262 results on '"Roberto Coppola"'
Search Results
152. Prognostic factors after surgical resection for pancreatic carcinoma
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Roberto Coppola, Gennaro Nuzzo, Aurelio Picciocchi, Riccardo Masetti, Paolo Magistrelli, Antonio Crucitti, Antonio La Greca, and Armando Antinori
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Adult ,Male ,medicine.medical_specialty ,Settore MED/18 - CHIRURGIA GENERALE ,medicine.medical_treatment ,Adenocarcinoma ,Pancreatectomy ,Pancreatic cancer ,medicine ,Humans ,Stage (cooking) ,Survival rate ,Aged ,Proportional Hazards Models ,Retrospective Studies ,Aged, 80 and over ,Univariate analysis ,business.industry ,Proportional hazards model ,Mortality rate ,Retrospective cohort study ,General Medicine ,Middle Aged ,Prognosis ,medicine.disease ,Surgery ,Pancreatic Neoplasms ,Survival Rate ,Treatment Outcome ,Oncology ,Multivariate Analysis ,Female ,business - Abstract
Background and Objectives: Surgical resection offers the only potential cure for pancreatic carcinoma. Several recent series have reported an encouraging increase in 5-year survival rate exceeding 20% and have emphasized the importance of patient selection based on reproducible prognostic factors. The impact on survival of demographic, intraoperative, and histopatologic factors are investigated in this study. Methods: Seventy-three patients with adenocarcinoma of the pancreas, treated at the Department of Surgery of the Catholic University of Rome during 1988-1998, were retrospectively analyzed. Survival data were reviewed, and potential prognostic factors were compared statistically by univariate and multivariate analyses. Results: There was no operative mortality, and the morbidity rate was 37%. Actuarial overall and disease-specific survival rates for all 73 patients were, respectively, 27% and 31% at 3 years and 13% and 21% at 5 years, with a median survival time of 16 months. T stage and nodal status significantly affected survival according to univariate analysis (P = 0.0017 and 0.04). An impact on survival, even if not of statistical significance, was shown for other pathologic or intraoperative factors. Conclusions: T and nodal stage are the strongest independent predictors of survival. Limited intraoperative transfusion, reduced operative time, and clear margins also may play a role, which requires further confirmation in a larger series.
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- 2000
153. Il Trattamento Chirurgico Resettivo Del Carcinoma Pancreatico
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Roberto Coppola, Armando Antinori, Gennaro Nuzzo, Paolo Magistrelli, Aurelio Picciocchi, Antonio Crucitti, and Antonio La Greca
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03 medical and health sciences ,Cancer Research ,0302 clinical medicine ,Oncology ,business.industry ,030220 oncology & carcinogenesis ,Medicine ,General Medicine ,business ,030218 nuclear medicine & medical imaging - Abstract
Aims and background Surgical resection offers the only potential cure for pancreatic carcinoma. Although the overall prognosis remains a dismal, several recent series have reported an encouraging increase in 5-year survival after resection, ex-ceding 20%. As the reasons for this improvement are not clearly understood, numerous clinico-pathological parameters (demographic, intraoperative and histopatologic factors) have been investigated to evaluate their role in predicting long term survival. In this single-institution study, immediate and long-term outcome after pancreatic resection in patients with pancreatic adenocarcinoma was retrospectively evaluated, focusing attention on the possible impact of different clinico-pathologic factors on long-term survival. Methods Sixty-six patients with a confirmed histologic diagnosis of adenocarcinoma of the pancreas, treated by pancreatic resection at the Department of Surgery of the Catholic University of Rome in the years 1988-1997, were retrospectively analyzed. Morbidity and survival data were reviewed and potential prognostic factors were compared statistically by univariate analysis. Results There was no postoperative mortality. Twenty-five patients (38%) developed major operative complications. Pancreatic fistula was the most common complication, and occurred in 7 patients (11%). The actuarial overall and disease-specific survival for all 66 patients were respectively 58% and 59% at 1 year, 27% and 31% at 3 years, and 13% and 20% at 5 years, with a median survival time of 13.4 months. Nodal status was the only single factor significantly affecting survival by univariate analysis. The 3-and 5-year survival rates were respectively 35% and 19% for node-negative patients and 7% and 0% for node-positive patients (P = .04). A positive correlation with improved survival, even if not of statistical significance, was shown for other pathologic or intraoperative factors. Among the former, 5-year survival rates were better for patients with negative resection margins as compared to patients with positive margins (12% vs 7%, P = ns). Among the latter, a better actuarial 5-year survival rate was shown for patients with shorter operative time (4 hours 5%, P = ns) and for patients that received fewer transfusions (0-2 blood units, 14% survival vs 3 or more blood units, 0%; P = ns). Age, gender, tumor diameter and tumor grading showed no influence on survival in this series. Conclusions Our series confirmed that nodal status is the strongest independent predictor of survival. Limited intraoperative transfusion, reduced operative time and clear margins could also yeald a prognostic significance, and require further confirmation in larger series.
