Biomedical subjects

Stefano Crippa

Publications and source records attributed to Stefano Crippa.

22 records · Page 2Linked to original sources

PubMedDate not supplied

Management of small bowel tumors: personal experience and new diagnostic tools.

Small bowel tumors are uncommon lesions that are infrequently suspected. We analyzed the clinical presentation, traditional and new diagnostic tools, surgical treatment, and survival in our experience. This was a retrospective review of 45 patients with small bowel neoplasm over a 20-year period. Preoperative diagnosis was made only in 17 cases (38%). One lesion was shown using a new diagnostic system: wireless capsule endoscopy (WCE). All patients underwent surgery. Mean 5-year overall survival for malignancies was 23%. Female sex and localized disease were positive prognostic factors for survival. Small bowel neoplasms must be considered in differential diagnosis in patients with abdominal symptoms, weight loss, and intestinal bleeding. Because the preoperative diagnosis rarely is made with traditional diagnostic tools, patients are seen late in the course of the disease, and the prognosis is poor. WCE is useful for identifying lesions earlier than by other diagnostic procedures.

Adult↗

PubMedDate not supplied

Endocrine and immunological alterations during cancer processes.

An immunological deficit is often associated with cancer processes. Because cortisol has an important immunosuppressive activity and it is strictly involved in stress responses, we examined its serum levels in colorectal cancer patients and its relationships with peripheral lymphocyte counts. Cortisol circadian rhythm and total and CD4+ lymphocytes were determined in 40 patients. The rate of patients with an altered cortisol circadian rhythm was 28%, and it was significantly more frequent in patients with nodal involvement (P < 0.005) and with metastatic spread (P < 0.005). Patient ratio with total lymphocytes assessment decrease was 30%. There was no correlation between lymphocytopenia and alteration of cortisol circadian rhythm. Data suggest a significant adrenal glands rhythm modification during cancer processes, associated with poor prognostic factors. Cortisol levels and lymphocytopenia seem not to be related. The origins of these alterations are unknown. They may favor or result from cancer spread.

Adrenal Glands↗

PubMedDate not supplied

Preoperative IL-2 immunotherapy enhances tumor infiltrating lymphocytes (TILs) in gastric cancer patients.

BACKGROUND/AIMS: Tumor infiltrating lymphocytes (TILs), recognized as a tumor-host reaction, have been linked to prognosis in various tumors, with a clear positive correlation between the density of the lymphoid infiltrate at the advancing margin of the tumor and the prognosis of the patients. TILs are somewhat activated by tumor associated antigens and by IL-2 endogenous release. The aim of this study is to verify if subcutaneously administered IL-2 is able to enhance TILs in gastric cancer patients and is able to influence the prognosis of the patients. METHODOLOGY: We enrolled 39 consecutive patients with gastric adenocarcinoma. Patients were randomized to be treated with surgery alone (control group, 20 patients) or with surgery plus preoperative IL-2 (Interleukin-2) administration (treated group, 19 patients). Total lymphocytes, CD4 and CD4/CD8 were evaluated pre- and postoperatively. Peritumoral stromal reaction, neutrophils, lymphocytes and eosinophils infiltration in tumor histology were evaluated as well as survival curves and compared between the groups. RESULTS: IL-2 treatment was safe and well tolerated, and in the IL-2 treated group a significant increase over the baseline pretreatment values of the total lymphocyte, CD4 and CD4/CD8 on both the 14th and 50th postoperative days was observed (p < 0.05). Peritumoral stromal reaction, neutrophils and eosinophils infiltration did not shown any statistical difference between the two groups. Otherwise we observed a statistically significant difference in the peri- and intratumoral lymphocytes infiltration between IL-2 treated and control patients (p = 0.000026). Median overall and disease-free survivals were longer, even if not significantly, in the IL-2 group than in the control arm (p = 0.089 and p = 0.09 respectively). CONCLUSIONS: Our data shows that IL-2 seems to be able to induce substantial changes in the inflammatory infiltration of the neoplasm, improving the host activity toward the tumor and enhancing the TILs phenomenon in gastric cancer patients. This feature seems to improve the prognosis of the patients.

Adenocarcinoma↗

PubMedDate not supplied

Operative and long-term results after one-stage surgery for obstructing colonic cancer.

BACKGROUND/AIMS: To analyze retrospectively the operative results and five-year survival after single-stage resection and primary anastomosis for right- or left-sided colonic malignant obstruction. METHODOLOGY: From 1994 to 2002, 83 patients with acute obstruction due to primary cancer underwent a one-stage procedure, 36 (43.3%) for cancer of the right and 47 (56.7%) of the left colon. Of the 47 patients with left acute obstruction, 45 were treated with intraoperative colonic on-table lavage for decompression and wash-out before resection and anastomosis. Long-term survival was compared with the outcome of 369 patients with colonic cancer without obstruction 144 (39%) right and 225 (61%) left. RESULTS: Overall operative morbidity and mortality were 25.3% and 6%, respectively. Overall anastomotic leakage rate was 6%. Kaplan-Meier curves showed five-year survival rates poorer for patients operated on for obstructing malignancy than those observed for patients without obstruction (p=0.0001, Log-Rank test), obstructing malignancy was associated with more advanced age (p<0.0005) and staging of the cancer. CONCLUSIONS: One-stage resection and primary anastomosis can be applied to the majority of patients with malignant colonic obstruction and it allows achieving excellent operative results. Obstructing colonic cancer proved to be associated to a worse long-term survival.

Adenocarcinoma↗