Biomedical subjects
Publications and source records attributed to M Veroux.
The Authors report on a case of multiple metastases located in the jejunum (where it caused intussusception), the omentum, and retroperitoneum having originated from a malignant melanoma with subungual primary site on first finger of left hand. After thoroughly surveying the specific literature, the Authors deal in more detail with current treatments and therapeutic prospects for this kind of neoplastic disease.
INTRODUCTION: The success of renal transplantation as a treatment for end-stage renal disease has created a chronic shortage of donor organs. We present our initial experience in transplanting kidneys from hepatitis B surface antigen (HbsAg)-positive donors into HbsAg-positive recipients. MATERIAL AND METHODS: From January 2002 to March 2004, 5 patients with end-stage renal disease, hepatitis B virus (HBV) infection, and HbsAg seropositivity underwent a kidney transplantation from a cadaveric HbsAg-positive donor. The median time on the waiting list was 8 months, compared with the median of 3 years on the national waiting list. RESULTS: One patient experienced an acute rejection; 1 patient had an increase in serum level of aspartate aminotransferase (AST)/alanine aminotransferase (ALT) with no signs of recurrence of hepatitis. Graft and patient survival at a median follow-up of 12 months was 100%. CONCLUSIONS: Although the number of patients is small and the follow-up is short, our results suggest that HbsAg-positive donors can be considered as an alternative donor source because their kidneys are allocated to the matched serology-positive recipients, shortening their time on the waiting list.
INTRODUCTION: Because the disparity between the number of patients waiting for kidney transplants and the number of available cadaveric renal allografts continues to increase, there is a clear need to review the inclusion criteria for cadaveric donors. PATIENTS AND METHODS: From January 2001 to March 2004, 24 patients with end-stage renal disease and hepatitis C virus (HCV) seropositivity underwent a kidney transplantation. In 10 transplants in HCV-positive recipients, the donor was HCV-positive (D+/R+) and in 14 cases the donor (1 living donor) was HCV-negative (D-/R+). RESULTS: Two of 3 HCV-RNA-negative recipients who received a HCV-RNA+ kidney became HCV-RNA+ in the posttransplantation period. There was a low rate of acute rejection (8.3%). One D+/R+ patient experienced an acute vascular rejection, which finally resulted in graft loss, due to the resurgence of severe infectious disease. The serum creatinine levels at 6 months posttransplantation were similar in both groups. Acute liver dysfunction was observed in 1 patient. There was no death in the entire series. Graft survival was 92% and 90% for D+/R+ and D-/R+, respectively.
INTRODUCTION: The rate of hepatitis B virus transmission via organs from with isolated hepatitis B virus core antibody-positive (HBcAb+) donors in kidney transplant recipients seems very low. PATIENTS AND METHODS: Over 4 years, we performed 36 transplants from Ig HBcAb+, hepatitis B surface antigen (HBsAg)-negative donors into recipients with a history of prior hepatitis B virus (HBV) infection or reported vaccination (28 patients) and in recipients who were not immunized and received a pretransplant prophylaxis with hepatitis B immunoglobulins. We examined the HBV-related outcomes in these 36 patients in comparison with 40 recipients of allografts from HBcAb- donors. RESULTS: No patient receiving an allograft from an HBcAb+ donor developed clinical HBV infection or HBSAg positivity. The rate of seroconversion was 14.2% in immunized patients, 12.5% in nonimmunized patients, and 0% in the control group. The 17.8% of immunized patients developed elevated transaminases after transplant, in comparison with 25% and 10% in the nonimmunized patients and the control group, respectively. Graft and patient survival was 93% and 93% for immunized patients, 100% and 100% for nonimmunized patients, and 98% and 95% for the control group, respectively. CONCLUSION: The use of anti-HBc antibody-positive kidneys was associated with no risk of transmission of HBV infection, without affecting graft and patient survival, and could be considered a safe way to expand the donor pool. Our preliminary results suggest that such kidneys could be safely transplanted even in not immunized patients who underwent a prophylaxis with hepatitis B immunoglobulins.
