Biomedical subjects

M Sacchi

Publications and source records attributed to M Sacchi.

At least 55 records · Page 3Linked to original sources

PubMedDate not supplied

Immunomodulation therapy for squamous cell carcinoma of the head and neck.

The role of the immune system in the pathogenesis and treatment of cancer is currently a popular area of research. An underlying fundamental concept of cancer immunology is the supposition that tumor cells express antigens differently than normal cells, both qualitatively and quantitatively. Understanding tumor-host interactions may suggest opportunities to modify these relationships to obtain antitumor effects. There is growing evidence that the immune system plays an important role in the pathogenesis of squamous cell carcinoma of the head and neck (SCCHN). Based on this evidence, trials studying the therapeutic efficacy of biologic response modifiers (BRMs) have been undertaken. These trials have had variable success, but continued efforts incorporating newer cytokines are underway.

Carcinoma, Squamous Cell↗

PubMedDate not supplied

Diagnostic and surgical features of Klatskin tumors.

AIM OF STUDY: Klatskin tumors are rare and their prognosis is poor. Long term survival can be expected only after a surgical resection, the treatment of choice. The aim of this study is to report our single centre experience and, by literature analysis, to define the role of surgery in the treatment of hilar cholangiocarcinoma. MATERIALS AND METHODS: Between 1990 and 1998, 27 patients affected by Klatskin's tumor were observed. Eight women and seven men (mean age 59 years) underwent surgical resection. Thirteen patients (86%) had curative resection (7 hilar resection (HR), 4 HR combined with partial hepatectomy (PH) and 2 HR + PH with portal vein resection). Two patients (13%) had palliative biliary resection and surgical drainage. RESULTS: One in-hospital death was recorded after a right hepatectomy with portal vein resection (6.6%). Postoperative morbidity rate was 40%. Patients were regularly followed up to date or to death. Ten patients died and 5 survived. The 1-, 2- and 3-year survival rate after curative resection was 84%, 54% and 34%. The median survival was 28.5 months. Lymph node involvement did not show a statistically significant difference on median survival between the positive group and the negative group (26.2 vs 29.8 months), nor did perineural invasion, because of the small number of patients. The 1-, 2-, 3- and 5-year survival rate after isolated hilar resection was 100%, 57.1%, 28.6% and 0. Four out of 6 patients who underwent hilar resection combined with partial hepatectomy are still alive 1, 23, 29, 38 months after resection. Hepatectomy increased mortality (16% vs 0). Palliative biliary resection and surgical drainage were successfully performed in 2 patients with satisfactory results. CONCLUSION: Aggressive surgical treatment of Klatskin tumors can improve patients' survival. Careful preoperative management has to be carried out by a multidisciplinary approach including surgeons, gastroenterologists, radiologists and pathologists. Hepatic resection involving the caudate lobe is often performed in order to obtain microscopic tumor-free margins and curative resection (R0). Biliary drainage and treatment of cholangitis is mandatory before surgery in order to improve surgical outcome. Surgical treatment is characterized by high technical difficulties and better results can be achieved by hepatobiliary surgical teams.

Adult↗

PubMedDate not supplied

[Liver metastasis of breast carcinoma. Results of surgical resection. Analysis of 15 operated cases].

AIM OF THE STUDY: The aim of the study was to define the efficacy of liver resection for metastases from operated breast cancer by means of analysis of the results of a single institution compared to the literature data. MATERIALS AND METHODS: Over the period from 1990 to 1998, 15 patients with liver metastases from operated breast cancer were submitted to surgical resection. Thirteen patients were operated on for single metastases and two for multiple liver metastases. In the first group, a simple metastasectomy or wedge resection was sufficient, while in the second a bisegmentectomy and a right hepatectomy, respectively, were performed. Nine patients were subsequently submitted to adjuvant chemotherapy, two to chemo- and hormonotherapy, and two to hormonotherapy alone, while two other patients received no systemic treatment. RESULTS: No major complications or postoperative mortality were observed. Median survival was 44 months. The actuarial 5-year survival rate was 38.3%. Eight patients are still alive, and 7 patients have died as a result of their liver and systemic metastases. CONCLUSIONS: Hepatic metastasis from breast cancer is a good indication for surgical resection. Resection is capable of providing curative treatment and better results in terms of quality of life and survival rates, as compared to chemotherapy and hormonotherapy, especially in patients operated on for primary tumours more than three years earlier.

Adult↗

PubMedDate not supplied

Management of caudate lobe injury. Case report.

