PubMed Health⌕ Search

Biomedical subjects

E Contessini Avesani

Publications and source records attributed to E Contessini Avesani.

At least 19 recordsLinked to original sources
PubMed2006

Inguinal hernia recurrence: classification and approach.

We reviewed case reports, updated to January 2005, of 2,468 operations for groin hernia in 2,350 patients, including 277 recurrent hernias. The data obtained, following a simple anatomo-clinical classification into three types that could be used to orient surgical strategy, were: type R1--first recurrence of "high" oblique external reducible hernia with small (<2 cm) defect in non-obese patients after pure tissue or mesh repair; type R2--first recurrence of "low" direct reducible hernia with small (<2 cm) defect in non-obese patients after pure tissue or mesh repair; and type R3--all other recurrences, including femoral recurrences, recurrent groin hernia with large defect (inguinal eventration), multi-recurrent hernias, non-reducible contralateral primary or recurrent hernia, and situations compromised by aggravating factors (e.g. obesity) or otherwise not easily included in R1 or R2 after pure tissue or mesh repair.

Female↗
PubMed2005

Carriage of CARD15 variants and smoking as risk factors for resective surgery in patients with Crohn's ileal disease.

BACKGROUND: It is controversial whether CARD15 variants are truly associated with a more severe form of Crohn's disease. The relative role of CARD15 genotype and smoking in Crohn's disease progression is also debated. AIM: To investigate the association between CARD15 variants and history of resective surgery in patients with Crohn's ileal disease, taking into account smoking as a possible confounding factor. METHODS: We originally assessed CARD15 genotype in 239 north Italian Crohn's disease patients (mean follow-up: 10.1 +/- 8.1 years). We then focused on 193 patients with proven ileal involvement, 70 of whom (36.3%) carried CARD15-mutated alleles (G908R, R702W, L1007fs). RESULTS: Carriage of CARD15 variants was positively associated with family history and ileal-only disease and negatively associated with uncomplicated behaviour at maximal follow-up (P < 0.05). Ileal resection was the only variable independently associated with CARD15 variants at multivariate analysis (OR 3.8; 95% CI 1.6-9.2; P = 0.003). Kaplan-Meier analysis showed that ileal resection was favoured both by CARD15 variant-carriage (P = 0.01) and by smoking (P = 0.05), but smoking did not affect progression to surgery in variant carriers (P = 0.31). Thirteen of 14 (93%) patients being resection-free at 15-year follow-up, had CARD15 wild-type genotype (P = 0.01), whereas only seven (50%) had never smoked (P = 1.0). CONCLUSIONS: In summary, CARD15 variant-associated Crohn's ileitis is virtually committed to stricturing and/or penetrating disease and, eventually, to resective surgery. Smoking accelerates progression to surgery in patients with wild-type CARD15 genotype, but it seems to exert no additional effect in CARD15-variant carriers.

Adult↗
PubMed2005

Kallikrein-kinin system in inflammatory bowel diseases: Intestinal involvement and correlation with the degree of tissue inflammation.

BACKGROUND: Tissue kallikrein and its natural inhibitor, kallistatin, play opposite roles in the generation of bradykinin, a potent mediator of inflammation. Observations on experimental models and humans with ulcerative colitis suggest a pathogenetic role of the kallikrein-kinin system in inflammatory bowel diseases. AIM: To evaluate tissue kallikrein and kallistatin in intestinal tissue samples from Crohn's disease and ulcerative colitis patients with different degrees of disease involvement. PATIENTS AND METHODS: Full-thickness surgical intestinal samples were obtained from 144 subjects (38 normal controls, 32 inflammatory controls, 38 Crohn's disease, 36 ulcerative colitis) and tested for kallikrein and kallistatin by immunoperoxidase techniques. RESULTS: Compared with controls, kallikrein immunoreactivity was significantly weaker in goblet cells (p=0.0001) and significantly stronger in interstitium (p=0.0001) of the Crohn's disease and ulcerative colitis samples. Kallistatin colocalised with kallikrein, with almost no reactivity in goblet cells but strong reactivity in interstitium of inflammatory bowel disease patients (p=0.0001 versus controls). The kallikrein and kallistatin depletion of goblet cells and the increased interstitial kallikrein and kallistatin reactivity correlated with the degree of tissue inflammation (p=0.0001). Disease-free samples had normal kallikrein and kallistatin patterns. CONCLUSIONS: Kallikrein-kinin system is actively involved in inflammatory bowel disease as a result of the release of kallikrein in the intestinal extracellular space; this involvement correlates with the degree of tissue inflammation. The normal pattern observed in the disease-free samples seems to rule out a genetic defect of kallikrein and kallistatin in inflammatory bowel diseases.

