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L Minelli

Publications and source records attributed to L Minelli.

At least 19 recordsLinked to original sources
PubMed2006

Laparoscopic nerve-sparing complete excision of deep endometriosis: is it feasible?

BACKGROUND: Little is known about the morbidity associated with laparoscopic complete excision of endometriosis in terms of urinary, digestive and sexual function. METHODS: We performed a prospective non-randomized study in 45 patients with laparoscopic complete excision of all detectable foci of endometriosis with segmental bowel resection using a non nerve-sparing technique (control group-group A n=20) and a nerve-sparing technique (case group-group B n=25). At initial gynaecological evaluation, and at follow-up details on dysmenorrhoea, pelvic pain, dyspareunia and dyschezia were evaluated using an interview-based questionnaire (10-point analogue rating scale: 0=absent, 10=unbearable). RESULTS: The mean (+/-SD) follow-up period was 15.3+/-10 months (range, 8.8-23 months) for group A and 3.5+/-2.1 months (range, 0.3-5.2 months) for group B. In the immediate postoperative course, in group A three women required blood transfusion vs seven women in group B (P=0.003). The median time to resume the voiding function was significantly shorter in group B (12.5 vs 3.0 days; P<0.01). At the time of follow-up a higher proportion of patients in group B were 'very satisfied' than those in group A (87.7% vs 59.0%, P=0.013). CONCLUSIONS: Laparoscopic nerve-sparing complete excision of endometriosis seems to be feasible and offers good results in terms of bladder morbidity reduction with apparently higher satisfaction than classical technique. Larger series with longer follow-up are needed to confirm our results.

Adult↗
PubMed2005

Immunological markers anti-saccharomyces cerevisiae antibodies (ASCA) and anti-neutrophil cytoplasmic antibodies (ANCA) in inflammatory bowel disease: a helpful diagnostic tool.

AIM: Nowadays the diagnosis of inflammatory bowel disease (IBD) and the differentiation between Crohn disease (CD) and ulcerative colitis (UC) is still based on morphological changes identified at endoscopy, radiology, and histopathology. In 5-15% of cases this differentiation is not possible (diagnosed with indeterminate colitis). METHODS: We evaluated if recently developed commercial kits for the determination of anti-Saccharomyces Cerevisiae antibodies (ASCA) and anti-neutrophil cytoplasmic antibodies (ANCA) are useful in differentiating cases of UC from CD diseases with a consequent reduced number of undefined colitis and improved clinical management. Sera from 56 consecutive patients with a clinical diagnoses of IBD were evaluated in a blinded fashion for the presence of ASCA IgA and IgG and ANCA IgG with 2 different diagnostic methods: indirect immunofluorescence (IIF) and enzyme-linked immunosorbent assay (ELISA). RESULTS: In our cases we observed good agreement between histopathological examination and laboratory results and the combined use of ASCA and ANCA yielded a correct diagnosis in 93% of patients with CD and in 97% of the UC patients. CONCLUSIONS: We confirm the value of the test for the diagnosis of CD and UC and the differentiation from other forms of colitis.

Adult↗
PubMed2004

Pelvic endometriosis: US and MRI features.

Endometriosis represents a common and important clinical problem of women of childbearing age. It is a disabling disorder manifesting with pain and infertility. The exact pathogenesis of the disease remains unclear, despite the different theories that have been formulated. The literature on endometriosis is extensive, but often in regard to classic endometrioma. It is surprising that, to the best of our knowledge, the many radiologic features of extraovarian endometriosis have not been well documented thus far. Although ultrasound (US) remains the imaging modality of choice in the radiologic evaluation of female patients with pelvic pain, the role of magnetic resonance imaging (MRI) in the evaluation of abdominal pain is expanding. In the young patient, MRI may be performed if a gynecologic disorder is not suspected at first, especially if US findings are equivocal or the abnormality extends beyond the field of view of the sonographic probe. Moreover, MRI is useful whenever further characterization of pelvic disorder is required. In fact, many causes of pelvic disorders and of endometriosis in particular demonstrate characteristic MRI findings. For these reasons, in this work we describe the protean US and MRI appearances of endometrial foci as encountered in daily experience.

