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Raffaele Pezzilli

Publications and source records attributed to Raffaele Pezzilli.

At least 19 recordsLinked to original sources
PubMed2007

The imaging of pancreatic exocrine solid tumors: the role of computed tomography and positron emission tomography.

The only potentially radical treatment for pancreatic cancer is the removal of the tumor which can be performed by total or subtotal surgical resection of the pancreas; this is possible in the early stages of the disease when the tumor is confined to the pancreatic gland without metastasis to the liver, lymph nodes and/or the peritoneum, or involvement of the vascular system such as the celiac trunk and its branches and the superior mesenteric artery. In this paper, we describe the accuracy of computed tomography and positron emission tomography in the diagnosis of exocrine pancreatic cancer.

Humans↗
PubMed2007

Pancreatectomy for pancreatic disease and quality of life.

The aim of this paper was to review the data existing in the English literature on the quality of life in patients who undergo surgical resection of the pancreatic gland either for benign or for malignant diseases. MEDLINE, Web of Science, and ScienceDirect were browsed in order to select the data existing in the literature on quality of life and pancreatic surgery. Alerts received by e-mail were also taken into account. Only full text papers were selected. Of the 161 papers found, only 13 papers were evaluated for the purpose of this study: 11 focused on surgical resective procedures in chronic pancreatitis and two focused their interest on assessing the quality of life related to resective procedures in pancreatic neoplasms. Despite the scarcity of studies assessing the quality of life in patients who underwent pancreatic surgery, there is the need to routinely assess well-being in patients who have been operated on.

Humans↗
PubMed2006

Quality of life in chronic pancreatitis.

In an era such as the present one in which there is a high demand for health services with the associated pressure of controlling spending, health care organizations are concerned about the cost-effectiveness of quality improvement interventions. On the other hand, the impact of the disease and the treatment on the patient's overall well-being and functioning has become a topic of growing interest not only in clinical research but also in practice. The clinical evaluation of the benefits of specific treatments for chronic, debilitating and incurable diseases should increasingly include formal assessment of patient activity and well-being. Thus, health-related quality of life as subjectively perceived by the patient, is becoming a major issue in the evaluation of any therapeutic intervention, mainly in patients with chronic or difficult diseases where the aim of the intervention is to keep patients either symptom-free and capable of living in the community for a long time or to reduce the discomfort caused by the disease. In this paper, we review the current knowledge on the quality of life assessment in chronic pancreatitis patients.

Evaluation Studies as Topic↗
PubMed2006

Endocrine tumors of the ileum: factors correlated with survival.

AIM: To evaluate the most important factors correlated with survival in patients with endocrine tumors of the ileum, both at the time of diagnosis and during the follow-up period. METHODS: Fifty-nine patients with ileal endocrine tumors diagnosed in our institution between 1990 and 2004 were studied. RESULTS: The study included 36 men (61%) and 23 women (39%). The median age of the patients at the time of diagnosis was 61.4 (range 18-83) years. The median follow-up period was 71.9 (range 5-287) months. Forty patients (67.8%) were still alive at the end of the study; the median survival time was 172 months, and the 5-year survival rate was 78.9%. By univariate analysis, the survival rate was significantly related to female sex (p = 0.024) and flushing alone (p = 0.028) and associated with diarrhea at diagnosis (p = 0.015), weight loss at diagnosis (p = 0.038), Ki-67 level (p = 0.025), stage of disease at diagnosis (p = 0.012), presence of liver metastases at follow-up (p = 0.005), presence of diffuse metastases at diagnosis (p = 0.005) and at follow-up (p = 0.007), and type of surgical approach (overall: p = 0.018; not operated vs. radical surgery: p = 0.008; not operated vs. palliative surgery: p = 0.045). Using multivariate analysis, only female gender (p = 0.012) and the presence of liver metastases at follow-up (p = 0.004) were significantly related to survival. CONCLUSION: In the present study, female gender and the appearance of liver metastases at follow-up seem to be the main conditions which determine the poor prognosis of patients with ileal endocrine tumors.

Adolescent↗
PubMed2006

Management of acute pancreatitis: current knowledge and future perspectives.

In recent years, a number of articles have been published on the treatment of acute pancreatitis in experimental models and most of them concerned animals with mild disease. However, it is difficult to translate these results into clinical practice. For example, infliximab, a monoclonal TNF antibody, was experimentally tested in rats and it was found to significantly reduce the pathologic score and serum amylase activity and also to alleviate alveolar edema and acute respiratory distress syndrome; however, no studies are available in clinical human acute pancreatitis. Another substance, such as interleukin 10, was efficacious in decreasing the severity and mortality of lethal pancreatitis in rats, but seems to have no effect on human severe acute pancreatitis. Thus, the main problem in acute pancreatitis, especially in the severe form of the disease, is the difficulty of planning clinical studies capable of giving reliable statistically significant answers regarding the benefits of the various proposed therapeutic agents previously tested in experimental settings.According to the pathophysiology of acute pancreatitis, the efficacy of the drugs already available, such as gabexate mesilate, lexipafant and somatostatin should be re-evaluated and should be probably administered in a different manner. Of course, also in this case, we need adequate studies to test this hypothesis.

