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Biomedical subjects

G Giustozzi

Publications and source records attributed to G Giustozzi.

At least 19 recordsLinked to original sources
PubMed2004

[Laparoscopic and general surgery guided by open interventional magnetic resonance].

Interventional magnetic resonance (IMR) machines have produced unique opportunity for image-guided surgery. The open configuration design and fast pulse sequence allow virtual real time intraoperative scanning to monitor the progress of a procedure, with new images produced every 1.5 sec. This may give greater appreciation of anatomy, especially deep to the 2-dimensional laparoscopic image, and hence increase safety, reduce procedure magnitude and increase confidence in tumour resection surgery. The aim of this paper was to investigate the feasibility of performing IMR-image-guided general surgery, especially in neoplastic and laparoscopic field, reporting a single center -- St. Mary's Hospital (London, UK) -- experience. Procedures were carried out in a Signa 0.5 T General Elettric SP10 Interventional MR (General Electric Medical Systems, Milwaukee, WI, USA) with magnet-compatible instruments (titanium alloy instruments, plastic retractors and ultrasonic driven scalpel) and under general anesthesia. There were performed 10 excision biopsies of palpable benign breast tumors (on female patients), 3 excisions of skin sarcoma (dermatofibrosarcoma protuberans), 1 right hemicolectomy and 2 laparoscopic cholecystectomies. The breast lesions were localized with pre- and postcontrast (intravenous gadolinium DPTA) sagittal and axial fast multiplanar spoiled gradient recalled conventional Signa sequences; preoperative real time fast gradient recalled sequences were also obtained using the flashpoint tracking device. During right hemicolectomy intraoperative single shot fast spin echo (SSFSE) and fast spoiled gradient recalled (FSPGR) imaging of right colon were performed after installation of 150 cc of water or 1% gadolinium solution, respectively, through a Foley catheter; imaging was also obtained in an attempt to identify mesenteric lymph nodes intraoperatively. Concerning laparoscopic procedures, magnetic devices (insufflator, light source) were positioned outside scan room, the tubing and light head being passed through penetration panels. Intraoperative MR-cholangiography was performed using fast spin echo (SSFSE) techniques with minimal intensity projection 3-dimensional reconstruction. About skin sarcomas, 2 of them were skin recurrences of previously surgically treated sarcomas (all of them received preoperative biopsy) and the extent of the lesion was then determined using short tau inversion recovery (STIR) sequence. The skin was closed in each case without need for any plastic reconstruction. The breast lesions were visualized with both Signa and real-time imaging and all enhanced with contrast: 2 (20%) were visualized only after contrast enhancement; intraoperative real time imaging clearly demonstrated a resection margin in all cases. Maximum dimensions of breast specimens (range 8-50 mm, median 24.5 mm) were not significantly different from those measured by Signa (p>0.17, Student's paired t-test) or real time images (p>0.4): also there was no significant difference in lesion size between Signa and real time images (p>0.25). All postprocedure scans clearly demonstrated complete excision. The extent of the tumor at MR imaging was greater in each case than suggested by clinical examination. Adequate resection margins were planned using STIR sequences. Histological examination confirmed clear surgical margins of at least 1 cm in each case. During right hemicolectomy, both intraoperative SSFSE and FSPGR contrast imaging revealed the lesion and details of the colonic surface; imaging of the lymph node draining right colon was only partially successful, due to movement artifact. Concerning laparoscopic procedures, both FSE and SSFSE techniques produced reasonable images of the gallbladder and intrahepatic ducts, but the FSE imaging was of poor quality due to respiration artifact; however, SSFSE allowed visualization of the gallbladder and part of the common bile duct. About skin sarcomas, the extent of the tumor at MR imaging was greater in each case than suggested by clinical examination and in each case the complete tumor excision was confirmed. Histological examination confirmed clear surgical margins of at least 1 cm in each case. Intraoperative MR scanning reliably identifies palpable breast tumours and skin sarcomas and is sufficiently accurate to guide their surgical excision. Further work may be done to develop laparoscopic and open abdominal surgery as well.

Anesthesia, General↗
PubMed2004

[Laparoscopic treatment for Crohn's disease].

