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S Manfredi

Publications and source records attributed to S Manfredi.

18 recordsLinked to original sources
PubMed2006

Incidence and patterns of recurrence after resection for cure of colonic cancer in a well defined population.

BACKGROUND: The aim of this study was to determine the incidence and patterns of failure following potentially curative surgery of colonic cancer. METHODS: Data were obtained from the cancer registry of the Côte-d'Or (France). Data on 2657 patients who had resection for cure of colonic cancer between 1976 and 2000 were analysed. Local and distant failure rates were calculated using the actuarial method and multivariable analysis was performed using a Cox model. RESULTS: The 5-year cumulative rate was 12.8 percent for local recurrence and 25.6 percent for distant metastases. Five-year cumulative local recurrence rates were 4.9 percent for stage I, 11.0 percent for stage II and 23.5 percent for stage III tumours (P<0.001). The corresponding rates for distant metastases were 6.4, 21.4 and 48.0 percent (P<0.001). The 5-year cumulative rates for distant metastases were 31.7 percent for the period 1976-1980 and 21.1 percent for 1996-2000, and the local recurrence rates were 17.6 and 9.0 percent respectively. The decreases in rates of local recurrence and distant metastases were significant in multivariable analysis. Cancer extension and presenting features were related to patterns of failure. Tumour location was significantly associated with risk of local recurrence, whereas age and gross features were associated with risk of distant metastasis. CONCLUSION: Recurrence following resection of colonic cancer remains a substantial problem. Follow-up is of particular importance in the 3 years after surgery.

Aged↗
PubMed2005

Time trends in the treatment and survival of recurrences from colorectal cancer.

BACKGROUND: Little is known about the management of recurrences from colorectal cancer at a population level. MATERIALS AND METHODS: Data was obtained from the population-based cancer registry of Cote d'Or (Burgundy, France) over a 28-year period. Univariate and multivariate analyses were performed to analyse trends in treatment and survival for local recurrence and distant metastases. RESULTS: The proportion of patients resected for cure increased from 6.7% (1976-1984) to 23.7% (1994-2003; P <0.001) for distant metastases and from 15.9% to 58.1% (P <0.001) for local recurrence. Age and period of diagnosis were independent factors associated with a resection for cure. Rectal cancer local recurrence was less often resected for cure than colon cancer local recurrence (P=0.05). Long-term survival was observed only after resection for cure: 5-year relative survival rates were 36.1% for local recurrence and 24.0% for distant metastases. In the multivariate analysis, survival decreased with age and increased over time but significantly only over the last study period. Surgical resection and palliative chemotherapy were other determinants of prognosis for distant metastases whereas surgical resection and palliative radiotherapy did influence the prognosis for local recurrence. CONCLUSION: Substantial advances in the management of recurrences have been achieved over time. More effective treatments and mass screening represent promising approaches to decrease this problem.

Age Distribution↗
PubMed2002

Colon cancer in France: evidence for improvement in management and survival.

BACKGROUND: Cancer registries recording all cases diagnosed in a well defined population represent the only way to assess real changes in the management of colon cancer at the population level. AIMS: To determine trends over a 23 year period in treatment, stage at diagnosis, and prognosis of colon cancer in the Côte-d'Or region, France. PATIENTS: A total of 3389 patients with colon cancer diagnosed between 1976 and 1998. METHODS: Time trends in clinical presentation, surgical treatment, chemotherapy treatment, stage at diagnosis, postoperative mortality, and survival were studied. A non-conditional logistic regression was performed to obtain an odds ratio for each period adjusted for the other variables. To estimate the independent effect of the period on prognosis, a relative survival analysis was performed. RESULTS: Between 1976 and 1991, the resection rate increased from 69.3% to 91.9% and then remained stable. This increase was particularly marked in the older age group (56.4% to 90.5%). The proportion of stage III patients treated with adjuvant chemotherapy rose from 4.1% for the 1989-1990 period to 45.7% for the 1997-1998 period. Over the 23 years of the study the proportion of stage I and II patients increased from 39.6% to 56.6%, associated with a corresponding decrease in the proportion of patients with advanced stages. Postoperative mortality decreased from 19.5% to 7.3%. This led to an improvement in five year relative survival (from 33.0% for the 1976-1979 period to 55.3% for the 1992-1995 period). CONCLUSIONS: Advances in the management of colon cancer have resulted in improving the prognosis of this disease. However, progress is still possible, particularly in the older age group.

