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Biomedical subjects

G Clemente

Publications and source records attributed to G Clemente.

119 records · Page 7Linked to original sources
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[Clinical heterogeneity and distinct outcomes in hepatic epithelioid hemangioendothelioma].

Epithelioid hemangioendothelioma is an infrequent mesenchymal tumor of unknown etiology and variable clinical symptoms. It usually affects black, middle-aged women. The most frequent symptoms are right hypochondrium pain, abdominal discomfort and constitutional syndrome with progressive liver damage. Diagnosis is difficult and detailed pathological analysis is required. Controlled clinical studies are lacking and there are no factors that predict the clinical course or serve as a guide to the most effective treatment. We report 3 cases with distinct clinical course ranging from clinical stability to dissemination and death. Treatment differed in the three patients.

Adolescent↗
PubMedDate not supplied

[Intrahepatic calculosis].

A review of one-hundred cases of intra-hepatic lithiasis, observed between 1967 and 1996 by the same surgical team, was reported in this paper. There were 61 cases of migrated stones and 39 cases of primary duct stones (31 above a stenosis and 8 associated to biliary malformations). 83 patients underwent surgery: in 31 cases, gallstones were removed through the CBD, while a bilio-enteric anastomosis was required in 47 cases; 5 patients underwent a left liver resection. Finally, 17 patients were treated by non-surgical means (endoscopic or radiologic). In a first period, diagnosis was made intraoperatively by cholangiography or choledochoscopy and surgery was the only therapeutic option. After 1980, diagnostic procedure included ultrasonography, CT and direct cholangiography (endoscopic or percutaneous). Consequently to the development of endoscopic (ERCP) or percutaneous (PTC) approaches to remove intrahepatic gallstones, many patients were treated by these non-surgical means, which, in some cases, were associated with extracorporeal lithotripsy. Abnormalities of intrahepatic biliary tree represented an elective indication for liver resection in the last years. The clinical results improved progressively: mortality was 8.3% in the first ten years (67-76), 7.1% in the second decade (77-86) and there was no mortality in the last ten years. In the first decade, intrahepatic biliary tree was completely cleared from gallstones in the 70.8% of cases, in the second decade in the 80.9% of cases and, in the last ten years, in the 97% of cases.

Adult↗
PubMedDate not supplied

Adrenomedullin assay and its clinical significance.

Adrenomedullin (Am) is a recently discovered peptide, first purified from pheochromocytoma specimens, with a chemical structure similar to that of CGRP and amylin. Adrenomedullin is present in numerous human body tissues and its powerful vasodilatatory activity is thought to play an essential role in cardiovascular and renal homeostasis.

Adrenomedullin↗
PubMedDate not supplied

Intraoperative esophageal manometry in surgical treatment of achalasia: a reappraisal.

BACKGROUND/AIMS: Intraoperative Esophageal Manometry is used during surgery for gastroesophageal reflux disease to obtain a better lower esophageal sphincter pressure, or during the Heller procedure for achalasia to verify the myotomy. The effectiveness of this manometry is not explicit. MATERIAL AND METHODS: From 1977 to 1987, 58 patients underwent surgery for achalasia at our Institution. A transabdominal Heller's myotomy and a modified Dor's anterior fundoplication were performed in all cases. During the operation, Lower Esophageal Sphincter Pressure was measured in 38 patients (A group) to verify the completeness of the càr-diomyotomy; the fundoplication-induced pressure increase was also recorded. Twenty patients (B group) underwent surgery without intraoperative manometry. Forty-six patients (30 of A group and 16 of B group) were followed up for 24 to 120 months (median 68 months) by means of a clinical questionnaire, barium meal, manometry and 24-hour esophageal pH monitoring. RESULTS: In 21 cases, intraoperative manometry showed the completeness of the myotomy at the first record, while in the remaining 17 it revealed the persistence of a High Pressure Zone; in these, a more accurate incision of the muscle layers on the anterior surface of the esophagus was subsequently performed up to a complete abolition of the HPZ. Long-term results were excellent or good in 27 (90%) patients of A group and in 9 (56%) patients of B group. Dysphagia and gastro-esophageal reflux were the commonest findings in patients with poor results. CONCLUSION: The usefulness of intraoperative manometry in the surgical treatment of achalasia is emphasized and some technical details are reported.

Adult↗
PubMedDate not supplied

Resection of hepatic metastases from colorectal cancer.

BACKGROUND/AIMS: Long term results of hepatic resection for metastases from colorectal cancer depend upon several factors which are related to both features of primary cancer and of metastases. The aim of this study was to evaluate prognostic factors that best correlate with long-term results. MATERIALS AND METHODS: Fifty-eight hepatic resections were performed for colorectal cancer metastases. Long-term results were evaluated in relation to age of patients, features of primary tumor, features of metastases, section margin, number of intra-operative blood transfusions and execution of adjuvant chemotherapy. RESULTS: Overall 5-year survival rate was 17%. 5-year survival rate in patients with stage B primary tumor was 63%, in patients with late metachronous metastases it was 28%, in patients with section margin > 1 cm it was 33% and in patients who did not receive intra-operative transfusions it was 45%. Patients with a solitary metastasis or with metastases sized less than 4 cm and those who received adjuvant chemotherapy also showed a better survival than the others. CONCLUSIONS: Better results were observed in patients without nodal involvement of the primary tumor. Patients with a small solitary metachronous metastasis that appeared more than one year after the colorectal resection and resected with a section margin of more than 1 cm, also showed good results.

Adult↗