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Biomedical subjects

L Alessandroni

Publications and source records attributed to L Alessandroni.

17 recordsLinked to original sources
PubMed2006

Control of matrix metalloproteinase production in human intestinal fibroblasts by interleukin 21.

BACKGROUND: T cell-mediated immunity plays a central part in the pathogenesis of tissue damage in inflammatory bowel disease (IBD). The mechanism by which T cells mediate tissue damage during IBD remains unclear, but evidence indicates that T cell-derived cytokines stimulate fibroblasts to synthesise matrix metalloproteinases (MMPs), which then mediate mucosal degradation. We have previously shown that, in IBD, there is high production of interleukin (IL) 21, a T cell-derived cytokine, which enhances Th1 activity. AIM: To investigate whether IL21 controls MMP production by intestinal fibroblasts. METHODS: IL21 receptor (IL21R) was evaluated in intestinal fibroblasts by reverse transcriptase-polymerase chain reaction (RT-PCR) and western blotting. Fibroblasts were stimulated with IL21 and MMPs were evaluated by RT-PCR and western blotting. The effect of a neutralising IL21R fusion protein (IL21R/Fc) on the induction of MMPs in fibroblasts stimulated with IBD lamina propria mononuclear cell (LPMC) supernatants was also evaluated. RESULTS: Intestinal fibroblasts constitutively express both IL21R and the common gamma chain receptor, which are necessary for IL21-driven signalling. IL21 enhances fibroblast production of MMP-1, MMP-2, MMP-3 and MMP-9, but not tissue inhibitors of MMP-1 and MMP-2. Moreover, IL21 synergises with tumour necrosis factor alpha to increase synthesis of MMP synthesis. IL21 enhances MMP secretion without affecting gene transcription and protein synthesis. IBD LPMC supernatants stimulate MMP secretion by intestinal fibroblasts, and this effect is partly inhibited by IL21R/Fc. CONCLUSIONS: These results suggest that fibroblasts are a potential target of IL21 in the gut and that IL21 controls MMP secretion by fibroblasts.

Cells, Cultured↗
PubMed2004

[The surgical treatment of gastric carcinoma. Evolution in surgical technique and staging in a series of 194 patients].

AIM: Surgery is, at present, the only potentially curative treatment for gastric carcinoma. The curability depends upon the extension and localization of the tumor and, particularly, the lymphatic involvement and the presence of distant metastases. The aim of this paper is to describe the personal experience during the last 2 decades and analyze the results of the surgical approach which has changed over the time. METHODS: One-hundred and ninety-four consecutive patients have been reported (127 male and 67 female, with a median age of 65.8 years), affected by gastric carcinoma and subjected to surgical procedures from 1987 to 2000. Because of the wide period of time which it refers to, this study is overlapped by a radical change in the staging rules of gastric carcinoma, according to the publication, in 1997, of the 5th edition of the TNM. This has made necessary to divide the series into 2 different groups. The 1st group is composed of 123 patients (63.4%), staged according to TNM-1987; the 2(nd) group is composed of 71 patients (36.6%) staged according to the TNM-1997. A D1 lymphadenectomy was used as treatment protocol until 1995. Subsequently, a D2 lymphadenectomy was performed in the most part of potentially curable patients. The reconstruction after total gastrectomy was carried out in all cases with Roux technique. In distal gastrectomies a Billroth 2 technique was performed in 89.3% of the cases and a Billroth 1 technique in 10.7% of the cases. RESULTS: The operative mortality observed on the total of patients was 1.5% (3 cases). With a median follow-up of 83 months (minimal 24, maximum 180 months), 134 patients were died, 50 are alive and 10 have been lost. The total median survival, in the 2 groups, was 24 months. We have observed a trend to improvement of survival for patients with carcinoma in stage II and III operated after 1997. CONCLUSION: The treatment of unresectable gastric cancer, i.e. palliative surgery, is the best choice when possible in comparison to other surgical procedures (gastroenteronastomosis, jejunostomy), endoscopic procedures (dilatation, endoprosthesis, laser, percutaneous endoscopic gastrostomy) and medical therapies. In order to choose the best palliative treatment, a careful evaluation of the non-curability signs is necessary to avoid high risk surgical interventions in patients with a low expectation of life.

Adult↗
PubMed2003

Bile duct injuries during laparoscopic cholecystectomy: a 1994-2001 audit on 13,718 operations in the area of Rome.

BACKGROUND: Bile duct injuries (BDIs) during laparoscopic cholecystectomy (LC) still are reported with greater frequency than during open cholecystectomy (OC). METHODS: In 1999, a retrospective study evaluating the incidence of BDIs during LC in the area of Rome from 1994 to 1998 (group A) was performed. In addition, a prospective audit was started, ending in December 2001 (group B). RESULTS: In group A, 6,419 LCs were performed (222 were converted to OC; 3.4%). In group B, 7,299 LCs were performed (225 were converted to OC; 3.1%). Seventeen BDIs (0.26%) occurred in group A and 16 (0.22%) in group B. Overall, mortality and major morbidity rates were 12.1% and 30.3%, respectively, without significant differences between the two groups. CONCLUSIONS: The incidence and clinical relevance of BDIs during LC in the area of Rome appeared to be stable over the past 8 years and were not influenced by the use of a prospective audit, as compared with a retrospective survey.

