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Biomedical subjects

E E Frezza

Publications and source records attributed to E E Frezza.

35 records · Page 2Linked to original sources
PubMed1997

Laparoscopic repair of paraesophageal hernia.

OBJECTIVE: The purpose of this report is to describe the authors' technique for the laparoscopic repair of paraesophageal hernias and the outcome in their series of patients. METHODS: Thirty patients underwent elective laparoscopic repair of paraesophageal hernias. All were pure type II paraesophageal hernias as defined by upper gastrointestinal contrast studies. All operations were performed by a single surgeon (JKE) assisted by five different chief surgical residents. The authors have used various prototypes of a laparoscopic utility belt to reduce the physician requirement to the surgeon and a first assistant. The operative setup and specific techniques of the repair are described and illustrated. A concomitant anti-reflux procedure was performed in the last 23 patients. RESULTS: Satisfactory repair using video-laparoscopic techniques was achieved in all cases. There were no deaths. Complications occurred in 8 of 30 patients. Postoperative gastroesophageal reflux developed in three of the first seven patients in whom fundoplication was not performed. Three consecutive patients had left lower lobe atelectasis believed to be related to endotracheal tube displacement during the passage of the bougie. One patient had postoperative dysphagia. There was one case of major deep venous thrombosis with pulmonary embolism. Twenty-eight of 30 patients were discharged home by postoperative day 3. Twenty-four of 30 patients had returned to normal activity by the time of their first postoperative office visit 1 week after surgery.

Adult↗
PubMed1996

Venous thromboembolism after penetrating chest trauma is not a cause of early death.

BACKGROUND: Venous thromboembolism has been recognized as a potentially life-threatening complication following major thoracic trauma. Little or no attention has been directed at the difference in rates of venous thromboembolism in subjects with penetrating and nonpenetrating chest trauma. METHODS: The reported experience with venous thromboembolism in subjects with chest trauma has not segregated the effect penetrating vs. closed chest trauma. The influence of long-term hospitalization to the formation deep vein thrombosis, pulmonary embolism or subsequent death. The present study evaluated the causes of early death occurring within 96 hours of hospitalization for penetrating chest trauma. The clinical records and autopsy reports of 32 individuals, who died within 96 hours of admission to hospital for penetrating chest trauma, were evaluated for the presence of deep vein thrombosis and pulmonary embolism. RESULTS: All 32 subjects were male with an average age of 31 years. Eighty percent were successfully resuscitated in the emergency room. Forty percent (40%) required an emergency or operating room thoracotomy. The initial revised trauma score (RTS) was below 4 in each case. Thirty-two percent (32%) of the patients died on the fourth day; 48% died between 1 and 3 days of admission and 20% died in the emergency room. None of the patients had any clinical signs or evidence of deep vein thrombosis or pulmonary embolism. Moreover, the autopsy findings were negative for deep vein thrombosis and pulmonary embolism. CONCLUSION: Deep vein thrombosis and pulmonary embolism is rarely a cause of death within the initial 96 hours of hospitalization in individuals sustaining penetrating chest trauma.

Adolescent↗
PubMed1994

NK activity during graft-versus-host disease and graft rejection in rats following intestinal semiallogenic and allogenic transplantation with or without mesenteric lymphadenectomy.

Graft-versus-host disease (GVHD) and graft rejection are major problems following intestinal transplantation (IT). Natural killer (NK) cells may be important effector cells in both conditions. In this study, Sprague-Dawley (SD) or SD-Brown Norway (BN) F1 rat intestine was transplanted into BN recipients with and without associated graft mesenteric lymphadenectomy (GML). Cyclosporine (15 mg/kg day) was administered to all animals. Pieces of the intestinal graft were examined 4 days posttransplant and again at death. NK activity calculated using intestinal intraepithelial lymphocytes (IL) was determined utilizing an 18-hr cytotoxic assay assessing 51Cr release and the results are reported as lytic units. YAC-1 cells were used as the target. NK activity was reduced 4 days after IT both in native (8.02 +/- 0.64) and in grafted bowel (3.14 +/- 1.51), with histological evidence of rejection as compared with that of control bowel in ungrafted rats (21.1 +/- 2.14). Survival was increased, on mean, a total of 6 days with the addition of GML in both semiallogenic and allogenic transplanted rats. At the time of death, the NK activity in the native bowel had increased (17.1 +/- 3.02) and histologic evidence of GVHD was present. These data suggest that: (1) NK cells are important in GVHD and (2) both semiallogenic and allogenic transplants survive longer if they are combined with GML (P < or = 0.05 and P < or = 0.01, respectively).

