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Giuseppe Navarra

Publications and source records attributed to Giuseppe Navarra.

15 recordsLinked to original sources
PubMed2005

Sarcoglycan subcomplex in normal human smooth muscle: an immunohistochemical and molecular study.

The sarcoglycans are transmembrane components of the dystrophin-glycoprotein complex, which links the cytoskeleton to the extracellular matrix in adult muscle fibers. Sarcoglycans seem to be functionally and pathologically as important as dystrophin. In the skeletal and cardiac muscle, the sarcoglycan subcomplex is a heterotetrameric unit composed of the transmembrane glycoproteins alpha-, beta-, gamma- and delta-sarcoglycan. A fifth sarcoglycan with significant homology to alpha-sarcoglycan, epsilon-sarcoglycan, has been identified; this sarcoglycan is expressed in both muscle and non-muscle cells. It is hypothesized that epsilon-sarcoglycan might replace alpha-sarcoglycan in smooth muscle, forming a novel sarcoglycan subcomplex consisting of epsilon-, beta-, gamma-, and delta-sarcoglycan. Recently, zeta-sarcoglycan, a novel sarcoglycan highly related to gamma-sarcoglycan and delta-sarcoglycan, has been identified. On this basis, growing evidence suggests that there are two types of sarcoglycan complex; one, in skeletal and cardiac muscle, consisting of alpha-, beta-, gamma- and delta-sarcoglycan; and the other, in smooth muscle, containing beta-, delta-, zeta- and epsilon-sarcoglycan. epsilon-sarcoglycan may be substituted for alpha-sarcoglycan in a subset of striated muscle complexes. Our results, obtained with immunofluorescence semi-quantitative analysis and molecular methods on smooth muscle biopsies of human adult gastroenteric tract, show for the first time that alpha-sarcoglycan fluorescence is also always detectable in smooth muscle, although its staining pattern is lower than epsilon-sarcoglycan. Normal alpha-sarcoglycan staining was detected at times, whereas there was reduced, but clearly detectable staining for epsilon-sarcoglycan. Moreover, gamma-sarcoglycan staining is always detectable in all analyzed biopsies. On the basis of our results, we would be able to hypothesize the existence of a pentameric or, considering zeta-sarcolgycan, a hexameric arrangement of the sarcoglycan subcomplex. The hexameric sarcoglycan subcomplex, in conformity with a larger or lower expression of single sarcoglycans, could characterize skeletal, cardiac or smooth muscle, or distinct parts of gastroenteric tract. It is intriguing to integrate these results with other vascular and urogenital smooth muscle, skeletal and cardiac muscle, while also analyzing zeta-sarcoglycan.

Adult↗
PubMed2003

How we do a bloodless partial splenectomy.

Partial splenectomy and Tru-cut biopsy are not routinely practiced because of the lack of vascular control to arrest bleeding. Using radiofrequency energy to coagulate the resection margin and biopsy tract, a 74-year-old woman with a tumor in the lower pole of the spleen underwent partial splenectomy and Tru-Cut biopsy of the spleen. Hemostasis was excellent. Blood loss was minimal and the patient was discharged with a functioning spleen. This new technique may allow safe and bloodless partial splenic resection and Tru-cut biopsy of the spleen, which might reduce the number of splenectomies performed and the consequent difficulties for the patient that can arise.

Aged↗
PubMed2003

Bradykinin B2 receptors mediate contraction in the normal and inflamed human gallbladder in vitro.

BACKGROUND & AIMS: The components of the kinin system, including kinongens, kininogenases, and B(2) and B(1) receptors, are expressed and activated during inflammation. Here, we investigated the expression of the kinin B(2) receptor messenger RNA, kininogen and kallikrein immunoreactivity, and the ability of kinins to contract control and inflamed gallbladders in vitro. METHODS: Human gallbladders, obtained from patients undergoing cholecystectomy either for acute cholecystitis secondary to gallstone disease or during elective gastro-entero-pancreatic surgery (controls), were processed for reverse-transcription polymerase chain reaction analysis, kallikrein and kininogen immunohistochemistry, binding studies, and in vitro contractility studies. RESULTS: Tissue expression of B(2) receptor messenger RNA and specific binding of [(3)H]-bradykinin increased significantly in acute cholecystitis compared to controls. Kallikrein immunoreactivity was detected in the epithelium and infiltrating leukocytes, whereas kininogen immunoreactivity in the lumen of blood vessels and interstitial space. Bradykinin contracted isolated strips of control and acute cholecystitis gallbladders. In acute cholecystitis tissue, efficacy of bradykinin was higher than that of control gallbladders and similar to that of cholecystokinin. The contraction induced by bradykinin was significantly attenuated by B(2) receptor antagonism but not by cyclooxygenase inhibition and B(1), muscarinic, or tachykinin receptor antagonism. CONCLUSIONS: All the components of the kinin system are expressed in the human gallbladder. Bradykinin is a powerful spasmogen via B(2) receptor activation in the normal and, especially, in the inflamed human gallbladder.

