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Biomedical subjects

P Magistrelli

Publications and source records attributed to P Magistrelli.

At least 55 records · Page 3Linked to original sources
PubMedDate not supplied

Sutureless cholecystojejunostomy in pigs using an absorbable intraluminal stent and fibrin glue.

The absence of foreign bodies in sutureless anastomoses provides faster healing. The first sutureless cholecystojejunostomies were reported by Murphy in 1892. The common bile duct was tied and 11 cholecystojejunostomies plus 12 jejunojejunostomies were performed in 12 Landrace pigs employing sliding absorbable intraluminal nontoxic stents (SAINTs) and fibrin glue. One cholecystojejunostomy was not performed owing to a gallbladder morphologic anomaly. Three animals died of problems unrelated to the SAINT-glue anastomoses. Of the 18 anastomoses in the 9 remaining animals, all were patent at the verification times of 14, 30, 120, and 480 days. Morphologically,there was greater edema and reduced height of the glandular epithelium in the 30-day CJs when compared to the jejunojejunal anastomoses. Results indicate that the sutureless SAINT-fibrin glue procedure is quite versatile and may be utilized for cholecystoenteric anastomoses.

Anastomosis, Surgical↗
PubMedDate not supplied

[Surgical resection of pancreatic cancer].

AIMS AND BACKGROUND: Surgical resection offers the only potential cure for pancreatic carcinoma. Although the overall prognosis remains a dismal, several recent series have reported an encouraging increase in 5-year survival after resection, exceeding 20%. As the reasons for this improvement are not clearly understood, numerous clinico-pathological parameters (demographic, intraoperative and histopathologic factors) have been investigated to evaluate their role in predicting long term survival. In this single-institution study, immediate and long-term outcome after pancreatic resection in patients with pancreatic adenocarcinoma was retrospectively evaluated, focusing attention on the possible impact of different clinico-pathologic factors on long-term survival. METHODS: Sixty-six patients with a confirmed histologic diagnosis of adenocarcinoma of the pancreas, treated by pancreatic resection at the Department of Surgery of the Catholic University of Rome in the years 1988-1997, were retrospectively analyzed. Morbidity and survival data were reviewed and potential prognostic factors were compared statistically by univariate analysis. RESULTS: There was no postoperative mortality. Twenty-five patients (38%) developed major operative complications. Pancreatic fistula was the most common complication, and occurred in 7 patients (11%). The actuarial overall and disease-specific survival for all 66 patients were respectively 58% and 59% at 1 year, 27% and 31% at 3 years, and 13% and 20% at 5 years, with a median survival time of 13.4 months. Nodal status was the only single factor significantly affecting survival by univariate analysis. The 3-and 5-year survival rates were respectively 35% and 19% for node-negative patients and 7% and 0% for node-positive patients (P = .04). A positive correlation with improved survival, even if not of statistical significance, was shown for other pathologic or intraoperative factors. Among the former, 5-year survival rates were better for patients with negative resection margins as compared to patients with positive margins (12% vs 7%, P = ns). Among the latter, a better actuarial 5-year survival rate was shown for patients with shorter operative time (< 4 hours, 21% survival vs > 4 hours 5%, P = ns) and for patients that received fewer transfusions (0-2 blood units, 14% survival vs 3 or more blood units, 0%; P = ns). Age, gender, tumor diameter and tumor grading showed no influence on survival in this series. CONCLUSIONS: Our series confirmed that nodal status is the strongest independent predictor of survival. Limited intraoperative transfusion, reduced operative time and clear margins could also yeald a prognostic significance, and require further confirmation in larger series.

Adult↗
PubMedDate not supplied

Ampullary carcinoma: prognostic significance of ploidy, cell-cycle analysis and proliferating cell nuclear antigen (PCNA).

BACKGROUND/AIMS: The aim of the present study is to assess the nuclear DNA ploidy patterns, the fraction of cells in the various phases of the cell cycle as determined by flow cytometry and to evaluate Proliferative cell-nuclear antigen (PCNA) expression in order to examine the relationships between phase-two molecular factors, clinicopathological aspects and outcome of patients with cancers of the ampulla of Vater. METHODOLOGY: Paraffin-embedded specimens from 18 cases of cancers of ampulla of Vater radically resected between 1985 and 1995 were analyzed by flow-cytometry and immunohistochemical staining with monoclonal antibody to the PCNA. The relationships between cell-proliferation kinetics, PCNA-positive cancer cells, clinicopathological findings and the clinical course were evaluated. RESULTS: Pathologist reports documented 17 papillary adenocarcinomas and one case of mucinous carcinoma. According to the TNM classification, 4 patients were in stage I, 7 in stage II and 7 in stage III. Locally advanced ampullary tumors (T3-T4) had a significantly worse prognosis (p = 0.01); survival at 3 and 5 years for stage I-II patients (11 cases) was 90% and 79% as compared to 42% and 42% for patients with stage III (8 cases), respectively (p = n.s.). Thirteen cancers (72%) were diploid and 5 (28%) aneuploid. Patients with aneuploid tumors were younger (mean age: 59 years) than patients with diploid tumors (mean age: 66 years; p = 0.04). No significant correlation was found between size of the tumor (T), lymphnodal status (N), grading (G) or aneuploidy. Difference in terms of survival between aneuploid and diploid patients was relevant (16 vs. 121 months) but, due to the small number of cases, was not statistically significant (p = n.s). The mean value of S-phase fraction (SPF) was 14.8%. PCNA positive rate significantly correlates with size of the tumor (T1-T2 vs. T3-T4; p = 0.03). Actuarial overall survival resulted in 70%, 63% and 31% at 1, 5 and 10 years, respectively. The high rate of diploidy (72%) supports the relative benign behavior of ampullary cancers. CONCLUSIONS: PCNA positive rate significantly correlates with size of the disease. Aneuploidy, although without significant prognostic value, correlates well with survival. Because of the wide range of all variables, more data are needed to establish the relationships between pathological factors, DNA ploidy and PCNA rate and their significance as molecular predictors of prognosis in ampulla of Vater cancers.

