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Luigi Gandolfo

Publications and source records attributed to Luigi Gandolfo.

11 recordsLinked to original sources
PubMedDate not supplied

Locally advanced breast cancer in the elderly: a major challenge requiring effective and appropriate treatment.

AIMS AND BACKGROUND: Breast cancer is the most common tumor in women. As the population above 65 years increases, breast cancer will be a more substantial problem for elderly patients. This work reports our experience in the management of stage III and IV locally advanced breast cancer. METHODS: Nineteen patients over 65 years of age (mean, 70.3 years) with stage III and IV breast cancers, treated between 1990 and 2000, are considered. The management and outcome are evaluated. RESULTS: Nine patients had stage IIIA breast cancer, 7 stage IIIB and 3 stage IV. Sixteen underwent Madden mastectomy and 3 simple mastectomy. Patients at stage IIIB and 1 patient at stage IV with T4 tumor received neo-adjuvant chemotherapy. There were no significant postoperative complications. Sixteen patients were given tamoxifen and 10 patients adjuvant chemotherapy. Patients were followed for a median of 36.7 months (range, 6-72 months). In 8 patients with stage IlIl disease, metastasis developed. Two patients had local recurrence of disease. Of the patients at stage IIIA, 6 were free from disease (one died from unrelated causes) and 3 had recurrent disease (2 died). Of the patients at stage IIIB, 2 are disease free and 5 had recurrent disease and died. Of the patients at stage IV, only one is alive. CONCLUSIONS: Stage and individual characteristics of elderly women influence management. Patients should be managed adequately since most of them are fit enough to undergo treatment.

Age Factors↗
PubMedDate not supplied

[Robotic techniques in laparoscopic surgery].

Robotic technology is being increasingly used in surgery. The authors assess the usefulness, effectiveness and safety of the AESOP 2000 robotic device (Automated Endoscopic System for Optimal Positioning) in videolaparoscopic surgery. Two laparoscopic cholecystectomies were performed with the aid of the AESOP 2000 robot. A short increase in operative time was observed and there were no complications. Voice understanding was accurate and flawless and no inadvertent smearing of the lens occurred. The use of the AESOP 2000 robotic device is safe, improves the quality of vision and reduces the number of surgeons needed in the team. Nevertheless, a learning curve and simultaneous training in the use of the device are required.

Cholecystectomy, Laparoscopic↗
PubMedDate not supplied

[Extraperitoneal prosthesis repair in the surgical treatment of inguinal hernias].

The authors analyse the current state of the art of the prosthetic repair of incisional hernia and the problems involved in positioning the prosthesis, comparing their own experience with the most recent literature. From January 1994 to June 2001, 50 patients were operated on for incisional hernia (28 males and 22 females); 12% had recurrent or re-recurrent incisional hernias. Defects smaller than 3 cm were repaired with a polypropylene plug; a double-layer polypropylene mesh placed in a preperitoneal position was used for defects measuring from 3 to 5 cm; in defects greater than 5 cm a double-layer mesh was placed behind the muscle layer. Fifteen patients were operated on under local anaesthesia. Only 22% required postoperative analgesia. The mean hospital stay was 3.95 days. Only 3 recurrences (6%) were recorded. On the basis of our experience it seems appropriate to repair incisional hernias when of small size, preferably under local anaesthesia, avoiding opening the hernia sac, using an extraperitoneal approach with an overlap technique that employs polypropylene.

Adult↗
PubMedDate not supplied

[Role of nutritional support in the treatment of enteric fistulas].

Enteric fistulas are nowadays considered an important therapeutic challenge. Artificial, total parenteral and enteral nutrition have allowed an improvement in the healing of these fistulas and a lower incidence of mortality. Fourteen patients with enteric fistulas (10 men, 4 women; mean age: 64.4 years; range: 20-80 years) were observed. The fistula was located in the large bowel in 11 patients, in the ileum in 2, and in the jejunum in 1. Thirteen patients received enteral nutrition. The patient with the jejunal fistula received total parenteral nutrition for 30 days and then enteral nutrition. The fistulas were successfully treated in 11 patients. One patients underwent surgery after 6 weeks of treatment with enteral nutrition because of lack of improvement of the symptomatology. In two patients, with advanced cancer of the colon and stomach, respectively, only a reduction of the fistula output was achieved. Nutritional support in the treatment of enteric fistulas is an effective procedure widely utilised to restore adequate nutritional status and bowel rest, which are two important targets for achieving fistula closure. Nutritional support is also useful in the management of patients undergoing surgery in order to reduce the postoperative complication rate.

Adult↗
PubMedDate not supplied

[Laparoscopic treatment of benign ovarian cysts].

