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R Rosati

Publications and source records attributed to R Rosati.

At least 37 records · Page 2Linked to original sources
PubMed1998

Evaluating results of laparoscopic surgery for esophageal achalasia.

BACKGROUND: Extramucosal myotomy of the lower esophagus and cardia, combined with anterior fundoplication, is, in our opinion, the procedure of choice to treat stage I-III esophageal achalasia. METHODS: After a successful experience with open surgery in over 280 patients, from January 1992 through February 1997, 61 patients underwent laparoscopic Heller-Dor for stage I-III achalasia. Conversion to laparotomy was done in three cases. All procedures were performed under intraoperative endoscopic control. Intraoperative complications were seven mucosal tears, which were sutured laparoscopically in five cases. The sole postoperative complication was bleeding from an acute gastric ulcer (conservative treatment). RESULTS: Follow-up consisted of clinical and radiographic study 1 month after surgery, and endoscopy and manometry within 1 year. After a mean follow-up (F.U.) of 21 months (1-62), clinical results range from excellent to good in 98.2%. One patient (1.7%) complaining of recurrent dysphagia improved after endoscopic dilation. Esophageal diameter reduced from 52 to 27 mm. LES pressure reduced from 30.3 +/- 12.4 to 10.7 +/- 3.5 mmHg (basal) and from 14. 8 +/- 9.3 to 2.9 +/- 2.1 mmHg (residual). CONCLUSIONS: Laparoscopic Heller-Dor operation is feasible, safe, and effective. Special care should be taken in patients with previous endoscopic dilations.

Adolescent↗
PubMed1998

Induction of apoptosis by a short-chain neuropeptide analog in small cell lung cancer.

Small cell lung cancer (SCLC) cells express a variety of neuropeptides which act as autocrine growth factors. Although several neuropeptide analogs have been reported to antagonize SCLC proliferation, the development of these compounds has been limited by their low potency and the cytostatic nature of their effects. In the present study we evaluated the cytotoxic activity of four short-chain substance P analogs (NY3460, NY3238[-pHOPA], NY3238[Phe1], NY3238[Lys5]) against a panel of five SCLC cell lines. NY3460 was the most potent compound in all five SCLC cell lines (IC50 = 2.8-3.7 microM) as assessed by a MTT growth inhibitory assay. NY3238[Phe1] was also relatively active in all cell lines (IC50 = 3.5-11.2 microM), while NY3238[Lys5] and NY3238[-pHOPA] were substantially less active. NY3460 was the only agent to induce an increase in the percentage of cells with subdiploid DNA content suggestive of apoptosis by flow cytometric DNA content analysis. The induction of apoptosis was confirmed by fluorescent microscopy in NCI-H69, NCI-H82, NCI-H446, and NCI-H510 cells after exposure to 5.0 microM NY3460 for 48 h. These findings suggest that NY3460 is a relatively potent cytotoxic inhibitor of SCLC growth, and that short-chain neuropeptide analogs deserve further evaluation as anti-SCLC agents.

Antineoplastic Agents, Hormonal↗
PubMed1998

Diverticulectomy, myotomy, and fundoplication through laparoscopy: a new option to treat epiphrenic esophageal diverticula?

OBJECTIVE: To describe the technique and the results of laparoscopic diverticulectomy combined with esophageal myotomy and antireflux wrap for epiphrenic diverticula of the esophagus. SUMMARY BACKGROUND DATA: The epiphrenic diverticulum of the esophagus is a rare disease probably caused by a longstanding impairment of the esophageal motor activity. Although there is almost universal agreement to operate only on symptomatic patients, the optimal treatment is controversial. The best-accepted guideline is to treat the underlying motor disorder. This is generally done through a left thoracotomic approach that allows diverticulectomy, esophageal myotomy, and partial fundoplication. METHODS: From January 1994 through February 1996, 4 patients underwent laparoscopic transhiatal diverticulectomy, esophageal myotomy, and partial fundoplication at our institution. A thorough preoperative study was done with barium swallow, esophagoscopy, and manometry in all patients; 24-hour pH monitoring was done in one case. RESULTS: No postoperative complications were observed. Short- and medium-term results are satisfactory. CONCLUSIONS: No theoretical objection should be made to this approach, because the principle of treatment of the diverticular pouch and the underlying motor disorder and the prevention of reflux is respected. Longer follow-up and a wider series are mandatory to substantiate these initially favorable results.