Adrenergic beta-Antagonists↗
PubMed2003

Octreotide in the treatment of lymphorrhea after axillary node dissection: a prospective randomized controlled trial.

BACKGROUND: Axillary lymph node dissection for staging and local control of nodal disease is an integral part of breast cancer therapy. Lymphorrea is a serious and disabling complication of axillary lymphadenectomy, but no effective therapy is currently available. Octreotide is a hormone with general antisecretory effects that has been used to control lymphorrhea in thoracic duct injury and after radical neck dissection. The aim of the study we describe in this article was to determine whether octreotide has a role in the treatment of post axillary lymphadenectomy lymphorrhea. STUDY DESIGN: This is a prospective randomized controlled trial. Two hundred sixty-one consecutive patients with various stages of breast cancer who underwent axillary lymph node dissection were randomized and followed for 7 years. The treatment group received 0.1 mg octreotide subcutaneously three times a day for 5 days, starting on the first postoperative day, while the control group received no treatment. Of the 261 patients undergoing axillary node dissection, 136 were assigned to the control group and 125 composed the treatment group. The control group and the treatment group were evaluated for amount and duration of lymphorrhea as well as inflammatory and infectious complications. RESULTS: In the control group, the mean quantity (+/- standard deviation) of lymphorrhea was 94.6 +/- 19 cc per day and the average duration was 16.7 +/- 3.0 days. In comparison, the mean quantity of lymphorrhea in the treatment group was 65.4 +/- 21.1 cc (p < 0.0001) per day and the average duration was 7.1 +/- 2.9 days (p < 0.0001). We did not find an important difference in the number of infectious complication or hematomas formation between the study groups. CONCLUSIONS: Octreotide can be used successfully for the treatment of post-axillary dissection lymphorrea, and potentially, in the prevention of post-axillary lymph node dissection lymphosarcoma, since the amount and duration of lymphorrhea in this setting are known to be important risk factors for its development. Potentially, octreotide might be used in similar situations where lymphorrhea is detrimental, such as peripheral vascular surgery and regional lymph node dissection for melanoma.

Adult↗
PubMed2002

New technique for liver resection using heat coagulative necrosis.

OBJECTIVE: To assess a new bloodless technique using radiofrequency energy for segmental liver resection of hepatic tumors. SUMMARY BACKGROUND DATA: Liver resection remains a formidable surgical procedure; safe performance requires a high level of training and skill. Intraoperative blood loss during liver resection remains a major concern because it is associated with a higher rate of postoperative complications and shorter long-term survival. METHODS: From January 2000 to June 2001, 15 patients with various hepatic tumors were operated on using radiofrequency energy to remove the tumor in its entirety. Radiofrequency energy was applied along the margins of the tumor to create "zones of necrosis" before resection with a scalpel. RESULTS: No blood transfusions were required. The mean blood loss during resection was 30 +/- 10 mL. No mortality or morbidity was observed. The median postoperative stay was 8 days (range 5-9). No liver recurrence was detected in patients undergoing resection with this technique during follow-up periods ranging from 2 to 20 months. CONCLUSIONS: Segmental and wedge liver resection assisted by radiofrequency is safe. This novel technique offers a new method for transfusion-free resection.

Adult↗
PubMedDate not supplied

Early and late outcome after surgery for colorectal cancer: elective versus emergency surgery.

AIMS AND BACKGROUND: Emergency surgery for colorectal cancer is associated with a higher postoperative morbidity and mortality rate and a poor long-term outcome compared with elective surgery. The aim of the present study was to compare early and late outcome after elective and emergency surgery for malignant colorectal cancer, looking for the principal determinants of a worse outcome after emergency colorectal surgery. METHODS: A retrospective study of 236 patients presenting with colorectal cancer over an 8-year period was undertaken. Of these, 118 presented as emergencies, whereas 118 patients, well matched for age, sex, site of tumor and TNM admitted as elective, were included in the study. Data reviewed included postoperative mortality and morbidity and long-term outcome. RESULTS: The 30-day operative mortality rate was significantly higher in the emergency group than in the electively treated group (11.9% versus 3.4%, P < 0.01). The higher mortality rate was observed in the perforation group. The 30-day operative morbidity was higher in the emergency group (27.1% versus 12.7%, P < 0.05). Anastomotic failure was a serious complication: following primary resection, we observed 4 non-fatal (5.4%) and two fatal (2.7%) anastomotic leaks after 74 primary anastomoses. Among emergency-treated patients, the procedures characterized by the highest percentage of postoperative complications were three-stage resections (63.6%). The 5-year survival rate was greater after elective surgery (59% versus 39%). CONCLUSIONS: The early and long-term outcome following emergency colorectal surgery was significantly lower than that after elective surgery. Although medical complications in patients with end-stage cancer played an important role, surgical failures still had an important impact on outcome.