INTRODUCTION: The demand for kidney transplants and the improvement in recipient outcomes over the last years have stimulated surgeons to expand the criteria for usable donor organs, by accepting older patients to expand their donor pool. We herein report our experience with kidney transplants from donors aged older than 60 years, who have been declined by other transplantation centers. PATIENTS AND METHODS: Sixty kidney transplantations were performed with grafts procured from donors aged older than 60 years. Forty-five patients received a single kidney graft (SKG) and 15 received a dual kidney graft (DKG). Mean donor age was 62 years for SKG and 64 years for DKG. Double kidney transplantations were performed with the ipsilateral allocation of both grafts. RESULTS: No primary graft nonfunction occurred. Delayed graft function was observed in 22 SKG (48.8%) and in 7 DKG (46.6%). Acute rejection rates were 9% for SKG and 0% for DKG. One-year patient survival rates were 95% and 100% for SKG and DKG, respectively. Mean serum creatinine levels at 1-year posttransplantation were 1.9 mg/dL for SKG and 1.3 mg/dL for DKG. There were no surgical postoperative complications and mortality. Death censored 1-year graft survival rate was 88% for SKG and 94% for DKG. CONCLUSIONS: Our experience with marginal donors who have been declined by other transplantation centers has demonstrated that such organs, with accurate selection criteria, could be safely allocated to elderly recipients with no increase in postoperative complications, guaranteeing satisfactory results in the short and medium term, allowing a significant improvement in the number of transplants.
Although clinical staging of neoplastic diseases has long remained the only approach to prognosis and treatment, parameters for stage determination, such as tumor size (T) and lymph-node involvement (N), do not always provide effective indication of optimal treatment. Molecular medicine has also provided useful indications as to an alternative and/or integration to clinical staging. Despite the numerous possibilities afforded by pre-operative staging techniques, failures in defining the real spread of neoplasias into surrounding structures have remained a very important diagnostic problem. The labeling of monoclonal antibodies binding with neoplastic target cells by way of radioactive isotopes introduced the techniques known as immunoscintigraphy and SPECT, which then evolved into radioimmunoguided surgery. Fourty patients suffering from colorectal cancer whose age ranged between 42-82 years were singled out for this study. Before undergoing surgery, they were administered pancoloscopy and macrobiopsies, AP-LL chest x-rays, hepatobiliary ECT, echoendoscopy, abdomen and pelvis CT with nephrostographic phase, and total body bone scintigraphy. They were treated with 125I-B72.3 and 125I-FO23C5 (5% and 95% of patients, respectively). Thyrosuppression was achieved by Lugol solution (15 drops x 3/die) from the 6th day before infusion and until the day of surgical operation. Radioimmunoguided surgery (RIGS) has also been tested on staging and second-look of ovarian tumors. Five years after surgical operation the survival rate of Dukes A patients (15%) was confirmed to amount to 100%, whereas for Dukes B patients (50%) having undergone RIGS-guided exeresis on single unrecognized metastases (2 patients) and on unrecognized n+ (5 patients) the survival rate was found to be 85% after 5 years; 2 patients deceased due to relapse; 1 patient deceased due to e.p.a. Finally, for Dukes C patients; (35%) having undergone RIGS-guided exeresis on unrecognized liver micrometastases (1 patient), on single isolated metastases (2 patients) and in the occurrence of multicentric lymph-node positivity (9 patients), the survival rate after 5 years was found to amount to 64%; 5 patients deceased due to relapse. Out of 19 patients without pre-operative evidence of ovarian tumor as opposed to just 1 patient suspected of pelvic recurrence, after intra-operative surgical radicalization (45%), 1 patient was diagnosed fibrosis (suspicious lesion on CT) and 1 other patient peritoneal MTS (negative CT) by means of RIGS. RIGS has made it possible: to localize primary and/or metastatic lesions; to determine tumor-free margins, loco-regional disease spread; to differentiate suspicious foci on inspection and palpation (biotopic sampling); to detect invisible and impalpable tumor foci (occult sites); to verify radical exeresis; to evaluate lymphatic drainage stations; to enable guided exeresis of liver metastases.
The Authors present an additional case of a 70-years old male patient with skin metastasis from renal cell carcinoma, 15 months after nephrectomy. The patient died ten months later for advanced neoplastic disease. Skin metastasis affect 3-6% of patients with renal cell carcinoma. The surgical treatment is mandatory for single nodule. Chemotherapy is often ineffectual. The prognosis is poor, with a 0-8% 5-years survival for patients with multiple nodules.