Aged↗
PubMed2002

Evidence for association of a common variant of the endothelial nitric oxide synthase gene (Glu298-->Asp polymorphism) to the presence, extent, and severity of coronary artery disease.

BACKGROUND: Genetic variants of endothelial nitric oxide synthase (eNOS) could influence individual susceptibility to coronary artery disease. OBJECTIVE: To assess whether Glu298-->Asp polymorphism of the eNOS gene is associated with the occurrence and severity of angiographically defined coronary artery disease in the Italian population. METHODS: Polymerase chain reaction/restriction fragment length polymorphism analysis was done to detect the Glu298-->Asp variant of the eNOS gene in 201 patients with coronary artery disease and 114 controls. The severity of coronary artery disease was expressed by the number of affected vessels and by the Duke scoring system. RESULTS: The frequencies of the eNOS Glu/Glu, Glu/Asp, and Asp/Asp genotypes in the coronary artery disease group were significantly different from those of controls (45.3%, 38.8%, and 15.9% v 42.1%, 51.8%, and 6.1%, respectively; chi2 = 8.589, p = 0.0136). In comparison with subjects who had a Glu298 allele in the eNOS gene, the risk of coronary artery disease was increased among Asp/Asp carriers (odds ratio 2.9, 95% confidence interval 1.2 to 6.8, p = 0.01) and was independent of the other common risk factors (p = 0.04). There was a significant association between the eNOS Glu298-->Asp variant and both the number of stenosed vessels (mean (SEM), 2.3 (0.1) for Asp/Asp v 1.9 (0.1) and 1.8 (0.1) for Glu/Glu and Glu/Asp, respectively; p = 0.01) and the Duke score (56.1 (3.1) for Asp/Asp v 46.7 (2.0) and 46.1 (1.9) for Glu/Glu and Glu/Asp, respectively; p = 0.02). CONCLUSIONS: Glu298-->Asp polymorphism of the eNOS gene appears to be associated with the presence, extent, and severity of angiographically assessed coronary artery disease.

Coronary Artery Disease↗
PubMed2001

Evidence for DNA damage in patients with coronary artery disease.

According to the "monoclonal hypothesis" of atherosclerosis, several studies suggest that cancer and atherosclerosis may have several fundamental biological mechanisms in common. Therefore, an increase in the mutation rate may be involved in the pathogenesis of atherosclerotic plaques. The aim of the study was to verify the presence of chromosomal damage in peripheral blood lymphocytes in patients with coronary artery disease by using micronucleus (MN) test, a reliable biomarker in genetic and cancer risk assessment. Subjects included 53 patients with documented coronary ischemic heart disease (group I); 10 patients with valvular heart disease in absence of atherosclerotic lesions of the coronary arteries (group II) and 16 healthy subjects, age- and sex-matched (group III) were studied as controls. For each subject, two separate cultures were performed and 1000 binucleated cells were scored for the evaluation of MN frequency. The mean (+/-S.E.M.) of MN frequency were 11.9+/-1.7, 5.9+/-1.2 and 3.6+/-0.7 in groups I, II and III, respectively. The MN frequency of group I was significantly higher than that of group III (P=0.02). In group I, MN frequency increased with the number of affected vessels (6.3+/-0.7, 13.9+/-1.6, 14.9+/-5.3 for one-, two-, and three-vessel disease, respectively). Scheffe's test showed that MN frequency was significantly higher in two-vessel compared with one-vessel disease (P=0.0077). Moreover, a positive relationship was found between MN levels and the severity of the disease, calculated by the Duke scoring system (R=0.28, P=0.032), as well as the systolic blood pressure (R=0.34, P=0.009). These results suggest that coronary artery disease in humans is a condition characterized by an increase of DNA damage, positively correlated with the severity of the atherosclerotic disease.

Adult↗
PubMed2001

Population-based study of factors influencing occurrence and prognosis of local recurrence after surgery for rectal cancer.