Journal Article↗
PubMed2006

New approaches for the treatment of acute pancreatitis.

In recent years, a number of articles have been published on the treatment of acute pancreatitis in experimental models and most of them were published about animals with mild disease. However, it is difficult to translate these results into clinical practice. For example, infliximab, a monoclonal TNF antibody, was experimentally tested in rats and it was able to significantly reduce the pathologic score and serum amylase activity, and also alleviate alveolar edema and acute respiratory distress syndrome; no studies are available in clinical human acute pancreatitis. Another substance, such as interleukin 10, was efficacious in decreasing the severity and mortality of lethal pancreatitis in rats, but seems to have no effect on human severe acute pancreatitis. Thus, the main problem in acute pancreatitis, especially in the severe form of the disease, is the difficulty of planning clinical studies capable of giving hard statistically significant answers regarding the benefits of the various proposed therapeutic agents previously tested in experimental settings. According to the pathophysiology of acute pancreatitis, we may re-evaluate the efficacy of the drugs already available, such as gabexate mesilate, lexipafant and somatostatin which should be probably administered in a different manner. Of course, also in this case, we need large studies to test this hypothesis. Another great problem is prevention of the infection of pancreatic necrosis. A randomized study has been published to test the hypothesis that probiotics and specific fibres used as supplements in early enteral nutrition may be effective in reducing pancreatic sepsis and the number of surgical interventions. A study named PROPATRIA (Probiotic Prophylaxis in Patients with Predicted Severe Acute Pancreatitis) has been planned to give a more robust confirmation to the previous study. Furthermore, the open question of the prevention of the fungal infection of necrosis is still being debated. Finally, the prevention of pain relapse after oral feeding in patients with mild or severe acute pancreatitis should be explored. Even if some studies exist on this issue, the question of optimal treatment is still unanswered. As in other diseases, obtaining results when treating patients with acute pancreatitis is difficult and will take continuous small steps.

Acute Disease↗
PubMed2006

Pancreatic solid-cystic papillary tumor: clinical features, imaging findings and operative management.

Solid-cystic papillary tumors of the pancreas are very rare and, until today, 718 cases have been reported in a review of the literature. Four patients affected by solid-cystic papillary tumors, observed in our Institute between January 1985 and July 2005, are reported. The clinicopathological, operative and survival data of this tumor were reviewed comparing our experience with a review of the literature. Solid-cystic papillary tumor have a preference for young women (age between 19-50 yrs) and show a large round, well-defined pancreatic mass(greater than 5 cm), clinically silent or with unspecific symptoms. The tumor is more frequently localized in the pancreas (80%) and is rarely a metastatic disease (20%). Surgical treatment with radical pancreatic resection of the tumor was performed in approximately 95% of the cases. In 467 patients, two-year survival was 97% (16 deaths) and 5-year survival was 95% (21 deaths). In conclusion, preoperative diagnosis of solid-cystic tumors of the pancreas is difficult but knowledge of its characteristic findings can aid in reaching a proper diagnosis. Surgery is the treatment of choice; it should be conservative in localized tumors, and aggressive, in non-localized tumors. The prognosis is very good, with long-term survival also in patients with metastases or unresectable tumors.

Adult↗
PubMed2006

Acute suppuration of the pancreatic duct associated with pancreatic ductal obstruction due to pancreas carcinoma.

Acute obstructive suppurative cholangitis is a well-known clinical entity; however, acute suppuration of the pancreatic duct in the setting of pancreatic ductal obstruction is an uncommon pancreatic disorder. We report a case of acute suppuration of the pancreatic duct without either a concomitant pancreatic abscess or an infected pseudocyst, presenting as acute relapsing pancreatitis. In this case, the underlying cause of suppuration of the pancreatic duct was pancreatic ductal obstruction and chronic pancreatitis secondary to pancreas head carcinoma along with infection of Escherichia coli. Endoscopic placement of a pancreatic stent resulted in an evacuation of grayish thick pus from the distal pancreatic duct with a dramatic improvement of the disease. This case proposes the concept that acute suppuration of the pancreatic duct is a complex process involving the chronically damaged pancreas, pancreatic outflow obstruction, and subsequent bacterial infection. Antibiotic treatment is effective but temporary; therefore, the immediate drainage of the infected pancreatic duct is mandatory.

Aged↗