Animals↗
PubMed1994

CCL4-induced liver cirrhosis and hepatocellular carcinoma in rats: relationship to plasma zinc, copper and estradiol levels.

A number of biochemical events accompany the development of chronic liver disease and its evolution into hepatic cancer. Low plasma zinc and high plasma copper levels have been observed in individuals with advanced hepatocellular liver disease. Moreover, many investigators have demonstrated an increase in serum estradiol levels in individuals with chronic liver disease and hepatocellular carcinoma (HCC). In the present study, the relationship between these biochemical events and HCC was investigated in an animal model. Specifically, carbon tetrachloride (CCL4) was administered intragastrically to 20 female Sprague Dawley rats for 30 weeks. All 20 animals developed cirrhosis. Six (30%) developed HCC. Significantly higher serum estradiol, zinc and copper levels were observed in the rats developing HCC as compared with those with cirrhosis alone (P < or = 0.05, 0.01 and 0.001, respectively). A trend toward increased serum levels of progesterone, ALT and total bilirubin (0.1 > or = P < or = 0.05) was found in the animals developing HCC. No differences in serum testosterone and alkaline phosphatase levels were noted between animals with and without HCC. These studies demonstrate that in animals with experimental CCL4-induced cirrhosis and HCC serum levels of estradiol, zinc and copper are increased, as is the case in man.

Animals↗
PubMed1993

Effect of ursodeoxycholic acid administration on bile duct proliferation and cholestasis in bile duct ligated rat.

The origin, mechanism, and significance of the bile duct proliferation (BDP) associated with cholestasis remain unexplained. This study examined the effect of oral administration of ursodeoxycholic acid (UDCA) on both BDP and cholestasis in the rat. After bile duct ligation, male Sprague-Dawley rats were treated for 30 days with either UDCA (5 mg/day) (group A) or saline solution (group B). Animals were sacrificed at day 30. The serum activity of aminotransferase (ALT, AST), alkaline phosphatase, and gamma-glutamyltransferase (GGT) was significantly lower (P < 0.01) in the UDCA-treated rats. Total serum bilirubin and total serum bile acids were lower (P < 0.001) in group A. Moreover, the control of BA in bile was reduced also (P < 0.02). Conversely, serum cholesterol levels were not different between the two groups. Histological examination showed that the number of ductular cells in the portal areas was significantly (P < 0.001) reduced in UDCA-treated as compared to saline-treated rats. The replication activity, assessed as the number of bromodeoxyuridine-positive cells, was also significantly lower in treated animals (33 +/- 11 vs 64 +/- 22 per 1000 cells; P < 0.001). Lobular bile ductules were three times larger in group B, and extrahepatic duct measurements confirmed this increase in size of the larger biliary ducts (P < 0.001). These findings demonstrate that UDCA reduces BDP in response to BD ligation. Although the mechanism(s) of this effect is still hypothetical, UDCA may reduce the level of irritating bile salts such as chenodeoxycholic acid and lithocolate and increase periductular bile acid recirculation.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

Sex hormones and trace elements in rat CCL4-induced cirrhosis and hepatocellular carcinoma.

Several biochemical events accompany and mediate the development of chronic liver disease and its evolution into cancer. Low plasma zinc and high copper levels have been observed in various liver diseases, such as liver cirrhosis and viral hepatitis, while increased oestradiol levels have been documented in chronic liver damage and hepatocellular carcinoma. We administered CCL4 intragastrically to 10 female Sprague Dawley rats for 30 weeks. All animals developed cirrhosis and four also developed hepatocellular carcinoma. Plasma levels of zinc, copper and oestradiol were significantly higher in the latter group than in animals with simple cirrhosis. Progesterone, AST and bilirubin showed a trend toward significant differences whereas testosterone and ALP levels were unchanged. These findings add to the evidence that sex hormones and trace elements are involved in the process of the development of chronic liver damage and carcinogenesis.

