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V Speranza

Publications and source records attributed to V Speranza.

At least 19 recordsLinked to original sources
PubMed1995

[Risk factors for recurrence of Crohn disease after intestinal resection].

From 1965 to 1990, postoperative risk factors (age, sex, preoperative history of CD, initial location of CD, length of affected intestinum, extent of bowel resection) for recurrence of Crohn's Disease (CD) were retrospectively analysed from data of 172 patients (104 men, 68 women; age 14 to 65 yrs.) with primary bowel resection and compared with the international literature. The mean follow-up interval was 10 (1-21) years. Additionally full thickness biopsies from resection margins of 66 consecutive ileocecal specimen (45 men, 21 women; age 21-70 years) with ileitis were studied, histopathologically classified into 3 groups and correlated with the rate, manifestation and onset of early recurrence. The cumulative CD recurrence rate was 69% after 10 years and 86.4% after 15 years. There was no statistically significant correlation between recurrence rate and age, sex, initial location or extent of bowel resection, only an higher rate with an preoperative duration of CD longer than 5 years (p < 0.05). The histopathology of the ileocecal resection specimen showed no statistically significant differences of the recurrence rate within the 3 groups. Surgery cannot minimize the recurrence rate of CD after resection but do clearly improve the quality of life.

Adolescent↗
PubMed1995

["Occult" carcinoma of the thyroid: clinical, morphological, and biologic characteristics for a correct therapeutic regime].

The "occult" carcinoma of the thyroid is still a highly controversial topic. The controversies not only regard its diagnosis, treatment, natural history and, therefore, its biological potential, but also aspects of a nosological nature in that there is still no unequivocal acceptance of its originality, thus leading to discussions focused on its precise definition. On the basis of our experience and other published data, we have reached the following conclusions: a) the term "occult" carcinoma of the thyroid must be used to describe a neoplasia which does not exceed 1.5 cm in diameter, irrespective of the presence or otherwise of laterocervical adenopathy, and leaving aside the fact that it can be identified using clinical and instrumental tests; b) high-resolution echography and echo-guided FNA are fundamental instruments for a correct and early preoperative diagnosis; c) the clinical, morphological and, above all, biological (a very slowly evolving neoplasia) characteristics make the occult carcinoma of the thyroid seem to be a tumour with its own nosological identity; d) on the strength of the latter, and in particular in view of its natural history, conservative surgery (lobectomy with isthmectomy), in the differentiated forms, might play a primary role in the treatment of occult carcinoma of the thyroid in the very near future. However, at present complete thyroidectomy represents the treatment of choice even in differentiated forms, whereas lobectomy is only reserved for incidental cases of occult carcinoma discovered during the final histological test; e) lymphadenectomy is indicated in the event of lymph node involvement, not to achieve a longer survival rate but to reduce the incidence of recidivation in the form of lymph node metastases. In these cases, even the mere removal of macroscopically damaged lymph nodes is sufficient to ensure the virtual absence of recidivation on which, it is worth noting, metabolic radio-iodotherapy is efficacious in the large majority of cases.

Adult↗
PubMed1994

[Anorectal functional study. The state of the art].

