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Biomedical subjects

S Tagliacozzo

Publications and source records attributed to S Tagliacozzo.

At least 19 recordsLinked to original sources
PubMed2001

Total mesorectal excision and low rectal anastomosis for the treatment of rectal cancer and prevention of pelvic recurrences.

HYPOTHESIS: Total mesorectal excision lowers the rate of pelvic recurrence and positively affects the survival after surgical treatment of rectal cancer. DESIGN: Case series. SETTING: Tertiary care university hospital. PATIENTS: Fifty-three consecutive patients were admitted with curative intent to surgery at the First Department of Surgery of the University of Rome "La Sapienza," Rome, Italy, with diagnoses of rectal carcinoma. The mean follow-up was 68.9 months; follow-up was complete for all patients who entered the trial. INTERVENTIONS: Low anterior resection and total mesorectal excision were performed in all cases, regardless of the location of the rectal cancer. A straight mechanical colorectal anastomosis was performed on a rectal stump, never exceeding 5 cm. No kind of adjuvant therapy was given. Mesorectum and open rectum were studied by serial transverse section at 5-mm intervals. A search for depth of penetration and distal intramural extension of the tumor was made. Lymph nodes were detected by clearing method, and nodal metastases (NM) and nonnodal metastases (NNM) were recorded as situated proximally, distally, or at the level of the tumor. RESULTS: There was no postoperative mortality. Clinical and radiologic leaks occurred in 2 and 4 patients, respectively. Mean disease-free survival was 65.9 months. Pelvic recurrence occurred in 5 patients (9%). Overall 5-year survival rate was 75%. Involvement of mesorectum by NM and NNM was detected in 27 and 24 cases, respectively. Both NM and NNM were found to be distal in 33% and 40% of cases, respectively. CONCLUSIONS: Microscopic spread to the distal mesorectum may exceed the intramural spread of rectal cancer. Failure to perform total mesorectal excision leaves a potentially residual disease in the distal mesorectum, thus predisposing the patient to pelvic recurrence.

Adenocarcinoma↗
PubMed2001

Preservation of the inferior mesenteric artery in colorectal resection for complicated diverticular disease.

BACKGROUND: Preservation of the inferior mesenteric artery (IMA) and consequential blood flow to the rectum would reduce the risk of leakage of a colorectal anastomosis. METHODS: One hundred and sixty-three patients undergoing left colectomy for complicated diverticular disease of the colon were randomly placed into two groups: A, n = 86; and B, n = 77. In group A, the integrity of the IMA was preserved by artery skeletization (IMAS); in group B, the IMA was divided at its origin. Variables recorded included duration of the surgical procedure, need for blood transfusion, length of hospital stay, operative mortality and morbidity, staple-ring disruption, and radiologic and clinical leakage. Anastomotic stenosis and recurrence of diverticular disease were noted. RESULTS: Surgical time was superior in the IMAS group. Radiologic and clinical leakages were significantly higher in group B (P = 0.02, P = 0.03, respectively). In group A a significant lower number of staple-ring disruptions was observed, evolving into clinical dehiscence. CONCLUSION: Preserving the natural blood supply to the rectum and the ensuing use of a healthy well-nourished rectal stump are suggested as the main aspects of IMAS in preventing and healing leakage of colorectal anastomosis.

Aged↗
PubMed1999

Reliability of visual and quantitative hepatobiliary scintigraphy in the follow-up of patients who have undergone cholecystectomy and transduodenal sphincteroplasty.

A noninvasive scintigraphic technique to assess the efficacy of a surgical procedure (e.g., cholecystectomy and transduodenal sphincteroplasty) depends on the development of reliable and accurate qualitative or quantitative diagnostic criteria that allow early recognition of the occurrence and site of complications. For this purpose, the authors divided biliary flow into a four-step progression process and analyzed transit times from the peripheral vein to the gallbladder, common bile duct, and duodenum and the transit time from the common bile duct to the duodenum. These quantitative parameters were assessed in nine healthy volunteers and 31 asymptomatic patients who had previous cholecystectomy to validate their reliability. The results indicate that the four-step Tc-99m HIDA progression analysis provides a reliable, noninvasive evaluation of biliary flow, so that it can be applied to patients who have had cholecystectomy.