BACKGROUND: Few data are available from population-based statistics on the risk of local recurrence after surgery for rectal cancer. The aims of this study were to determine factors influencing local control and to analyse treatment and prognosis of recurrences in a well defined population. METHODS: Data were obtained from the cancer registry of the Côte d'Or (France). From 1976 to 1995, 682 patients resected for cure for a rectal carcinoma were included. Recurrence rates and survival rates were calculated using actuarial methods. A relative survival analysis and Cox multivariate analysis were performed. RESULTS: During the study 135 local recurrences were registered. The 5-year cumulative local recurrence rate was 22.7 per cent. In multivariate analysis the two variables significantly associated with local recurrence risk were stage at diagnosis and the macroscopic type of growth. There was a non-significant decrease in local recurrence rate in patients treated by preoperative radiotherapy compared with that in patients treated by surgery alone. The proportion of patients re-resected for cure was 25.2 per cent, and increased from 13.0 per cent in 1976-1985 to 37.9 per cent in 1986-1995 (P = 0.001). The 5-year relative survival rate was 13.6 per cent overall and 40.6 per cent after resection for cure (P < 0.001). CONCLUSION: Local recurrence of rectal cancer following resection remains a substantial problem. Improvement can be expected from better care and earlier diagnosis.

Adult↗
PubMed2001

[Adenocarcinomas of the distal esophagus and gastric cardia: non-surgical management].

Dedicated studies to esophageal carcinomas are few. Surgical excision remains the treatment of choice for localised tumours. External beam radiation therapy could be used alone to obtain a quick palliation and to allow the recovery of normal eating. Currently, combined modality treatment demonstrated better results when compared to radiation alone. Efficiency of combined modality treatment of adenocarcinoma seems equivalent to epidermoid. Numerous phase II studies demonstrated the feasibility of combined radio-chemotherapy in a preoperative setting. However, phases III trials are criticised and actually no definitive conclusion can be drawn. Inclusion of patients with such a tumour should be encouraged.

Adenocarcinoma↗
PubMed2000

Trends in incidence and management of gallbladder carcinoma: a population-based study in France.

BACKGROUND: Little is known, at a population level, about the incidence and management of gallbladder carcinoma. The objective of this study was to determine trends in incidence, treatment, stage at diagnosis, and prognosis of gallbladder carcinoma in a well defined population. METHODS: A series of 484 patients diagnosed over a 20-year period (1976-1995) in a French well defined population was used. Incidence rates were calculated by gender, age groups, and 5-year periods. Prognosis was determined using crude and relative survival rates. A multivariate relative survival analysis was performed. RESULTS: Age-standardized incidence rates were 0.8 per 100,000 inhabitants for men and 1.5 per 100,000 inhabitants for women. There were no significant time trends in incidence in both genders. The proportion of cases resected for cure increased from 18. 1% (1976-1980) to 42.4% (1991-1995) (P < 0.001) as well as the proportion of cases limited to the gallbladder wall, respectively from 15.7% to 27.8% (P < 0.001). Relative survival rates were 16.6% at 1 year and 6.2% at 5 years. Age, stage at diagnosis, and period of diagnosis significantly influenced the prognosis of gallbladder carcinoma. The 5-year relative survival rate rose from 2.7% (1976-1985) to 10.2% (1986-1995). The multivariate analysis showed that age and stage at diagnosis were independent prognostic factors. CONCLUSIONS: This study demonstrated that gallbladder carcinoma incidence is stable in France and that substantial advances in its management have been achieved, but there is evidence that further improvements are necessary to increase survival.

Adult↗
PubMed2000

Cancer of the ampulla of Vater: results of a 20-year population-based study.

BACKGROUND: Relatively little attention has been given to the epidemiology and management of cancer of the ampulla of Vater. SETTING: A series of 111 patients with a cancer of the ampulla of Vater diagnosed over a 20-year period (1976-1995) in a well-defined French population was used to analyse its incidence, management and prognosis as well as to determine time trends. Prognosis was determined by using crude and relative survival rates. Factors predictive of survival were also identified using a relative survival model in a multivariate analysis. RESULTS: Age-standardized incidence rates were 3.8 per 1000000 inhabitants in men and 2.7 per 1000000 inhabitants in women. Incidence increased over time in men from 1.9 during the first period (1976-1980) to 5.9 during the last period (1991-1995). In women, incidence rates remained stable. A resection for cure was performed in 52 cases (48.1%). Overall, 9.9% of these cancers were classified TNM stage I and 54.1% stage IV. There was no significant variation in treatment modalities and in stage at diagnosis over the study period. The overall operative mortality rate was 7.5%. Relative survival rates were 58.9% at 1 year, 30.9% at 3 years and 20.9% at 5 years. Five-year relative survival rates varied from 72.8% in TNM stage I cancers to 6.6% in TNM stage IV cancers. Age, treatment procedure and stage at diagnosis significantly influenced the prognosis of cancer of the ampulla of Vater. In a multivariate analysis, stage at diagnosis remained the major prognostic factor (P<0.01). CONCLUSIONS: Although its incidence is increasing in men, cancer of the ampulla of Vater remains a rare tumour in both sexes. No improvements in the management and care of patients have been achieved. Further studies are needed to enhance the understanding of this cancer.