Aged↗
PubMed2003

[Conservative surgery for ductal carcinoma in situ of the breast].

BACKGROUND: The conservative surgery is considered currently the treatment of choice for the carcinoma of the breast in the initial stage. METHODS: From 1993 to the 2000, 46 patients (median age 52 years) affected by intraductal carcinoma of the breast, have been submitted to surgical intervention. In 10 cases (21,7%) a palpable mass was observed (mean dimension of 1.3 cm). In 36 cases (78.3%) non palpable lesions were identified by mammography (26 microcalcifications and 10 non palpable masses). All patients have been treated after stereotactic preoperatory mammographic localization of the lesions. 15 simple mastectomies, 11 mammary resections without radiotherapy and 20 mammary resections followed by radiotherapy have been performed. No patient was submitted to axillary dissection. The radiotherapy has been administered with a boost of 50 Gy on the breast. RESULTS: At a 36 months median follow-up all the patients are alive and no local recurrence or distant metastases has been observed. CONCLUSIONS: The treatment of choice is the local resection of neoplasm followed by radiotherapy.

Adult↗
PubMed1995

A pilot study of concomitant protracted venous infusion 5-fluorouracil and hyperfractionated radiotherapy in rectal tumors.

It has recently been shown that postoperative radiotherapy combined with 5-fluorouracil (5FU) resulted in an increase of survival and local control in patients with rectal cancer. However, hematological and intestinal toxicity were also increased. Experimental and clinical studies showed an increased radiation effect with an acceptable toxicity by delivering 5FU via a continuous intravenous infusion. From July 1988, 38 patients radically operated on for stages B2-C rectal cancer were irradiated in our hospital with 3 fractions per day of 100 cGY to a total dose of 5,600 cGY. Of these 38 patients, 13 underwent postoperative radiotherapy alone, and 25 received postoperative radiotherapy combined with concomitant protracted infusion of 5FU at doses of 250 and 300 mg/m2 per day. In addition, 14 patients with inoperable, locally advanced tumors or postoperative recurrences, were treated with the same combination schedule of 5FU and radiotherapy to a total radiation dose of 6,500 cGy. After a median follow-up of 43 months, the actuarial 3-year overall and disease-free survival rates in the postoperative group of patients were 68% and 68%, respectively, in the combined modality group, as compared to 51% and 36%, respectively, in the radiation alone group. Patients with inoperable tumors exhibited 3-year overall and disease-free survival rates of 24% and 32%, respectively. The main toxicity was rectal tenesmus, diarrhea, dysuria, and, less frequently, leukopenia. These symptoms were responsible for a treatment delay of more than 5 days in 2 of 6 and in 7 of 33 patients who received 5FU doses of 300 and 250 mg/m2 per day, respectively, as compared to 2 of 13 patients treated with radiotherapy alone.

Adult↗
PubMed1992

[Adrenal myelolipoma. A case report and review of the literature].

Myelolipoma is a rare benign neoplasm of the adrenal gland, histologically characterized by the presence of mature fat cells and bone marrow elements. In the international literature were reported 126 cases of adrenal myelolipoma surgically treated. The indications to surgical removal of this tumor are the presence of large symptomatic tumours, high risk of spontaneous haemorrhage, and suspicion of malignant neoplasms. The authors present a case of adrenal myelolipoma, preoperatively identified with an abdominal MNR, and surgically removed.

Adrenal Gland Neoplasms↗
PubMed1992

[Leiomyoma associated with esophageal diverticulosis].

The Authors report a case of leiomyoma located in an epi-phrenic diverticulum. The development of the leiomyoma may have weakened the esophageal wall and caused the diverticulum to appear. Surgical treatment consisted of diverticulectomy with myotomy and a Belsey MK IV antireflux procedure.

Diverticulum, Esophageal↗
PubMed1986

Tumor extension along percutaneous transhepatic biliary drainage tracts.

Percutaneous Transhepatic Biliary Catheterization is commonly employed in the diagnosis and management of obstructive jaundice associated with malignant lesions. Tumor manipulation as an effort to obtain a histological diagnosis or to establish short or long-term internal-external biliary drainage is liable to disseminate the malignancy along the catheter tract. Two cases of malignant seeding of the catheter tract after biliary drainage have been observed.

Aged↗
PubMed1985

Detailed evaluation of angiographic findings in the surgical assessment of resectability for pancreatic cancer.

The role of angiography as a diagnostic approach and surgical assessment of resectability in pancreatic cancer patients is considered. Pre-operative arteriography of the celiac axis and superior mesenteric artery was performed in 27 patients with surgically proved pancreatic cancer. The operatibility of each patient was assessed according to arteriographic findings. The arteriographic features considered to establish tumor unresectability included: neoplastic arterial encasement or displacement, multiple involvement of pancreatic arteries, involvement of portal, splenic or superior mesenteric veins, liver metastasis. Nineteen angiographically predicted unresectable lesions proved to be unresectable at surgery. Of the eight additional patients who showed no remarkable unresectable angiographic features, 6 were confirmed resectable, while 2 were unresectable. Angiography was shown to be very accurate in differentiating resectable from unresectable cancer of the pancreas.