This article describes a case of abdominal trauma with laceration of the caudate lobe, avulsion of its short hepatic veins and tear of the inferior vena cava (IVC). Anatomic segmentectomy of I segment and direct suture of inferior cava vein was performed. On its arrival to the Emergency Department the patient was hemodynamically stable. Ultrasonography and CT scan demonstrated a fracture of I hepatic segment associated to a retroperitoneal haematoma. Because progressive anemia and unstable hemodynamic state, the patient was taken to the operating room for intervention. No postoperative complications due to surgery were reported. The patient left the hospital in XXII postoperative day, after normalization of clinical parameters.

Humans↗

PubMedDate not supplied

Traumatic diaphragmatic injuries.

Traumatic diaphragmatic rupture is an uncommon but important problem in patients with multiple injuries. A retrospective analysis of 37 cases with diaphragmatic injuries, 34 of the left and 3 of the right hemidiaphragm, was carried out. Thirty-two patients were treated surgically during the acute phase and 5 after a variable delay post-trauma. Diagnostic problems are discussed, so also for comportance of a proper evaluation of chest films. Factors leading to a strong suspicion of diaphragmatic rupture in patients suffering from thoraco-addominal blunt trauma are emphasized in order to recognize diaphragmatic lesions. Finally, surgical treatment is considered. In most cases, laparotomy is the access route of choice, not only to achieve reduction of herniated viscera and repair of the diaphragmatic lesions, but also to treating the frequently associated intra-abdominal injuries. Whenever thoracotomy is required, it should always be performed via a separate incision.

Adolescent↗

PubMedDate not supplied

[Open rhinoplasty: indications and limits of a controversial method].

As Aufricht has said, rhinoplasty is "... an easy operation to do, but it is hard to get good results". As it clearly observed in ENT rhinoplasties which deal with severe and combined defects of the nose which result in functional impairment. The aim of this study was to analyse complications in a personal series of open rhinoplasties as well as those in literature in order to standardize different surgical approaches possible in correcting various nasal deformities, divided according to a personal classification. Other than the classical intramucosal technique (following Roe, Joseph and Weir), the more conservative extramucosal operation (described by Jost and Aiach) and the more aggressive external approach are available to the surgeon. Intramucosal rhinoplasty is still the most dependable and widely used technique. However open rhinoplasty which brings about complications in less than 10% of the procedures, offers clear-cut advantages if employed following precise indications. In our experience, the main indications for open rhinoplasty are: severely crooked nose, above all of the II and III arch: crooked nose with saddle deformity; asymetrical defects (including those due to a cleft lip); 50% of the secondary rhinoplasties (excluding minor procedures).

Adult↗

PubMedDate not supplied

[Mobbing: analysis of an ambulatory case load].

We present twenty outpatients (11 males; 9 females) who asked medical assistance, during the last two years, for psychopathological problems by them ascribed to "mobbing" in the work environment. Six subjects were employed in public institutions, 14 in private companies. All patients underwent occupational health specialistic visit, psychological counselling (including personality tests administration), and psychiatric evaluation. A psychopathological picture reasonably correlable to "mobbing" was diagnosed in four subjects only (20% of the cases), i.e. in a lower proportion than that reported by other investigators.

Adult↗

PubMedDate not supplied

[Acute abdomen from ruptured adrenal pheochromocytoma: case report].

The pheochromocytoma is a very rare neoplasm, which originates in 98% of cases in the adrenal medulla; it is often bilateral in familial syndromes. It is more frequent in syndromes like MEN2, von Hippel-Lindau disease, and neuofribromatosis type 1. In this article the Authors report a case of a young woman with a large adrenal pheochromocytoma, that presented by an acute abdomen; the treatment was explorative laparotomy with unilateral adrenalectomy. Therapy of this tumour is founded on surgery, plus chemiotherapy radiotherapy or treatment with 131I-MIBG (iodine-131-metaiodobenzylguanidine in malignant cases (10%). According with the absence of a correlation between pathological findings and clinical behaviour, a long-term follow up is indispensable.

Abdomen, Acute↗

PubMedDate not supplied

Recent advances in the treatment of colorectal liver metastases.

Liver metastases are the major cause of death coloroctal resection for cancer. Colorectal liver metastases are unique because of the potential for cure. Presently surgical resection is the gold standard of treatment. Complete R0 resection gives 5-year survival of up to 24-44%. Over the years there have been extensive efforts in devising new modalities of treatment for this disease. These include methods to increase the resectability such as portal after vein emolization & two-stage surgery, py with newer drugs and methods such chronotherapy & hepatic artery infusion chemotherapy, newer methods of radiotherapy, local ablative therapies such as cryoablation, radiofequency ablation, microwave ablation & laser interstitial thermal therapy, and biological therapy. Biological therapy is largely investigational, but holds great promise for the future.

Antineoplastic Agents↗

PubMedDate not supplied

Carcinoma of the pancreas with portal vein involvement--our experience with a modified technique of resection.