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- 1999
154. Major liver resection for non-Hodgkin's lymphoma in an HIV-positive patient: Report of a case
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G. Marasca, Luigi Maria Pio Marino-Cosentino, Aurelio Picciocchi, Roberto Coppola, Maria Elena Riccioni, S. Ciletti, F. Pallavicini, and Luigi Ortona
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Adult ,Male ,medicine.medical_specialty ,Percutaneous ,medicine.medical_treatment ,Diagnosis, Differential ,Lesion ,Surgical oncology ,Laparotomy ,medicine ,Hepatectomy ,Humans ,Lymphoma, AIDS-Related ,business.industry ,Lymphoma, Non-Hodgkin ,Liver Neoplasms ,General Medicine ,medicine.disease ,Surgery ,Lymphoma ,Non-Hodgkin's lymphoma ,Radiology ,Differential diagnosis ,medicine.symptom ,business - Abstract
A very unusual clinical presentation of non-Hodgkin's lymphoma (NHL) of the liver is reported herein. The patient was a 35-year-old male who had been HIV-positive since 1987. Following an episode of acute pain in the right upper abdominal quadrant, ultrasonography (US) and computed tomography (CT) were performed, revealing a nodular tomography (CT) were performed, revealing a nodular lesion, 2.5 cm in diameter, localized in the eight segment of the liver. Despite the fact that the lesion became significantly enlarged over a 6-month period, three repeated percutaneous biopsies proved negative. Finally, his increasing pain and the lack of a definitive diagnosis prompted us to perform a right hepatectomy. The patient had an uneventful postoperative course and is well 1 year after his operation. Establishing a diagnosis of extranodal lymphoma can be difficult, especially in HIV-positive or AIDS patients. Thus, performing a laparotomy is justified to confirm a diagnosis and decide upon the most appropriate treatment. However, in about 10% of these patients, only surgical resection allows for the diagnosis. In accordance with other reports, our experience confirms that, in contrast with AIDS patients, HIV-positive patients have a similar prognosis as non-HIV patients, and are suitable candidates for even major surgical procedures.