Disturbances of anal continence and evacuation are frequent. Numerous techniques are now available to measure anorectal function. There is also a better understanding of the anatomy and physiology of the pelvic floor which has a major role in anorectal function. ANORECTAL MANOMETRY. Manometry of the anal canal is an index of the resistance of sphincters to the passage of faeces. Resting pressure is due mainly to the internal anal sphincter whereas voluntary contraction is due mainly to the external anal sphincter. Anorectal manometry is essential in measuring the length of the anal canal and in establishing the presence of the rectoanal inhibitory reflex. Several techniques are employed to evaluate anorectal manometry which is useful in the investigation of patients with faecal incontinence and constipation. PUDENDAL LATENCIES: Pudendal latencies are valuable in the study of the innervation of the external anal sphincter. Pudendal latencies are measured thanks to the stimulation of the S2-S4 nerves lying in the proximity of the ischial spine through the use of a special glove (St Mark's glove). Prolonged pudendal latencies are typical of neurogenic faecal incontinence but it can be brought about by childbirth, rectal prolapse, obstructed defecation and old age. ELECTROMYOGRAPHY. Electromyography is useful in the study of the function of the pelvic floor. This technique can be performed with single fibre needles which make it possible to measure the action potentials and the fibre density of the muscular fibres. Fibre density is raised in neurogenic faecal incontinence and the action potentials are polyphasic in this condition. Concentric needles are employed to map the anal sphincters and this is useful for evaluating the extent of the damage caused by traumatic events like a third degree tear. ANAL ENDOSONOGRAPHY. Anal ultrasound is very effective in the study of the morphology of the anal sphincters and it requires a rectal probe fitted with a 7-MHz transducer. It is as accurate as electromyography in evaluating the damage to the anal sphincters but it is not painful and it is more acceptable to the patient. DEFECOGRAPHY. This radiological test is a dynamic study of the pelvic floor during defecation. It is very useful for investigating the function and the morphology of the rectum and the pelvic floor during defecation. Important parameters like: the anorectal angle, the opening of the anal canal, the position of the pelvic floor and the descent of the perineum can be evaluated with this test. Defecography is useful in the study of patients with rectal prolapse and constipation. CONCLUSION. All these tests provide extremely useful information on the pelvic floor and are reproducible. They can be of great help in evaluating patients with pelvic floor disorders but they are no substitute for clinical judgement.

Anal Canal↗
PubMed1994

[The role of intraoperative echography in laparoscopic cholecystectomy].

On the basis of recent technological improvements, the laparoscopic approach has become the method of choice during cholecystectomy. This surgical procedure, however, needs that cholangiography be performed simultaneously to better define the anatomy of the biliary ducts and the possible presence of choledochus stones. The use of intraoperative US during cholecystectomy is nowadays advocated for the unquestionable advantages offered by this technique--i.e., its non-invasiveness, high spatial resolution and no need of contrast agent administration. In this study, we examined 30 patients with cholelithiasis who underwent laparoscopic cholecystectomy and were submitted to endolaparoscopic US besides routine intraoperative cholangiography. In all cases, both techniques allowed optimal visualization of the biliary tree, clearly demonstrating choledochus stones in 2 cases. Intraoperative US proved to be more accurate in two cases. In one case which was positive at intraoperative cholangiography, the method allowed the biliary duct filling defect to be referred to an artifact caused by the presence of an air bubble. In another case, the lack of opacification of the hepatic ducts at cholangiography was referred, after US, to extrinsic gallbladder compression. US also allowed the adjacent parenchymal organs, such as the liver and the head of pancreas, to be studied. A limitation of this technique was represented by the difficult assessment of the choledochus in the patients with anatomical abnormalities or adhesions of the intestinal loops of the upper abdomen. In conclusion, endolaparoscopic US proved to be a reliable technique in the intraoperative study of the biliary ducts and can be considered as a procedure complementary to intraoperative cholangiography.

Biliary Tract↗
PubMed1994

[Intraoperative digital cholangiography during laparoscopic cholecystectomy interventions].

In the last years, laparoscopic cholecystectomy has become the method of choice in the surgical treatment of gallbladder stones. Recently, the same laparoscopic approach has been used to remove choledochus stones. This surgical procedure needs the accurate intraoperative study of the biliary tree with diagnostic imaging modalities to better define the anatomy of the biliary ducts and the possible presence of choledochus stones. To this purpose, transcutaneous and endolaparoscopic US with dedicated probes and intraoperative cholangiography can be performed. In this study, we performed 30 laparoscopic cholecystectomies during which all the patients were submitted to intraoperative cholangiography with a digital fluoroscopic unit. The maneuvers for catheter insertion in the cystic duct and the examination as a whole took 3 to 5 minutes. Intraoperative cholangiography demonstrated choledochus stones in 3 patients, while preoperative US detected them in 2 patients only. In 8 cases the dynamic study, carried out with digital image acquisition, allowed to refer the biliary duct filling defects to artifacts caused by the presence of air bubbles. In conclusion, intraoperative cholangiography, also during endolaparoscopic cholecystectomy, plays a major role in the surgical assessment of the biliary tree. When the procedure was performed with a digital fluoroscopic unit, its diagnostic accuracy was higher and the images on the TV monitor were better visualized.