Adult↗
PubMed2004

Spigelian hernia.

UNLABELLED: We report on the evolution in concept and techniques that allowed us to improve the treatment of spigelian hernia, operable in day surgery in 90% of cases and through a preperitoneal and recently a preperitoneal and subfascial prosthetic repair (PHS). BACKGROUND DATA: We propose an innovative use of the PHS mesh for spigelian hernia repair. With this new implementation, we confront the standard surgical technique and its postoperative period. METHODS: From January 1992 to March 2004, we performed 2,500 hernia surgical operations, including 32 spigelian hernia repairs (1.3% of total case series). The first surgical approach used for 20 of these 32 patients (62.5% of total spigelian hernias), all electively operated on, was a classical preperitoneal repair (Wantz), performed when possible by size of defect and weight (Body Mass Index) of the patient, under local anesthesia and on a day-surgery basis. Our new modified technique takes place through the insertion of a PHS large-type mesh, whose bottom underlay portion lies flat in the preperitoneal space with the connector obliterating the hernial orifice and with the overlay portion lying on the internal oblique muscle, covered by the aponeurosis of the external oblique muscle. RESULTS: Our modification to the classical technique consisted only in the application of a product, such as the PHS, in a hernia defect, which presented with an orifice of the size of the connector and, therefore, was easily repairable with the use of the PHS device. This approach is easier than the preperitoneal approach, it's always suitable for local anaesthesia, and it gives a more comfortable postoperative period. The surgical approach may be performed completely in day surgery. CONCLUSIONS: We believe that spigelian hernia surgical repair should always be performed by means of a preperitoneal prosthesis under local anaesthesia when the patient's clinical and physical conditions allow for it, always in day surgery, and using the PHS mesh when the hernia defect size fits with the connector diameter. This last possibility seems to be easier and more comfortable for the patient in the postoperative period.

Follow-Up Studies↗
PubMed2004

Prosthetic repair, intestinal resection, and potentially contaminated areas: safe and feasible?

INTRODUCTION: Prosthetic repair for abdominal wall hernia currently represents the gold standard. However, it is still difficult to identify the correct indication for prosthetic implant in borderline cases. The authors propose evaluating whether a prosthetic implant is absolutely contraindicated in potentially infected operating fields through the review of literature and personal experience. MATERIALS AND METHODS: The authors performed ten prosthetic hernia repairs in potentially contaminated areas, with a preliminary preparation of the retromuscular-preperitoneal space hosting the prosthesis implant, and subsequent performance of the major operation. RESULTS: There were neither major nor minor complications with a 21-month follow-up (mean period). DISCUSSION: It is certain that both in noncomplicated inguinal hernia and in abdominal wall hernia repairs, the use of antibiotics can significantly reduce the number of infections. It is very important to underline that the success of the described procedure can be guaranteed only by an accurate preparation of the preperitoneal space: perfect haemostasis, temporary closure of the space with the insertion of iodine gauzes and suturing the edges, local antibiotic treatment, washing of the cavity, and accurate drainage. CONCLUSIONS: Prosthetic repair is the gold standard for inguinal, incisional, and all abdominal wall hernias and should be used, with the method described, even in potentially contaminated areas. The use of a prosthesis has to be avoided in clearly infected cases.