Diverticulum, Esophageal↗
PubMed1998

Comparison of laparoscopic rectopexy with open technique in the treatment of complete rectal prolapse: clinical and functional results.

The aim of this retrospective study was to compare the functional and clinical results of laparoscopic rectopexy with those of the open technique in two similar groups of patients with complete rectal prolapse and fecal incontinence. Between November 1992 and June 1997, 21 patients underwent abdominal rectopexy. Thirteen patients (group A: 12 women and 1 man, mean age 52.9 years, range 28-70) and 8 patients (group B: 8 women, mean age 58.2 years, range 20-76) were submitted to Well's rectopexy by the open technique and the laparoscopic approach, respectively, without division of the lateral rectal ligaments. Assignment to each group was done randomly. Before the operation, a detailed clinical history was taken, and patients were studied with inspection and digital examination of the anorectum, proctosigmoidoscopy, determination of pancolonic transit time, dynamic defecography, anorectal manometry, and anal electromyography. After the operation, all patients underwent perineal physiotherapy, external electric stimulation, and perineal biofeedback. The mean follow-up time was 29.5 months (range 6-54) in group A and 25.7 months (range 8-45) in group B. Values were compared by chi-square, Mann-Whitney U, and Wilcoxon tests, as appropriate; differences were considered significant at p < 0.05. In both groups, dyschezia and fecal incontinence improved significantly (p < 0.05) after the operation. Basal pressure of anal sphincter, squeezing pressure, and rectoanal reflex improved without significance, whereas anoperineal pain was not significantly reduced. In group B, the postoperative hospital stay was shorter than in group A, with a marked reduction of costs. Laparoscopic Well's rectopexy has the same clinical and functional results as the open technique, with a shorter postoperative hospital stay and lower costs.

Adult↗
PubMed1997

Aphidicolin-induced FRA3B breakpoints cluster in two distinct regions.

The common fragile site at chromosomal band 3p14.2 (FRA3B) is the most sensitive single site in the human genome to induced chromosomal lesions. This fragile site may predispose chromosome 3p to breakage that is commonly observed in lung, renal, and many other cancers. We previously used aphidicolin induction of FRA3B expression in a chromosome 3-only somatic cell hybrid to generate a series of hybrids with breakpoints in the 3p14.2 region. These breakpoints were localized to two distinct clusters, separated by 200 kb, that lie on either side of a region of frequent breakage within FRA3B as observed by FISH analysis. Seven proximal aphidicolin-induced breakpoints were localized at or near the end of a THE element. The THE-1 element is flanked by LINE and Alu repetitive elements. The eight distal aphidicolin-induced breakpoints clustered in a region capable of forming multiple hairpin-like structures. Thus repetitive elements and hairpin-like structures may be responsible for chromosome fragility in this region.

Aphidicolin↗
PubMed1997

Frequent breakpoints in the region surrounding FRA3B in sporadic renal cell carcinomas.

The constitutive fragile site at chromosomal band 3p14.2, FRA3B, is the most active common fragile site in the human genome. We have localized aphidicolin-induced breakpoints to two distinct clusters, separated by 200 Kb, in FRA3B (Paradee et al., 1996). Sequence analysis of these regions identified two polymorphic microsatellite markers immediately adjacent to each of these breakpoint clusters. In this report we have used these two new microsatellites and 14 additional 3p microsatellites to analyse chromosome 3p breakage and loss in 94 sporadic RCC samples, including nonpapillary, papillary and oncocytomas. We have found heterozygous loss of 3p14 sequences in >60% of the RCC samples, including both clear cell and papillary renal cell carcinomas. We have found frequent breakage in the region immediately surrounding FRA3B, demonstrating that FRA3B does play a role in chromosome breakage and loss in RCC. In contrast to other reports, >50% of the papillary tumors also showed LOH of 3p markers. We also observed microsatellite instability (MIN) with most of the tested markers in seven of eight oncocytomas and one of 69 clear cell carcinomas. The MIN in some oncocytomas was of the RER+ (replication error) type I phenotype. None of the five 3p14.2 markers detected any homozygous deletions in tumor samples, but 69/94 (73%) of the tumors had LOH for the region, which includes the recently identified FHIT gene.

Adult↗
PubMed1997

[Video laparoscopic surgery and rectal prolapse. Our experience in rectopexy].