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- 1998
155. Assessment of balance abilities in elderly people by means of a clinical test and a low-cost force plate
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Francesco Sgrò, Danilo Licari, Roberto Coppola, Mario Lipoma, Francesco Sgrò, Danilo Licari, Roberto Coppola, and Mario Lipoma
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Balance and mobility assessment, and the estimation of the risk of falls, represent crucial elements for supporting a healthy aging process. In this work, we evaluated the association of two approaches used to estimate standing balance and sit-to-stand abilities in community-dwelling older people. The clinical-based test was the Short Physical Performance Battery, while the laboratory-based assessments were realized by means of output measures obtained with the Wii Balance Board. The correlation between clinical scores and laboratory measures showed poor association for the standing balance test (.05
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- 2015
156. Fast-track pathway after pancreaticoduodenectomy. Specific diet therapy protocols reduces the rate of delayed gastric emptying
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Roberto Coppola, Rossana Alloni, Paolo Luffarelli, GiovanBattista Giorgio, Sergio Valeri, and Sara Emerenziani
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medicine.medical_specialty ,Hepatology ,Gastric emptying ,business.industry ,Diet therapy ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Gastroenterology ,Pancreaticoduodenectomy ,Internal medicine ,Medicine ,Fast track ,business - Published
- 2015
157. Cerebellar Metastasis from Pancreatic Adenocarcinoma
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Roberto Coppola, Carla Rabitti, Giuseppe Tonini, Fabio Ausania, Marco Caricato, Domenico Borzomati, and Garberini A
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Chemotherapy ,Pathology ,medicine.medical_specialty ,Hepatology ,Intracranial tumor ,business.industry ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Gastroenterology ,medicine.disease ,Pancreaticoduodenectomy ,Gemcitabine ,Peritoneal carcinomatosis ,medicine.anatomical_structure ,Medicine ,Adenocarcinoma ,Radiology ,business ,Cerebellar metastasis ,Pancreas ,medicine.drug - Abstract
The first discovery of a cerebellar metastasis of pancreatic carcinoma in a living patient is described. Two years earlier the patient had undergone a pancreaticoduodenectomy for an adenocarcinoma of the head of the pancreas with a lymph node metastasis. After complete surgical removal of the tumor, he underwent adjuvant chemoradiation. Two years later the patient presented with intractable vomiting, which was attributed to peritoneal carcinomatosis. Clinical evaluation revealed an intracranial tumor without signs of pancreatic recurrence. The tumor was surgically removed. One year later the patient developed multiple brain metastases and he is currently undergoing gemcitabine-based chemotherapy.
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- 2006
158. Analysis of complications of endoscopic sphincterotomy for biliary stones in a consecutive series of 546 patients
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Maria Elena Riccioni, L. Cosentino, Aurelio Picciocchi, Paolo Magistrelli, Claudio Coco, Roberto Coppola, and S. Ciletti
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Perforation (oil well) ,Gallstones ,Sphincterotomy, Endoscopic ,Risk Factors ,Internal medicine ,medicine ,Humans ,Aged ,Retrospective Studies ,Aged, 80 and over ,Cholangiopancreatography, Endoscopic Retrograde ,business.industry ,Middle Aged ,Hepatology ,Prognosis ,medicine.disease ,Surgery ,Evaluation Studies as Topic ,Biliary tract ,Cholecystitis ,Pancreatitis ,Female ,Complication ,business ,Abdominal surgery - Abstract
Background: Endoscopic sphincterotomy (ES) plays an important role in treatment of biliary stones; however, there remain some controversies concerning complications of ES, which in most cases seem not to be predictable. Methods: The aim of this study was a retrospective analysis of complications in 546 consecutive patients (267 males, 279 females, average age 63.7 years) who underwent endoscopic retrograde cholangiography (ERCP) for biliary stones from 1988 to 1995. Results: ES was performed in 535 patients (98%), and extraction of stones was successful in 493 (92%). In all, 29 complications (5.4%) were observed, including bleeding 13, cholangitis seven, cholecystitis four, pancreatitis three, retroduodenal perforation two; of these, four (14%) required an operation. Overall mortality was 0.3%. Conclusion: While a significant decrease of the incidence of complications was observed in the course of the study, due to constantly improving experience, no correlation between risk factors and complications was identified.
