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Biomedical subjects

G Mangiante

Publications and source records attributed to G Mangiante.

At least 19 recordsLinked to original sources
PubMed2001

Treatment of recurrent hepatocellular carcinoma by radiofrequency thermal ablation.

BACKGROUND AND AIMS: The treatment of choice for hepatocellular carcinoma is surgical resection. Recurrence occurs in most patients. Aggressive treatment of liver recurrence increases patients' survival, but most frequently, these patients are not suitable for surgery. The aim of this study was to analyze the indications for and results of radiofrequency thermal ablation (RFTA) in the treatment of intrahepatic recurrences of hepatocellular carcinoma after surgical resection or after RFTA. PATIENTS AND METHODS: Seventy-nine patients with HCC were treated by RFTA (17 during laparotomy, 1 in video-laparoscopic surgery, and 61 percutaneously). Five (5/79) of these patients had recurrences after surgical resection and 1 patient had a recurrence (new lesion) after percutaneous RFTA. Fifteen of the 79 patients were treated for recurrence after transarterial chemoembolization (TACE) and, for the remaining 58 patients, RFTA was the first treatment. We used a radiofrequency generator with an expandable needle with four, seven, or nine hooks at its end. We followed up all patients with enhanced computed tomography (CT) scans and alpha-fetoprotein sampling 1 month after RFTA, and then every 4 months. RESULTS: All 5 patients treated for recurrence after resection are alive, after a mean period of 43 months from liver resection. One patient is disease-free, 1 patient has controlled disease, and 3 patients are in progression. The patient treated for recurrence after RFTA is disease-free after 4 months. CONCLUSIONS: We treated all our patients with intrahepatic recurrence after surgical resection by a multimodal approach. We regard RFTA as the treatment of first choice in the management of intrahepatic recurrence. For superficial tumors, surgical resection is still the best treatment. For multifocal recurrence, TACE is needed. RFTA can be useful as a complementary technique for lesions not completely treated by TACE.

Adult↗
PubMed2001

Prophylaxis for septic complications in acute necrotizing pancreatitis.

Because the mortality of severe pancreatitis is higher when infected necrosis supervenes, prevention of infections has become a relevant endpoint for management. The "ideal" drug should be characterized by specific activity against the bacteria known to be responsible for infection and should be able to penetrate the gland in a sufficient concentration. To date there have been eight prospective trials with antibiotics, one on selective digestive decontamination, and others with enteral nutrition. A meta-analysis regarding experiences with antimicrobial drugs reports a significant reduction in the incidence of infected necrosis and pancreatic abscesses during severe pancreatitis. In conclusion, among the several options aimed at reducing infections during necrotizing pancreatitis, the prophylactic use of antibacterial drugs is the only one to have been tested to date in several randomized studies. Strong consideration should be given to treating patients with severe pancreatitis with broadspectrum antibiotics, selective digestive decontamination, and enteral nutrition.

Animals↗
PubMed2001

Lactobacillus plantarum reduces infection of pancreatic necrosis in experimental acute pancreatitis.

BACKGROUND: Infection is the commonest cause of death in acute pancreatitis. Early reduction of commensal flora (particularly Lactobacillus species) and, at the same time, overgrowth of Enterobacteriaceae, especially Escherichia coli, have recently been described during acute pancreatitis. Lactobacillus plantarum has been shown to be effective in reducing the egress of endotoxin and microbial translocation in several experimental models such as chemically induced hepatitis and ulcerative colitis. AIM: The aim of the study was to determine whether L. plantarum 299v (Lp 299v) is capable of effectively reducing microbial translocation in experimental pancreatitis. METHODS: Acute pancreatitis was induced by isolation and ligation of the biliopancreatic duct in Lewis rats weighing 250-350 g. The animals were divided into 3 groups: group A, sham operation; group B, induction of pancreatitis and no further treatment, and group C, induction of pancreatitis + daily administration by gavage of a 5-ml/day suspension of Lp 299v at 0.5-1.0 x 10(9) bacteria/ml for 8 days, 4 days before and 4 days after induction of pancreatitis. All animals were sacrificed after 96 h. Histological studies and microbiological analyses were performed. RESULTS: At sacrifice, 40/55 animals showed signs of severe pancreatitis. Since acute pancreatitis was the specific disease investigated, only these animals were subjected to further study. In group B, we found pathogenic micro-organisms in the mesenteric lymph nodes in 14/20 animals and in the pancreatic tissue in 10/20. The bacterial flora consisted predominantly of E. coli, Enterococcus faecalis, Pseudomonas and Proteus species. In contrast, when the animals were kept under an 'umbrella' of Lp 299v, growth of E. faecalis or E. coli were detected only in 4/20 mesenteric lymph node cultures and in 3/20 pancreatic tissue cultures. CONCLUSIONS: Lp 299v is effective in reducing microbial translocation in experimental pancreatitis. Treatment with probiotic bacteria seems to be a promising alternative to antibiotic therapy.