Endometriosis↗
PubMed2004

Breast cancer incidence, mortality and survival in the Umbria region of Italy (1978-1999).

Recent incidence, mortality and survival rates of female invasive breast cancer in the Umbria region were compared with data of 20 years ago and with data from other Italian Registries. Incidence data, derived from an ad hoc survey and from cancer registry records, were analysed for the periods 1978-1982 and 1994-1999; mortality trend rates were calculated based on data from official publications and the variation was assessed by joinpoint analysis. Fifteen-year survival rates, observed, relative and age-adjusted, were also calculated. Compared with the years 1978-1982, the age-adjusted incidence rates rose during 1994-1999, while age-adjusted mortality rates decreased in this latter period. Incidence and mortality rates specific for each age group showed a constant increase with age, in both periods of observation, especially among women from 50 to 75 years of age. The 5-year relative survival rates increased 17%, rising from 0.71 in 1978-1982 to 0.86 in 1994-1998; the survival improvement was evident among women aged 45-54, and 65-74. Age-adjusted incidence and mortality rates in Umbria were lower than in other Italian Registries and survival rates showed a better prognosis for breast cancers diagnosed in Umbria in the period 1994-1998. In conclusion, the 1994-1998 decline in breast cancer mortality and the survival improvement may in part reflect the effectiveness of earlier detection by mammography and the progress in treatments. Genetic and lifestyle factors along with the improvement in diagnosis, and in quality of data collection and classification could have determined the recorded increase in breast cancer incidence.

Aged↗
PubMed2001

Laparoscopic myomectomy: technique, complications, and ultrasound scan evaluations.

STUDY OBJECTIVE: To evaluate the feasibility, limits, and complications of laparoscopic myomectomy, assess time to full recovery, and evaluate uterine wound healing by ultrasound in the early postoperative period. DESIGN: Prospective study (Canadian Task Force classification II-2). SETTING: General hospital. PATIENTS: Three hundred sixty-eight women undergoing laparoscopic myomectomy. INTERVENTION: Laparoscopic myomectomy and laparoscopic and/or hysteroscopic treatment of associated pathologies. MEASUREMENTS AND MAIN RESULTS: In these women 768 myomas were removed laparoscopically. Mean operating time was 100.78 +/- 43.83 minutes, mean decreases in hemoglobin and hematocrit were 1.38 +/- 0.93 g/100 ml and 4.8 +/- 2.9 g/100 ml, respectively, and mean length of hospital stay was 2.89 +/- 1.3 days. Intraoperative complications occurred in 12 patients (3.34%) and intraoperative transfusion of autologous blood was required in 10. Main postoperative complications were continuing hemorrhage requiring blood transfusion in three women and second laparoscopy in two. Pyrexia occurred in 12 patients. Average time to full recovery was 10.58 +/- 6.68 days. At 1-month follow-up 12 of 282 women developed further complications: abdominal pain 5, vaginitis 4, metrorrhagia 2, and dysuria 1. Sonographic evaluation of the uterine scar showed a highly echogenic area with ill-defined margins. In 81 women who had sonographic evaluation 30 days postoperatively, the uterine scar was reduced by an average of 44.1% (p <0.001). Of 176 patients screened at day 30, 6 (3.4%) had anechoic areas adjacent to the uterine scar, possibly due to hematoma. A previously unknown myoma, two ovarian cysts, and two pelvic hematoma were also discovered. CONCLUSION: . Laparoscopic myomectomy is effective and relatively safe. In skilled hands it has a low risk of complications and appears to be a valid alternative to the open procedure. Sonographic assessment allows detection of alterations in muscular echotexture, but its effectiveness in identifying women at risk of uterine rupture or dehiscence has to be proved.