BACKGROUND: Laparoscopy is gaining an important role in the treatment of benign colorectal disorders. The aim of this study is the evaluation of clinical and functional results in 4 patients submitted to a laparoscopy rectopexy according to Wells. METHODS: Four females (22-76, mean 53.7 years) affected from a total rectal prolapse with fecal incontinence underwent this procedure from 1993 through 1995. Six months after surgery, at the end of a rehabilitation program consisting of kinesitherapy, bio-feedback and electrostimulations, all patients have been re-evaluated by means of a clinical exam, anorectal manometry, defecography. RESULTS AND CONCLUSIONS: Preliminary results seem satisfactory and may allow to prefer this approach instead of the traditional open one.

Adult↗
PubMed1996

Experimental oesophagogastric anastomosis: preliminary report of a new compression device that also fragments.

Fifteen Beagle dogs underwent oesophagogastric anastomosis with a new device which enables a 'sutureless' compression anastomosis. The device fragmented and was passed in bits anally without causing obstruction. Immediate bursting pressure, tested in five dogs, was between 175 and 190 mmHg. The anastomoses of the remaining dogs were examined macroscopically and microscopically from day 6 to day 30. Healing was excellent with good muscular apposition and minimal residual inflammation.

Anastomosis, Surgical↗
PubMed1996

Laparoscopic treatment of paraesophageal and large mixed hiatal hernias.

BACKGROUND: Laparoscopic treatment of large mixed hiatal hernias was attempted in eight patients. METHODS: One patient (12.5%) was converted to open surgery due to difficulty in repositioning the LES into the abdomen resulting from a shortened esophagus. One left pleural tear occurred intraoperatively and was repaired without further consequence. Median duration of the operation was 150 min (range 120-300 min). RESULTS: No postoperative complications were recorded. All patients are asymptomatic after a median follow-up of 14 months (range 7-15 months). Correct repositioning of the stomach was confirmed by radiological evaluation 1 month after surgery. Early functional results are good. (One asymptomatic gastroesophageal reflux was detected and medical treatment was undertaken). CONCLUSIONS: Laparoscopic crural repair and fundoplication are feasible even in paraesophageal and large mixed hiatal hernias. Advantages of the minimally invasive approach are clear in terms of morbidity, patient comfort, and duration of hospital stay. Nevertheless, long-term assessment is required to confirm the effectiveness of the laparoscopic approach in patients with large mixed hiatal hernias.

Esophagus↗
PubMed1996

A special instrument for a safe and effective laparoscopic esophageal myotomy.

The authors describe the use of particular endoscopic scissors that allow a safe and easy laparoscopic performance of Heller myotomy. Although originally designed for another use, these scissors are extremely useful for esophageal myotomy, their most important feature being the smooth and insulated protection of the lower jaw. This feature keeps the mucosa constantly away from the myotomy and allows the safe use of electrocautery, resulting in a perfect hemostasis.

Equipment Design↗
PubMed1995

Laparoscopic approach to esophageal achalasia.

Certain technical details are considered important to ease the laparoscopic performance of a Heller myotomy combined with a Dor antireflux procedure for esophageal achalasia. A special emphasis is given to intraoperative esophagoscopy combined with a mild balloon distension of the esophagogastric junction. These maneuvers prove helpful in identifying the esophagogastric region, easing the myotomy, and controlling its completeness.

Adolescent↗
PubMed1995

Laparoscopic Heller-Dor operation for the treatment of oesophageal achalasia: technique and early results.

From January 1992 to December 1994, a laparoscopic oesophageal myotomy combined with Dor fundoplication was performed in 33 patients with oesophageal achalasia. Intraoperative endoscopic balloon distension of the cardia proved useful to identify the oesophagogastric junction, ease the myotomy, and control its completeness. There was no operative mortality. A mucosal tear not requiring conversion occurred in three patients who had previously undergone pneumatic endoscopic dilations of the cardia. The early clinical and functional results show the effectiveness of the operation.

Adolescent↗
PubMed1995

[Synergism between cyclosporin and gangliosides in anti-rejection therapy. Experimental in vivo model].