Acute Disease↗
PubMed1997

Delayed traumatic hernia of the diaphragm presenting with hypertensive pneumothorax. Case report and review of the literature.

The diagnosis of traumatic hernia of the diaphragm can be obtained at the time of injury or months-years after the trauma. The Authors report a case of traumatic hernia of the diaphragm, diagnosed 3 years after a blunt thoracic trauma in a 47-year-old man. The patient was admitted to the hospital for a pneumothorax caused by perforation of the herniated colon. He underwent colonic resection and reduction of the herniated viscera but unfortunately he died of septic shock on the 40th postoperative day. Pneumothorax is a very rare complication of traumatic diaphragmatic hernia and few cases are reported in literature. The diagnosis in the delayed phase is not easy since the correlation with the trauma is not always clear.

Hernia, Diaphragmatic, Traumatic↗
PubMed1995

[Reoperation in necrotizing acute pancreatitis: evaluation of physiopathology and surgical treatment].

We reviewed our experience of PAN cases operated for complications after a first laparotomy over the period 1992-1994. Over 29 PAN cases, 7 (24%) had been submitted to a second laparotomy or more. Total mortality rate of PAN was 10.3%, while mortality rate of relaparotomy was 14.2%. Haemorrhage and intra-abdominal sepsis were the main cause of relaparotomy (42.8% of the re-operations in both cases). Abdominal wall abscesses (14%) were treated locally; enteric or pancreatic fistulas (34%) were successful treated by drugs, such as somatostatin and octreotide, and / or by total parenteral nutrition. The main diagnostic tools to evaluate clinical course of the patients were computed tomography scan, that seems to gain serial staging of the necrosis and the septic collections. Arteriography is necessary to identify the bleeding source and to perform temporary embolization in the massive arterial haemorrhage before surgical treatment. Moreover, we need radiological exploration to explain fistulas pathways. According to circumstances, we can perform surgically the definitive hemostasis, the pancreatojejunostomy in pancreatic fistulas, and the digestive reconstruction in enteric fistulas. At all events the debridement of necrosis and septic collection is necessary. Up to date, there are not prognostic differences between "closed laparotomy" and "open laparotomy", and we think that the choice is determined only by individual believing of the surgeon.

Acute Disease↗
PubMed1995

[Hepatobiliopancreatic surgery in patients over 70 years old: which anesthesia?].

In the last years the criteria of operability have been extended to elderly patients with hepato-pancreatic-biliary diseases. We selected 46 patients (in the seventies or older, class 3 or 4 of ASA score, affected by hepato-pancreatic-biliary neoplasms) in order to evaluate the behavior of these patients undergoing to different anaesthesiological techniques. Randomly, we treated 24 patients (group A) in general anaesthesia, and 22 patients (group B) in peridural anaesthesia. We considered mortality rate, morbidity rate, as sepsis, wound infection, pleuritis, and pneumonias. The data were analyzed by chi2-test and Fisher's exact test (p < 0.05). Mortality rate was similar in the two groups (A = 4.1, B = 4.5) (p = ns), and no complications were determined by the different anesthesiologic procedures. Pleuritis was present in 44% of group A vs 45% of group B (p = ns). Atelectasis areas were present in 58% of group A vs 27% of group B (p = ns), pneumonia was present in 33% of group A vs 9% of group B: this value was significant (p = 0.049). There were no differences between the two groups regarding wound infection rate (only one case in group B). We think that pulmonary diseases can be determined by intubation and mechanical ventilation. We show a significant reduction of pneumonia in the patients that underwent peridural anaesthesia. For this reason, peridural technique can be safely extended to elderly patients with hepato-pancreatic-biliary diseases.