Adult↗
PubMed2001

Small-bowel occlusion after operative laparoscopy: our experience and review of the literature.

Bowel complications as a consequence of laparoscopic surgery are usually due to direct injuries; on the other hand, bowel occlusion is a rarely described event. We have retrospectively analyzed our data in this field. Out of 2652 laparoscopies performed between July 1996 and March 2000, three cases of small-bowel occlusion were observed. Two cases were due to bowel hernia through a 5-mm trocar port incision, the third was a consequence of an adhesion between the ileum and lost fragment of myoma. Two cases were treated laparoscopically, while in the third a laparotomy was required. At the time of writing, all the patients are well after a mean follow-up of 6 months. It appears important to also perform closure of the fascia and peritoneum after a 5-mm trocar port incision where there has been extensive manipulation.

Adult↗
PubMed2001

Endoscopic features of celiac disease in children.

BACKGROUND: Endoscopic abnormalities have been described in adult patients with celiac disease that may suggest the diagnosis, especially when the presentation is atypical. METHODS: The duodenum of 140 children undergoing EGD for various different indications was evaluated macroscopically and histologically. RESULTS: Histology revealed total villous atrophy in 80 patients, 79 of whom had celiac disease. Among these, 100% had a mucosal mosaic pattern in the duodenum (sensitivity 98.7%, specificity 96.7%, positive predictive value 97.5%, negative predictive value 98.3%), 70% had scalloped duodenal folds (sensitivity 68.7%, specificity 98.3%, positive predictive value 98.2%, negative predictive value 70.2%), 15% had visible vasculature, and 6% had reduction of duodenal folds. Sensitivity and specificity of endoscopic findings were not modified by chromoendoscopy. Except for the mosaic pattern, the frequency of endoscopic abnormalities increased with age; reduction of duodenal folds was never seen in children with celiac disease who were less than 5 years of age. CONCLUSIONS: The frequency and diagnostic value of endoscopic abnormalities are different in children with celiac disease compared with adults with this disease. Because indications for endoscopy, such as abdominal pain, dyspepsia, and unexplained anemia, can be manifestations of celiac disease, and villous atrophy may have a patchy distribution, awareness of these endoscopic abnormalities is important in the diagnosis of celiac disease in children.

Adolescent↗
PubMed2001

CD4+IL13+ T lymphocytes at birth and the development of wheezing and/or asthma during the 1st year of life.

BACKGROUND: Despite our knowledge that maternal inheritance influences the development of asthma in childhood, attempts to identify a clear-cut Th2-oriented cytokine production by T lymphocytes at birth have given conflicting results. The prognostic significance of these cells for asthma development later in life remains to be determined. METHODS: We evaluated at the single cell level Th1- and Th2-type cytokines in 208 randomly selected cord blood mononuclear cell (CBMC) samples obtained from pregnant women (group A, n = 68 with diagnosed respiratory allergic disease; group B, n = 140, with no evidence of atopy), and prospectively followed newborns for 1 year. RESULTS: There was no difference in IFN-gamma, IL-4 and IL-5 production at birth between both groups, whereas a correlation between CD4+IL13+ lymphocytes from CBMC samples derived from atopic mothers and the occurrence of wheezing and/or asthma during the 1st year of life was found. CONCLUSIONS: Our observations suggest that the intracellular cytokine profile of cord blood CD4+ cells, in terms of IL-13 production, could be considered a useful tool for a more accurate identification of newborns from atopic mothers who are at high risk of developing asthma.

Asthma↗
PubMed1998

Uterine leiomyoma metastasis as a first sign of breast cancer.

Uterine metastases from extragenital cancer are rarely reported in the literature. More frequently, the female genital tract is involved by direct extension from an adjacent pelvic organ. A 37-year-old woman had a myoma of the uterine wall and hypermenorrhea. The mass was laparoscopically enucleated, and frozen section examination was performed because it was macroscopically suspicious for sarcomatoid degeneration. The final diagnosis was metastatic carcinoma in the uterus of probable breast origin.