AIM: Several studies have demonstrated the feasibility and safety of laparoscopic surgery for Crohn's disease. A trend towards less morbidity as compared to laparotomy has been suggested. However, problems noted early in the experience may have prevented the optimal benefit from having been conferred. Accordingly, the aim of this study was to evaluate perioperatively those patients. METHODS: All 51 patients with Crohn's disease who underwent an intestinal resection at Cleveland Clinic Florida between January 1997 and December 1998 were analyzed. RESULTS: Seventeen patients underwent laparoscopic treatment: there were no significant differences between the 2 groups as to age, gender, incidences of comorbidity, prior laparotomy, or the use of anti-inflammatory and immunosuppressive agents. Similarly, there were no significant differences between the 2 groups as to either surgical indication, intraoperative findings, or procedure performed. Moreover, there were no significant differences concerning total anesthetic time or surgical operative time, the incidence of intraoperative morbidity or need for enterolysis or stoma construction, use of intraoperative endoscopy, or need for transfusion. Significant differences were noted in the duration of patient controlled analgesic usage (3.1 days in the laparoscopic group vs 3.9 days, respectively; p = 0.03), the incidence of postoperative morbidity (7/17 patients in the laparoscopic group vs 27/34 patients: p = 0.01), and length of hospital stay (6.4 days in the laparoscopic group vs 9.6 days, respectively; p = 0.05). CONCLUSIONS: In this retrospective cohort comparative study, laparoscopic intestinal resection for Crohn's disease, when compared to laparotomy, was associated with a short duration of patient controlled analgesic usage, a lower incidence of postoperative morbidity and a shorter hospital stay, without significantly increased operative time.

Adult↗
PubMed2003

[Laparoscopic surgery for endoscopically irretrievable colonic polyps].

AIM: The vast majority of benign colorectal neoplasms can be safely removed by colonoscopic polypectomy; while peduncolated polyps can be easily endoscopically excised, the removal of sessile polyps may be more difficult. METHODS: Between January 1997 and December 1998, 12 patients underwent laparoscopic or laparoscopic-assisted colonic resection for treatment of endoscopically irretrievable colonic polyps; this group was compared to 12 patients who underwent a laparotomic approach for polyps in the same period of time and to 23 patients who previously underwent similar laparoscopic resections. RESULTS: There were no significant differences between laparoscopic and laparotomic groups. CONCLUSION: Laparoscopic or laparoscopic-assisted colonic resection for treatment of endoscopically irretrievable colonic polyps remains our preferred method of treating these lesions.

Aged↗
PubMed2002

[Laparoscopic surgery for colon diverticulitis].

BACKGROUND: Laparoscopic surgery is used with increasing frequency to treat colorectal pathologies and some groups have also attempted to treat the complicated forms of diverticulitis (abscesses and/or fistulas). The results reported in the international literature are still controversial, especially in terms of the duration of surgery, the frequency of laparotomic conversions and postoperative morbidity. The aim of this study was to analyse the results of laparoscopic or laparotomic treatment of diverticular disease of the colon in patients admitted to the Department of Colorectal Surgery at the Cleveland Clinic in Florida over a three-year period. METHODS: A retrospective analysis was made of 57 patients with diverticular disease of the colon who were admitted to CCF (Cleveland Clinic Florida) between January 1996 and December 1998 and underwent elective laparoscopic or laparotomic surgery. A comparative analysis was made of the results in the two groups. RESULTS: Of the 57 patients treated only 15 underwent laparoscopic surgery; the majority were treated for uncomplicated diverticulitis. 22 out of 42 patients (53%) undergoing laparotomic surgery presented complicated diverticulitis (abscesses, fistulas or stenosis), whereas 12 out of 15 patients undergoing laparoscopic surgery (80%) were treated for uncomplicated diverticulitis. Statistically significant differences were found in relation to the duration of surgery: 152 min in the laparotomic group vs 209 in the laparoscopic group. No differences were found in the frequency of intraoperative complications, transfusions and the number of drainages inserted (p=0.66). The postoperative period showed significant differences in terms of the reappearance of intestinal peristalsis, use of PCA and postoperative stay. CONCLUSIONS: This retrospective study confirms that the laparoscopic treatment of colon diverticulitis offers a number of advantages: reduced postoperative pain, more rapid recovery of intestinal peristalsis and shorter postoperative stay. Laparoscopic sigma colectomy represents the treatment of choice for diverticulitis in uncomplicated cases.

Aged↗
PubMed2001

Synthesis and secretion of transforming growth factor-beta1 by human desmoid fibroblast cell line and its modulation by toremifene.