Adenocarcinoma↗
PubMed2000

Family history and risk of colorectal cancer: implications for screening programmes.

OBJECTIVE: To estimate the lifetime risk of colorectal cancer in the general population and in first degree relatives of patients with sporadic colorectal cancer or adenoma. MAIN OUTCOMES MEASURES: The cumulative risk of colorectal cancer (0-74) in the general population combined with the relative risk of colorectal cancer and the prevalence of different groups of subjects with family history of colorectal tumour allows the calculation of cumulative risks in these groups. RESULTS: The lifetime risk of colorectal cancer was 1 in 23 in men and 1 in 40 in women. In males, 0.5% in the 55-59 age group and 4.5% in the 70-74 age group will develop a colorectal cancer. The corresponding values in females were 0.4% and 2.5%. The cumulative risk at age 74 varied between 7.7% (one family member affected) and 25.6% (two affected) in males, and 4.3% and 14.3% respectively in females. The risk in the 40-44 year age group for individuals with one first degree relative affected before 45 years of age was 0.5%, similar to that of those aged 45-49 with one first degree relative affected with a colorectal cancer or a large adenoma (> 1 cm). CONCLUSIONS: These results suggest that screening in the general population should start at 50 or 55. The lifetime risk is high enough (over 10%) among individuals with one affected first degree relative before age 45, or with at least two affected first degree relatives, to warrant colonoscopic screening. The data provide a basis for recommendations that relatives of these patients should enter screening programmes at age 40 to 44.

Adult↗
PubMed1998

Staphylococcus aureus prophylaxis in hemodialysis patients using central venous catheter: effect of mupirocin ointment.

Central venous catheterization is a common technique to establish rapid and temporary access for hemodialysis. However, it is a known risk factor for Staphylococcus aureus infection and bacteremia. Mupirocin is a topical antibiotic with high in vitro anti-staphylococcal activity. A randomized prospective trial was conducted to assess the effectiveness of mupirocin ointment in the prevention of Staphylococcus aureus skin and catheter colonization, and episodes of bacteremia in 136 end-stage renal disease patients. Of these, 67 received skin disinfection at the venous catheter insertion site with povidone iodine (control group), and 69 received the same treatment followed by application of 2% mupirocin ointment at the cannula site after catheter placement and at the end of each dialysis session. Patients were followed until catheter removal and were monitored for the development of Staphylococcus aureus skin/catheter colonization and episodes of bacteremia. Median duration of catheter use was greater in the mupirocin than in the control group (37 versus 20 d, P < 0.01). Patients in the mupirocin group had a significantly lower rate of Staphylococcus aureus isolation from the pericatheter skin (1.76 per 1000 versus 14.27 per 1000 patient-days, P < 0.001) and from the catheter surface (3.17 per 1000 versus 14.27 per 1000 patient-days, P < 0.001). The proportion of patients with Staphylococcus aureus skin infection at the insertion site was lower in the mupirocin group (4.3% versus 23.9%, P = 0.001). Staphylococcus aureus-associated bacteremia was observed in 17 patients (two in the mupirocin group [0.71 episodes per 1000 patient-days] and 15 in the control group [8.92 per 1000 patient-days], P < 0.001). The hazard ratio of developing Staphylococcus aureus bacteremia was 7.2 (95% confidence interval, 1.6 to 31.6) times greater in patients not receiving mupirocin. Mupirocin applied to the insertion site significantly reduces the risk of Staphylococcus aureus skin and catheter colonization, exit-site infection, and Staphylococcus aureus bacteremia in hemodialysis patients.

Adolescent↗
PubMed1994

[Inguinal hernia: technics compared in our experience. Hernioplasties compared].

