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S Pucciarelli

Publications and source records attributed to S Pucciarelli.

26 records · Page 2Linked to original sources
PubMed1990

[Malfunctioning of linear staplers as a cause of gastro-gastric fistula in vertical gastroplasty].

The Authors reviewed their series of patients submitted to VBG in order to investigate the rate and cause of gastric partition disruption. This complication was found only in patients who had the gastric partition done by means of a double application of TA-90. No gastric partition disruption was found in those patients in which TA-90-B was used. The partition breakdown might be due to occasionally defective closure mechanism in the traditional staplers.

Adult↗
PubMedDate not supplied

Rectal cancer: CT local staging with histopathologic correlation.

BACKGROUND: Many surgical options, eventually combined with neoadjuvant therapy, are available for the treatment of rectal cancer. Preoperative staging is essential to plan the correct treatment. Our aim was to evaluate the diagnostic accuracy of computed tomography (CT) in the local staging of rectal cancer. METHODS: Between February 1995 and May 2000, 105 patients (65 male, 40 female; mean age = 58, range = 36-88 years) after preoperative locoregional CT staging underwent rectal resection for rectal cancer. In all patients, radiologic T and N staging was verified with pathologic examination of excised specimens. Patients were examined after air insufflation of the ampulla, during intravenous contrast injection; analysis of the rectoanal region was performed with thin (3-5 mm) contiguous slices. For T staging, Tis-T2, T3, and T4 groups were considered. For N staging, two groups of patients were considered: in 52 patients, N+ stage was attributed to all visible lymph nodes; in the other 53 patients, only lymph nodes >5 mm were recorded as N+. RESULTS: Pathologic examination showed 61 T1-T2, 40 T3, and four T4 tumors; CT examination correctly identified 50 T1-T2 (81.9%), 33 T3 (82.5%), and three T4 (75%) lesions. With regard to N stage, pathologic examination in the first group (52 patients) showed only 11 cases of lymph node involvement. CT examination detected all 11 true-positive lymph nodes but overestimated 30 false-positive cases. In the second group (53 patients), pathology showed 26 cases of nodal involvement: CT examination identified 23 true-positive, 19 true-negative, eight false-positive, and three false-negative lymph nodes. CONCLUSION: CT correctly staged 86 (82%) of 105 lesions. Overestimation occurred in T2 patients (11 of 61, 18%) and underestimation in T3 patients (seven of 33, 21%), in accordance with other reports dealing with superior accuracy of endorectal ultrasonography in local staging of early disease. Conversely, the criterion we suggest for evaluating metastatic perirectal lymph nodes (diameter > 5 mm) provided 79.2% diagnostic accuracy, 88.5% sensitivity, and 86.5% negative predictive value. This can be useful in those patients in whom prompt surgery, soon after radiochemotherapy in the case of nodal involvement, may likely be curative. With further improvement with spiral CT in local staging and nodal involvement, a larger number of transanal curative resections can be predicted.

Adult↗
PubMedDate not supplied

Preoperative combined radiotherapy and chemotherapy for middle and lower rectal cancer: preliminary results.

BACKGROUND: Adjuvant treatment for rectal cancer is still controversial. This study reports on overall survival and disease-free survival, toxicity, downstaging, and surgical morbidity in rectal cancer patients who received combined chemoradiation therapy followed by curative surgery. METHODS: Between 1993 and 1998, 51 patients (31 males and 20 females; median age, 60 years; range, 33-73 years) underwent chemoradiation therapy followed by radical surgery for middle and lower rectal adenocarcinoma. Criteria for giving preoperative radiotherapy (total 45 Gy in 25 fractions of 1.8 Gy/day for 5 weeks) and chemotherapy (5-fluorouracil 350 mg/m2/day and leucovorin 10 mg/m2/day, bolus on days 1-5 and 29-33) were an age younger than 75 years; an Eastern Cooperative Oncology Group performance status score of 0 to 2; and clinical preoperative stage II-III. Forty-three low anterior and eight abdominoperineal resections were performed. Median follow-up time was 29 (range, 3-63) months. RESULTS: Although grade 3 to 4 toxicity occurred in 14 cases (27.4%), all patients completed the planned adjuvant therapy. At pathology, a complete response was found in eight (15.7%) cases. Of the remaining 43 cases, 22 were stage I, 12 were stage II, and 9 were stage III. Five-year actuarial disease-free survival and overall survival rates were 86.4% and 85.5%, respectively. Whereas no local recurrences were found, 4 patients had distant metastases. Three patients died (1 of cancer-related causes), 45 are alive and disease free, and 3 are alive with disease. CONCLUSIONS: The combined preoperative chemoradiation approach used by us seems to improve the disease-free survival and overall survival of selected patients with rectal cancer. However, a longer follow-up time is required to confirm these preliminary results.

Adenocarcinoma↗
PubMedDate not supplied

Percutaneous endoscopic gastrostomy for feeding. A comparison between neurologic and neoplastic indications.

