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Biomedical subjects

R Bardini

Publications and source records attributed to R Bardini.

At least 37 records · Page 2Linked to original sources
PubMed1991

Surgical treatment of carcinoma of the gastric cardia.

The ideal surgical treatment for adenocarcinoma of the gastric cardia is still controversial. In 189 consecutive patients who underwent resection, 127 esophagogastric resections and 62 total gastrectomies plus esophageal resection were performed. Short- and long-term results of the two surgical procedures were compared in order to define the specific indications for each. Abdominal nodes were metastatic in 73.5% of the cases, and mediastinal nodes in 29.1% of the patients who were also approached through the thorax. Neoplastic permeation of the esophageal resection margin occurred in 3.2% of the patients. No positive resection margins were found in the cases in whom 10 or more cm. of uninvolved esophagus were resected. The superiority of the laparotomy and right thoracotomy approach was thus evident in terms of oncologic radicality. Anastomotic leakage occurred in 8.7% of esophagogastric resection, and in 6.5% of total gastrectomy plus esophageal resection, patients. No correlation between the stage of the tumor or the neoplastic permeation of the section margin and the incidence of anastomotic leakage was found. Operative mortality was 3.9% after esophagogastric resection, and 6.5% after total gastrectomy plus esophageal resection; this may suggest that esophagogastric resection is the procedure of choice in poor risk and elderly patients. After curative resection, locoregional or systemic neoplastic recurrence was observed in 15.0% of the cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1991

[Cancer of the hypopharynx and cervical esophagus].

Between 1975 and 1988 we observed 169 patients with carcinoma of the cervical esophagus, 85 with a carcinoma involving the hypopharynx and the cervical esophagus, and 27 patients with a carcinoma of the cervical esophageal region arising after laryngectomy for laryngeal cancer. The mean age was 57.5 years (range 41-73). 167 patients underwent surgical exploration (operability rate 59.5%) and in 152 cases the tumor was resected (resectability rate 91.1%). The resection was complete in 129 patients (84.5%) and palliative in 23 (14.5%). In 33 cases a segmental laryngo-pharyngo-cervical esophagectomy with free intestinal loop transplantation was performed with an operative mortality of 6.1%. 101 patients underwent total laryngo-pharyngo esophagectomy and the gastrointestinal tract was reconstructed by means of pharyngo-gastrostomy and pharyngo-colostomy in 85 and 16 cases, with an operative mortality of 12.9% and 18.3%, respectively. Total esophagectomy without laryngectomy was performed in 18 patients with a carcinoma of the distal cervical esophagus refusing laryngectomy with a hospital mortality of 5.5%. The overall 5-year actuarial survival, excluding the operative mortality, was 15.8%. After complete resection, better results were recorded with patients operated for carcinoma of the hypopharynx than with patients with carcinoma of the cervical esophagus: the 2-year and 5-year actuarial survival was 59% vs 26% and 43% vs 17%, respectively. No patient undergoing palliative resection was alive at the 3-year interval.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Surgical management of carcinoma of the hypopharynx and cervical esophagus.

Between 1975 and 1988 we observed 169 patients with carcinoma of the cervical esophagus, 85 with a carcinoma involving the hypopharynx and the cervical esophagus, and 27 with a carcinoma of the cervical esophageal region that developed after laryngectomy for laryngeal cancer. The mean age of the patients was 57.5 years (range: 41-73). One hundred and sixty-seven patients underwent surgical exploration (operability rate 59.5%), and in 152 cases the tumor was resected (resectability rate 91.1%). The resection was complete in 129 patients (84.5%) and palliative in 23 (14.5%). In 33 cases a laryngopharyngo-cervical segmental esophagectomy with free intestinal loop transplantation was performed, with an operative mortality of 6.1%. One hundred and three patients underwent laryngo-pharyngo-total esophagectomy, and the digestive tract was reconstructed by means of pharyngo-gastrostomy and pharyngo-colostomy in 85 and 16 cases, with an operative mortality of 12.9% and 18.3%, respectively. Total esophagectomy without laryngectomy was performed in 18 patients with a carcinoma of the distal cervical esophagus who refused laryngectomy, with an hospital mortality of 5.5%. The overall 5-year actuarial survival, excluding the operative mortality, was 15.8%. After complete resection, better results were recorded in patients operated on for carcinoma of the hypopharynx than in patients with carcinoma of the cervical esophagus: the 2-year and 5-year actuarial survival was 59% vs. 26% and 43% vs. 17%, respectively. No patient undergoing palliative resection was alive at the 3-year interval.(ABSTRACT TRUNCATED AT 250 WORDS)

Colon↗
PubMed1990

[Surgical treatment of carcinoma of the hypopharynx and cervical esophagus].