Adenocarcinoma↗
PubMed1984

Pancreatic carcinoma in childhood: case report of long survival and review of the literature.

A case of exocrine pancreatic carcinoma in a 14-year-old boy is reported. The primary site of the tumor was in the head of the pancreas, and pathologic features were consistent with an anaplastic lesion. Ten years after curative resection the patient is still living. Extensive review of the literature has revealed 27 other cases of pancreatic carcinoma in children under 15 years of age. Aggressive surgical treatment is emphasized by the long survival observed in four patients who underwent radical operations and by this case report.

Adolescent↗
PubMedDate not supplied

[Treatment of perianal Crohn's disease].

Perianal Crohn's disease (PACD) is defined as the presence of persistent lesions in the anal canal and perianal region in patients with Crohn's disease. The relative incidence of PACD in Crohn's disease patients ranges from 15 to 80% in the literature, depending on the accuracy of the clinical investigations and the clinical importance attributed to the lesions in the various study populations. The incidence is significantly higher if the intestinal disease is located in the colon-rectum rather than in the small bowel. We reviewed our experience in 105 patients with PACD, 32 of whom presenting rectal localisation of the primary disease. We observed 2 stenoses, 3 perirectal abscesses, 3 rectal ulcerations, 5 skin tags, 10 fissures and 77 fistulas. Two dilatations under narcosis, 2 intrarectal drainages of abscesses, 19 fistulotomies, 7 partial fistulotomies and insertion of loose setons, 47 loose setons and 4 anoperineal diversions were performed. The remaining patients received medical and topical treatments. After a median follow-up of 30 months, 90 patients (86%) showed a good response with improvement in functional scores, while 15 (14%) showed no improvement or a worsening requiring proctectomy in 13 cases. All patients submitted to proctectomy had rectal localization of the disease.

Adolescent↗
PubMedDate not supplied

[Complex duodenopancreatic injuries].

Injuries of the duodenopancreatic region are rare and difficult to diagnose and treat. The related high mortality is mainly due to the presence of associated lesions. Complex traumas (AAST grade IV and V lesions) require difficult surgical treatment with high postoperative morbidity and mortality rates. In a review of 200 pancreaticoduodenectomies performed for pancreatic head traumas the postoperative mortality was 31%. The authors present 6 cases of complex duodenopancreatic traumas, treated from 1995 to 1999. The aetiology was blunt trauma in 5 cases (83%) and a shotgun wound in 1 case (17%). In 3 cases, with a grade V lesion of the pancreatic head, a pancreaticoduodenectomy was performed. A case of a grade IV lesion of the tail of the pancreas was treated with distal splenopancreatectomy. Two cases of grade IV lesions of the third part of the duodenum were submitted to duodenal resection with direct anastomosis. One postoperative death was observed in a patient treated with duodenal resection. The overall mortality was 16%. A pancreatic fistula, which healed spontaneously, was observed in a case of pancreaticoduodenectomy.

Adult↗
PubMedDate not supplied

[Anoplasty with House advancement flap for anal stenosis after hemorrhoidectomy. Report of a clinical case].

Anorectal strictures may occur after anorectal surgery and in particular after surgical haemorrhoidectomy. Anal examination under general anaesthesia was recommended to evaluate the stricture and to choose the appropriate technique. The house advancement flap has been recently proposed for postsurgical anal stenosis repair. The house flap receives its blood supply through unnamed vessels extending through a fatty pedicle from the underlying external sphincter muscle and not from a skin or mucosal bridge like the other common flaps (Y-V and mucosal advancement flap). The aims of this study were firstly to report a case of post-haemorrhoidectomy anal stenosis in a 68-year-old man treated in our institution by house advancement anoplasty and secondly to evaluate the efficacy and safety of this new technique. The technique was totally successful in alleviating anal stenosis and maintaining faecal continence. House advancement anoplasty should be part of the armamentarium of colon and rectal surgeons for treating severe anal stenosis.

Aged↗
PubMedDate not supplied

[Cystic pancreatic tumors. Review of literature and proposal of a diagnostic-therapeutic pathway].

In this paper the Authors consider the epidemiological, clinical, pathological, instrumental, chemical and physical findings of every type of pancreatic cystic lesions. They perform a critical examination of each of them. In this way, they can identify the most important features of every single class. A pathway consisting in four main groups of instrumental and chemical tests (abdominal ultrasonography / EUS, CT, MR, FNA / biopsy/ assay of tumoral markers and amylase of cystic fluid) was chosen to know all these informations according to careful principles of specificity, sensitivity and diagnostic accuracy taken from international scientific literature. In each subgroup of cystic pancreatic tumor, at last, the most reliable therapeutic project is suggested according to the common international scientific agreement.

Aged↗