Abdominal Muscles↗
PubMed2003

Colorectal cancer and high grade dysplasia complicating ulcerative colitis in Italy. A retrospective co-operative IG-IBD study.

BACKGROUND: Ulcerative colitis is a well-known risk factor for colorectal cancer. AIM: To take a census of the cases of colorectal cancer in ulcerative colitis patients observed in Italy and to evaluate the clinical presentation of neoplastic complication. PATIENTS AND METHODS: Experts from 28 Italian centres specialised in the management of inflammatory bowel disease or malignancies participated to the study. They were invited to send clinical data of patients with ulcerative colitis complicated by colorectal cancer or high-grade dysplasia consecutively observed between 1985 and 2000. One hundred and twelve patients (92 with cancer and 20 with high-grade dysplasia) were collected. Fourteen of them had undergone colectomy and ileo-rectal anastomosis for ulcerative colitis. Data of surgical patients were analysed separately. RESULTS: The mean age at diagnosis of ulcerative colitis and colorectal cancer patients was 39.3 and 53.2 years, respectively, and the mean duration between diagnosis of ulcerative colitis and cancer was 13.9 years (range 0-53). Inflammation was proximal to the splenic flexure in 71 cases (76.3%). One hundred and three colorectal cancers were registered (93 patients with single lesion and five patients with two synchronous cancers), with 76.7% of cancers being located in the left colon. As to the surgical patients, the mean age at diagnosis of ulcerative colitis and cancer was 28.9 and 47.0 years, respectively, and the mean diagnostic interval for ulcerative colitis and cancer was 18.1 years. Only 51 out of 112 patients were in follow-up. An early diagnosis of neoplasia (high grade dysplasia, stage A or B sec. Dukes) occurred in 72.5% of patients who were subjected to endoscopic surveillance and in 48.0% of patients who did not undergo endoscopic surveillance (p=0.02). CONCLUSIONS: These data show an earlier diagnosis of cancer in patients who had undergone endoscopic surveillance. The poor compliance to the follow-up program, however, reduces its effectiveness. Moreover, total colectomy allows an easier follow-up, with only the rectum being controlled. Colectomy with ileo-rectal anastomosis or proctocolectomy with ileo-anal anastomosis, could represent a valid alternative in patients at high risk of cancer who refuse endoscopic surveillance.

Adolescent↗
PubMed2002

[Intestinal carcinoma in Crohn's disease. Report of four cases and review of the literature].

BACKGROUND: Increasing numbers of intestinal carcinomas in patients affected by Crohn's disease have been reported by several authors, even if the strength of this associations (age, longstanding of the disease, its characteristics and distribution) still has to be elucidated. METHODS: From January 1992 to July 2000, 130 patients with Crohn's disease were submitted to surgery. RESULTS: Four patients showed an associated intestinal carcinoma at operation, in 3 cases located in the ileum, and in 1 case in the colon. Patients' mean age was 54 years. Mean duration time of the Crohn's disease was 7 years. One patient died 3 months after surgery for disseminated peritoneal carcinomatosis, whereas 3 patients are still alive with malignancy free at 5, 8, and 11 years after the tumor resection. CONCLUSIONS: These results suggest the difficulty in recognizing patients with Crohn's disease who are at risk for intestinal carcinoma. Longstanding disease, previous intestinal exclusion surgery, enterocutaneous or other types of fistulas should be considered for the development of cancer. Therefore, the prognosis may be good if early diagnosis and treatment are made.

Aged↗
PubMed2001

Repair of giant hernias using more prosthesis.