Alkaline Phosphatase↗
PubMed1992

Conservative and surgical treatment in acute and chronic anal fissure. A study on 308 patients.

The aetiology of anal fissure is not fully understood--why some heal spontaneously and others become chronic remains a mystery. In this study we compared surgical and conservative therapy and investigated which surgical procedure is most useful in the treatment of fissure. There were investigated 308 patients, 157 with acute fissure and 151 with chronic fissure. Healing was achieved in 45 +/- 15 days and in 40 +/- 10 days in acute fissures treated conservatively and surgically, respectively, 40 +/- 15 days and 30 +/- 5 days were required to achieve healing in chronic fissure by conservative and surgical therapy, respectively. Manometric tests showed a decrease in resting pressure and maximum voluntary contraction pressure at one month, and an increase towards the pre-operative level at 4 months for both parameters. There were no recurrences at 5 years in 100 patients (50 males and 50 females).

Acute Disease↗
PubMedDate not supplied

Commentary: quality of care and cost containment are the hospital-based ambulatory surgery challenges for the future.

Cost containment and quality of care represent the most important objectives of all health care professionals. Because of its progressive growth over the past decade, ambulatory surgery has become an area where these 2 issues need to be addressed. The goal of this paper is to discuss the economic and quality of care challenges faced by hospitals as they strive to become competitive in the 21st century. The quality of care in ambulatory surgery has been improving because of multidisciplinary activities. Hospitals tend to hire the staff on the basis of their expertise in certain areas, and those personnel do not have to cover other hospital roles. Moreover, the hospital staff is able to seek information at any time from coworkers in other areas of specialty. Ambulatory surgery in a hospital offers advantages, such as multiple operating rooms, multiple skilled health care providers, and the ability to stay overnight if needed. The consolidation of supplies makes it easier to contract for a better price. Aggressive contract negotiations and implementation of cost-effective and cost-efficient strategies are the keys to success in the future. Quality improvement (QI) initiatives and quality of care (QC) indicators need to be developed to address various problems in the ambulatory surgery setting such as unnecessary admissions, inadequate staffing, efficient operating room (OR) utilization, quality of care, and assessment outcome. These initiatives should be addressed at regular meetings where opportunities to improve the ambulatory services are discussed. The number of ambulatory surgery procedures performed each year will continue to increase, although perhaps not at the rate we experienced in the past. Procedures that once were performed in an inpatient setting can now be accomplished on an outpatient basis or even in the physician's office. We will continue to see this shift of volume as technologic advancements and anesthetic agents allow more complex procedures to be performed on an outpatient basis.

Ambulatory Surgical Procedures↗
PubMedDate not supplied

Local and general anesthesia in the laparoscopic preperitoneal hernia repair.

OBJECTIVE: The extraperitoneal laparoscopic approach (EXTRA) has been shown to be an effective and safe repair for primary (PIH), recurrent (RIH) and bilateral hernia (BIH). There is very little data examining the merits of laparoscopic repair for hernias under local anesthesia. In this' paper, we compare EXTRA performed under both general and local anesthesia. METHODS: This nonrandomized prospective study was performed selectively on a male population only. Patients with associated pulmonary disease and high risk for general surgery were selected. Patients with recurrence and previous abdominal operations were excluded to decrease confounding variables in the study. A Prolene mesh was used in all patients. RESULTS: Between May 1997 and September 1998, 92 male patients underwent the repair of 107 groin hernias using the EXTRA technique. The procedure was explained to them, and different anesthesia options were given. Fourteen of these repairs were performed under local anesthesia and 93 under general anesthesia. Of the 10 patients who underwent a repair under local anesthesia, there were 8 indirect, 5 direct and 1 pantaloon. The mean age was 53 years. In the group of general anesthesia, the types of hernias repaired were 45 indirect, 30 direct and 11 pantaloon. The mean age was 45 years. The mean follow-up was 15 months. Each patient was sent home the same day. Two peritoneal tears were recorded in the first group. The operative time was longer in the local group (47 +/- 11 vs 18 +/- 3). None of the patients required conversion to an open technique or change of anesthesia. No recurrences were found in either group. The average time of return to work and regular activity was 3.5 +/- 1 and 3 +/- 1 days, respectively. CONCLUSION: There appears to be no significant difference in recurrence and complication rates when the EXTRA is performed under local anesthesia as compared to general. Blunt dissection of the preperitoneal space does not trigger pain and does not require lidocaine injection. The most painful area is the peritoneal reflection over the cord structure. The laparoscopic repair under local anesthesia represents an advantage in the repair of the inguinal hernia, particularly in the population where general anesthesia is contraindicated.