Between 1975 and 1988 we observed 169 patients with carcinoma of the cervical esophagus, 85 a carcinoma involving the hypopharynx and the cervical esophagus, and 27 patients with a carcinoma of the cervical esophageal region arose after laryngectomy for laryngeal cancer. The mean age was 57.5 years (range 41-73). 167 patients underwent surgical exploration (operability rate 59.5%) and in 152 cases the tumor was resected (resectability rate 91.1%). The resection was complete in 129 patients (84.9%) and palliative in 23 (14.1%). In 33 cases of laryngo-pharyngo-cervical segmentary esophagectomy with free intestinal loop transplantation was performed with an operative mortality of 6.1%. 101 patients underwent laryngo-pharyngo-total esophagectomy and the digestive tract was reconstructed by means of pharyngo-gastrostomy and pharyngo-colostomy in 85 and 16 cases, with an operative mortality of 12.9% and 18.3%, respectively. Total esophagectomy without laryngectomy was performed in 18 patients with a carcinoma of the distal cervical esophagus refusing laryngectomy with an hospital mortality of 5.5%. The overall 5-year actuarial survival, excluding the operative mortality, was 15.8%. After complete resection, better results were recorded with patients operated for carcinoma of the hypopharynx than with patients with carcinoma of the cervical esophagus: the 2-year and 5-year actuarial survival was 59% vs 26% and 43% vs 17%, respectively. No patient undergoing palliative resection was alive at the 3-year interval.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Cancer of the hypopharynx and cervical esophagus. Role and limits of the surgical treatment].

From 1975 to 1988, we observed 169 patients with a carcinoma of the cervical esophagus, 85 with a carcinoma involving the hypopharynx and the cervical esophagus, and 27 with a carcinoma of the cervical esophagus occurring after laryngectomy for laryngeal carcinoma. The average age was 57.5 years (41-73). Exploration was surgical for 167 patients (operability ratio 59.5%), and the lesion was resected in 152 cases (resectability ratio 81.1%). Resection was complete in 129 patients (84.5%) and palliative in 23 (14.5%). A laryngopharyngoesophagectomy involving the cervical esophagus and requiring the transplantation of a free intestinal loop was performed in 33 cases, with an operative mortality rate of 6.1%. Pharyngolaryngectomy with total esophagectomy was performed in 101 patients, and the digestive tract was reconstructed by means of pharyngogastrostomy or pharyngocolostomy (respectively 85 and 16 cases) with an operative mortality rate of 12.9% and 18.3%, respectively. Complete esophagectomy without laryngectomy was performed for 18 patients with carcinoma of the distal cervical esophagus who refused laryngectomy, the hospital mortality rate being of 5.5%. The actuarial survival rate after 5 years (not including operative mortality) was 15.8%. Better results were achieved after complete resection for carcinoma of the hypopharynx than for carcinoma of the cerebral esophagus. The actuarial survival rates after 2 and 5 years were 59% vs. 26% and 43% vs. 17% respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1990

[Costs and benefits of mechanical sutures in esophageal surgery].

The cost/benefit ratio of mechanical sutures is a controversial issue. Aim of this work was to compare the cost of esophago-visceral anastomoses performed with staplers versus the cost of conventional anastomoses. Not only the cost of the material, but also the economical impact of the hospital stay and operative complications was evaluated. Results show a statistically significant decrease of morbidity in patients treated with mechanical sutures (3.7% vs 18.8%, p = 0.0001). The overall cost of a single mechanical suture was markedly lower than that of a single manual suture (934.000 vs 2,209.000 Italian lira). We conclude that a significant decrease of hospital cost can be expected using mechanical sutures. It has to be noted, however, that in order to achieve such results, an adequate surgical training with staplers is mandatory.