BACKGROUND/AIMS: Up to 40% of the patients with pancreatic carcinoma are not fit for curative resection due to the locally advanced nature of the disease in the form of vascular involvement. In recent years a more aggressive approach of vascular resection with pancreaticoduodenectomy (PD) has resulted in the increase in resectability rate and survival in this group of patients. The most important determinant of survival in these patients is negative resection margins. The aim of the present study is to present our experience of vascular resection using a modified technique, in patients with pancreatic cancer. METHODOLOGY: This is a retrospective study of 48 patients who underwent portal vein/superior mesenteric vein (PV/SMV) resection along with PD using the modified technique of resection, during 1982-2004. The principle modification is the initial extensive retroperitoneal dissection for the assessment of the extent of tumor involvement of the superior mesenteric vessels and division of retroperitoneal margin before the division of the pancreas. All patients also underwent extended lymphadenectomy. RESULTS: The subtotal PD was done in 26 and total PD in 22 patients, with resection of the PV/SMV in all of them. The end-to-end anastomosis was possible after adequate mobilization of the PV and SMV in 40 patients. In 4 patients reconstruction was able to be done with the use of a graft. The portal vein occlusion time was 8-15 minutes. Histopathological examination showed negative margins in all the resected specimens. Postoperative complications occurred in 16.66% with reoperation rate of 8.33%, and mortality of 6.25%. After a mean follow-up of 110 months, mean survival was 40 months with the range of 18-250 months. The five-year and 10-year survival was 18% and 10% respectively. The venous patency rate was 100% at three years. CONCLUSIONS: In conclusion, PD with en bloc resection of the PV/SMV confluence can safely be done with morbidity and mortality similar to that of standard PD. The survival advantage is directly related to the attainment of negative resection margins. The modified technique is a useful way of doing vascular resection with the least amount of bowel congestion and securing negative resection margins.

Adenocarcinoma↗

PubMedDate not supplied

[Splenic marginal zone lymphoma: case report and review of the literature].

Splenic marginal zone lymphomas are rare tumors which take origin from the B cells. More common in the elderly, often asymptomatic, they can present with abdominal pain, splenomegaly and cytopenia and have an indolent clinical course. We describe a case of a women 79 years old who presented with abdominal pain, fever and splenomegaly. Computed tomography demonstrated splenomegaly with an area of low density in the spleen. Only by laparotomy and splenectomy the correct diagnosis was possible. Because of the indolent course of this kind of lymphomas, splenectomy is the main treatment for patients with abdominal pain, splenomegaly and cytopenia. If there is no pain and no cytopenia, the treatment can be only wait and see. Only in case of progression of disease chemotherapy can be employed.

Abdominal Pain↗

PubMedDate not supplied

[Endovascular laser ablation of the greater saphenous vein for varicose veins: our initial experience].

Laser treatment of primary varicose veins of the legs is a new mini-invasive technique which represent an alternative to the safenectomy. Endovascular laser treatment is based on the employ of laser to destroying the vascular wall and inducing fibrosis. This technique is not without complications: burns, paraesthesias, haematomas, but most of all disappear in few days. Encouraged by the promising results reported in literature, we have performed 18 laser ablation of greater saphenous vein since 2003 till today. Our patients had a good post-operative course and a follow up without troubles (3-17 months). We think that laser treatment is effective in the treatment of the primary varicose veins of the legs. It requests attention and experience in dosing the laser energy for minimizing the complications. Today there isn't long term follow up in literature.

Adult↗

PubMedDate not supplied

[Spontaneous rupture of common iliac artery: a case of Ehlers-Danlos syndrome and review of the literature].

Authors report an uncommon case of spontaneous rupture of common iliac artery in a man 43 years old with Ehlers-Danlos syndrome. The clinical presentation was devious in the beginning and catastrophic after few hours with a haemo-peritoneum and haemorragic shock. The Ehlers-Danlos syndrome is a rare affection of the connective tissue with an incidence of 1/5000, representing one of the most common disorders of the connective tissue. This disease is characterized by the fragility of arteries, intestine and uterus. Its presentation is often catastrophic, with rupture of a big artery, rupture of uterus during pregnancy or bowel perforation. The mean age of death in subjects with Ehlers-Danlos syndrome is 45 years. This syndrome is inherited in most cases in an autosomal dominant manner; 50% of the cases are due to new mutations. A minority of cases, due to deficit of tenascina X, is inherited in an autosomal recessive manner.

Adult↗

PubMedDate not supplied

[Antitumor activity of adherent LAK cells (A-LAK) in a model of squamous carcinoma of the head and neck].

