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Biomedical subjects

P Magistrelli

Publications and source records attributed to P Magistrelli.

At least 37 records · Page 2Linked to original sources
PubMed1994

Concomitant preoperative radiochemotherapy in operable locally advanced rectal cancer.

PURPOSE: The aim of this study was to examine the effectiveness of a combination of preoperative radiotherapy and chemotherapy for operable locally advanced rectal cancer (Stages II and III). METHODS: Chemotherapy and radiotherapy are started jointly on day one of the therapy. 5-Fluorouracil is given in a dosage of 1000 mg/m2/day as a continuous 24-hour infusion for 4 days. Mitomycin C is given as a bolus intravenous at a dosage of 10 mg/m2 the first day. The radiation therapy is given to a total dosage of 37.8 Gy. Surgery is generally performed four to five weeks following completion of the radiation therapy. From March 1990 to April 1993, 34 patients with histologically documented adenocarcinoma of the rectum have been treated. Twenty-one lesions were located in the lower third of the rectum. Twenty-nine neoplasms were judged by initial clinical staging as Stage III. RESULTS: Patients compliance to the treatment have been 97 percent. Toxicity of treatment has been low (15 percent). Tumor sizes decreased 50 percent or more in about 80 percent of patients. Distance of the tumor from the anal canal increased in all but seven cases. Twenty-two anterior resections have been performed. The morbidity rate has been 24 percent. No postoperative mortality has been reported. Histologic examination of surgical specimens after integrated treatment showed in 10 cases a tumor confined to the rectal wall (T2), in 3 patients only a residual tumor limited to submucosa (T1), and in 5 (15 percent) patients no evidence of neoplastic cells (T0). CONCLUSIONS: We conclude that preoperative radiochemotherapy was generally well tolerated; in all cases we had a reduction of tumor sizes, surgery presented no technical difficulties, and there was the effect of stage reduction.

Adenocarcinoma↗
PubMed1994

[The diagnosis of primary lesions of the anterior mediastinum].

The treatment of anterior mediastinal tumours is often subordinated to histological diagnosis. Sometimes topographic, radiographic and clinical criteria are sufficient to indicate surgical therapy. From January 1988 to June 1992, 31 patients (40.7%) underwent immediate surgery, while 47 patients (59.3%) underwent fine needle aspiration and Trucut biopsy under ultrasonographic or computed tomographic guidance. Thirteen of these patients had also an anterior mediastinotomy according to McNeill-Chamberlain technique. In 36 patients it was possible to verify accuracy of diagnostic procedures comparing these specimens with surgical histological reports. Only 3 patients had minimal complications. No patients undergone anterior mediastinotomy had morbidity or mortality. Our reports show that transthoracic fine needle aspiration and Trucut biopsy have a diagnostic accuracy of 72% and 83% respectively in identifying malignant from benign lesions. These procedures are not adequate to detail diagnosis for tumours with pleomorphic pathologic characteristics (diagnostic accuracy of 39% and 75% respectively). This disagreement is due to false-positive results (one for fine needle aspiration and four for tru-cut biopsies), this discordance occurred in lymphomas and thymomas groups. Such correct diagnosis is very important either for frequency of these tumours either for different therapeutic approach: chemo-radiotherapy in lymphomas and surgery in thymomas.

Adolescent↗
PubMed1993

Changing attitudes in the palliation of proximal malignant biliary obstruction.

The majority of patients with malignant hilar obstruction have an unresectable tumor. Thus an effective palliation of obstructive jaundice is the main therapeutic goal and can be achieved by either surgical or non-surgical procedures. One hundred twenty-nine consecutive patients with proximal biliary stricture, admitted to our institution, were retrospectively reviewed. Thirty patients underwent surgical bypass, with 30-day mortality and morbidity rates of 10% and 23%, respectively. Median survival time was 41 weeks. Twenty-six patients were treated by percutaneous stenting, with 30-day mortality and morbidity rates of 15% and 19%, respectively. Median survival time was 19 weeks. Endoscopic palliation was performed in 73 patients, with 30-day mortality and morbidity rates of 5% and 18%, respectively. Median survival time was 27 weeks. Although the differences among the three groups of patients were not statistically significant, a lower morbidity rate in patients treated by endoscopic stenting was shown.

Adenoma, Bile Duct↗
PubMed1992

Conservative surgery for early cancer of the distal rectum.