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- 1997
159. US-guided application of Nd:YAG laser in porcine pancreatic tissue: an ex vivo study and numerical simulation
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Roberto Coppola, Sergio Silvestri, Luca Breschi, M. Martino, Roberta Rea, Emiliano Schena, Egidio Stigliano, Francesco Maria Di Matteo, Guido Costamagna, Giuseppe Perrone, Paola Saccomandi, Monica Pandolfi, Claudio Maurizio Pacella, and F. Panzera
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Pathology ,medicine.medical_specialty ,neodymium-doped yttrium aluminum garnet ,Swine ,Settore MED/18 - CHIRURGIA GENERALE ,medicine.medical_treatment ,Lasers, Solid-State ,law.invention ,Va ,Animal model ,Vc ,law ,ablation volume ,medicine ,Animals ,Radiology, Nuclear Medicine and imaging ,Yttrium ,central carbonization volume ,Pancreas ,Ultrasonography, Interventional ,Neodymium ,Laser ablation ,output power ,Pancreatic tissue ,business.industry ,Gastroenterology ,Nd:YAG ,Ablation ,Laser ,OP ,Surgery, Computer-Assisted ,Nd:YAG laser ,Models, Animal ,laser ablation ,Laser Therapy ,LA ,business ,Ex vivo ,Biomedical engineering ,Ablation zone ,Aluminum - Abstract
Background Laser ablation (LA) with a neodymium-doped yttrium aluminum garnet (Nd:YAG) laser is a minimally invasive approach able to achieve a high rate of complete tissue necrosis. In a previous study we described the feasibility of EUS-guided Nd:YAG pancreas LA performed in vivo in a porcine model. Objective To establish the best laser setting of Nd:YAG lasers for pancreatic tissue ablation. A secondary aim was to investigate the prediction capability of a mathematical model on ablation volume. Design Ex vivo animal study. Setting Hospital animal laboratory. Subjects Explanted pancreatic glands from 60 healthy farm pigs. Intervention Laser output powers (OP) of 1.5, 3, 6, 10, 15, and 20 W were supplied. Ten trials for each OP were performed under US guidance on ex vivo healthy porcine pancreatic tissue. Main Outcome Measurements Ablation volume (Va) and central carbonization volume (Vc) were measured on histologic specimens as the sum of the lesion areas multiplied by the thickness of each slide. The theoretical model of the laser-tissue interaction was based on the Pennes equation. Results A circumscribed ablation zone was observed in all histologic specimens. Va values grow with the increase of the OP up to 10 W and reach a plateau between 10 and 20 W. The trend of Vc values rises constantly until 20 W. The theoretical model shows a good agreement with experimental Va and Vc for OP between 1.5 and 10 W. Limitations Ex vivo study. Conclusion Volumes recorded suggest that the best laser OP could be the lowest one to obtain similar Va with smaller Vc in order to avoid the risk of thermal injury to the surrounding tissue. The good agreement between the two models demonstrates the prediction capability of the theoretical model on laser-induced ablation volume in an ex vivo animal model and supports its potential use for estimating the ablation size at different laser OPs.
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- 2012
160. MON-P232: Weight Loss and Surgical Outcomes in Patients Undergoing Pancreaticoduodenectomy (PD) for Pancreatic Cancer
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Michele Pier Luca Guarino, S. Lucia, Alessio Molfino, Roberto Coppola, Silvia Cocca, L. Trillo, F. Rossi Fanelli, Sara Emerenziani, Maurizio Muscaritoli, Sergio Valeri, Maria Paola Rescio, and Michele Cicala
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medicine.medical_specialty ,Nutrition and Dietetics ,business.industry ,General surgery ,medicine.medical_treatment ,Critical Care and Intensive Care Medicine ,medicine.disease ,Pancreaticoduodenectomy ,Gastroenterology ,Weight loss ,Pancreatic cancer ,Internal medicine ,Medicine ,In patient ,medicine.symptom ,business - Published