The present study provides evidence that the in vitro cultured fibroblast cell line from desmoid tumors differs from normal fibrobasts in its extracellular matrix (ECM) macromolecule composition and is modulated by treatment with toremifene, an antiestrogen that reduces tumor mass by an unknown mechanism. The results showed increased transforming growth factor-beta 1 (TGF-beta1) production, TGF-beta1 mRNA expression, and TGF-beta1 receptor number in desmoid fibroblasts compared with normal cells. As desmoid fibroblasts did not produce tumor necrosis factor-alpha (TNF-alpha) but were sensitive to it, which enhanced glycosaminoglycans (GAG) accumulation, we assessed the TGF-beta1 effects on TNF-alpha production by human monocytes. Our results showed TGF-beta1 significantly increased TNF-alpha secretion by monocytes. Toremifene mediated its effects in desmoid fibroblasts via an estrogen receptor-independent pathway. It inhibited GAG accumulation and the secretion of both latent and active forms of TGF-beta1 and had an inhibitory effect on TNF-alpha production by monocytes. Our results suggest that in reducing TGF-beta1 production by desmoid fibroblasts and TNF-alpha production by monocytes, toremifene may restore the balance between the two growth factors.

Antineoplastic Agents, Hormonal↗
PubMed2000

Locally advanced rectal cancer: a multivariate analysis of outcome risk factors.

BACKGROUND AND OBJECTIVES: Stages II and III rectal tumors are known as locally advanced rectal cancer (LARC) because they are characterized by a high incidence of local and distant relapses and a low probability of long-term survival. Adjuvant treatments have been advocated to ameliorate overall survival (OS), local recurrence-free survival (LRFS), and metastasis-free survival (MFS) without a univocal beneficial trend. The aim of this study was to identify the independent predictive factors of OS, LRFS, and MFS which could best select patients for adjuvant treatment of LARC. METHODS: Of 153 rectal cancer cases seen consecutively from 1991 to 1998, we studied the main clinical and pathological parameters of 73 LARCs. Clinical and pathological variables were studied by univariate analysis, and independent predictive factors were identified by multivariate analysis. RESULTS: Stages II and III rectal cancer have shown not statistically different rates of OS, LRFS, and MFS. Factors independently associated with increasing OS and MFS were low preoperative carcinoembryonic antigen level (CEA), low number of metastatic lymph nodes, low percentage of metastatic lymph nodes out of the total number of lymph nodes excised, and adjuvant treatment. Increased staging and distal resection margins < or =1 cm were shown to be independent detrimental risk factors regarding OS and MFS, respectively. Independent prognostic factors associated with a reduction in LRFS were advanced age, Hartman's resection, distal resection margins < or =1 cm, and fewer than 14 resected nodes. CONCLUSIONS: Whereas stage I rectal cancer can be treated with a good probability of cure by surgery alone, avoiding adverse effects of adjuvant regimens, the outcome of LARC appears to be positively influenced by adjuvant therapies. In LARC, an accurate study of risk factors would be useful to identify which subset of patients could be favorably influenced by postoperative radiochemotherapy.

Adult↗
PubMed2000

Biological prognostic factors for early stage completely resected non-small cell lung cancer.

BACKGROUND AND OBJECTIVES: The different and unpredictable outcomes in early-stage non-small cell lung cancer patients requires urgent research concerning the biological pathway of this neoplasm. Our study investigated the frequency of expression and the clinicopathologic and prognostic significance of a series of biological markers in stage I and II resected non-small cell lung cancer. METHODS: A total of 99 cases of pathologic stage I and II were analyzed. The mean follow-up of surviving patients was 41 months. The expressions of the following biological markers were tested: bcl-2, p53, Ki-67, angiogenesis, and tumor vessel invasion. Kaplan-Meier estimates of survival and time to recurrence were calculated for clinical variables and biological markers using Cox's model for multivariate analysis. RESULTS: Tumoral vessel invasion was present in 22 (22%) pathologic samples, the angiogenesis mean value was 37 +/- 13, and median was 35; 13 (13%) patients showed positive immunostaining for bcl-2 oncoprotein. P53 oncoprotein expression was present in 48 patients (48.5%). All samples presented Ki-67 expression (mean value = 25.3 +/- 19.3, median = 20). The pathologic staging of the tumor was the most important independent prognostic factor for survival (P = 0.037) and for recurrence of disease (P = 0.040). Tumoral vessel invasion was the only marker with an independent predictive factor for survival and recurrence of disease in the group of patients without lymph node involvement (P = 0.02). CONCLUSION: Our data do not support a relevant prognostic role for p53, bcl-2, or Ki-67 immunohistochemical markers in non-small cell cancer. Tumor vessel invasion was an independent predictive factor of poor outcome in the group of patients without lymph node involvement. Pathological stage was confirmed as the most important independent prognostic factor.

Biomarkers, Tumor↗
PubMed2000

[Registry of genetic and malformative diseases in the province of Macerata].