Adult↗
PubMedDate not supplied

[Transplantation of isolated hepatocytes into the spleen of rats].

The effects of splenic transplantation of hepatocytes on survival time and hepatic regeneration were studied in adult rats subjected to: 1) 90% hepatectomy plus portocaval shunt (graft of 4 x 10(6) hepatocytes) and 2) 90% hepatectomy (graft of 4 x 10(6) and 8 x 10(6) hepatocytes); data were compared with those obtained in hepatectomized rats. Hepatic regeneration was significantly higher in transplanted rats and, within animals with grafted hepatocytes more pronounced in rats without porto-caval shunt. This support the hypothesis that a hepatotrophic factor is produced by grafted hepatocytes: its activity is more pronounced in the absence of porto-caval shunt since all splenic blood reach the liver. The activity of the putative hepatocyte growth factor does not depend on the number of grafted hepatocytes since no significant differences in survival time and hepatic regeneration was observed between rats grafted with 4 x 10(6) and 8 x 10(6) hepatocytes.

Animals↗
PubMedDate not supplied

Small bowel transplantation: current progress and clinical application.

Total parenteral nutrition (TPN) is used routinely to maintain patients with the Short Bowel Syndrome (SBS). Until recently, TPN has been the only available therapeutic modality for patients with SBS. Currently, it is the treatment of choice for such individuals and occasionally, when the loss of bowel is extensive, it may be the only way of maintaining life. Unfortunately, TPN is expensive and markedly restrains an individual's lifestyle. Despite the overall success of TPN, the numerous risks associated with its use and the many complications of having an intravenous indwelling for years have served as the stimulus for alternative treatments such as small bowel transplantation (SBT). The first attempts at small bowel transplantation in clinical medicine were by Detterling almost 25 years ago. Patient death or graft loss in these early attempts was caused by the failure to control graft rejection and/or the inability to prevent Graft Versus Host Disease (GVHD). A stimulus for renewed clinical interest in SBT was provided by Starzl et al in 1988 with a report of prolonged graft survival without graft rejection or GVHD in a patient who was the recipient of a multivisceral graft consisting of the entire small bowel and other abdominal organs. Since 1964, 78 Small Bowel transplants have been performed in humans. Several variations of the multivisceral procedure in which the liver and the small bowel constitute the major components of the graft were adopted. The longest survival has been in a child who is still alive with a working graft for more than two years, as reported by Goulet from Paris in 1989. The introduction in SBT of the new immunosuppressive agent FK 506 had provided results which are superior to those achieved with Cyclosporine A (CsA). This latter observation prompted the Pittsburgh group to initiate a large series of isolated and composite intestinal grafts. The remarkable results have demonstrated the clinical utility of intestinal transplantation. This paper will try to summarize the history of the small bowel transplantation until the end of the year 1992, with the current progress in use today.

Animals↗
PubMedDate not supplied

Non-lymphoid cancer after liver transplantation.

