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V Di Carlo

Publications and source records attributed to V Di Carlo.

At least 19 recordsLinked to original sources
PubMed1992

Octreotide administration in the treatment of pancreatic fistulae after pancreas transplantation.

Among the surgical complications of pancreas transplantation are pancreatic fistulae, which arise rather frequently. Suppression of exocrine secretion with polymers has succeeded in reducing the rate of this complication. Nevertheless, in some instances, pancreatic fistulas may occur. Thirty pancreas transplantations were performed in 27 diabetic patients. In 5 cases a pancreatic fistula occurred and was drained after the insertion of a catheter for the collection of secretions. A serous liquid was collected with a high concentration of amylases (61604 +/- 19562 IU/24 h). Fistula output was 280 +/- 87 ml/24 h. Patients were treated with octreotide, administered subcutaneously in a dose of 300-750 micrograms/day. In all patients a progressive reduction in fistula output was observed after a mean of 16 + 2 days. Fistula flow rate dropped to 24 +/- 10 ml/24 h--a reduction of 95% +/- 5% and drainage was subsequently stopped. Sonographic follow-up did not show recurrence of peripancreatic collections in these patients. All patients were insulin-independent up to 12-44 months after surgery.

Adult↗
PubMed1992

Human islets chronically exposed in vitro to different stimuli become unresponsive to the same stimuli given acutely: evidence supporting specific desensitization rather than beta-cell exhaustion.

The aim of this study was to evaluate the effects of long term in vitro exposure of human pancreatic islets to different secretagogues on their subsequent secretory activity. Therefore, groups of 100 islets were cultured for 48 h in standard tissue culture medium (CMRL 1066) in the presence of 1 of the following: 5.5 mmol/L glucose, 16.7 mmol/L glucose, 5.5 mmol/L glucose plus 10 mmol/L L-arginine, or 5.5 mmol/L glucose plus 100 mumol/L tolbutamide. Insulin levels in the culture medium declined with time under all culture conditions. Islets were then perifused and acutely stimulated with glucose (16.7 mmol/L), L-arginine (10 mmol/L), and tolbutamide (100 mumol/L). Islets cultured in 16.7 mmol/L glucose showed no response to 16.7 mmol/L glucose [net area under the curve (delta AUC), 11% of control], and a reduced response to acute tolbutamide (delta AUC, 35% of control), but responded to L-arginine (delta AUC, 75% of control). Islets cultured in the presence of 10 mmol/L L-arginine had reduced responses to glucose (delta AUC, 11% of control) and tolbutamide (delta AUC, 27% of control), but responded to L-arginine (delta AUC, 75% of control). Islets cultured in tolbutamide did not respond to tolbutamide (delta AUC, 14% of control) and showed a reduced responses to acute glucose (delta AUC, 36% of control) and L-arginine (delta AUC, 24% of control). In a second set of experiments, islets cultured in 5.5 or 16.7 mmol/L glucose showed an insulin response to a supramaximal glucose stimulation (30 mmol/L glucose plus 0.5 mmol/L isobutylmethylxanthine) that was not statistically different. Similarly, islets that were cultured in the presence of 100 mumol/L tolbutamide still responded to 1 mmol/L tolbutamide. In conclusion, all stimuli evaluated in this study, chronically applied, reduced the insulin response to further acute stimulations. The different patterns of unresponsiveness observed together with the finding of a preserved insulin content in the islets after perifusions and a maintained capability to release insulin in response to supramaximal stimulations suggest that after chronic exposure to different stimuli, human islets become selectively desensitized to the same stimuli given acutely and do not become exhausted.

Arginine↗
PubMed1992

Liver resection for hepatocellular carcinoma in cirrhotic patients.

The results of a multicentric retrospective analysis of 265 liver resections for hepatocellular carcinoma in cirrhotic patients have been collected and assessed. Overall operative mortality was 9.1%. The actuarial 3-year survival was 46.5%. Better results were obtained in patients with encapsulated lesions and alphafetoprotein levels less than 400 ng/dl. Tumoral recurrence, which was the main cause of late death, was related to alphafetoprotein higher levels and to the type of surgery performed: tumor resection with short tumour free margin had the highest recurrence rate. Results were significantly better in those centers where intraoperative ultrasonography was systematically employed.

Adult↗
PubMed1992

[The usefulness of dietetic supplementation in feeding after gastric and pancreatic surgeries].