The most common indications for percutaneous endoscopic gastrostomy (PEG) are neurologic deficits precluding adequate oral nutrition. The aim of this study was to ascertain whether PEG is as feasible, safe and effective in patients with advanced oropharyngeal, oesophageal and pulmonary carcinoma as it is in patients with neurologic deficit. PEG, attempted in 108 consecutive patients, was successful in 100 (overall success rate of 92%). On the basis of primary disease, the patients were subdivided into two groups: patients with neurologic diseases (group A, n = 50) and patients with oropharyngeal, oesophageal and lung carcinoma precluding adequate oral nutrition (group B, n = 50). No statistically significant difference was found between the PEG placement success rates of the two groups. Of the patients PEG placement 1 died and 2 had major complications. 15 out of 50 patients in group A and 11 out of 50 in group B had minor complications. No statistically significant differences were found between the mortality and morbidity rates of the two groups. Duration of nutrition was similar in both groups. In particular, 46% group A patients and 46% group B patients were PEG-fed for more than 3 months. A wider use of PEG is suggested in patients with advanced oropharyngeal, oesophageal and pulmonary carcinoma precluding adequate oral nutrition.

Adolescent↗
PubMedDate not supplied

Genetic heterogeneity of variable number tandem repeats in thymidylate synthase gene in colorectal cancer patients.

PURPOSE: To analyze the genetic variability in a variable number of tandem repeats (VNTR) in the thymidylate synthase (TS) enhancer promoter region and assess the influence of functional alterations in mismatch repair genes by analyzing constitutional and tumoral DNA from patients with colorectal adenocarcinoma with a high microsatellite instability (MSI-H) or microsatellite stability (MSS) status. PATIENTS AND METHODS: Patients who underwent surgery for colorectal adenocarcinoma were selected from the colorectal database of our institute and, on the basis of MSI status, assigned to a study group and a control group: group A, MSI-H; group B, MSS. Microsatellite status was investigated using the Bethesda recommended panel (BAT-26, BAT-25, D2S123, D5S346, D17S250). In MSI-H patients an additional analysis was made of the microsatellite loci D18S61 and D18S58, both mapping in the region containing the TS gene (18p11.2-11.32). Based on the number of altered microsatellites (> or = 2, 1, or 0), tumors were considered as having high (MSI-H) or low (MSI-L) instability or microsatellite stability (MSS), respectively. Genotyping for thymidylate synthase promoter polymorphism was carried out on constitutional and tumor DNA of each patient by PCR amplification of the polymorphic region. RESULTS: MSI-H was found in 55 patients (group A) and MSS in 50 patients (group B). In none of the MSI-H patients was microsatellite instability found in the additional D18S61 and D18S58 loci. In five group A and ten group B cases the analysis was not performed because constitutional DNA and/or tumoral DNA were not amplifiable. Homozygotes for the triple repeat variant (3R/3R) displayed only the large PCR product, homozygotes for the double repeat variant (2R/2R) displayed only the smaller PCR product, while heterozygotes (2R/3R) displayed both the larger and smaller PCR products. In 3/50 (6%) group A patients and 5/40 (12%) group B patients repeat variations were found in tumoral DNA. CONCLUSION: Our findings demonstrate that there is genetic homogeneity between constitutional and tumoral DNA but do not support the hypothesis that mismatch repair genes are involved in VNTR recombinant events in TS gene variability.

Adenocarcinoma↗
PubMedDate not supplied

NAD+ metabolism in lymphocytes of patients affected by B-cell chronic lymphocytic leukaemia.

In the present work we have quantified some enzymatic activities, related to NAD+ metabolism, in lymphocytes of healthy donors and of patients affected by B-cell chronic lymphocytic leukemia (B-CLL): NADase activity for NAD+ degradation and NMN adenylyltransferase (NMNAT) activity for NAD+ biosynthesis. Most of the samples under investigation (12 B-CLL patients and 12 healthy donors) presented the enzymatic activities assayed. No significant differences in terms of specific activity have been found between ill and healthy subjects. Nevertheless by expressing the activity as mU/10(9) cells (nmol min(-1) 10(9) cells) we observed significantly higher values of both enzymatic activities, involved in the NAD+ metabolism, in healthy donors with respect to the B-CLL patients.

B-Lymphocytes↗
PubMedDate not supplied

Temporary occlusion of the hepatic artery plus infusion and systemic chemotherapy for inoperable cancer of the liver.

Fourteen patients with diffuse tumors of the liver were treated with temporary occlusion of the hepatic artery (HA) by an external tourniquet followed by infusion and systemic chemotherapy. Three patients had primary neoplasms (one hepatocarcinoma and two cholangiocarcinomas) and eleven had metastatic disease (nine from carcinoma of the colon and rectum, one from retroperitoneal liposarcoma, and one from pulmonary small cell cancer). Infusion chemotherapy in all patients was based on 5-FU, Mitomycin and Vincristine. Systemic chemotherapy was FIVB in metastatic carcinoma and Adriamycin in primary liver tumors. All patients showed improvement of the performance status according to the Karnofsky Index. Objective response (OR) was present in 54% of cases. At present, median survival time in 12.5 months. Aggressive treatment combining hepatic ischemia with infusion and systemic polychemotherapy seems to provide an effective method of palliation in diffuse tumors of the liver. Delayed occlusion by an external tourniquet appears safer than intraoperative ligation of the HA.

Adenoma, Bile Duct↗