Adult↗
PubMedDate not supplied

The use of prosthesis in abdominal and thoracic wall defect, 15 year experience: evaluation of tissue reactions and complications.

Synthetic prosthesis (Polypropylene, Dacron and expanded Polyterafluoroethylene) is now widely used in abdominal and thoracic wall reconstructive surgery. Many surgeons have reported great success with various types of prosthetic implants but tissue reactions and other complications have never been well defined. The aim of this study was to determine which molecules react upon tissue contact, which synthetic materials result in less complications and whether some non-specialized prosthetics are correlated with certain types of complications. We studied 54 patients from 1982-1997 who had each been re-operated on for prosthetic complications. Our clinical data was then compared to data collected from animal models. Twenty-one pigs received one or more prosthetic implants: 14 of these pigs received their implants with a "proper surgical technique" while 8 underwent "improper surgical technique". The results from both the clinical and animal study were significantly similar. From a microscopic point of view, we can conclude that different tissues react in the same way with the same or similar types of prostheses. The reactions begin to differ when the thickness and rigidity of the material is considered. A PTFE-polyporpylene combination (Composix Mesh) seems to be the most effective solution, especially in abdominal defect repair which involves peritoneal organ contact. We would also like to emphasize that prosthetic complications can be quite serious and this type of procedure should only be performed by experienced and qualified surgeons.

Abdominal Muscles↗
PubMedDate not supplied

[Radiofrequency thermal ablation of hepatic nodules: selection criteria for percutaneous treatment].

Radiofrequency thermal ablation (RFA) of liver tumor is done by percutaneous, laparoscopic and open surgical approach. Selection criteria for percutaneous or open surgical ablation of 54 hepatic lesions are here evaluated in 30 consecutive patients. Open surgical approach was performed in 9 cases only, 5 of them due to concomitant treatment of associated diseases. Number and size of the lesions did not interfere with surgical approach. Postoperative CT control showed no differences in terms of complete ablation of the tumor in between the two groups of patients. Percutaneous approach of RFA is gone to be in the future the modality of choice in these patients.

Catheter Ablation↗
PubMedDate not supplied

[Thermal ablation by radiofrequency of hepatic metastasis of colorectal cancer: short-term results].

Radiofrequency (RF) was used to ablate 42 colorectal liver metastases in 20 patients (10 males and 10 females) in a four years period. Median age was 62.2 years, 36 lesions (75%) had 3 cm diameter or less. An open surgical approach was adopted in 13 patients, whereas a percutaneous one in 14. On 27 surgical sessions, RFA was used in 49 procedures for a total of 81 needle applications. Morbidity was 6.0% (3 cases), one patient died on third po day for myocardial infarction. No differences in terms of complete ablation rate was observed in the two approach's groups. Overall survival was 65% with a median follow-up of 18.5 months.

Aged↗
PubMedDate not supplied

[Prognostic factors of pancreatic carcinoma: analysis of the 5-year-survivor cases].

Pancreatic carcinoma remains a letal disease with an overall 5-year survival of less than 5%. Recent reports of increases in actuarial survival after resection have determined some optimism. Our objective was to identify the actual 5-year survival rate of patients with pancreatic carcinoma who underwent a resection with curative intent, analyzing those factors associated with a more favorable prognosis.

Adenocarcinoma↗
PubMedDate not supplied

[The prognostic role of anatomo-pathological factors in colorectal cancer: an univariate analysis].

An univariate analysis of pathologic data of 987 patients with primary colorectal carcinoma treated over a period of 22 years was performed. Six variables such as tumor site, histologic type, depth of invasion, nodal involvement, distant metastases, histologic grade and tumor stage were tested for their prognostic value. 5-year survival rate was investigated. Patients with tumors in the left colon and rectum have shown a better prognosis than patients with tumors in the right colon (53-51% vs. 38% p = 0.0007). As regard histologic type non significant differences between mucinous and non-mucinous carcinoma was observed (44% vs 48% respectively p = 0.4). The depth of tumor invasion was an important prognostic factor; according to tumor infiltration patients can be divided in four groups (T1, T2, T3, T4) with 5-year survival rates of 80%, 74%, 39% and 16% respectively (p = 0.0000). Highly significant decrements in survival occurred when lymph node metastases were demonstrable (20% vs. 67% p = 0.0000). Prognosis was still strongly related to histologic grade, with significant difference in survival rates between G1 and G2-G3 tumors (71% vs. 48%-42% p = 0.0000). Finally prognosis was closely related to the stage of spread at the time of diagnosis.