Adult↗
PubMed1997

Cancer survival from incident cases of a population-based study in the Umbria region, Italy.

Survival of 12,051 cancer patients was investigated in incident cases registered in an ad hoc survey in the Umbria region for the period 1978-82. Death certificate only cases were excluded. The follow-up was carried out by an automatic link with the RENCAM (nominative register of causes of death) and verified at the Registrar's Offices of the various towns of the region. Both observed and relative survival rates according to sex and selected time periods (1, 5 and 10 years) were calculated. Generally, the relative survival rate for all tumour sites at 5 years was 0.35 in males and 0.53 in females (P < 0.01), and 0.31 and 0.49, respectively, at 10 years. 5-year relative survival rates greater than 0.50 were found for only three tumour sites in men (bladder, larynx, colon), accounting for approximately 21% of all men included in the study, but for six sites in females (breast, uterus, kidney, bladder, rectum, colon), accounting for more than 50% of the female cases. The 5-year age-adjusted relative survival rates in Umbria were higher than in other Italian and European registries for selected sites (stomach, colon, rectum, lung). High survival in Umbria could probably be related to the availability of specialist care and to the easy access to a network of oncological services.

Aged↗
PubMed1997

Ten-year survival of patients with cancer of the digestive tract in Umbria, Italy.

Survival statistics of 4135 incident cases of digestive system cancers in the Umbria region of Italy are reported. The original data are derived from an ad hoc survey carried out in the period 1978-1982. Observed and relative rates at 1, 5 and 10 years are presented separately by sex and age (< 60 and > or = 60 years). In both sexes there are very short survival rates for liver, bile duct and pancreas cancers, whereas about 50% of colon and rectum cancer patients survived at five years. About 20% stomach cancer patients survived at the same time. In males the survival rate for oesophagus cancer is close to 10%. The rates at ten years confirm the trend. Comparisons between sexes show that there is no significant differences in age at first diagnosis. Survival values are higher in females only for rectum cancers. In both sexes, for stomach, colon and rectum sites younger patients had a significantly longer survival than older ones.

Aged↗
PubMed1996

Ovarian cysts.

The Author intends to compare the data available in literature on the topic of 'laparoscopic surgery of ovarian cysts' to his case material. From 1985 to 1994, the author carried out 920 laparoscopic operations for the removal of ovarian cysts. Of these, 13 were converted to laparotomies, mostly because of peri-adnexal adhesions. There were 22 recurrences (endometriosic and mucinous multilocular cysts), and five severe complications (two purulent inflammations, one intra-operative haemorrhage and one post-operative one, one post-operative acute abdomen sine causa). In one case, an unrecognised endometrioid carcinoma was inadequately treated with laparoscopy. The author considers laparoscopy as the elective choice for surgical treatment of ovarian cysts. Suspect malignancy is not a contra-indication to laparoscopic surgery, since the removal of the operative specimen and its subsequent histological examination can be effected-in the large majority of cases-with the same results both laparoscopically and laparotomically. There is a problem with undiagnosed carcinomas in fertile females, but it is equally present in laparotomy.

Adenocarcinoma↗
PubMed1996

Digestive endoscopy and portal hypertension. North Italian Endoscopic Club.