Local adoptive immunotherapy employed on a selected population using IL2-activated immune cells (A-LAK cells) and IL2 resulted in complete growth inhibition of a human squamous cell carcinoma of the head and neck implanted three to seven days previously and growing in nude mice. Although the in vitro cytotoxicity of A-LAK cells against the carcinoma cells was not higher than that of the whole population (LAK cells), the in vivo antitumor efficacy was from 4 to 9 times higher for A-LAK cells, as confirmed by the total number of injected cells needed for a complete growth inhibition. In addition, local A-LAK cell administration was characterized by early peritumoral erythema and swelling, not observed during LAK-cell therapy, which disappeared at the end of therapy. Histology of the tumors, during and at the end of therapy, showed an initial granulocytic and plasma cellular infiltration followed by mononuclear infiltration of the stroma of the tumor. The tumors showed a terminal-like differentiation with an increase of the keratinic layer and decrease of basal epithelial cells. These effects were proportional to the number of A-LAK cells injected. With the highest number of A-LAK cells, a complete epithelial disorganization was observed and 4 weeks from therapy termination the tumors were reduced to keratinic areas surrounded by connective tissue. These observations suggest the possibility of a A-LAK cell-dependent process of accelerated tumor differentiation and keratinization leading to tumor regression in nude mice.

Animals↗

PubMedDate not supplied

[Interleukin-2 and LAK cells in the local immunotherapy of tumors of the head and neck: an experimental model].

A xenograft model of local adoptive immunotherapy would be useful in evaluating the therapeutic effects both cytokines with and without added effector cells have on human head and neck tumors implanted into nude mice. Human squamous cell carcinomas of the head and neck lend themselves to local intervention and, since conventional radio- and/or chemotherapy often fail to arrest tumor growth, new therapeutic modalities, including immunotherapy, must be considered and local immunotherapy may have the advantage of minimal side effects. In the present study the ability of local adoptive immunotherapy with human lymphokine-activated killer cells (LAKc) and recombinant interleukin-2 (IL-2) to inhibit the growth of established squamous cell carcinoma of the head and neck was evaluated in nude mice. The model was established by subcutaneous injections of in vitro maintained tumor cells into the flank splenectomized animals pretreated with cyclophosphamide and anti-asialo GM1. The line used was tumorigenic in 95% of the nude mice and neither metastasized nor killed the animals. The local daily administration of IL-2 to the tumor site for two weeks resulted in a significant inhibition of tumor growth. Complete inhibition of tumor growth was achieved with three times weekly injections of 5 to 10 x 10(6) LAKc delivered to the tumor site and 1000 U of IL-2 administered locally every day for two weeks. The data obtained indicate that local adoptive immunotherapy with IL-2 and an adequate dose of LAKc may be effective in preventing the in vivo growth of established squamous cell carcinomas of the head and neck.

Animals↗

PubMedDate not supplied

[Basal serum production of gamma-interferon in subjects with gramineous allergic rhinosinusitis, in carriers of cancer of the larynx and in normal control subjects: study with specific monoclonal antibody. Preliminary data].

The authors report preliminary data about IF-gamma (Interferon-gamma) basal serum production tested by monoclonal antibody in three groups of 25 patients: alpha (normal controls), beta (ragweed hayfever patients) and gamma (laryngeal carcinoma patients pT3-4, pN0----3, pM0 by UICC). The IF-gamma mean value in ragweed hayfever patients is about five times higher then normal controls. These data are highly statistically significative. Moreover no value of IF-gamma basal serum production is tested in laryngeal carcinoma patients. The data are discussed.

Adult↗

PubMedDate not supplied

[Presence of dilatations of the aneurysm type in the abdominal aorta after experimental terminoterminal anastomosis in the rat].

We have examined the aneurysmal dilatations in the wall of abdominal aorta after microsurgical experimental operation of end-to-end anastomosis. We observed this alteration both by macroscopic examination and by optical light microscopy. The wall presents various damages, particularly in the media, that seems thick, disarranged and often necrotic.

Animals↗

PubMedDate not supplied

[Histological and immunohistochemical aspects of mucosal-epidermal junction following surgical reconstruction of upper aero-digestive tract].

As a preliminary of the study of the possibility of upper aerodigestive tract reconstruction using "myomucosal" flaps derived by the classical pectoralis major myocutaneous flap, the evaluation of histologic and immunohistochemical modifications of epidermidis implanted in oral cavity and oropharynx has been conducted in 10 patients. The patients were operated for cancer of oral cavity and oropharynx and then reconstructed using the pectoralis major flap and biopsies from the mucosal-cutaneous junction were taken at different times from operation. Histologically, epidermidis preserved its morphology (a keratinized layer thinner but still present at 24 months by the operation, all the cutaneous annexes). A progressive modification of basal characteristics at the cutaneous side and rapid repair of the basal membrane were observed both histologically and immunohistochemically. In addition, a rich inflammatory infiltrate was present in the derma of the cutaneous area. Histochemistry demonstrated that mucosa and skin keep their own cytokeratin production although they repair in the absence of a fibrotic scar.

Basement Membrane↗