- 2016
161. Evaluation of preoperative inflammatory markers in prediction of post-operative complications and survival after pancreatic surgery for cancer
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Roberto Coppola, Tommasangelo Petitti, G. Nappo, Julie Perinel, Mustapha Adham, and M. El Bechwaty
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medicine.medical_specialty ,Hepatology ,business.industry ,Gastroenterology ,Medicine ,Cancer ,Post operative ,business ,medicine.disease ,Pancreatic surgery ,Surgery - Published
- 2016
162. Peer review report 1 on 'The 100 most influential manuscripts in gastric cancer: A bibliometric analysis'
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Roberto Coppola
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medicine.medical_specialty ,Bibliometric analysis ,business.industry ,Alternative medicine ,Cancer ,General Medicine ,medicine.disease ,computer.software_genre ,Family medicine ,medicine ,Surgery ,Data mining ,business ,computer - Published
- 2016
163. Carcinoma of the ampulla of Vater: morphological and immunophenotypical classification predicts overall survival
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Domenico Borzomati, Giuseppe Perrone, Bruno Vincenzi, Giuseppe Tonini, Sergio Morini, Daniele Santini, Carla Rabitti, Daniela Righi, Andrea D. Manazza, Roberto Coppola, Andrea Onetti Muda, and Federica Castri
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Surgical resection ,Adult ,Male ,Pathology ,medicine.medical_specialty ,Ampulla of Vater ,Time Factors ,Endocrinology, Diabetes and Metabolism ,Common Bile Duct Neoplasms ,Kaplan-Meier Estimate ,Keratin-20 ,Immunophenotyping ,histology ,surgery ,Endocrinology ,Predictive Value of Tests ,cancer of ampulla of vater ,Internal Medicine ,Carcinoma ,Overall survival ,Biomarkers, Tumor ,Medicine ,Humans ,Aged ,Proportional Hazards Models ,Retrospective Studies ,Ampullary carcinoma ,Hepatology ,Proportional hazards model ,business.industry ,Keratin-7 ,Middle Aged ,medicine.disease ,medicine.anatomical_structure ,Treatment Outcome ,Italy ,Predictive value of tests ,Multivariate Analysis ,Immunohistochemistry ,Female ,business - Abstract
The objective of the study was to verify if histopathological differentiation of ampullary carcinoma after surgical resection may be related to survival.The prognostic role of an accurate histological and immunohistochemical classification has been investigated in a multicentric series of carcinoma of the ampulla of Vater. Immunohistochemical expression of cytokeratin 7 (CK7) and CK20 were analyzed in the different morphological histotypes of ampullary cancers, and results were compared with overall survival.Of 72 ampullary cancers, 48.6% were classified as pancreaticobiliary-type carcinomas, 43.1% were classified as intestinal-type carcinomas, and 8.3% were classified as "unusual"-type carcinomas. Cytokeratin 20 was expressed in 28 (90.3%) of the 31 intestinal-type carcinomas, whereas it was always negative in the pancreaticobiliary histotype; CK7 was expressed in 32 (91.4%) of the 35 pancreaticobiliary-type carcinomas and in 18 (58.1%) of the 31 intestinal-type carcinomas. By univariate analysis, overall survival was influenced significantly by pathological T factor, lymph node involvement, and histological/immunohistochemical subtyping. Furthermore, using a multivariate Cox regression model, lymph node metastasis and CK20 were identified as significant independent factors related to prognosis.Our results prove the clinical use of ampullary cancer subclassification based on different histotypes and indicate the useful role of the CK7/CK20 expression profile for consistent histopathological classification and prognostic relevance.