Adult↗
PubMed1997

Antimesenteric perforations of the colon during diverticular disease: possible pathogenetic role of ischemia.

UNLABELLED: The pathogenesis of free perforations occurring on the antimesenteric border of the pelvic colon during the course of diverticular disease has received little attention, with most being generically referred to as diverticular perforations. PURPOSE: This study was designed to identify the pathogenetic factors responsible for free perforations that may occur in the antimesenteric intertenial area during the course of diverticular disease. METHODS: Vascular alterations of the colonic wall associated with diverticula and open antimesenteric perforations were analyzed. RESULTS: Previous data on the site of diverticula formation and related intramural vascular alterations were confirmed. A subserosal vascular network developed in the antimesenteric intertenial area in instances of multiple bilateral diverticula. Free perforations occurred in the antimesenteric haustral area only with multiple bilateral diverticula. CONCLUSIONS: Alterations of the intramural vascular pattern secondary to the presence of multiple and bilateral diverticula may predispose the colonic wall to acute vascular injury. These changes may be enhanced by an episodic increase of intraluminal pressure and consequent distention of the colonic wall occurring in the course of diverticular disease.

Colon, Sigmoid↗
PubMed1997

Extended mesenteric excision in right hemicolectomy for carcinoma of the colon.

Between 1979 and 1989, 169 patients had a curative operation for right sided colonic cancer. A retrospective analysis of the incidence and degree of lymph node metastasis was performed in all and survival rate was determined in 144 patients who could be followed over a period of 5 years or more. In all patients, dissection involved the removal of right colon (i.e., caecum, ascending colon, and right side of transverse colon). Dissection of regional lymph nodes in 84 patients (group 1) involved the removal of mesocolic lymph nodes related to the segment of the removed intestine. In 60 patients (group 2) dissection was extended to the nodes situated anterior to mesenteric and retropancreatic vessels. Morbidity and mortality rates were similar in the two procedures. The number of lymph nodes and the level of apical node examined were significantly different in the two groups. The 5-year survival rates showed no statistically significant difference, but in group 2 three of the nine patients with metastasis to N4 nodes are free of disease, surviving at 7, 12 and 14 years, respectively. The principle of extensive lymph node dissection is proposed as a procedure that supplies more accurate staging and might reduce the incidence of loco-regional recurrence.

Aged↗
PubMed1997

Arteriomegaly and inflammatory abdominal aortic aneurysm. Case report.

In this case report inflammatory abdominal aortic aneurysm (IAAA) was superimposed on an arteriomegaly condition complicated by bilateral aneurysm of the common iliac arteries. Obstruction of the right ureter, mild hydronephrosis of the left system and a slight impairment of renal function were also present. Preoperative cellular and humoral immunological parameters were within normal limits while the erythrocyte sedimentation rate (ESR) was elevated (74 mm). Histological analysis showed numerous scattered lymphoid cells or organized in follicles with germinal centers within the adventitial thickening of the IAAA wall. Immunohistochemical analysis on frozen sections demonstrated that dispersed and perivascular lymphoid cells were mainly composed of similar amounts of CD3+/CD4+ and CD3+/CD8+ T lymphocytes. Histological analysis of the common iliac artery aneurysm showed a mild intimal thickening will small aggregates of macrophages. After aneurysm repair all peripheral blood analysis normalized within one month after surgery. The IAAA observed in our patient with arteriomegaly as underlying arterial disease cannot be interpreted as an inflammatory variation of an atherosclerotic aneurysm. The histological pattern of the inflammatory reaction and its resolution after surgery give, in our opinion, more credit to the etiopathogenetic hypothesis of a reaction elicited by an antigen within the arterial wall of the infrarenal aorta which might be enhanced by the lymphatic stasis subsequent to aneurysm compression.