OBJECTIVES: The aim of this epidemiological research is to evaluate the prevalence of genetic diseases and malformative syndromes in paediatric population living in the Macerata county. MATERIAL AND METHODS: All the data were collected through a careful analysis of a specific questionnaire sent to all the family paediatricians. RESULTS: 23,379 children living in Macerata county, aged 0 to 9 years, were evaluated (93.8% of all this paediatric population). Among those were found N 400 cases of genetic diseases and malformative syndromes: Malformations Tot.N. 255 cases (63.3% of the reported cases); Malformative Syndromes Tot. N. 55 cases (27.8% of the reported cases); Endocrinology and Metabolic Diseases Tot. N. 41 cases (10.3% of the reported cases); Osteochondrodysplasia Tot. N. 22 cases (5.7% of the reported cases); Other Tot. N. 28 cases (7.0% of the reported cases); Male population was found more affected than female: M/F ratio = 1.4. The analysis of the data showed an increasing trend in detecting these pathological conditions, consistent with the increase in geographic altitude (3 areas considered): 0-100 meter = 0.88%; 100-600 m.a.s. = 1.34%; over 600 m.a.s. = 1.88%. CONCLUSION: The knowledge of the number of children affected by genetic and malformative diseases in the Macerata county is relevant in order to establish a Genetic Service with the aim to better support the medical assistance of these patients and counselling service for the families.

Child↗
PubMed1999

Pancreatic regeneration after subtotal distal resection in rats. Effects of bombesin and octreotide by the in vivo bromodeoxyuridine uptake technique.

Forty male Wistar rats were randomly allocated to four treatment groups after 90% distal pancreatectomy: group A (control) received saline (0.5 ml subcutaneously); group B received bombesin (BBS; 10 microg/kg intraperitoneally); group C received octreotide (2.5 microg/kg subcutaneously), and group D received BBS and octreotide. All substances were injected three times a day until sacrifice after 28 days. BBS increased pancreas weight (p = 0.003) and DNA synthesis (p < 0.001), as measured by a bromodeoxyuridine nuclear-labeling index (BrdU LI). The simultaneous administration of octreotide significantly decreases the remnant pancreas weight (p = 0.016) as compared to group B rats; however the BrdU LI is not significantly reduced in group D as compared to group B. BBS administration promotes regeneration of the remnant pancreas in terms of hypertrophy and hyperplasia. Although octreotide appears to significantly reduce the pancreatic weight increase induced by BBS, it does not reduce DNA synthesis and cell proliferation.

Animals↗
PubMed1999

Hepatoid carcinoma of the stomach: is it still an unusual anatomo-clinical entity? Six cases-report.

Hepatoid carcinoma of the stomach is a rare neoplasm (especially in western countries) characterized by high levels of serum alpha-fetoprotein (AFP), the presence of "hepatoid foci" inside the gastric tumor and poor prognosis, due to the earlier onset of liver metastases. We treated six patients for hepatoid carcinoma of the stomach between 1990 and 1997. The female to male ratio was 1:1, the average age was 71 (54-81) and the average AFP-level was 1160 ng/ml (603-1531). We performed 2 total gastrectomies, 2 subtotal gastrectomies and 2 gastro-jejunostomies (due to presence of liver metastases): in one case, the patient underwent a splenectomy as well. All the tumors showed the presence of "hepatoid foci" (the morphological feature is close to the hepatocellular carcinoma) and a positive immunoreactivity to AFP. The mean survival was 3 months: only one patient is still alive and disease-free (with a 52 months follow-up). After radical surgery, she underwent a chemotherapic treatment with cisplatin, epirubicin, 5-fluorouracil and l-leucovorin. We conclude that our series (the widest in Italy and one of most impressive in Europe) confirm the poor prognosis of this neoplasm, but we also want to underline that this tumor is not so "unusual" any more and it requires new types of treatment, like postoperative chemotherapy, besides surgery, to be fighted properly.

Aged↗
PubMed1998

Rupture of the azygos vein in blunt chest trauma.

Isolated traumatic laceration of the azygos vein is a rare condition that is mainly associated with violent deceleration traumas. Diagnosis is crucially based on radiologic evidence of massive right pleural bleeding and hemorrhagic shock. Surgical exploration needs to be early and concomitant with resuscitation, prognosis largely depending on timely intervention. Median sternotomy provides the most advantageous access because it can be quickly performed and allows for surgical exploration.

Accidents, Traffic↗
PubMed1997

["Hepatoid" gastric tumor].