BACKGROUND/AIMS: The increasing length of survival of organ transplant recipients necessitates careful attention to the potential neoplastic complications of life-long immunosuppression, which is required for such patients. Previous studies by Penn of patients taking triple drug therapy (Cyclosporin, Azathioprine and Prednisone) for immunosuppression, or even of those taking Imuran and Cyclophosphamide, have shown a high percentage of tumor development (3117 per 2915 patients). METHODOLOGY: Three thousand three hundred and ninety-four adult patients underwent orthotopic liver transplantation (OLTx) at the University of Pittsburgh Medical Center, Transplant Institute prior to December, 1992. Of these, 1657 were examined (48.8%). All patients with hepatic or biliary cancer as the indication for OLTx were excluded; all other indications were considered. All forms of tumor development after OLTx were considered, except for lymphoprolipherative disease and hepato-biliary tumors. The immunosuppressive regimens were reviewed and patients treated with FK 506 and Cyclosporin A (CSA), as well as those switched from CSA to FK 506, were divided into different groups. RESULTS: A total of 50 patients with tumors were identified (37 males, 13 females), ranging between 34 and 69 years of age. Of these patients, 48 are still alive. In these patients, 64 tumors, classified according to the TMN classification, were discovered: 50 in males and 14 in females. Two metastases were found following discovery of the tumor. The tumors identified were as follows: basalioma 25%, squamous 20.3%, Bowen 6.2%, warts 3.1%, melanoma 6.2%, Kaposi's sarcoma 3.1%, colonic adenocarcinoma 3.1%, colonic polyps 4.6%, rectal cancer 1.5%, breast cancer 4.6%, cervical cancer 3.1%, ovarian cancer 3.1%, laryngeal cancer 3.1%, prostate cancer 1.5%, lung cancer 3.1%, gastric cancer 3.1%, and hemangioblastoma 1.5%. CONCLUSIONS: Skin cancer is the most common type of tumor discovered after liver transplantation (The transplant does not change the occurrence in lung transplants with a positive smoking history). A lower incidence of tumors was found after liver transplantation as compared to kidney transplantation. A higher incidence of tumors was found with CSA, as opposed to FK 506 immunosuppression therapy. None of the patients in this series experienced acute graft rejection necessitating re-transplantation. Chronic graft rejection was treated either with FK 506 or with OKT3, without an increase in the incidence of tumor development.

Adult↗
PubMedDate not supplied

Gallbladder carcinoma: a 28 year experience.

BACKGROUND: Despite the fact that several studies have been conducted to demonstrate advancements in the treatment and prognosis of gallbladder carcinoma, no standard method of treatment has been identified or agreed upon. OBJECTIVE: The aim of this study were to review the presentation, staging, treatment and prognosis of subjects with cancer of the gallbladder at Howard University and its affiliated Institutions over the last three decades to see if there were any improvement in the survival. METHODS: A retrospective analysis of a 28 year experience at Howard University was performed. Patient gender, age, symptoms, signs, the diagnostic tests, pathology reports, operative and adjuvant treatments of each case were reviewed. A review of the English literature on the subject of gallbladder carcinoma covering the last twenty years using a Medlars search of the subject was also performed. An attempt was made to determine the utility of the various radiological tests used to diagnose and stage gallbladder, cancer. RESULTS: Patients with Stage I tumors using the Nevin classification had a 100% survival at 5 years. Patients with Stage V had 0% survival at 5 years. Stages II, III and IV had survivals of 51%, 12% and 10% respectively. The most common presenting symptom was abdominal pain which was present in 45% of cases. Gallbladder ultrasound studies had a sensitivity of 50% while the CT scanning had a sensitivity of 40% for disease detection. ERCP, when used, had a sensitivity of 75%. Radio and chemotherapy did not influence the survival of patients in this series. The most common surgical procedure performed was cholecystectomy with or without an associated hepatic resection for stage II and III, combined with adjuvant chemotherapy. CONCLUSIONS: The current prognosis of individuals with gallbladder carcinoma is dismal, nevertheless a slightly improvement over the last three decades has been achieved particularly regarding the sensitivity of the radiological tests to diagnosis GBC. Five fluorouracyl may be promising as adjuvant therapy associated with radiotherapy. Consideration should be given to a more aggressive screening with the up-to-date radiological tools, of high risk individuals and early resection of the gallbladder in high risk cases with any findings suggestive of gallbladder cancer.

Adult↗