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- 2012
164. Symposium on surgical robotics — Invited talks: Robotic percutaneous beating-heart intracardiac surgery
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Roberto Coppola, Gregory S. Fischer, Venkat Krovi, Rajni V. Patel, Nabil Simaan, Philippe Poignet, Robert D. Howe, Pierre E. Dupont, Sarthak Misra, Robert J. Webster, Cameron N. Riviere, Masakatsu G. Fujie, and Arianna Menciassi
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medicine.medical_specialty ,Beating heart ,Engineering ,Percutaneous ,business.industry ,Open surgery ,Intracardiac injection ,Surgery ,Catheter ,medicine ,Robot ,Motion planning ,business ,Surgical robotics ,Biomedical engineering - Abstract
Image-guided minimally invasive surgery has revolutionized the standard of care throughout the body. The use of catheters in cardiology, for example, has substantially reduced the risk and trauma for the patient in comparison to open-heart surgery. Many intracardiac repairs, however, require manipulating tissue in ways that cannot be achieved by catheters and so still require open surgery. In this talk, I will describe a robotic technology and surgical tool set that my group is developing to convert these intracardiac repairs to percutaneous, beating-heart interventions. The robotic technology is based on concentrically combining pre-curved elastic tubes. Coordinated motorized control of individual tube rotations and translations enables the robot to be navigated through the vasculature and into the heart. Once the surgical site is reached, the distal sections of the robot can deploy and manipulate tools to perform the repair. The robot forms a slender curve comparable in cross section to a catheter, but with a substantially higher tip stiffness. We have developed tools for the fundamental surgical tasks of tissue removal and tissue approximation. Our surgical tools are manufactured using a metal MEMS process that produces fully assembled, millimeter-scale devices with micron-scale features. The potential of these technologies as well as our current challenges will be illustrated through ex vivo and in vivo experimental results.
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- 2012
165. Randomised trial comparing Lichtenstein vs Trabucco vs Valenti techniques in inguinal hernia repair
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V. Ripetti, Roberto Coppola, Sergio Valeri, F. Bono, Greco S, and V. La Vaccara
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Operative Time ,Hernia, Inguinal ,law.invention ,Postoperative Complications ,Randomized controlled trial ,law ,Clinical endpoint ,Medicine ,Humans ,Hernia ,Single-Blind Method ,Prospective Studies ,Prospective cohort study ,Herniorrhaphy ,Aged ,Pain Measurement ,Surgical repair ,Pain, Postoperative ,business.industry ,General surgery ,Length of Stay ,Middle Aged ,Surgical Mesh ,medicine.disease ,Surgery ,Inguinal hernia ,Surgical mesh ,Treatment Outcome ,Female ,business ,Abdominal surgery ,Anesthesia, Local - Abstract
Following Lichtenstein’s technique, over the last 15 years several variation have been proposed, such as Trabucco’s sutureless technique and the use of two self-regulating prostheses, proposed by Valenti that have given excellent results. The aim of this prospective and randomised study was to determine whether there are differences in the results obtained with these three techniques. Of 812 patients submitted to inguinal hernia repair, we selected and randomised 162 patients into three groups of 54 patients each: Lichtenstein (Group L), Trabucco (Group T) and Valenti (Group V). Surgical procedures were performed in all cases by residents in surgery using local anaesthesia. Primary endpoint was intensity of postoperative pain. Median follow-up was 8 years. The primary analysis of postoperative pain at 48 h did not report any significant difference between the three groups as for secondary analyses except that the Trabucco procedure took less operative time than the Lichtenstein, and the Valenti group was more painful than the Lichtenstein group at the third postoperative day. In our series median operation time was 60 min. Recurrence rate was 1.85 %. Surgical repair of inguinal hernia according to the Lichtenstein, Trabucco and Valenti techniques is safe and easy to perform regardless of the surgical experience of the operator, with excellent results and no differences due to technique used as regards almost all of the parameters studied.