INTRODUCTION: The authors review their experience about treatment of occult thyroid carcinoma. PATIENTS AND METHODS: 24 patients with papillary occult carcinoma of the thyroid were observed in the period 1999-2001. All carcinoma was 10 mm in diameter. In seventeen patients (71%) was performed a total thyroidectomy, while in seven (29%) a lobectomy; in four of seven patients treated with lobectomy was subsequently performed a total thyroidectomy. Total thyroidectomy wasn't performed in three female patients aged < 35 years, with a 5 mm diameter carcinoma. In two patients (8.3%) with nodal metastasis a lymph node excision was performed. All patients were alive and free of disease at last control. CONCLUSIONS: The incidental finding of occult thyroid carcinoma in a patient treated with a lobectomy does not entail a subsequent total thyroidectomy, because of this surgical procedure may be oncologically correct; therefore the authors believe that total thyroidectomy may be the treatment of choice of occult carcinoma, because it allows a correct oncological follow-up.
Traumatic injuries of left and right hepatic ducts are rare, with about 40 cases reported in literature. Preoperative diagnosis is difficult, so that up to 40% of lesions may be undetected at laparotomy. Prompt diagnosis could preserve by high morbidity rate of such injuries. The extremely widespread and routine use of ERCP as well as intraoperative cholangiography may allow reducing dramatically the diagnostic time lag and the percentage of lesions formerly undetected by laparotomy. Therapeutic options are extremely variable. On the basis of the experiences reported for the treatment of iatrogenic lesions of the biliary tract, reconstruction by jejunal Roux-en-Y loop biliodigestive anastomosis is preferred, whenever lacerations of an hepatic duct appear to be complete or nearly so, on account of the high incidence of stenosis and late complications, detected in case of termino-terminal direct biliary anastomosis. However, in selected cases, when the transection appear neat and simple, an end-to-end anastomosis could be performed with low risk. Mortality after blunt biliary duct injury represents nowadays a rare event at least in patients presenting without severe associated traumatic lesions, so that the clinical attention has been progressively focused on the relatively high rate of postoperative complications. These adverse events are often extremely demanding in terms of prolongation of hospital stay, need for multiple invasive procedures and overall costs of patient's management.
The surgery of the thyroid pathologies in Day and/or One-Day-Surgery requires a thorough choice former of the surgery of the patients and the availability of the team specialist that could guarantee an adequate nursing after surgery. The authors describe the advantages and the limits of the short confined to stay in hospital for the surgery of the thyroid pathologies. The selection criteria for patients undergoing thyroidectomy in One-Day-Surgery have been: euthyroid patients with benign pathologies concentrate only thyroid lobe and lack of associated pathologies as cardiopathy, broncopathy, nephropathy, hepatopaty, diabetes, etc. Were executed in general anaesthesia forty lobectomies for uninodular thyroid disease and three enucleoresections for a nodule of pyramidal lobe, and only two cases the histological definitive diagnosis of carcinoma has caused a second hospital stay. In all forty-three cases was used a drainage, removed after 24 hours.
Breast cancer represents 40% of all carcinomas and is responsible for the 20% of deads due to a cancer in female population. Patients in more of 50% age over 65 years. 150 patients with breast cancer older then 65 years underwent surgery. T1 and T2 < 2 cm patients were treated with quadrantectomy and radiotherapy. T2 > 2 cm and T3 patients underwent radical mastectomy. T4 patients were treated with neoadjuvant chemotherapy before surgery. Mean follow up was 48 (range 12-78) months. 43 patients (28.6%) had a progression of the neoplasia. Five years mortality rate was 18.6%. Surgery nowadays represents the treatment of choice for breast cancer even in elderly woman. Associated diseases in these patients shouldn't always considered an absolute contraindication for surgery.
BACKGROUND: This retrospective study was undertaken to evaluate if a high resectability rate could improve the long-term outcome of patients with proximal bile duct cancer. METHODS: Between 1985 and 2001, 50 patients (34 males and 16 females) with proximal bile duct cancer were treated. The tumor site were classified according to Bismuth-Corlette's classification: 9 lesions (18%) were Bismuth type I, 23 lesions (46%) type II, 12 lesions (24%) Type IIIa, 5 lesions (10%) type IIIb and only 1 resected tumor (2%) was type IV. Thirty-six patients (72%) were considered suitable for surgery, while 14 underwent non surgical palliative procedures. Twenty patients had bile duct resection only. Ten patients had Roux-enY cholangiojejunostomy with two or three divided segmental hepatic ducts; in ten, the cholangiojejunostomy was performed with 4 or 5 divided segmental hepatic ducts. Thirteen patients had bile duct resection plus hepatectomy. Despite the curative intention of the operation, only in 19 (52.7%) patients did the histopathological examination reveal tumor-free margins. RESULTS: There was no operative mortality. Overall 1-year, 3-year and 5-year survival of the entire surgical group was 61%, 22.5% and 9% respectively. In the 19 patients treated with curative intent the survival at 1,3, and 5 years was 66%, 30% and 15%, respectively, while in the palliative group it was 45%, 15% and 0%, respectively. CONCLUSION: Only margins free from tumor may guarantee an improvement in long-term outcome. Increasing resectability improves survival and could offer a chance of better 5-year survival.