The authors describe their survey carried out on 875 patients operated on for inguinal hernia between 1984 and 1989. 412 of these patients were checked in the out-patients' department after a minimum 2 year period. The regular check-up parameters were assessed, paying particular attention to the problem of recurrence. This occurred in 47 patients, which is equal to 11% of the total for the Bassini and Postempski techniques, and 8.9% for the Shouldice method. On first observation, statistical data analysis carried out on the results obtained, do not show any significant differences. However, notwithstanding the fact that the authors are at the initial stages with chances of varying results, important data have emerged in favour of the canadian technique.

Adolescent↗
PubMed1992

Postnatal ultrasound screening of urinary malformations.

We performed routine neonatal ultrasound screening on 3,454 neonates in the first week of life to establish the real incidence of congenital uropathy. Pronounced anomalies were found in 36 cases (1.04%) and mild renal pelvis dilatation in 159 (4.60%). In the population study prenatal ultrasonography showed evidence of severe anomalies in only 7 fetuses (0.2%). Surgical correction was required in 14 cases. Our results indicate that neonatal ultrasound screening has sufficient sensitivity and specificity for the early detection of the vast majority of urinary tract malformations. In 2 cases mild vesicoureteral reflux was not detected until a urinary tract infection was noted. Thus, neonatal sonography appears to be of limited value in detecting mild reflux.

Congenital Abnormalities↗
PubMed1989

[Anti H2 receptors and perforated peptic ulcer. Review of 442 cases].

H2 blockers have accelerated the reduction in elective peptic ulcer surgery but appear to have had no equivalent effect on the incidence of perforated ulcer success. A 13 year (1975-1987) review of perforated peptic ulcer is presented. The mean annual number of operations for perforation fell from 8.21% to 4.93% after 1980, while the number of operations for perforated gastric ulcer in this period was almost unchanged. A significant reduction was found in mean annual rates for perforated duodenal ulcer from 6.86% to 3.82% after 1980, while the number of operations for perforated gastric ulcer in this period was almost unchanged.

Cohort Studies↗
PubMed1989

[Use of blood and its derivatives by the emergency surgeon].

In spite of the fact that the initial injury has to be treated as quickly as possible, in many emergency pathologies, the priority in early resuscitation periods is to provide an adequate blood flow, tissue perfusion and oxygenation. In multiple injuries, treatment starts before diagnosis because diagnostic examinations cannot begin until the patient's condition has become more stable.

Blood Transfusion↗
PubMedDate not supplied

A respiratory and allergy survey in textile workers employed in early stages of wool processing.

OBJECTIVES: To determine frequency and type of respiratory and allergic symptoms in textile workers employed in early stages of wool processing. METHODS: A cross-sectional study was carried out in four wool textile mills. 202 subjects (n. 148 males, 54 females, mean age 38.9 yrs, SD 9.5) employed in early stages (combing, n. 138, carding, n. 64) of wool processing were examined and an environmental survey was carried out to determine the level of wool dust exposure. All subjects were submitted to clinical interview, spirometry and measurement of serum specific IgE (s-IgE) against extracts of two wool lots (Australia and New Zealand) by means of RAST. In the subjects with a positive questionnaire for allergic symptoms serum specific IgE for common pneumoallergens were measured (PHADIATOP test). RESULTS: We found higher air dust concentrations during carding operations (inspirable fraction-IF-: range 1.6-20 mg/m3; respirable fraction (RF): 0.5-6.9 mg/m3) and lower concentrations during combing (IF 0.3-0.7 mg/m3, RF 0.1-0.3 mg/m3). 70 out of 202 subjects (34.7%, n. 26 employed in carding and n. 44 in combing operations) reported work-related symptoms. Cutaneous itching was reported by 30 subjects, upper airway irritation by 24, ocular irritation by 17 and dyspnoea by 5. Globally 27 subjects (13.4%) had respiratory work-related symptoms. 12 subjects reported only seasonal respiratory symptoms not related to work. Within the group of 82 symptomatic subjects, 62 (75.6%) had serum specific IgE for common pneumoallergens. In the whole group (n. 202) mean basal FEV-1 was L 3.6, SD 0.9 (103.6% of predicted values). No significant difference was found in basal FEV-1 between carding and combing workers. No s-IgE against the two wool extracts was detectable in any of the 202 examined subjects. CONCLUSIONS: Our data show that in early stages of wool processing: 1) the overall frequency of respiratory work-related symptoms is low and does not seem to be related to the stages of processing, 2) symptoms are mainly nasal and/or ocular; 3) serum s-IgE against wool extracts are not detectable. We conclude that respiratory allergy risk in wool textile mills is low.

Adult↗