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V Perri

Publications and source records attributed to V Perri.

71 records · Page 4Linked to original sources
PubMedDate not supplied

Treatment of "obstructive" pain by endoscopic drainage in patients with pancreatic head carcinoma.

Obstruction of the main pancreatic duct with secondary upstream ductal hypertension is one cause of pain in patients with pancreatic cancer. Pancreatic endoscopic stenting and decompression of the pancreatic duct have been effective in the treatment of pain secondary to chronic calcifying pancreatitis and in one case of pancreatic cancer. We describe eight patients with unresectable cancer of the pancreatic head associated with upstream dilatation of the pancreatic duct and severe pancreatic "obstructive"-type pain (correlation with meals and pain radiation to the back) in which a pancreatic stent was inserted across the neoplastic stricture. No mortality was associated with the procedure. All patients but one were free of pain within 48 hours after endoscopic pancreatic stenting, and all discontinued narcotics. Mean survival time was 165.5 days (range, 26 to 575 days). Six patients were still without symptoms, whereas two had a painful relapse a few days before death. No clinical evidence of pancreatic clogged stent was observed during follow-up. Endoscopic pancreatic drainage is a safe and effective way of controlling cancer pain in selected cases and should be considered as a further therapeutic option in these patients.

Aged↗
PubMedDate not supplied

Insulin adsorption to three-liter ethylen vinyl acetate bags during 24-hour infusion.

Insulin adsorption to ethylen vinyl acetate, 3-liter bags injected with 10 insulin units, during 24-hr infusion has been studied. Three different infusions systems (A, B, and C) were tested and eight bags for each system were used. An elevated insulin adsorption resulted in each system. The maximal insulin recovery, expressed as percentage of the original theoretical 3333 microIU/ml insulin concentration, was 19.54% (at time 6), 20.93% (at time 4), and 16.95% (at time 22) for system A, B, and C, respectively. "Dismissed insulin amount" after 24-hr infusion was 1590 +/- 279.5 microIU, 1505.8 +/- 430.5 microIU, and 1253.3 +/- 369.8 microIU for system A, B, and C, respectively. Comparison of insulin concentration values at different times revealed significant differences only at time 18 (if compared with times 0,2.4,6,8,12,14,16) ant at time 20 (if compared with time 4,6,8,10) for system A, and at time 4 (if compared with time 12,14,16,18,20,22,24) for system B. We conclude that a constant but low insulin delivery can be achieved using 3-liter EVA systems and a 24-hr infusion.

Adsorption↗
PubMedDate not supplied

Stomach cancer: a study of 117 consecutive resected cases and results of R2-R3 gastrectomy.

In a consecutive series of 175 patients with gastric carcinoma, 66.8% underwent gastric resection: 74 total gastrectomies with R3 lymphadenectomy and 43 distal subtotal gastrectomies with R2 lymphadenectomy were performed. 73% (86 cases) of resective procedures proved to be "absolute curative" according to Japanese criteria (JRSGC). Nodal involvement was present in 62 out of 117 resected patients (52.9%): 29.9% N1, 9.4% N2, 13.6% N3; a significant relationship (p = 0.012) between depth of invasion of the gastric wall and lymph node metastases was revealed. The hospital mortality after R2-R3 gastrectomy was 4.2%, major surgical complications occurred in 6.8% of cases. The actuarial 5-year survival after curative resection was 59%. The results suggest that extended lymphadenectomy (R2-R3 gastrectomy) is justified in the surgical treatment of gastric cancer; this procedure can be safely performed and permits "absolute curative" resections in a remarkable percentage of cases.

Actuarial Analysis↗
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Diagnostic and therapeutic ERCP in patients with Billroth II gastrectomy.