We evaluated the efficacy of an oral artificial supplementation in 22 patients who underwent surgery for gastric or pancreatic cancer. From 8th to 14th postoperative day, 11 patients (cases) received a diet consistent in their REE, and an oral integrator (40% of REE); controls received only the diet. On 7th and 15th day, nutritional and anthropometric parameters were evaluated, and bioelectrical impedance analysis (BIA) was performed to assess body composition. The dietary caloric input was similar in cases (1154 kcal, 86.0% of REE) and controls (1393 kcal, 92.3% of REE). Due to the integrator, cases reached 121.4% of REE (p less than 0.001). The nutritional and anthropometric parameters studied did not show significant variations in the two groups, but BIA showed a decrease of fat mass in controls with respect to cases (p less than 0.02). Our results demonstrate that the oral artificial supplementation was well tolerated, and did not reduce food intake, but induced a significant increase of total caloric input.

Adult↗
PubMed1992

Association between perioperative blood transfusion and postoperative infection in patients having elective operations for gastrointestinal cancer.

OBJECTIVE: To assess the effect of blood transfusion on the development of infection after elective operations for gastrointestinal and pancreatic cancer. DESIGN: Prospective open study. SUBJECTS: 285 consecutive patients admitted with gastric, colorectal, and pancreatic cancer, 215 of whom were suitable for the study. MAIN OUTCOME MEASURES: Sex, age, total iron binding capacity, measurement of haemoglobin and serum albumin concentration, assessment of immune response by delayed hypersensitivity skin test, and weight loss were recorded, as were duration of operation, operative blood loss, and pathological TNM stage of the disease. RESULTS: Sixty patients (28%) developed infections postoperatively. Univariate analysis showed that the development of infection was significantly associated with the amount of blood transfused (p < 0.001), operative blood loss (p < 0.05), and length of operation (p < 0.01), but not weight loss (p = 0.07) or delayed hypersensitivity response (p = 0.08). Multiple logistic analysis showed that blood transfusion was a significant independent variable only when more than 1,000 ml were transfused (odds ratio 6.5, p < 0.05). CONCLUSION: Transfusion of more than 1,000 ml of blood is an independent risk factor in the development of infection postoperatively in patients undergoing operations for gastrointestinal cancer.

Adult↗
PubMed1992

[Perioperative administration of thymopentin for the prevention of infections in oncologic surgery].

The efficacy of thymopentin in reducing postoperative infections (PI) was prospectively evaluated in 138 patients with abdominal cancer, who underwent major surgery. Comparable subsets of patients were obtained according to age (cutpoint 65 years) and nutritional status (patients with serum albumin less than 30 g/l or weight loss greater than or equal to 10% with respect to their usual body weight were considered as malnourished). Patients were then at random attributed to a control group and to a thymopentin receiving (Thy) group, in the latter thymopentin (50 mg) was given three times before surgery and three times after operation. All patients received perioperative short term antibiotic prophylaxis and postoperative parenteral nutrition. The severity of Pl was expressed by the sepsis score which was calculated on all those patients developing Pl. Overall complication rate was 26.3% in the control group and 20.3% in the Thy group (p ns). Surgical-related infections occurred in 14 (20.3%) control group patients and in 10 (14.5%) Thy group patients (p ns). The average sepsis score was 10.11 +/- 6.69 in control group (2 patients died) and 6.85 +/- 3.80 in the Thy group (all patients survived) (p less than 0.05). By considering the elderly patients, a reduction in both Pl rate and the average sepsis score was observed in Thy group. Otherwise, no difference was observed in the young patients. Our data suggest that Thymopentin is useful in reducing both the incidence and the severity of Pl in elderly patients.

Adult↗
PubMed1991

Hepatocellular carcinoma in Italian patients with cirrhosis.

BACKGROUND AND METHODS: Patients with cirrhosis of the liver are recognized as being at risk for hepatocellular carcinoma. The magnitude of the risk, the natural history of this disease, and the possibilities for detecting potentially curable tumors in patients in the Western world are unknown. To address these questions, we examined 447 Italian patients with well-compensated cirrhosis (which was of viral origin in 62 percent of them) from 1985 through 1990, performing serum alpha-fetoprotein assays and real-time ultrasonography every 3 to 12 months. RESULTS: Hepatocellular carcinoma was found in 30 patients (7 percent) at base line and in another 29 patients (7 percent of 417 patients free of tumor at base line) during follow-up periods averaging 33 months (range, 1 to 48). The cumulative hazard of the development of hepatocellular carcinoma during follow-up was higher among patients with persistently elevated serum alpha-fetoprotein levels (12 with tumors among 42 with such levels) than among those with fluctuating levels (11 among 82) or those with consistently normal levels (6 among 255). Only 17 patients had potentially operable tumors. The proportion of potentially operable tumors among those detected during follow-up was significantly lower than the proportion at enrollment (4 of 29 vs. 13 of 30, P = 0.027). The survival at one year of the 12 patients who underwent surgery was 67 percent, and the tumor-recurrence rate was 60 percent. Outcome was not appreciably different for the five patients who refused surgery. CONCLUSIONS: In the West, as in Asia, patients with cirrhosis of the liver are at substantial risk for hepatocellular carcinoma, with a yearly incidence rate of 3 percent. Our screening program did not appreciably increase the rate of detection of potentially curable tumors.