Age Factors↗
PubMed1994

[Iatrogenic rupture of the esophagus: presentation of several cases].

Four cases of iatrogenic rupture of the oesophagus are presented. The site of the lesion was in the cervical tract in 1 case and in the thoracic tract in the other 3 cases. Their etiology was pneumatic endoscopic dilatation for achalasia in 2 cases, endoscopic insertion of a Celestin tube for carcinoma of the thoracic tract of the oesophagus in 1 case, and diagnostic endoscopy in the last one. Instrumental findings were relevant in all cases. All patients underwent surgery. In the patients suffering from achalasia, the rupture was repaired by a patch of the gastric fundus. The patient suffering from carcinoma underwent an oesophageal resection, the one with cervical perforation underwent a mediastinal drainage. There were no deaths or considerable post operating complications. In a patient suffering from achalasia gastro-oesophageal reflux was demonstrated after some months following the operation.

Aged↗
PubMed1994

[Repeated liver resections for metastases from colorectal carcinoma: the experience of 23 cases].

One hundred and thirteen patients with metastases from colorectal carcinoma underwent liver resection. The authors report their experience with respect to 23 repeated hepatic resections (or metastases from colorectal carcinoma). The calculated actuarial survival from the first operations is 100% at 12 months, 67% at 24 months, 48% at 36 months and 26% at 60 months. In 90 patients who underwent a single liver resection during the same period, 76% were alive at 12 months, 40% at 24 months, 27% at 36 months and 14% at 60 months (p = 0.03). Survivals calculated from the second operation were 67% at 12 months, 41% at 24 months and 11% at 35 months. There was no operative mortality with morbidity added to that of the first operation. None patients had extrahepatic disease at the second operation: this was resected. Seven patients were treated with neo adjuvant chemotherapy; six with systemic adjuvant chemotherapy; in one this was associated with loco-regional chemotherapy. The number of lesions (single versus multiple), the presence or absence of extrahepatic disease, neo-adjuvant chemotherapy and adjuvant chemotherapy did not seem to influence the prognosis. Average survival calculated from the appearance of the first metastasis in the liver is better in patients with a synchronous lesion compared to the patients with a metachronous lesion (48.1 months versus 29.3). The authors claim that surgery is indicated, when technically possible, in the hepatic recurrence of disease. The results are not as good as those obtained following the first liver resection, with a probability of earlier recurrence of disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[The therapeutic strategy in benign liver tumors: a 20-year experience].

Therapeutic choices for benign liver tumours have changed over the last 20 years. From 1975 to December 1993, we observed 145 hemangiomas (HMG) (57.2% females-mean age 47.3 years, 42.8% males-mean age 50.4 years): we resected 42 symptomatic hemangiomas: mortality rate was 2.3%. 93 HMG without symptoms were only followed-up: 5 of these increased in size and were resected. 27 symptomatic cases over 50 focal nodular hyperplasia (FNH) were resected, 7 cases were resected and 3 biopsied during laparotomy performed for other pathology. Postoperative mortality was nil. 13 cases were only followed-up after diagnosis by imaging techniques and fine needle biopsy: over a mean period of 23 months. No variations have been recorded. Increases in GGT and ALP were present respectively in 34% and 22% of FNH-cases. Scintigraphic techniques were the most diagnostically accurate (96.2%). All 16 hepatocellular adenomas (HCA) were removed (11 females, 5 males), postoperative mortality was nil: oestrogen administration was present in 36.4% of female cases, histological diagnosis v/s well differentiated hepatocellular carcinoma was difficult in 2 cases, whilst 3 cases had spontaneous rupture. We resected also 8 cases of biliary adenomas in order to determine a precise diagnosis v/s liver metastases, and 4 biliary cystadenomas for their malignant potential. Asymptomatic HMG and FNH for their low tendency to increase, can be only observed, whilst HCA must be fully resected for risk of bleeding and misdiagnosis v/s well differentiated hepatocellular carcinoma.

Adenoma, Liver Cell↗
PubMed1994

[Postoperative ischemic ileocolitis in the elderly. Suggested therapy with intraluminal administration of oxygen and glutamine].