Diagnostic and therapeutic endoscopic cholangio- pancreatography (ERCP) are more difficult in patients with Billroth II gastrectomy. A six-year experience including 274 ERCP in 175 Billroth II patients is reviewed. Overall diagnostic success-rate was 88.3% while a complete endoscopic treatment could be accomplished in 92.8% when indicated. Endoscopy related morbidity and mortality were 5.1% and 0 respectively, while in-hospital mortality was 2.3%. Diagnostic and therapeutic ERCP techniques in Billroth II patients are then discussed with special reference to the choice of the scope and of the accessories to perform a safe endoscopic sphincterotomy. The use of the lateral-viewing duodenoscope and of the long-nose sigmoid inverted sphincterotome (originally modified by our group) are emphasized. ERCP and endoscopic sphincterotomy in Billroth II subjects are today as safe and nearly as effective as in the non-gastrectomized patient.

Adult↗
PubMedDate not supplied

Endoscopic diagnosis and treatment of malignant biliary strictures: review of 505 patients.

The role of ERCP and endoscopic drainage in the diagnosis and treatment of patients with malignant biliary obstruction is well established. Endoscopic drainage is an effective therapy for palliation of malignant obstructive jaundice and does not preclude definitive treatment in appropriate candidate. We report our experience, in a retrospective review, of 505 patients with malignant biliary obstruction. In this series, endoscopic biliary drainage is shown to be safe and effective management for these patients. Relief of obstruction was obtained in a large majority of patients with a low, procedure related, morbidity and mortality. We conclude that ERCP, to diagnose and localize obstructive lesions, followed by endoscopic biliary drainage can be strongly considered in all patients with suspected malignant obstructive jaundice.

Adolescent↗
PubMedDate not supplied

Carcinoma of the pancreatic head area. Therapy: nonoperative biliary drainage for palliation.

Jaundice is the dominant symptom in patients with biliary obstruction from carcinomas of the pancreatic head area. The many symptoms usually associated to prolonged biliary stasis (malnutrition, coagulopathy, pruritus hepatocellular failure, renal dysfunction, angiocolitis) is commonly resolved or relieved by biliary drainage. Palliation is frequently the only feasible treatment in these patients due to the biological aggressiveness of these tumors characterized by the early infiltration of adjacent tissues. Endoscopic and percutaneous procedures of biliary recanalization are as effective as those of surgical palliation, are more comfortable to the patients and burdened with a lower morbidity and mortality. In selected patients, palliation of jaundice can be combined with intraluminal radiotherapy or pancreatic drainage the latter aimed at the relief of the "obstructive" pain present in some patients with carcinoma of the area of the head of the pancreas.

Combined Modality Therapy↗
PubMedDate not supplied

[Dispersion of QT interval in arterial hypertension with left ventricular hypertrophy].

QT interval dispersion (QTD) is considered to reflect the inhomogeneity of ventricular repolarization. Increased QTD has been shown to be positively correlated to complex ventricular arrhythmias (CVA) in many clinical conditions. The aim of this study was to assess QTD in arterial hypertension with left ventricular hypertrophy (LVH) and to verify the possible relationship between increased QTD and the presence of CVA in this population. We studied 100 patients with essential arterial hypertension, aged 25-78 years, mean 53. Half of the patients had LVH (group A); LVH was defined as diastolic septal thickness of 1.2 cm or more (by echocardiography). The septum was 1.1 cm or less in the patients without LVH (group B). QTc intervals were measured on the 12-lead surface ECG; QTD was defined as the difference between the longest and the shortest QTc. The presence of Lown class 2 (or more) ventricular arrhythmias on a 24-hour Holter monitoring was considered CVA. In the 100 patients studied, QTD ranged from 10 to 128 ms, mean 43.7 ms. It was longer in group A than in group B; 56.1 ms versus 51.5 ms (mean values). 14 patients in group A had CVA; they had a shorter QTD than patients without CVA: 51.2 ms versus 57.9 ms. In patients with essential arterial hypertension the presence of LVH is positively correlated to increased QTD. Increased QTD however does not seem to be an adjunctive risk factor for CVA in is population.

Adult↗