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- 2012
166. Aberrant promoter methylation of beta-1,4 galactosyltransferase 1 as potential cancer-specific biomarker of colorectal tumors
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Paola Parrella, Roberto Coppola, Vito Michele Fazio, Emanuela Massi, Milo Frattini, Giuseppe Perrone, Maria Luana Poeta, Francesca Molinari, Carla Rabitti, Pasquale Pellegrini, Massimiliano Copetti, Damiano Caputo, Stefano Crippa, Andrea Onetti Muda, Mariangela De Robertis, Marco Caricato, and Elena Zanellato
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Male ,Proto-Oncogene Proteins B-raf ,Cancer Research ,Colorectal cancer ,Bisulfite sequencing ,Biology ,medicine.disease_cause ,Proto-Oncogene Proteins p21(ras) ,Proto-Oncogene Proteins ,Genetics ,medicine ,Biomarkers, Tumor ,Humans ,Epigenetics ,RNA, Messenger ,Promoter Regions, Genetic ,Aged ,Cancer ,Microsatellite instability ,Methylation ,DNA Methylation ,Middle Aged ,medicine.disease ,Galactosyltransferases ,Molecular biology ,Gene Expression Regulation, Neoplastic ,Phenotype ,DNA methylation ,Cancer research ,ras Proteins ,Female ,Microsatellite Instability ,KRAS ,Colorectal Neoplasms - Abstract
Epigenetic alterations, such as CpG islands methylation and histone modifications, are recognized key characteristics of cancer. Glycogenes are a group of genes which epigenetic status was found to be changed in several tumors. In this study, we determined promoter methylation status of the glycogene beta-1,4-galactosyltransferase 1 (B4GALT1) in colorectal cancer patients. Methylation status of B4GALT1 was assessed in 130 colorectal adenocarcinomas, 13 adenomas, and in paired normal tissue using quantitative methylation specific PCR (QMSP). B4GALT1 mRNA expression was evaluated in methylated/unmethylated tumor and normal specimens. We also investigated microsatellite stability and microsatellite instability status and KRAS/BRAF mutations. Discriminatory power of QMSP was assessed by receiving operating curve (ROC) analysis on a training set of 24 colorectal cancers and paired mucosa. The area under the ROC curve (AUC) was 0.737 (95% confidence interval [CI]:0.591-0.881, P = 0.005) with an optimal cutoff value of 2.07 yielding a 54% sensitivity (95% CI: 35.1%-72.1%) and a specificity of 91.7% (95% CI: 74.1%-97.7%). These results were confirmed in an independent validation set where B4GALT1 methylation was detected in 52/106 patients. An inverse correlation was observed between methylation and B4GALT1 mRNA expression levels (r = -0.482, P = 0.037). Significant differences in methylation levels and frequencies was demonstrated in invasive lesions as compared with normal mucosa (P = 0.0001) and in carcinoma samples as compared with adenoma (P = 0.009). B4GALT1 methylation is a frequent and specific event in colorectal cancer and correlates with downregulation of mRNA expression. These results suggest that the glycogene B4GALT1 represent a valuable candidate biomarker of invasive phenotype of colorectal cancer.
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- 2012
167. In Situ Identification of CD44+/CD24− cancer cells in primary human breast carcinomas
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Andrea Onetti Muda, Daniele Santini, Laura Maria Gaeta, Giuseppe Perrone, Mariagiovanna Zagami, Roberto Coppola, Vittorio Altomare, Francesca Nasorri, Giuseppe Tonini, Lucio Trodella, Francesco Bartolozzi, Andrea Cavani, and Domenico Borzomati
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Pathology ,Anatomy and Physiology ,Invasive Ductal Carcinoma ,Metastasis ,Immune Physiology ,Basic Cancer Research ,Breast Tumors ,Neoplasm Metastasis ,skin and connective tissue diseases ,Lymph node ,Aged, 80 and over ,education.field_of_study ,Multidisciplinary ,biology ,Cell Surface Molecules ,Obstetrics and Gynecology ,Middle Aged ,Hyaluronan Receptors ,medicine.anatomical_structure ,Oncology ,Medicine ,Female ,Invasive Lobular Carcinoma ,Breast carcinoma ,Research Article ,Adult ,medicine.medical_specialty ,Proliferative index ,Science ,Population ,Histopathology ,Breast Neoplasms ,Immunophenotyping ,Breast cancer ,Diagnostic Medicine ,Breast Cancer ,Biomarkers, Tumor ,medicine ,Humans ,Mammary Glands, Human ,education ,Aged ,Neoplasm Staging ,breast cancer ,CD44+/CD242 ,Carcinoma ,CD44 ,Cancers and Neoplasms ,CD24 Antigen ,medicine.disease ,Anatomical Pathology ,Surgical Pathology ,Cancer cell ,Cancer research ,biology.protein ,Neoplasm Grading ,Biomarkers ,General Pathology - Abstract