Adenocarcinoma↗
PubMedDate not supplied

[Hartmann's procedure in emergency surgery of the colorectum].

The authors report their experience with Hartmann procedure. 28 patients were treated: 21 males and 7 females. The mean age was 58 years. Perforative diverticulitis was the commonest indication (14 patients), followed by carcinoma (11 patients). Miscellaneous causes accounted for 3 patients. This procedure was primarily performed as an emergency operation (71%). One patient died post-operatively (3.5%); post-operative morbidity was 10.7%. A second operation was not planned if the first operation had been performed for palliation of metastatic or locally advanced cancer (7 patients). Restoration of colonic continuity was achieved successfully in 14 patients with no mortality and morbidity. According to their experience, authors believe Hartmann procedure to be the most suitable operation facing a left colon emergency. It is usually easy to perform and well tolerated by poor risk patients.

Anastomosis, Surgical↗
PubMedDate not supplied

Cell-mediated immune response in human hepatic echinococcosis. Analysis of antigen-induced lymphoproliferation and NK activity.

In vitro cellular immune responsiveness was studied in 25 patients undergoing surgery for hepatic hydatid disease and in 22 matched healthy controls. Proliferation of peripheral blood mononuclear cells (PBMC) induced by phytohaemagglutinin (PHA) was not statistically different in the two groups, while proliferation induced by antigenic preparations obtained from the human commensal microorganism Candida albicans was depressed in patients as compared to healthy subjects. Confirming previous data, antigen specific proliferative response to hydatid cyst fluids was greatly enhanced in patients as compared to controls (P less than 0.01). On the other hand, natural killer (NK) activity was significantly reduced (P less than 0.005). Both impairment of NK activity and lymphoproliferation induced by commensal microorganisms suggest that patients following the parasitic infection present a condition of relevant hyporesponsiveness in cell-mediated defence.

Adolescent↗
PubMedDate not supplied

Combined modality therapy in low risk (T2N0) rectal cancer.

The authors' experience with local excision (LE) and adjuvant radiotherapy in the treatment of selected cases of rectal cancer, is reported. 41 patients with distal rectal cancer underwent elective LE for cure. Selection criteria were: the site of tumor in the lower rectum, exophytic growth, maximum diameter equal to or lower than 4 cm, tumor "freely" mobile on the rectal wall, clinical staging T1-2 N0M0, histological grading G1-2. Patients shown to be T2 on definitive histology underwent adjuvant radiotherapy to the site of tumor and to pelvic lymph nodes. LE was performed via transanal route under general anesthesia. Operative mortality was 0% and morbidity 7.3%. In 37 cases (90%) surgery was considered radical and curative. The incidence of local recurrence was 5.4%, overall evidence of disease 8.1%, cancer-specific mortality 5.4% and 5-year actuarial survival 90%. The combination with radiotherapy has achieved similar results in T1 (22 cases) and T2 (15 cases) tumors. It is concluded that LE combined with radiotherapy in T2 tumors in selected cases represent a valid therapeutic alternative to more demolitive surgery.

Adenocarcinoma↗
PubMedDate not supplied

Combined modality therapy of resectable high risk rectal cancer.

Aim of this phase I-II study was to evaluate the efficacy of preoperative concomitant radiochemotherapy in resectable high risk (TNM stage: II and III) rectal tumors, 64 patients entered the study: 37 had low rectal cancer, 27 mid-rectal cancer. 50 patients were clinically staged as stage III (Dukes C) and 14 as stage II (Dukes B). Treatment protocol included bolus mitomycin C at the dose of 10 mg/m2 on day 1 and 5FU continuous infusion at the daily dose of 1000 mg/m2 on day 1, 2, 3, 4. Concomitant external radiotherapy up to a dose of 3780 cGy was delivered at the daily dose of 180 cGy. Surgery was performed 4 to 5 weeks after radiation therapy (RT). Before surgery all patients were clinically restaged to evaluate the response to concomitant radiochemotherapy. Treatment compliance was 97%. Toxicity was 27% prevalently shown as bone marrow depletion and radiodermatitis. In 37 patients (61%) there was 50% reduction (partial response) of neoplastic volume. In 5 patients (8%) no neoplastic cells were evidenced in the surgical specimen on histology (complete response). The distance between the lower margin of the tumor and the internal anal orifice increased in 72% of cases. Postoperative morbidity was 28%. The incidence of anastomotic dehiscences was 8.7% over 46 anterior resections. Postoperative mortality was nil. Definitive staging evidenced 24 patients (39%) stage I or with no evidence of tumor. The incidence of local recurrence was 5% and that of distant metastasis 8%.

Antibiotics, Antineoplastic↗