Aged↗
PubMed1996

Is there a causal connection between bile acids and colorectal cancer?

Bile acid composition was assessed in 50 patients with colorectal cancer as compared to that in a control group of 50 subjects. The two groups were age- and sex-matched. The overall bile acid values were similar in both groups, while the relative concentrations of primary and secondary bile acids were different, a significant increase in the patients with colorectal cancer being observed. This finding thus seems to confirm the existence of a link between colorectal cancer and cholelithiasis. Both conditions share common risk factors, such as alterations in cholesterol metabolism and bile acid composition.

Adult↗
PubMed1993

The impact of ultrasonography on the prognosis of pancreatic cancer.

The authors review 207 consecutive patients admitted for pancreatic cancer from 1960 to 1989 to the 1st Department of Surgery of the University of Rome "La Sapienza", in order to ascertain whether ultrasonography contributes to achieving the ideal goal of early diagnoses. The results achieved show a higher number of early diagnoses (< 1 month from first symptoms) performed by means of US, and a concurrent increase of cases amenable to radical surgery during the period 1975-1989, and basically from 1985 to 1989. Diagnostic imaging, namely US, is therefore deemed to provide earlier diagnoses and higher rates of pancreatic resectability.

Female↗
PubMed1992

Pelvic recurrence after surgical treatment of rectal and sigmoid cancer. A prospective clinical trial on 274 patients.

The aim of this collaborative prospective study was to verify the incidence of pelvic recurrence (PR) after radical surgery for cancer of the rectum and sigmoid. Very low anterior resection (VLAR) was usually performed, with the aim of preserving anal function and obtaining the maximum of radicality by means of en bloc excision of the mesorectum. Between 1984 and 1987, 274 patients underwent curative surgery for rectal and sigmoid cancer, 230 (84%) of whom underwent anterior resection (AR) and 44 (16%) abdominoperineal resection (APR). Post-operative mortality was 2.5%. Follow-up ranged from 24 to 72 months (mean 37 m); 248 cases (90.5%) were included in the final prospective study. PR occurred in 41/248 cases (16%), within 24 months in 80% of cases. PR occurred in 15.8% (33/208) after AR and in 20% (8/40) after APR, p = NS. Nevertheless in middle and low rectal tumours at stage C the incidence of PR in patients who had VLAR was 34.5% (10/29) and 12% (3/25) in those who had APR (p < 0.05). PR rates in VLAR patients was 40% for stage C low rectal tumours and 54.5% for low rectal tumours at Astler Coller stage C2. The PR incidence for stage C1 tumours of the low rectum was zero after VLAR and APR, allowing the assumption that lymphnode metastases in non-penetrating tumours do not compromise the results when the mesorectum is completely excised. We can assume that the choice of VLAR as a substitute for APR whenever possible limits the comparison of their results.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1980

[Indications and results of thrombo-embolectomy in acute ischemia of the extremities].

A personal series of 176 thrombo-embolisms in the extremities, 157 of them operated, observed at the Surgical Clinic of Cagliari University in the period 1969-1977, is reported. The results of surgery are discussed in relation to the factors which most affect prognosis: age, time and degree of ischaemia, anatomo-pathological condition of the arteries and site of obstruction. Severe ischaemia poses the problem of indication for disobstruction: the possible onset of the revascularization syndrome, which almost always causes the death of the patient, should be borne in mind. Recently proposed local wash-out techniques do not complete solve the problem because although they manage to prevent the revascularization syndrome, they do not always save the extremity, which has to be amputated at a later stage after pointless risks to the patient. On the other hand, the poor functional results obtainable from an extremity that has suffered severe ischaemia must be considered. It is therefore preferred to forgo disobstruction when the ischaemia is so serious that revascularization syndrome is probable.

Adult↗