Anastomosis, Surgical↗
PubMed1990

[Esophagectomy without thoracotomy as a treatment of esophageal cancer. Indications, technical features and results].

Between 1980 and 1989, 229 patients with squamous cell carcinoma of the esophagus underwent esophagectomy without thoracotomy. The tumor was located in cervical and thoracic esophagus in 112 and 117 cases, respectively. Out the patient with a tumor of the thoracic esophagus, the mean age was 63 years (range 32-81). There were 90 males and 27 females. The locations inside the thoracic esophagus were as follows: upper thoracic 39, middle thoracic 40, lower thoracic 38 cases. A complete resection of the tumor was performed in 87 patients and in 30 cases the procedure was palliative. The digestive tract was reconstructed by means of esophago-gastrostomy in 101 patients, esophago-colostomy in 13, esophago-jejunostomy in 2, and pharyngo-colostomy in 1 patient, respectively. The post-operative morbidity was as follows: pulmonary complications 13.6%, anastomotic leak 17.1%, necrosis 5.1%, recurrent laryngeal nerve injuries 10.2%. The overall hospital mortality was 7.6%. Actuarial survival rates after curative and palliative resection were 82.4% and 47.1% at 7 year, 46.3% and 8.1% at 2 years, 39.0% and 0% at 3.5 and 6 years. In our experience, esophagectomy without thoracotomy is an excellent technique, with low morbidity but with oncologic limitations. Patients with carcinomas of the thoracic esophagus in whom thoracotomy is contraindicated can be resected with this technique with morbidity and mortality rates comparable to those of patients undergoing transthoracic esophagectomy.

Actuarial Analysis↗
PubMed1989

Surgical and endoscopic palliation of esophageal carcinoma.

We reviewed the records of 732 patients with advanced esophageal carcinoma to determine the efficacy of palliative therapy. Palliative resection was performed in 156 patients. Hospital mortality was 9.6%, 1-year survival was 29.1%, and median survival was 7.8 months. Excellent or good palliative results were obtained in 78% of operative survivors. Bypass procedures were performed in 49 patients: hospital mortality was 20.4%, with a median survival of 6.2 months. Excellent or good palliative results were obtained in 71% of operative survivors. Intubation of the tumor was performed in 254 patients. Thirty-day mortality was 10.2%, and median survival was 4.0 months. No patient received excellent palliation. Neodymium:yttrium-aluminum-garnet laser therapy or photodynamic therapy was performed in 50 patients. No procedure-related deaths were recorded, and median survival was 4.1 months. Excellent or good results were obtained in 83% of patients. Lesser procedures were performed in 106 patients, and 117 had only staging examinations. Although surgical palliation of esophageal cancer with resection or bypass provides good results, the cost is high. Improvements in palliative results require reduction in operative mortality, increased accuracy of preoperative staging, continuing use of laser therapy, and increased use of chemotherapy alone or in combination with radiotherapy and operation.

Adult↗
PubMed1989

Identification of an attachment site for human liver plasma membranes on hepatitis B virus particles.

The surface antigen of hepatitis B virus (HBsAg) exposes three protein domains: preS1, preS2, and S. In a previous study we have shown that preS1 sequences expressed in transfected yeast cells bind specifically to plasma membranes of human liver. In this study we show that purified virus particles from a virus carrier bind also specifically to such membranes. Subviral HBsAg filaments which are rich in preS1 bind well too, while HBsAg 20-nm particles which contain small amounts of preS1 bind to a much lesser degree. The binding can be inhibited by a monoclonal antibody which recognizes a sequential epitope between amino acids 27 and 49 of the preS1 domain.

Antibodies, Monoclonal↗
PubMed1989

[Early cancer of the esophagus: results in 61 operated cases].

