 15 patients. Patient division by stage according, respectively, to UICC and JPS classifications was: stage I: 28 and 2 patients; stage II: 12 and 11 patients; stage III: 29 and 30 patients; stage IV: 5 and 31 patients. Median survival by UICC stages was: 17 months (m) in stage I, 10 m in stage II, 12 m in stage III, and 6 m in stage IV; by JPS stages it was 29 m in stage II, 14 m in stage III, and 7 m in stage IV. A radical resection was possible in 48 patients (65%); the survival was significantly worse in the nonradical resection group. The survival difference among UICC stages was not significant in a multivariate analysis with radicality, whereas among JPS stages a significant survival difference was found in both univariate and multivariate analysis. The tumor invasion of the retroperitoneal tissues and the presence of distant metastasis were indicators of a significantly worse prognosis. Lymph node involvement, tumor size, and serosal invasion had no significant effect on survival. Peritoneal cytology and liver biopsies did not provide further prognostic information.

Adult↗
PubMed1994

[Personal experience in surgical resection of pancreatic carcinoma].

The period 1981-1993, 124 patients underwent resection for pancreatic cancer; they represented 30.8% of all patients observed in that period. Surgical procedures were a pancreatoduodenectomy (PD) in 100 cases, a total pancreatectomy (TP) in 3 cases and a distal pancreatectomy in 21 cases. PD was performed by the injection of Neoprene into the residual pancreatic stump, rather than of pancreatojejunal anastomosis; in 37 cases a pylorus-preserving PD was performed. Adjuvant treatments were given in addition to resection in 75 patients: 47 underwent intraoperative radiation therapy, following a PD in 41 cases, a TP in 1 case and a distal pancreatectomy in 5 cases. Overall operative mortality was 2.4%, overall morbidity 26.6%. In the 103 patients undergoing PD or TP mortality was 2.9% and morbidity 29.1%. Postoperative diabetes occurred in 12.8% of patients undergoing PD with Neoprene injection. Overall median survival was 16 months. Survival was significantly related to UICC staging distribution, to the radical nature of the operation or to adjuvant treatments. No relationship was found between survival and the type of resection (PD versus distal pancreatectomy) or the pylorus preservation. Pancreatic resection, whenever technically possible, represents the treatment of choice of localised pancreatic cancer, in association with adjuvant treatments.

Adult↗
PubMed1993

An oncocytic carcinoma of the pancreas with pulmonary and subcutaneous metastases.

A 72-year-old man with an oncocytic carcinoma of the pancreas of 3 years' duration was treated by pancreatoduodenectomy; 5 and 16 months later, two pulmonary metastases and one subcutaneous metastasis of the thigh were removed. No sign of local recurrence or metastases was present at 20-month follow-up. It is suggested that oncocytic carcinomas of the pancreas have a favorable prognosis if treated surgically.

Aged↗
PubMed1993

Fat absorption and gastroenteric pH profile in postsurgical pancreatic insufficiency: role of the association of H2-receptor antagonists with pancreatic enzymes.

The complete control of steatorrhea in post-surgical exocrine pancreatic insufficiency is difficult. The aim of this study was to evaluate the effect of the association of ranitidine with pancrelipase om fecal fat excretion in patients who had undergone a pancreatoduodenectomy with suppression of the exocrine pancreatic secretion by Neoprene injection. Ten patients were studied 1 year after surgery. Steatorrhea was measured as an integrated test of 3-day stools, while patients were kept on a diet of 100 g lipid/day, with their usual enzyme supplementation therapy (16,050 USP units of lipase/meal). A basal 24-h gastroenteric pH profile was also obtained. In the following month, patients had ranitidine (150 mg twice a day) in addition to pancrelipase. Then steatorrhea and gastroenteric pH were reassessed. Mean fecal fat was 26.9 (SD 13.7) g/day without ranitidine and 30.5 (SD 13.9) g/day during combined treatment. Body weight and nutritional parameters did not show any significant variation after ranitidine administration. Even in the absence of ranitidine, postprandial gastroenteric pH values were always > 4; the H2-receptor antagonist only reduced fasting gastric acidity. In conclusion, the gastroenteric pH and fecal fat determinations showed that ranitidine is not useful in patients with total postsurgical exocrine pancreatic insufficiency.

Adult↗
PubMed1993

Behavior of tumor markers CA19.9, CA195, CAM43, CA242, and TPS in the diagnosis and follow-up of pancreatic cancer.

We compared the recently proposed tumor markers CA195, CA242, and CAM43 with a widely used antigen, CA19.9, and a circulating marker of cellular proliferation, TPS, to define their specificity, sensitivity, and cost-benefit ratio. The tumor markers were measured in 41 pancreatic carcinoma patients and in two control groups, the first comprising 19 patients with benign pancreatic diseases, the second comprising 41 healthy blood donors. Sensitivities were 79% for CA19.9, 57% for CA242, 60% for CAM43, 76% for CA195, and 98% for TPS. Specificities calculated for the group with pancreatic diseases were 60% for CA19.9, 84% for CA242, 95% for CAM43, 53% for CA195, and 22% for TPS. Specificities for the blood donor group were 100% for CA19.9, 93% for CA242, 98% for CAM43, 85% for CA195, and 88% for TPS. Positive values for the tumor markers appeared from second stage (Hermreck classification). Metastases, invasion of lymph nodes, and coupling of cancer-associated antigens did not significantly modify marker sensitivity. In pancreatic carcinoma, CA19.9 showed good sensitivity (79%) and high specificity (60-100%). In view of their own advantages (e.g., high specificity of CAM43, high sensitivity of TPS in recurrences) and limits (e.g., low sensitivity of CAM43, very low sensitivity of TPS), the other markers could be used alone or with CA19.9. Two pairs of tumor markers showed high similarity in our study: CA19.9 and CA195, and CAM43 and CA242.