Adult↗
PubMed1991

[Lymph node localization of gastrinoma. Diagnosis and treatment].

The case of a 48-year old woman with a lymph node localization of gastrinoma is reported. The preoperative workup (US-scan, TC-scan and NMR) made it possible to detect and localize the lesion. A conservative surgical approach was decided according to the latest literature reports which showed a favourable course in patients with lymph node gastrinoma. Surgical resection has been accomplished. The patient's hormone level was normal at one-year follow-up.

Female↗
PubMed1991

[Microbiological analysis of postoperative infectious complications].

A variation among the strains responsible of nosocomial infections was noted in the last years with a revival of Gram + bacteria. Coagulase-negative staphylococci assumed a great importance, particularly those resistant to methicillin. Staphylococcus epidermidis is now an important infective agent, especially in patients with prostheses or other devices. To value the impact of these microbiological variations on surgical patients, we studied data related to 1271 specimens from postoperative septic complication from 1980 to 1988. The incidence of Gram + strains in surgical infections was 46.8% in 1980-1983 period and 59.2% in 1984-1988 period with statistical significance (p less than 0.05).

Bacteria↗
PubMed1991

Diabetic retinopathy after successful kidney-pancreas allotransplantation: a survey of 18 patients.

To investigate the effects of normoglycaemia on diabetic retinopathy, we evaluated 18 uremic diabetic patients before and after successful pancreas kidney transplantation. In all, 12 uremic diabetic patients who submitted to kidney transplantation alone served as the control group; 4 of these subjects received a kidney transplantation alone, whereas 8 underwent a double kidney-pancreas transplantation but lost the pancreas graft within the first few weeks post-surgery. The mean age and the mean duration of both diabetes and dialysis were comparable in the two groups. All patients were studied prior to and at 6 and 9 months after surgery, then at annual intervals. Subjects were divided into three groups according to follow-up: less than 1 year, between 1 and 3 years and greater than 3 years. At each control visit, a complete clinical examination was performed by two independent examinators; retinal fluorescein angiography was carried out as well. The following parameters were evaluated: visual acuity, capillary closure, macular oedema, neovascularization at the disk and elsewhere and vitreous haemorrhage. A score ranging from -2 to +2 was assigned to each parameter for quantification of the variation between baseline values and those obtained at the end of the follow-up. This score was assigned by two different ophthalmologists. Eyes that were affected at baseline by end-stage diabetic retinopathy (secondary retinal detachment, neovascular glaucoma) were not entered in the study. A total of 18 eyes were lost to follow-up in the 2 groups because of laser treatment, cataract extraction, anterior ischaemic optic neuropathy and cytomegalovirus retinitis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Pancreas and kidney transplantation: the San Raffaele Hospital (Milan, Italy) experience.

Results of 33 simultaneous pancreas and kidney transplantations performed at the San Raffaele Hospital, Milan, Italy are presented. In 26 cases segmental neoprene duct-injected grafts were transplanted and in seven cases, duodenopancreatic bladder-drained grafts. Five-year patient, kidney and pancreas survival were respectively, 89%, 72% and 58%. Five-year survival in patients with technically successful pancreas transplants was 73%. Thrombosis occurred in 20% of cases. Mortality was 6% and overall morbidity 76%. Surgical complications were present in 51% of cases.

Adult↗
PubMed1991

First peak insulin release after intravenous glucose and arginine is maintained for up to 3 years after segmental pancreas transplantation.

In this study we have investigated blood glucose and serum free insulin response to glucose and to arginine orally or intravenously, 3 months and 3 years after a successful segmental, neoprene-injected, pancreas transplantation. Serum insulin responses to different secretagogues were normal 3 months after transplantation; they remained normal up to 3 years after transplantation.

Arginine↗