In vivo gangliosides (GS) bring about inhibitory effects on the immune response which is attributable to a weakening of the interaction between interleukin-2 (IL-2) and its receptor. In a previous paper we showed that the GS are capable of bringing about in vitro the immunosuppressive power of cyclosporin A CyA2 in this paper we have tried to associate gangliosides (GS) and low dose of CyA in the grafting of rat allogen cutis in order to have in this way in vivo a confirmation of the results previously obtained in vitro. Cutaneous strips taken from Lewis rats were grafted into Sprague Dawley rats and treated for 21 days with intraperitoneal administration of GS, of Cya, and a mixture of the two. The rats were not treated and the rats treated with GS and with CyA separately rejected the graft of the cutis. On the other hand, the use of an association of Gs and CyA brought about a successful graft in 8 rats out of 10. Splenic cells extracted 21 days after the graft from rats treated with GS and with CyA separately were stimulated in vitro with Packweed mitogen (PWM); on the contrary the cells extracted from rats treated with a combination of the two drugs did not react to the stimulation with PWM. Our results show that the GS brings about in vivo the immunosuppressive effects of low doses of CyA.

Animals↗
PubMed1995

Surgical therapy of esophageal leiomyoma.

BACKGROUND: Surgical enucleation is the treatment of choice in selected patients with esophageal leiomyoma. The video-thoracoscopic approach can potentially cause less patient discomfort postoperatively and reduce the hospital stay and recovery period. STUDY DESIGN: A retrospective evaluation of 66 patients who underwent surgical therapy for esophageal leiomyoma over a 27-year period was done. The main symptoms were dysphagia in 35 (53 percent) patients, heartburn or regurgitation, or both, in 11 (17 percent) patients, and retrosternal pain in ten (15 percent) patients. Associated esophageal disorders were found in 19 patients (some patients had more than one disorder): hiatal hernia in 15 (23 percent), epiphrenic diverticulum in four (6 percent), and achalasia in three (5 percent). The operation consisted of leiomyoma enucleation in 63 patients, and esophageal resection in three. In six patients, the enucleation was successfully performed by video-thoracoscopy combined with intraoperative esophagoscopy. The muscle layer of the esophagus was approximated in the majority of the patients after tumor enucleation. RESULTS: There was no operative mortality. The incidence of intraoperative esophageal perforation was greater in patients who had previously undergone endoscopic biopsy (p < 0.01). In one patient, a pseudodiverticulum developed after thoracoscopic enucleation, requiring reoperation with approximation of the muscle layer for relief of dysphagia. The length of hospital stay was shorter in patients undergoing the video-assisted operation (p < 0.05). The median follow-up period was 53 months (range, 12 to 248 months). No recurrence of leiomyoma was observed. Overall, seven (11 percent) patients complained of heartburn or epigastric pain, or both, which was responsive to antisecretory drugs, but only three had such symptoms induced by the operation. In two patients the symptoms appeared after combined treatment of an epiphrenic diverticulum, and in one patient after simple leiomyoma enucleation. CONCLUSIONS: Enucleation of esophageal leiomyoma is a safe and effective operation. The video-thoracoscopic approach combined with intraoperative esophagoscopy allows performance of this procedure with the added advantage of shortening hospital stay. The muscle layer of the esophagus should be approximated to avoid decreasing the propulsive activity of the esophageal body. This may improve the long-term outcome of the operation by preserving the acid-clearing mechanism of the esophagus and reducing the incidence of postoperative reflux esophagitis.

Adult↗
PubMed1995

Transgenic mice with deficiencies in cartilage collagens: possible models for gene therapy.

We address three issues that are important when considering somatic gene therapy approaches to osteoarthritis (OA) and related syndromes. First, only those diseases for which a precise molecular etiology has been established should be contemplated for somatic gene therapy. Second, DNA sequences should be identified that restrict expression of correcting genes to chondrocytes; we discuss the use of transgenic mice to identify such sequences. Third, we emphasize the usefulness of establishing animal models that mimic human OA syndromes by genetic manipulations. These transgenic models should be essential for testing gene therapy approaches in vivo.

Animals↗
PubMed1995

[Endoscopic surgery in ectopic pregnancy. Analysis of 105 cases].

A report on 105 cases of ectopic pregnancy resolved via endoscopy is presented. Surgical techniques for total salpingectomy (82), salpingotomy (11), tubal expression (6), partial salpingectomy (3), partial ooforectomy (2) and anexectomy (1) is described. The excellent postsurgical recovery and low incidence of complications are depicted, as well as the growing percentage of ectopic pregnancies resolved endoscopically in our Department.

Adult↗