Cholangiography↗
PubMed1993

Plasma opioid levels during extracorporeal gallstone lithotripsy.

Plasma levels of beta-endorphin (beta-EP), met-enkephalin (met-ENK), ACTH, cortisol, and prolactin were measured in 20 patients who underwent extracorporeal gallstone lithotripsy (ESWL) before the treatment, at 500 shock waves (SW) (15-20 min), at 1000 SW (40-50 min), and 10 min after the end of ESWL. According to the Visual Analog Scale, nine patients had no pain, seven patients had pain from level 1 to 5, and four patients had pain from 5 to 10. No complications were observed. Plasma beta-EP values increased during the treatment, both in patients without pain and in those with pain. Only in the former group was the increase significant (baseline values (pmol/L): no pain = 4.04 +/- 1.3; pain 1-5 = 3.6 +/- 1.06; pain 5-10 = 2.9 +/- 0.5. Peak values: no pain = 6.6 +/- 1.2 (p < 0.005); pain 1-5 = 4.6 +/- 2.5; pain 5-10 = 4.5 +/- 2.2). Moreover, a negative correlation between beta-EP levels and individual pain scores during ESWL has been observed (CC = -0.64, p < 0.003). Plasma met-ENK levels reached the peak at 1000 SW and declined 10 min after the end of the treatment, although they were always higher than basal values (baseline values (pg/ml): no pain = 45 +/- 12; pain 1-5 = 38 +/- 10; pain 5-10 = 48 +/- 8. Peak values: no pain = 112 +/- 42 (p < 0.005), pain 1-5 = 114 +/- 48 (p < 0.005), pain 5-10 = 85 +/- 10 (p < 0.005). This behavior has been the same, regardless of the presence or absence of pain. We conclude that during ESWL, a rise of beta-EP and met-ENK occurs, and the increase of the former can be responsible for induction of analgesia because of its inverse correlation with pain intensity.

Adolescent↗
PubMed1993

[Trends in the incidence of acute appendicitis in Italy during the past 30 years].

The incidence and mortality rate of acute appendicitis for the years 1955 and 1987 were calculated on the basis of data used by ISTAT. In 1955 the incidence was 5.7 per 1000 whereas in 1987 this had fallen to 3.7 per 1000. In both years examined there was a prevalence of females (in 1987 females accounted for 4.3 per 1000 in comparison to 3 per 1000 recorded for for males). In 1987 the lowest incidence was recorded in the over 60 years olds, whereas the highest incidence was in males between 1 and 14 years old (7.57 per 1000) and females between 15 and 24 years old (12.17 per 1000). Mortality diminished from 0.42% in 1955 to 0.05% in 1987. The highest rate of mortality was recorded in those patients over 60 years old (1.5%).

Acute Disease↗
PubMed1992

Serum neuron-specific enolase in diagnosis and follow-up of gastrointestinal neuroendocrine tumors.