From 1967 through 1988, 36 patients underwent local excision of a distal rectal cancer as an initial operative procedure with curative intent. A diagnostic, preoperative protocol was performed to assess the histologic grade of the tumor, the depth of penetration in the rectal wall, and the presence of positive lymph nodes or distant metastases. All patients had a transanal local excision performed under general anesthesia. If preoperative criteria were not confirmed by histopathologic specimen examination, a major operation was advised. To increase the chance of local control, external adjuvant radiotherapy was used in T2 cancers. Postoperative mortality was 0 percent. The postoperative complication rate was 9.3 percent. The observed local recurrence rate was 3 percent, and the rectal cancer-specific death rate was 6 percent. We compared these results with those obtained in 70 concomitant patients operated on by us employing a traditional resection for Dukes' A rectal cancer. There are no statistically significant differences between groups. In light of our findings, a policy of curative local excision is justified in accurately selected cases of distal rectal cancer.

Adenocarcinoma↗
PubMed1991

Surgical treatment of hydatid disease of the liver. A 20-year experience.

The medical records of 135 consecutive patients (74 women and 61 men) who underwent surgery for hydatid liver disease were reviewed. The patients ranged in age from 4 to 81 years. Twenty-seven patients had undergone previous surgery for hydatid liver disease. Cysts were solitary in 100 patients and multiple in 35 patients. Seventeen patients had concomitant extrahepatic disease. Conservative procedures were used in 71 patients (capitonnage in 50 patients and partial pericystectomy in 21 patients). Radical procedures were used in 64 patients (total pericystectomy in 35 patients, subtotal pericystectomy in 16 patients, and wedge or major liver resection in 13 patients). Operative mortality was 2.2% and morbidity rate was 23.7%. Recurrent disease was found in 13 patients at a mean interval of 3 years from the first operation. Better short- and long-term results were obtained with the use of radical procedures.

Adolescent↗
PubMed1991

Surgical approach and sandwich radiotherapy for resectable rectal cancer: advantages and problems.

One hundred and twelve patients with locally advanced adenocarcinoma of the rectum have been treated with a protocol of adjuvant radiotherapy from 1981 to 1989. Radiotherapy was administered with a "sandwich" method at a dosage of 2700 cGy preoperatively and of 1800 cGy post-operatively. Only patients in stages B and C have been considered for results. Postoperative morbidity has been 16% and postoperative mortality 2.7%. Local failure was seen in 20% of patients without significant differences by stage, location, grading and operative technique. Distant metastases were seen in 31% of patients. Five-year actuarial survival was 49% and respectively 58% in stage B and 38% in stage C (P less than 0.01). Compared with a series of historical controls treated with surgery alone, the local recurrence rate was 20% vs. 26%, the distant metastases rate was 31% vs. 38% and the five-year actuarial survival rate was 49% vs. 36% (P greater than 0.01).

Actuarial Analysis↗
PubMed1989

Value of ERCP in the diagnosis and management of pre- and postoperative biliary complications in hydatid disease of the liver.

Twenty-nine patients with symptomatic hydatid disease of the liver were evaluated preoperatively by endoscopic retrograde cholangiopancreatography (ERCP) in the years 1982-1987. In the same period, 6 patients who previously underwent surgery for the parasitic disease also underwent ERCP because of postoperative symptoms of biliary obstruction. Findings at ERCP excluded biliary tract involvement in 11 cases. Positive findings were shown in 24 patients, including compression of the bile ducts in 4, small cysto-biliary communications in 5, intrabiliary rupture in 9, residual hydatid material in the common bile duct, and sclerosing cholangitis in 3. Endoscopic removal of migrated hydatid debris was achieved in 8 patients, avoiding reoperation in 4.

Adult↗
PubMed1989

[Medical therapy with mebendazole in hydatid cyst disease. A follow-up of 40 cases].

Mebendazole (50-60 mg/kg/day in 7-8 divided doses after fatty rich meals for at least 6 months) was given to 44 patients with cystic hydatid disease of the liver and other organs, about 1/3 having suffered from recurrences, even multiple, before beginning the pharmacological treatment. Fifteen patients underwent operation after a course of mebendazole, and macroscopic and histological degeneration of hydatid cysts was always documented; sixteen subjects were not operated due to their severe general and/or local conditions but ultrasound, radiologic (CT) and clinical evidence of cyst regression was obtained, and was closely comparable to that in the aforementioned group. Some of the patients (13) began the treatment only after conservative surgery. The mean real follow-up available at the moment is for 40 subjects because 2 patients did not show adequate compliance for the drug and in 2 additional cases it was withdrawn because of an increase in serum transaminases. The rate of recurrence was 7.5% and occurred in high-risk patients (multiple, bone, lung locations) who had, however, an additional and longer course of mebendazole with good results. The detachment of membranes and the increase of internal echoes, observed by means of ultrasonography, which was successfully applied to liver and soft tissue sites as well as the decrease in blood eosinophils when elevated before therapy, were observed to be the most sensitive indicators of early success in the medical treatment for hydatid disease, as far as the viability of parasite cysts was concerned.