Ischaemic ileocolitis in postoperative course of major abdominal surgery is a great challenge for the surgeon: the mortality rate is very high, and therapeutic choices are poor. In the elderly patients ischaemic bleeding ileocolitis is often determined by low flow: sepsis and cytologic damage are primed by activation of endotoxins and chemical mediators, and bacterial translocation could develop across intestinal wall. In our case the patient (male, caucasian, 68 years old) underwent bilio-hepatic resection for hilar cholangiocarcinoma. In the postoperative period continuous enteric haemorrhage was determined by an ischaemic ileocolitis demonstrated by colonoscopy. Abdominal angiography did not show stenosis or occlusion of mesenteric vessels. We administered dopamine and dobutamine as vasodilator drugs for splanchnic circulation without any positive response. Surgical removal of the colon was unsuccessful to stop bleeding. ileostomy and sigmostomy were performed. Histologic samples of the specimen showed ischaemic ileocolitis. After a few days the patient bled again. As last therapeutic choice, we bubbled oxygen in a solution of L-glutamin 500 mml (3 liters/min for 5 min). We administered 500 mml of this solution three times a day by enteral sond, and 100 mml twice a day by sigmoidostomy and endoluminal oxygenation was performed twice a day (1l/min for 1-2 minutes) under continuous control. Bleeding was reducing during the next five days, until stopping. If glutamine and O2 can be considered the fuel of enterocytes, we hypothesized endoluminal oxygenation and glutamine enteral supply of the small intestine could feeding enterocytes, until a complete restoration of enteral mucosa and stopping of the haemorrhage.

Aged↗
PubMed1992

Contribution of CT to characterization of focal nodular hyperplasia of the liver.

Our personal series of 20 cases of focal nodular hyperplasia (FNH) of the liver is presented. All lesions were studied with computed tomography (CT), 16 of which with surgical control. Retrospective evaluation of the CT features of the identified FNH, along with those of five hepatocellular adenomas (HCA) and 30 hepatocellular carcinomas (HCC), allowed the definition of specific patterns leading to a correct characterization of FNH in 78% of cases. This greatly reduced the diagnostic errors, with the sole exception of patients with fatty liver in whom nuclear medicine may eventually provide a correct characterization. Fine-needle biopsy is thus only necessary in the dubious cases. A precise diagnostic workup of FNH is necessary, since it may avoid the surgical intervention.

Adenoma↗
PubMed1991

[Anti-gliadin antibodies in the diagnosis and follow-up of celiac disease].

The study assessed the value of anti-gliadin antibodies (AGA) as a diagnostic test for celiac disease (CD) by examining 219 children: 57 were affected by malabsorption syndrome and underwent the first duodenojejunal biopsy; 83 underwent a secondary diagnostic phase for CD; 44 underwent a challenge test; 35 controls. Duodenojejunal biopsy was performed in all subjects in the three stages of diagnosis for CD. By comparing AGA levels and on the basis of histological tests of duodenojejunal mucosa it is possible to confirm the reliability of the method as a screening test for use in subjects whose clinical symptoms suggest CD. AGA are however less reliable in the second and third stages, that is to say in the follow-up of CD, since they do not always reflect the conditions of intestinal mucosa.

Antibodies↗
PubMed1985

[Hepatic cystadenocarcinoma: presentation of a clinical case and review of the literature].

The finding of a case of cystadenocarcinoma supplies the opportunity for a reviewing of the literature concerning this rare liver neoplasm. From a diagnostical standpoint, the instrumental tests result non-specific. Only the needle-biopsy of papillary formations set forth through the echography within hepatic formations of cystic type is able to supply diagnoses of cystadenocarcinoma. Yet, the procedure is not exempt from risks. Decisive may be the peroperative histologic testing on fragments of the cyst wall. In consideration of the better prognosis of cystadenocarcinoma in respect of hepatocarcinoma and cholangiocarcinoma, and the risk of relapse, the election surgical treatment should be represented by hepatectomy.

Adult↗
PubMed1984

[Mechanical and chemotherapeutic preparation of the colon for surgical intervention].

The authors maintain the opportunity of a mechanical and chemotherapeutical preparation of colon for the surgical operation, and illustrate the methods thereof. They report their clinical experience about the preoperative and peroperative cleaning, and confirm the importance of decompressive transversostomy as a protection of colorectal anastomoses.

Administration, Oral↗