Neuron-specific enolase (NSE), the glycolytic isoenzyme of the enolase gamma-gamma dimer, is a specific marker for the diffuse neuroendocrine system and derivative tumors (NET). Serum levels of NSE were measured in 39 patients with NET of the gastrointestinal tract (including 3 gastric and 13 intestinal carcinoid tumors, 6 gastrinomas, 3 insulinomas, 1 glucagonoma, 2 mixed islet cell tumors, 11 neuroendocrine pancreatic carcinomas), in 15 healthy subjects and in 15 nonendocrine gastric, pancreatic, and intestinal tumors. Thirty-six of the 39 patients had elevated circulating levels of NSE, 2 insulinomas and 1 gastrinoma had values below 12 ng/ml like healthy subjects and nonendocrine tumors. No significant difference of serum NSE was found between 23 'functioning' and 16 'nonfunctioning' NET. Fourteen of the NET were malignant, and NSE circulating values were significantly higher than those of nonmalignant forms. After curative surgery serum NSE decreased significantly. NSE can be considered a reliable marker in the differential diagnosis between endocrine and nonendocrine neoplasms, in the clinical detection of silent endocrine tumors and in the follow-up of NET.

Adolescent↗
PubMed1990

Early complications after surgery for Crohn's disease.

A group of 212 patients operated upon for Crohn's disease were studied and the early postoperative complications with related problems were assessed. The morbidity was 28.3 per cent, 60 patients had at least one complication, mainly of septic nature. The mortality was 3.3 per cent (7 patients), sepsis and deep vein thrombosis with pulmonary embolism were the most common causes of death. Postoperative complications were significantly higher (39.7%) (p less than 0.001) in patients with a pre-operative nutritional deficit and in those who had urgent surgery (44.4%) (p less than 0.001). Among patients with pre-operative sepsis, the morbidity was also higher (34.6%), but was not significant. Peri-anastomotic complications (dehiscence, abscess, fistula, bleeding) were apparently more frequent (45.4%) in patients with histological residual Crohn's disease at macroscopically free resection margins although this contrasts with previous series. A proper pre-operative diagnostic approach, adequate peri-operative protein-caloric repletion, antibiotic therapy, prevention of thromboembolism and elective surgery, are still the primary tools in reducing the morbidity and mortality after surgery for Crohn's disease.

Adolescent↗
PubMed1989

Heterotopic gastric mucosa of the rectum--characterization of endocrine and mucin-producing cells by immunocytochemistry and lectin histochemistry. Report of a case.

Heterotopic gastric mucosa in the rectum is particularly uncommon; only 23 cases have been reported to date. Moreover, no studies have been done on the neuroendocrine apparatus and glycoprotein production of the heterotopic mucosa. This study reports on a 13-year-old boy, admitted with rectal bleeding and persistent tenesmus. An ulcerative lesion was found on colonoscopy; biopsies revealed a fundic-type gastric tissue. Medical therapy (H2-blockers) promptly healed the rectal ulcer; surgical excision of the heterotopia was performed with complete and permanent relief of symptoms (3-year follow-up). Immunocytochemistry (PAP) revealed 5-Ht and somatostatin cells in the gastric-type mucosa, as in the normal human stomach. These cells also were present in the surrounding rectal epithelium where PYY-enteroglucagon cells were detected, which were absent in the heterotopic tissue. Mucin histochemistry showed PAS-positive cells also strongly stained by LA lectin in the heterotopic tissue, differentiating the rectal epithelium that remained unstained. Therefore, the morphofunctional status (endocrine cells and mucins) of the gastric heterotopia was almost identical to its orthotopic counterpart, confirming the hypothesis that endocrine cells and mucin-producing cells differentiate their metabolic products according to the anatomic and functional activity of the epithelium where they grow.

Adolescent↗
PubMed1989

[Recurrence after intestinal resection for Crohn's disease].

Although recurrence is one of the major problems in the surgical management of a patient with Crohn disease, the factors that influence recurrence rate remain controversial. To elucidate some of this controversy, the records of a consecutive series of 100 patients, who underwent resectional surgery for Crohn's disease, were analyzed to evaluate the effect of several clinical and histologic features on the recurrence rate. In this study, recurrence was defined as clinical and or laboratory findings of re-emergent disease confirmed by objective means after resection of all lesions. Recurrence rate seems lower in colitis than ileitis or ileocolitis, but this data did not reach statistic significance; the site of recurrence was conditioned by the initial location of the disease and the extent of resection into healthy tissue above and below the lesions and the histological findings of section lines did not modify the risk of recurrence. In conclusion the recurrence is almost inevitable. The multifactorial aspect of the recurrence cannot be ignored, however some clinical factors were more closely related to the recurrence. A part from Crohn's colitis, type of surgery (radical vs limited resection) had little chance of minimizing the risk of recurrence.