From 1980 to 1987, 1338 patients with esophageal cancer were observed and 703 underwent esophagectomy. Pathologic exam of the operative specimen showed 61 early cancers of the esophagus: 10 mucosal and 51 submucosal. Hospital mortality in patients operated on (2 cases) for early esophageal cancer was 3.3% (2 cases). The 5-year survival rate in the cases of mucosal and submucosal tumors was 100% and 33%, respectively. The location of neoplastic recurrence was detected in 9 patients, all of whom had a submucosal tumor. The recurrence was local-regional in 4 cases, and remote in 5. The authors think that submucosal cancers of the esophagus may need a multimodality therapeutic approach to improve prognosis and prevent recurrence. Patients who are not surgical candidates and in whom the diagnosis of early cancer is likely on the basis of clinical staging may undergo endoscopic laser therapy.

Adult↗
PubMed1988

Esophagovisceral anastomotic leak. A prospective statistical study of predisposing factors.

An esophagovisceral anastomotic leak is a life-threatening postoperative complication, especially in the mediastinum. Of the 242 patients who underwent intrathoracic esophagogastric anastomosis for esophageal carcinoma (182 patients) and adenocarcinoma of the cardia (60 patients) between January 1980 and June 1985, 14 (5.8%) had esophageal anastomotic leakage and two died (0.8%). Various clinical and biologic parameters and aspects of operative technique were studied prospectively and analyzed statistically to identify possible factors responsible for leaks. Both bivariate and multivariate statistical analysis with logistic regression showed that the following clinical and biologic factors do not influence anastomotic leakage: tumor stage, the curative or palliative purpose of resection, neoplastic permeation of anastomotic margins, total protein concentration below 5 gm/dl, albumin concentration below 3 gm/dl, patient's age, diabetes, high blood pressure, cirrhosis of the liver, and cardiac, respiratory, or renal diseases. Technical factors, on the contrary, were statistically significant and of great clinical importance: manual as opposed to mechanical suturing (chi 2 = 8.8, p = 0.013) and single-layer as opposed to double-layer suturing (chi 2 = 9.9, p = 0.043). The level of the anastomosis was found to be a further statistically significant factor: The incidence of leakage was greater when the anastomosis was located between the azygos vein and the lower pulmonary vein (chi 2 = 15.5, p = 0.004) than above the azygos vein or below the lower pulmonary vein.

Adenocarcinoma↗
PubMed1987

[Esophageal lesions caused by oral drugs. Epidemiology, physiopathologic bases, prospectives of prevention].

Esophageal injuries caused by oral medications have recently been recognized as a iatrogenic entity. This pathogenesis is due to the retention in the esophagus of drugs with caustic properties. The main predisposing factor is the practice of taking oral drugs with a small quantity of water of and/or in a recumbent position. Elderly subjects and patients with pre-existing esophageal disorders are at higher risk, so that fluid formulations or different routes of drug administration are strongly recommended. A more widespread education to the correct use of drugs and a better drug formulation are necessary for effective prevention.

Administration, Oral↗
PubMed1987

Adenocarcinoma of the cardia: the choice of surgical treatment.

The ideal surgical treatment for adenocarcinoma of the cardia is still controversial. Out of 168 consecutive patients resected in a 10-year period, 98 underwent esophagogastric resection (EGR) and 70 total gastrectomy with esophageal resection (TGER). Early and long-term results were compared in order to define specific indications for both surgical procedures. Abdominal nodes were metastatic in 62% of the cases; mediastinal nodes were metastatic in 20.3% of 138 thoracotomized patients. Neoplastic permeation of the section margin occurred in 4.7% of the patients. No positive section margins were found in the cases with 10 cm or more of uninvolved esophagus resected. The superiority of the thoracoabdominal approach was therefore evident in terms of oncologic radicality. Anastomotic leakages occurred in 13.3% of EGR and in 7.1% of TGER patients. No correlation between the stage of the tumor or the neoplastic permeation of the section margin and the incidence of leak was found. Operative mortality was 7.1% after EGR and 10% after TGER, which may suggest that EGR is the procedure of choice in poor-risk and elderly patients. Loco-regional or systemic neoplastic recurrence was responsible for long-term mortality in 70% of the cases. Anastomotic recurrence was found in 12.2% of EGR patients and in 1.4% of TGER patients. Overall five-year survival was 19.1%. Mean survival was 29.5 months, 30 after EGR and 27 after TGER (p = NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