Adolescent↗
PubMed1987

[Hemobilia: comparison of diagnostic technics. Considerations on 14 patients].

Fourteen cases of hemobilia of traumatic (six), vascular (six) or neoplastic (two) origin were reviewed. Eleven patients obtained correct diagnosis only be integration of at least two diagnostic procedures out of Ultrasonography, Computed Tomography, arteriography and cholangiography. Although US and CT are extremely useful as screening procedures, correct diagnosis should be only possible by integration of more diagnostic technics. Arterial embolization represents a successful alternative to surgical intervention; moreover US may also be helpful for follow-up of treated patients.

Cholangiography↗
PubMed1987

Juxtapapillary choledochoduodenal fistula. Diagnosis and treatment in 19 cases.

Nineteen patients with distal juxtapapillary choledochoduodenal fistula diagnosed by endoscopic retrograde cholangiopancreatography are reported. Eighty-four percent of the patients had undergone previous operations on the biliary tract. Fistula appears to be mostly secondary to common bile duct exploration with rigid probes or to a technical mistake in performing sphincteroplasty. Spontaneous fistula secondary to the passage of a stone into the duodenal lumen may also occur. Common duct stones were responsible for the symptoms in most cases (70%). Endoscopic sphincterotomy showed good results in cholecystectomized patients with stones. Surgery directed to the fistula or biliary by-pass are not recommended. Uncomplicated fistula probably does not require treatment.

Adult↗
PubMed1983

99mTc-diethyl-IDA: the extraction efficiency of the liver.

The extraction efficiencies of the liver were studied in rabbits by injection in the portal vein of 99mTc-IDA and 131I-Rose Bengal in two experimental conditions. In the first experiment blood samples were collected for one minute from a catheter inserted into the vena cava with the tip at the sovrahepatic veins outflow level. The vena cava was ligated upperstream. In the second experiment blood was collected from the general circulation every other minute for 20' after administration. Control experiments were performed in rabbits by administration of 99mTc-Pertechnetate and 99mTc-Albumin. The results showed that the extraction of diethyl-IDA from the blood flowing through the liver is almost total.

Animals↗
PubMed1983

Post-gravidic Budd-Chiari syndrome treated by mesocaval H-graft shunt.

A new case of Budd-Chiari syndrome following pregnancy is reported. The patient, shortly after her second normal delivery, showed clinical evidence of hepatic venous outflow impairment. The diagnosis of Budd-Chiari syndrome was supported by angiographic studies, computed tomography, liver scanning and histology. Because of the poor results reported in the literature following medical treatment, portosystemic shunting was considered. At laparotomy, due to the huge caudate lobe hypertrophy, a mesocaval H-graft shunt was performed, using a 10 mm woven Impraflex graft. The patient is well, with normal liver function tests, 24 months following the procedure.

Adult↗
PubMed1983

Rupture of multiple hepatic adenoma and oral contraceptive use: a case report.

A 38-year-old woman was seen with a hemoperitoneum caused by rupture of a hepatic adenoma of the right lobe. The patient had been taking oral contraceptives for ten years, but discontinued their use three years previously. During the postoperative course a second adenoma of the contralateral lobe, not diagnosed at the first operation, ruptured. The relationship between oral contraceptive use and hepatic cell adenoma is briefly reviewed.

Adenoma↗
PubMedDate not supplied

Sutureless anastomosis of the small intestine and the colon in pigs using an absorbable intraluminal stent and fibrin glue.

A new sutureless anastomosis technique employing a sliding absorbable intraluminal nontoxic stent (SAINT) and fibrin glue with limited (minutes) stump margin pressure is described. Fifty-one (27 small intestine, 24 colon) SAINT anastomoses were performed in 31 Landrace pigs (25-35 kg). Controls consisted of 48 (26 small intestine, 22 colon) continuous single-layer submucosal anastomoses in 26 pigs. SAINTs, which dissolve in about 30-60 min, were formed from heated sucrose and water poured into handcrafted aluminum molds. Follow-up from 7 to 540 days showed no stenosis or anastomotic imperfections in the latter part of the experiment after the SAINT production and surgical techniques were improved. The SAINT group had fewer site adhesions, faster healing, less foreign body reaction, and fewer lymphocytes than the control group. Initial results indicate that the SAINT-fibrin glue procedure may be an effective sutureless anastomotic method from the duodenum to the sigmoid colon.

Anastomosis, Surgical↗