Giant incisional hernias with total loss of substance are an ominous pathological condition characterized by massive depletion of muscular and fascial tissue, by complete loss of the anatomical and physiological function of the abdominal wall and by severe respiratory and visceral involvement. Over a 10-year period we operated 270 patients with voluminous incisional hernias, 12 of which had a total loss of substance. There was no intraoperative mortality. One patient died of myocardial infarction on the fifth and one died of intestinal occlusion and peritonitis the 11th postoperative day. Early postoperative complications occurred in only one patient who had skin necrosis with an infection at the polypropylene mesh. This was successfully treated with systemic antibiotic therapy and topical medication of the wound. There was also one minor recurrence over the pubis 1 year after the operation that required a new operation to replace the mesh. No respiratory complications occurred and all patients were normally active. The good results reported in our series encourage us to continue in this direction even though these patients are at high risk.

Aged↗
PubMed2000

[Nosocomial infections. State of the art].

Little information exists up till now about the prevalence of nosocomial and community acquired infections in Italian hospitals. Little is known about the effects of thorough cleaning in today's hospitals. This review examines the common microorganisms associated with hospital acquired infections and their ability to survive in the hospital environment. The most frequent site of hospital acquired infections is the urinary tract, followed by surgical wounds and the upper respiratory tract. Analysis of North America and European data shows that the increase in length of stay for infected patients is the most striking of all examined costs. Improving standards of hygiene in hospitals would be a safe method to control hospital-acquired infections and their costs.

Costs and Cost Analysis↗
PubMed1998

[Surgical treatment of Crohn's disease. Indication and management in 20 patients].

MATERIALS AND METHODS: Sixty-seven patients with Crohn's disease underwent surgery in our department in the period 1989-1996. In this paper we evaluated only the first 20 patients. Ten were female and 10 male. There was single localization in 13 patients and multiple in 7. Surgery was limited to the macroscopically involved intestinal segment. Reconstruction of the intestinal tract has been carried out with a double layer polyglycolic acid end-to-end manual anastomosis. RESULTS: We had no operative deaths and early morbidity. In the follow-up we observed 2 anastomotic recurrences respectively three and five years after the operation; none of them required surgical treatment. One patient of 20 had a colocutaneous fistula four months after operation because of the relapse of the disease at preanastomotic level. CONCLUSIONS: The results obtained in our limited experience allow us to affirm that, when elective surgery is possible, the most reliable surgical behaviour is a limited resection of the diseased segment. Quality of life improved after surgery in all patients.

English Abstract↗
PubMed1991

[Early gastric carcinoma: short and long term results of surgical treatment].

This paper reports Authors' experience in 58 cases of early gastric cancer observed between 1972 and 1990. The diagnosis of E.G.C. was frequently obtained in patients with recent dyspeptic symptoms. The diagnostic importance of endoscopic procedures, upper gastrointestinal X-rays and endoscopic ultrasonography is underlined. The choice of total gastrectomy with the standardized dissection of regional lymph nodes in order to treat multicentric or upper gastric malignancies v.s. distal gastrectomy for antral lesions is discussed. The cumulative survival rate was 84.4%; local recurrence rate was 4.2%.

Adenocarcinoma↗
PubMed1981

[384 papillosphincterostomy operations. Indications, technic, results and long-term control].

The immediate and long-term results of 384 papillosphincterostomy operations carried out between 1969 and 1979 are presented and discussed. After defining the operation exactly, indications for it are illustrated, i.e.: VP lithiasis, fibrosclerotic odditis, Oddian functional pathology and other pathologies. Special attention is paid to diagnostic techniques. After commenting on surgical techniques, the results obtained in the immediate postoperative course are examined and it is pointed out that complications specific to the type of operation occurred in 1.5% of cases, with a mortality of 1.3% and an incidence of acute pancreatitis of 0.3% (3 cases of which 1 fatal). 162 patients (42%) were followed up between 10 years and 3 months after operation. Follow-up showed the absence of late after-effects and as well as the advantages of effecting an extensive incisura at the Oddian sphincter.

Adult↗