Adult↗
PubMedDate not supplied

Primary rectal lymphoma as a cause of bowel obstruction. Report of a case.

BACKGROUND: Malignant lymphoma involving the rectum either as a localized process or as a manifestation of disseminated disease is rare. Several treatments have been proposed and reported, including surgical resection alone or associated with adjuvant chemoradiation, chemotherapy alone, and radiotherapy alone. METHODS: A case of bowel obstruction caused by a primary rectal MALT lymphoma is reported. Following emergency loop sigmoid colostomy the patient was started on multiple specific cycles of chemotherapy according to the MACOP-B protocol. RESULTS: At the end of chemotherapy a remarkable reduction in the size of the tumor was noted. Subsequently the patient underwent an ultralow anterior resection followed by a straight coloanal anastomosis. At 36 months of follow-up the patient is alive with no tumor recurrence. CONCLUSIONS: The present report describes the unique case of a patient with primary obstructing rectal lymphoma treated with neoadjuvant chemotherapy and sphincter-saving curative surgery.

Female↗
PubMedDate not supplied

Early results after radiofrequency-assisted liver resection.

AIMS AND BACKGROUND: Intraoperative blood loss during liver resection remains a major concern due to its association with higher postoperative complications and shorter long-term survival. The aim of this study was to assess the feasibility and safety of a novel concept for liver resection using a radiofrequency energy-assisted technique. METHODS: From January 2001 to July 2002, 42 patients were operated on using radiofrequency energy-assisted liver resection. Radiofrequency energy was applied along the resection edge to create a 'zone of desiccation' prior to resection with a scalpel. RESULTS: Median resection time was 50 mins (range, 30-110). The median blood loss during resection was 30 mL (range, 15-992). Mean preoperative and postoperative hemoglobin values were 13.7 g/dL (SD +/- 1.6) and 11.8 g/dL (SD +/- 1.4), respectively. No blood transfusion was registered, nor was any mortality observed. There were 3 postoperative complications, one subphrenic abscess, one chest infection and one biliary leak from a hepatico-jejunostomy. Median postoperative stay was 8 days (range, 5-86). CONCLUSIONS: Liver resection assisted by radiofrequency energy is feasible, easy and safe. This novel technique offers a new method for 'transfusion-free' resection without the need for sutures, ties, staples, tissue glue or admission to an intensive care unit.

Adult↗
PubMedDate not supplied

[Impact of the sentinel lymph node in the staging of colorectal carcinoma].

In view of the very good results obtained by lymphatic mapping and sentinel node biopsy in the staging of patients with melanoma or breast cancer, we investigated the feasibility of intraoperative regional lymphatic mapping in patients with primary colorectal carcinoma. The aim of this study was to determine whether lymphatic mapping and sentinel node assessment can identify aberrant drainage patterns or make for better staging of the neoplasm in those cases with no or only minimal lymphatic neoplastic involvement. Sixteen consecutive patients with primary colorectal cancer (stage T2-T3) but without macroscopic involvement of the lymphatic system underwent intraoperative lymphatic mapping by injecting 1-1.5 ml of isosulfan blue dye. The identified and resected sentinel nodes were examined using conventional haematoxylin-eosin staining and cytokeratin immunohistochemistry. Sentinel node identification was successful in 15 out of 16 cases (93.8%). In 11 cases (73.3%) sentinel node status correctly predicted the final staging. The false-negative rate was 26.7%. Immunohistochemical analysis revealed the presence of micrometastasis in one case (6.7%), which was consequently upstaged. In cases of colorectal cancer lymphatic mapping is an easy, perfectly feasible technique. However, in our experience, it would not appear to significantly improve the accuracy of the histopathological staging of colorectal carcinoma.

Adenocarcinoma↗
PubMedDate not supplied

Hepatectomy using intraoperative ultrasound-guided radiofrequency ablation.

Radiofrequency (RF) ablation is emerging as a new therapeutic method for management of hepatic tumors. Here we report a new technique for hepatectomy using ultrasound-guided RF, which renders liver resection a less complex surgical procedure. Under intraoperative ultrasound (IOUS) guidance, a Cool-Tip RF probe is inserted into the liver parenchyma surrounding the tumor. A zone of coagulative desiccation is created around the tumor ensuring a 1-cm resection margin. Then, using a scalpel, the liver parenchyma is divided, and the tumor is removed with minimal blood loss. RF works by the conversion of RF waves into heat. Coagulative desiccation occurs and results in sealing of blood and biliary vessels. This is a new technique for liver resection that enables the surgeon to operate in a virtually bloodless field without the use of ischemia, sutures, or ties. It also spares the need for intraoperative blood transfusion and postoperative intensive care unit facilities, and it reduces the length of in patient stay.

Catheter Ablation↗