Laparoscopic surgery is the most frequent indication for the management of benign ovarian cysts in the obstetric and gynaecological field. On the basis of their experience the authors address the clinical classification of benign ovarian pathology and the surgical laparoscopic procedures utilised in the treatment of adnexal cysts. Forty-two patients underwent laparoscopic surgery after a preoperative clinical and biological evaluation and imaging in order to exclude the presence of ovarian malignancies. All surgical procedures were carried out laparoscopically, with a conversion index of 0%. The morbidity was 2.3% (one case of haematoma of the umbilical trocar site) and there was no mortality. No late complications were observed. In conclusion, laparoscopic surgery in the management of ovarian cysts is technically feasible. On the basis of these findings laparoscopic surgery is the treatment of choice for adnexal cystic tumours after careful exclusion of malignancy.

Adult↗
PubMedDate not supplied

[Laparoscopic treatment in a case of torsion of ovarian benign mature teratoma. Clinical case and review of the literature].

Benign mature teratomas account for approximately 10-17% of all ovarian neoplasms and are the type of ovarian neoplasm most likely to occur during a woman's reproductive life. Bilateral localization is observed in some 10-15% of cases and the estimated incidence of malignant degeneration is 0.5-1.8%. The authors report a case of a 35-year-old woman admitted with discontinuous abdominal and pelvic pain. Imaging procedures showed an adnexal mass with the appearance of a dermoid cyst. The patient underwent laparoscopic ovarian cystectomy with preservation of the adnexal gland. After a review of the international literature and a description of the clinical features of the disease the authors go on to stress the advantages of laparoscopic management of benign ovarian teratomas.

Adult↗
PubMedDate not supplied

[Organization of a day surgery unit for hernia].

The authors report their experience with the organisational aspects of minimal hospitalisation of patients undergoing surgical treatment for hernias of the abdominal wall. 1544 hernia repairs were carried out from January 1994 to March 2002; over 80% of these were performed on a day surgery basis. The organisation of a day surgery unit requires dedicated medical and nursing staff and also diagnostic imaging facilities that should be immediately available, though all this is not strictly necessary in a general surgery department. In conclusion, in addition to the organisational problems, inadequacy of the D.R.G. system in Italy is the primary obstacle to diffusion of the practice of ambulatory hernia repair.

Ambulatory Surgical Procedures↗
PubMedDate not supplied

[Inguinal hernia recurrence after prosthetic repair: our experience].

Inguinal hernia recurrence after prosthetic repair is a very rare clinical condition (1%), but it is probably underestimated and hard to resolve surgically. The authors reports their experience with 16 recurrent post-prosthetic inguinal hernias. A greater incidence of recurrence was noted in obese patients with concomitant chronic diseases (56%). Hernia recurrences following prosthetic repair are often asymptomatic. The use of Lichtenstein's plug technique yielded satisfactory results in terms of rehabilitation and incidence of recurrence and is also associated with a very low risk of complications.

Adult↗
PubMedDate not supplied

[Biologic tolerance of prolene prosthesis in inguinal hernia repair].

The aim of this study was to evaluate the efficacy, safety and durability of a calibrated inguinal hernioplasty polypropylene prosthesis, particularly in relation to the microbiological phenomena that may set in the vicinity of the polypropylene plugs and mesh employed. Over the period from January 1994 to December 2002, 1416 operations were carried out for inguinal hernia. In 5 of these patients we conducted an immunological study to assess serum cytokine concentrations. In addition, we incubated peripheral blood mononuclear cells for 24 or 72 hours in RPMI 1640 medium added with 10% FCS, with or without 0.5 cm2 of polypropylene. We then evaluated cytokine levels in the supernatant of these cultures. It proved impossible, either in vivo or in vitro, to detect appreciable levels of IL-10 or IP-10. Serum levels of IFN-gamma, TNF-alpha, IL-18 and IL-6 increased in the postoperative phases as compared to the preoperative period. In the study performed in vitro, in the presence of prosthetic material there was a remarkable increase in the production of TNF-alpha and INF-gamma both in basal conditions and after an appropriate mitogenic stimulus. The results of this study allow us to speculate that the use of polypropylene induces remarkable chemotactic activity in the tissues adjacent to the prosthesis. The in-vitro study data suggest that the presence of polypropylene may stimulate the immunocompetent cells of patients with prosthetic implants.

Adolescent↗
PubMedDate not supplied

[Antibiotic prophylaxis in laparotomic and laparoscopic cholecystectomy].

Antibiotic prophylaxis in biliary surgery, when correctly used, has led to the minimisation of postoperative infections. Conventional cholecystectomy, and particularly laparoscopic cholecystectomy give rise to a very complicated issue concerning the use of antimicrobial prophylaxis, especially in relation to low-risk patients. The authors describe their experience with the use of short-term prophylaxis in biliary surgery based on a hundred consecutive laparoscopic cholecystectomies. In addition, the literature on this topic strengthens the authors' conviction that antimicrobial prophylaxis may be indicated in all surgical cholecystectomy procedures, also in view of the difficult management of postoperative infection risk factors.

Adolescent↗