Actuarial Analysis↗
PubMed1989

Small bowel angiodysplasia in association with Crohn's ileitis. A case report.

A case of a female patient affected by Crohn's ileitis associated with small bowel angiodysplasia is reported. Despite a good clinical and laboratory response to steroid therapy the patient showed an unexplained hypochromic microcytic anemia. At laparotomy Crohn's ileitis as well as an angiodysplastic lesion were found. Both lesions were resected in continuity. During a 2-year follow-up the patient did not show anemia despite pregnancy. It is suggested that the angiodysplastic lesion was the possible cause of hypochromic anemia and that the patient should have been operated on before, based on her recurrent anemia.

Adult↗
PubMed1989

[Pharmacokinetics of the biliary excretion of some chemotherapeutic agents in patients with biliary disease].

The authors have assessed the concentration of 7 antibiotics in the bile of patients undergoing biliary surgery or carriers of a T tube in the common bile duct. 1 hour preoperatively, 122 patients were administered with the following chemotherapeutic agents: Cefoxitin 2 g i.v.; Cefamandole 2 g i.v.; Ceftriaxone 1 g i.v.; Clindamycin 600 mg i.v.; Amikacin 500 mg i.v.; Gentamycin 160 mg i.v.; Norfloxacin 400 mg by mouth; 30 patients showed obstructive jaundice or obstructed cystic duct. Samples of bile were withdrawn from gallbladder and common bile duct. The same antibiotics were administered to 81 patients carrying a T tube. Samples of bile and serum were collected at baseline and every 30 minutes for 4 hours and subsequently at 12 and 24 hours following administration. 18 patients showed altered liver function tests. The chemotherapeutic agents were tested by the microbiological assay as well as by HPLC. Mean concentration in the gallbladder bile was: Cefoxitin 209 +/- 86 micrograms/ml; Cefamandole 436 +/- 108 micrograms/ml; Ceftriaxone 482.7 +/- 214.84 micrograms/ml; Clindamycin 64 +/- 22 micrograms/ml; Amikacin 5 +/- 1.4 micrograms/ml; Gentamycin 4 +/- 2 micrograms/ml; Norfloxacin 22 +/- 14 micrograms/ml. In the bile of jaundiced patients or with non-visualized gallbladder no antibiotics were detected.(ABSTRACT TRUNCATED AT 250 WORDS)

Anti-Bacterial Agents↗
PubMed1988

Neuroendocrine innervation of the hepatic vessels in the rat and in man.

An extensive array of nerve fibers ramify around the afferent blood vessels of the liver and the extrahepatic and intrahepatic biliary pathways, and are thought to be involved in regulation of blood flow. Although the role of sympathetic innervation is established, little is known about the location or role of regulatory peptidergic innervation in the liver. We examined the anatomic distribution of a wide variety of regulatory peptides and several neural antigens by in situ immunohistochemistry in the rat and in man. A rich peptidergic plexus of nerve fibers and ganglion cells was observed around the arterial vessels in both species, with intense immunoreactivity for neuron-specific enolase, neurofilaments, neuropeptide Y, substance P, and vasoactive intestinal polypeptide. S-100 protein immunoreactivity was seen principally in large nerve bundles, suggesting that the majority of nerves in this area were unmyelinated. In contrast, the portal vessels revealed very little peptidergic innervation. No staining was observed with antibodies directed against insulin, glucagon, gastrin, serotonin, met-enkephalin-Arg-Gly-Leu, cholecystokinin, or growth hormone. These findings indicate the presence of a rich, although selective, peptidergic plexus surrounding afferent hepatic blood vessels. This plexus may play an important role in regulation of hepatic blood flow.

Animals↗