In this study the Authors describe two cases of hepatoid adenocarcinoma of the stomach: one is characterized by the presence of alpha-fetoprotein (AFP) high levels of the serum both pre and post-operating and by the very positive response to the adjuvant chemotherapy (how the return to the normality of such values demonstrates). The other is instead characterized by the presence of post operating hepatic metastasis, event which is very frequent in this kind of neoplasm, but presents many problems concerning the differential histological diagnostics with the primitive hepatocarcinoma (problems which are nowadays not completely solved). Moreover the Authors relate to this study the revision of the international literature of the main characteristics and of prognosis of this particular and rare neoplasm.

Adenocarcinoma↗
PubMed1991

[Lung surgery in patients over 70 years].

The Authors according to their previous experience, report on the possibility of thoracic surgery in patients older than 70 with lung cancer. Fourty-seven patients older than 70 have been operated in the period 1984-1988 for lung cancer. The Authors performed 34 lobectomy, 11 pneumonectomy, and 4 wedge resection. The mortality rate was 4.25% (2 patients). Thirty-four patients are still living (follow-up range 12-60 months). Ten patients died. The Authors report a diagnostic and therapeutic guideline for this kind of pathology.

Aged↗
PubMed1983

[Clinical value of hemorrheology in peripheral arterial occlusive diseases].

The authors report their study on the red blood cell deformability of 30 patients with isolated and combined obstructive lesions in both aorto-iliac and femoral trunk, performed before and after the exercise test. Such a test does not significantly change the deformability in normal patients while, on the contrary, the exercise test significantly changes the deformability in patients affected by atherosclerotic disease. Furthermore, in the experience of the authors the decrease of the deformability is directly related to the degree of the circulatory impairment.

Adult↗
PubMed1979

[Revascularization of the deep femoral artery in arterial insufficiency of the lower limbs. Clinical aspects and immediate results].

The main indications for revascularisation of the lower limb using the deep femoral artery are explained. In aorto-iliac disease with obstruction of the superficials, an aortofemoral by-pass is created, and the distal end of the prosthesis is sutured on the point of origin of the profunda in the form of a patch. In cases where the patients's local or general condition precludes the establishment of a femoro-popliteal by-pass in femoro-popliteal disease, endoarteriectomy is performed and a patch is applied from the CFA to the first segment of the profunda. Thirty-six cases in which the method described was applied are illustrated. These are culled from a total of 144 artery reconstructions performed in 1975--77. The results (33 asymptomatic cases 6 months after surgery, equal to 91.7%) are comparable with those obtained in by-passes with patent SFA in patients with aorto-iliac obstruction. In addition, the method often makes amputation unnecessary in patients with obstruction of the subinguinal trunks only, but unable to be treated by the establishment of a femoropopliteal by-pass.

Aorta, Abdominal↗
PubMedDate not supplied

[Perioperative changes in the plasma levels of fibrinogen and D-dimer during laparoscopic cholecystectomy: the preliminary results of a prospective randomized clinical study].

AIM: Considering that laparoscopic procedure is associated with increased resistance to lower-limb venous return and subsequent stasis, with possible implications in terms of thromboembolic complications, the aim of our study was to investigate prospectively the coagulative-fibrinolytic profile, in laparoscopic and open cholecystectomy, in patients randomly alloted to receive or not preoperative heparin. METHODS: We prospectively analyzed 36 patients (20 laparoscopic and 16 open) and we randomly divided the patients in two groups: Group-A (28 patients--16 laparoscopic and 12 open) didn't take any preoperative thromboprophylaxis, Group-B (8 patients--4 laparoscopic and 4 open) took preoperative subcutaneous heparin. We took blood venous samples before surgery, at time 0 and + 30 min., at the end and 1 and 24 hours postoperatively. The following parameters were assessed: prothrombin time, partial thromboplastin time, fibrinogen and D-dimer. We statistically analyzed the differences by ANOVA test. RESULTS: In Group A, fibrinogen and D-dimer were significantly higher (p < 0.0001 and p = 0.0266) in open group as compared with laparoscopic one and we observed significant time-depending changes of fibrinogen's concentration (p = 0.0168). In Group B we obtained a higher fibrinogen's value in laparoscopic group than in conventional one, with a significant difference (p = 0.0283); also, the sampling-time affected the result in a very significant meaning (p = 0.0041). Comparing fibrinogen levels between Groups A and B, we observed lower values in heparin-treated group than in the other one (p < 0.0001), while in laparoscopic surgery there was not a significant difference between two groups of treatment. CONCLUSIONS: Our preliminary data suggest that, perioperatively (besides a smaller laparoscopic acute-phase response) the coagulative-fibrinolytic changes are lower in laparoscopic cholecystectomy than in open one and heparin treatment significantly reduces these changes in open surgery but doesn't seem to affect laparoscopic group. Our results seem to show another possible advantage of the laparoscopic surgical procedures over the traditional ones.

Adolescent↗