Improved knowledge of pathophysiology of portal hypertension and technological progress have contributed to development of new endoscopic techniques and pharmacological approaches to treatment of this condition. To put the role of endoscopy in the right perspective, it is important to consider that liver transplantation has greatly modified prognosis of cirrhosis. Because of the increase of indications for transplantation, these complications are no longer regarded as the last, but rather as an intermediate stage before a possible transplantation. We have reviewed some pathophysiologic, diagnostic and therapeutic aspects on portal hypertension, especially the role of endoscopy in diagnosis, natural history and therapeutic options for complications of cirrhosis. In addition to sclerotherapy, new endoscopic methods have been developed, with a low complication rate and possibility of being applied for treatment of gastric varices, i.e. injection of tissue adhesives and rubber band ligation. Besides oesophageal varices, gastric varices and portal hypertensive gastropathy (and portal colopathy) are important findings in cirrhosis. Further information is needed on natural history and treatment of these conditions. Digestive haemorrhage is the most important consequence of portal hypertension, so treatment should be aimed at controlling acute bleeding, rebleeding and, more important, at preventing first haemorrhagic episode. Good results will probably be obtained using a combination of drugs, a combination of endoscopic methods or a combination of both. All will need evaluation in randomised, controlled trials. These considerations renew interest in strategies for diagnosis and treatment of portal hypertension and a multidisciplinary approach may be necessary, involving gastroenterologists, endoscopists, interventionist radiologists and surgeons, ideally in a departmental environment.

Endoscopy, Digestive System↗
PubMed1994

Acute tubular necrosis in a newborn suffering from neonatal necrotizing enterocolitis.

The case history of a newborn who at birth had a necrotizing enterocolitis, worsened by an acute tubular necrosis and anuresis, is presented. A continuous arteriovenous hemofiltration was instituted for the baby, who had previously undergone abdominal surgery with resection of the necrotic bowel. The hypothesis that necrotizing enterocolitis could be the cause of acute tubular necrosis in infancy is discussed.

Enterocolitis, Pseudomembranous↗
PubMed1994

[CA 125, CA 19.9, MCA, CEA, 17 beta-estradiol and progesterone in functional and benign cysts and carcinoma of the ovary].

CA 125, CA 19.9, CEA, MCA, E2 and P levels have been assessed in the serum and in the ovarian mass fluid of 216 patients through echo-guided puncture to distinguish between functional, benign and malignant cystic neoplasm. Statistically evaluated data have been assessed through histological diagnosis in 122 cases: cyst fluid markers do not always differentiate ovarian carcinoma from benign cysts, while they have a significant concentration in persistent functional cysts (follicular and luteal) if compared with benign and malignant neoplasms. The following management is suggested: 1) Echo-guided puncture in case of simple, persistent ovarian cyst with low levels of CA 125 and CA 19.9 in serum; 2) Operation in case of fatty, chocolate or mucinous fluid. Wait and see if the fluid is either clear or hematic/chocolate with high P levels (luteal cyst); 3) Operation on simple cyst with high CA 125 ald low E2 and P levels (serous c.), in case of relapse or persistence after aspiration; 4) Wait and see if CA 125 is low and E2 and P levels are high (follicular c.).

Antigens, Tumor-Associated, Carbohydrate↗
PubMed1991

Cigarette smoke and the hormonal receptors status in breast cancer.

This paper describes 188 cases of early breast cancer in which age, menopause status, smoking, and pathological characteristics of the tumor were investigated, as well as status and levels of estrogen and progesterone hormone receptors. Estrogen and progesterone receptor status did not seem to differ between smokers and non-smokers. The data of this study does not confirm the observation of a larger number of cases among women who smoke. However, the proportion of estrogen-receptor-negative cases is slightly higher in pre-menopause smokers and in those patients more exposed to smoke both in terms of intensity (cigarette per day) and duration (years of exposure).

Adult↗
PubMed1991

Laparoscopically-assisted vaginal hysterectomy.

We report on our initial experience with laparoscopically-assisted vaginal hysterectomy. Seven patients aged 41 to 67 years were successfully treated with this new technique without significant morbidity and with the advantage of early discharge and return to full activity. We discuss the indications, technical details including preparation and positioning, and the shortcomings and problems encountered. It is concluded that laparoscopically-assisted vaginal hysterectomy may in the near future become a valid alternative to the conventional procedures in selected cases.

Female↗