Adult↗
PubMed1991

Pancreatic cancer versus chronic pancreatitis: diagnosis with CA 19-9 assessment, US, CT, and CT-guided fine-needle biopsy.

The authors prospectively performed serum CA 19-9 assessment, ultrasound (US), computed tomography (CT), and CT-guided fine-needle aspiration biopsy (FNAB) of the pancreas in 81 consecutive patients with suspected chronic pancreatitis or pancreatic neoplasm. The final diagnosis was pancreatic cancer in 54 patients and chronic pancreatitis in 27 patients. CA 19-9 assessment, US, CT, and FNAB were considered nondiagnostic, respectively, in 0%, 25%, 19%, and 6% of cases. When a definite diagnosis was rendered, the positive predictive value was 90% for CA 19-9 assessment, 95% for US, 98% for CT, and 100% for FNAB; the negative predictive value was, respectively, 69%, 95%, 86%, and 100%. The accuracy of all diagnostic and nondiagnostic studies was 81% for CA 19-9 assessment, 72% for US, 77% for CT, and 94% for FNAB. It is concluded that CT-guided pancreatic FNAB is the most reliable examination for enabling differential diagnosis of pancreatic cancer and chronic pancreatitis. When the pancreas is well visualized at US, the negative predictive value for pancreatic cancer is more accurate than that of CA 19-9 assessment and CT.

Adenocarcinoma↗
PubMed1990

Diagnosis of malignant change in duodenal villous adenoma.

Villous adenomas of the duodenum are rare, and malignancy is discovered in about 30% of the lesions. The authors describe two cases of villous adenoma of the second portion of the duodenum (13 and 8 cm in diameter). The diagnosis was obtained through endoscopy, which did not demonstrate any malignant change. In both patients, malignant change was shown by intraoperative frozen sections, and a pancreatico-duodenectomy was performed. Review of the literature and the authors' experience indicate endoscopic biopsies do not rule out the presence of malignancy in adenomatous pathology of the duodenum. Therefore, laparotomy should be performed whenever endoscopic excision of the neoplasm is not feasible. The authors emphasize the importance of an intraoperative diagnosis based on accurate frozen sections and propose a correct procedure to obtain the best results.

Adenoma↗
PubMed1990

Postoperative management of patients with total exocrine pancreatic insufficiency.

The occurrence of maldigestion and malnutrition was studied in 14 patients who had undergone pancreaticoduodenectomy and occlusion of the Wirsung duct with Neoprene. Before discharge patients were put on a 70 g/day dietary fat intake. Mean faecal fat excretion was 32.9 g/day without enzyme replacement and fell to 14.2 g/day with pancrelipase supplementation. At discharge all patients were underweight (88 per cent of the usual mean body-weight) and nine patients showed alteration in laboratory nutritional parameters. At the time of discharge a low-fat diet (50 g/day) was prescribed. Six months after surgery, mean faecal fat excretion decreased further to 8.3 g/day (P less than 0.01) and all patients but one gained weight, reaching 93 per cent of the usual mean body-weight with normalized nutritional parameters. Our data show that the combination of enzyme replacement therapy and low-fat diet allows good correction of steatorrhoea and a significant improvement in nutritional status.

Adult↗
PubMed1990

The National Cholesterol Education program: guidelines and commentaries.

There is overwhelming evidence that atherosclerosis is caused by elevated cholesterol levels and that the process can be prevented, arrested, and even reversed by altering the cholesterol fractions. The National Cholesterol Education program established guidelines for the management of hypercholesterolemia. Classification of cholesterol values are: Desirable 200 mg./dl, Borderline high 200-239 mg./dl high risk 240 mg./dl and above. Total cholesterol is used for case finding and screening, but LDL cholesterol is the key index for decisions requiring treatment. Classification of LDL levels is as follows: High risk 160 mg/.dl and over, Borderline 130 to 159 mg./dl, Acceptable 130 mg./dl and below. Secondary and familiar disorders should be identified. Dietary therapy is the cornerstone of cholesterol reducing interventions. Steps one and two diets are described, with limitations of saturated fats to 10% of total calories and cholesterol to 300 mg./daily in step one; step two diet limits saturated fats to 7% of total calories-and cholesterol to 200 mg./daily. Pharmacotherapy is based on 5 groups of hypolipidemics agents: A--Resins (cholestyramine and colestipol) B--Nicotinic acid C--Probucol D--Fibric acids (gemfibrozil) E--Reductase inhibitors (lovastatin). Some areas of criticism and controversies regarding the guidelines are discussed and identified.

Humans↗