The incidence and mortality of breast cancer increase with increasing age, and almost half of all breast cancer cases are diagnosed in women aged 65 years and older. Moreover many studies have indicated that the elderly are less screened, and have lesser and frequently inferior treatment. In contrast, clinical trials focusing on the elderly suggest that they do as well with surgery, radiation, and standard chemotherapy regimens as their younger counterparts. Our study suggest that in women aged 65 years, and older, breast cancer can be detected at an earlier stage by mammographic screening.
Bilateral breast cancer has a cumulative incidence of 3-13% in patients with primary breast cancer, and the majority of these lesions are metachronous. The synchronous and metachronous bilateral breast cancer have at greater risk for distant metastasis than unilateral breast cancer. There was no difference in overall survival when comparing metachronous and synchronous bilateral patients to those with unilateral disease.
Anaplastic thyroid carcinoma is a rare and highly lethal cancer. Between 1969 and 2002, 9 cases with anaplastic carcinoma were reviewed. Surgical treatment with radiotherapy and chemotherapy were performed in all cases. All patients died of their disease within 5 years. The mean survival was 10 months. There is still controversy as to what constitutes adequate treatment for anaplastic thyroid carcinoma, and combined multimodal therapy seems to be the most common management strategy for this aggressive disease.
INTRODUCTION: The chronic use of immunosuppressive therapy in transplant recipients to prevent acute rejection increases the long-term risk of cancer. The overall incidence of de novo malignancies (DNM) after kidney transplantation ranges from 6% to 11%. PATIENTS AND METHODS: Between January 2000 and December 2002, 135 renal and 3 combined kidney-pancreas transplantations were performed. RESULTS: Of 138 solid organ transplant recipients, a total of 16 (11.6%) cancers were diagnosed in 10 renal transplant recipients (7.2%). Six patients were male and three female, with a mean age of 47 years (range, 19-63, years). Tumor presented at a mean time of 14 months (range, 2-24, months) after transplantation. There were three patients with skin cancers, three with Kaposis's sarcoma, one with renal cell cancer, one with bladder carcinoma and one with breast cancer. CONCLUSIONS: Although the DNM occurs more frequently many years after a kidney transplantation, our experience demonstrated that they can occur early in the follow-up. Skin malignancies had the best prognosis, probably because of early detection and treatment. Kaposi's sarcoma benefits from reduction or cessation of immuno-suppression, but there is a higher risk of graft loss. Solid organ de novo malignancies are often more aggressive than in normal population, and the life expectancy of these recipients is very low. Careful long-term screening protocols are needed for detection of such malignancies in an early stage.
INTRODUCTION: Acute gastrointestinal bleeding is rare in Crohn's disease. METHODS: We characterized the clinical features and course of such hemorrhage in patients seen at our institution from 1992 to 2000. RESULTS: Five patients had gastrointestinal bleeding during Crohn's disease. All patients had a known Crohn's disease, with a mean duration of the disease of 6 years. The source of bleeding was identified in four patients (80%). Endoscopy was, in all patients, the first diagnostic procedure. An Hartmann total colectomy with closure of the rectal stump and ileostomy was performed in three patients, while two patients with ileal massive bleeding were treated conservatively. One patient had a recurrence of bleeding from the small bowel one week later but he didn't required surgical treatment. One patient with pancolic Crohn's disease died on 10th postoperative day because of multiorgan failure and septic complications. CONCLUSIONS: Gastrointestinal bleeding is rare in Crohn's disease, with a predilection for site of involvement. The preoperative diagnosis of the site of bleeding is not easy, and enteroscopy should be mandatory in such patients. Surgery is required for half of cases and recurrent haemorrhage should be an appropriate indication for surgery.