Breast cancer cells with the CD44+/CD24- phenotype have been reported to be tumourigenic due to their enhanced capacity for cancer development and their self-renewal potential. The identification of human tumourigenic breast cancer cells in surgical samples has recently received increased attention due to the implications for prognosis and treatment, although limitations exist in the interpretation of these studies. To better identify the CD44+/CD24- cells in routine surgical specimens, 56 primary breast carcinoma cases were analysed by immunofluorescence and confocal microscopy, and the results were compared using flow cytometry analysis to correlate the amount and distribution of the CD44+/CD24- population with clinicopathological features. Using these methods, we showed that the breast carcinoma cells displayed four distinct sub-populations based on the expression pattern of CD44 and CD24. The CD44+/CD24- cells were found in 91% of breast tumours and constituted an average of 6.12% (range, 0.11%-21.23%) of the tumour. A strong correlation was found between the percentage of CD44+/CD24- cells in primary tumours and distant metastasis development (p = 0.0001); in addition, there was an inverse significant association with ER and PGR status (p = 0.002 and p = 0.001, respectively). No relationship was evident with tumour size (T) and regional lymph node (N) status, differentiation grade, proliferative index or HER2 status. In a multivariate analysis, the percentage of CD44+/CD24- cancer cells was an independent factor related to metastasis development (p = 0.004). Our results indicate that confocal analysis of fluorescence-labelled breast cancer samples obtained at surgery is a reliable method to identify the CD44+/CD24- tumourigenic cell population, allowing for the stratification of breast cancer patients into two groups with substantially different relapse rates on the basis of CD44+/CD24- cell percentage.
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- 2012
168. A rare case of complicated Meckel's diverticulum. Case report and images
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Marco, Caricato, Giuseppe, Mangiameli, Federica, Miccadei, Gianfranco, Bulzomi, and Roberto, Coppola
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Male ,Meckel Diverticulum ,Humans ,Aged - Abstract
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract, and account for 0.1%-1% of gastrointestinal malignancies. Meckel's diverticulum (MD) is the most prevalent congenital abnormality of the gastrointestinal tract (0.3%-4.0%).Their clinical presentation is strongly related to the occurrence of complications or the development of a neoplasm. Tumors and perforation of MD are infrequent. The case presented here is to our knowledge the fourth published case of a small intestine GIST causing perforation of the Meckel's diverticulum.Although there is no compelling evidence in the current literature to support prophylactic diverticulectomy for patients with MD, our and other similar cases could justify the use of simple laparoscopic tangential resection during elective operations for healthy patients.
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- 2011
169. A singular observation of a giant benign Brenner tumor of the ovary
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Roberto Coppola, Silvia Ruggiero, V. Ripetti, Antonella Bianchi, Vincenzo La Vaccara, and Rossana Alloni
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Ovarian Neoplasms ,Pathology ,medicine.medical_specialty ,Ovarian cyst ,Constipation ,business.industry ,Brenner Tumor ,Benign Brenner tumor ,Obstetrics and Gynecology ,Ovary ,General Medicine ,Middle Aged ,medicine.disease ,Malignancy ,Tumor Burden ,Lesion ,medicine.anatomical_structure ,medicine ,Humans ,Female ,medicine.symptom ,business ,Tomography, X-Ray Computed ,Pathological - Abstract
Brenner tumors are rare transitional cell tumors of the ovary. They are usually benign neoplasms, of solid or solid-cystic structure and small size. We describe the case of a benign, predominantly cystic Brenner tumor measuring 39 cm in diameter. A 62-year-old woman presented to the outpatient visit complaining about vague abdominal symptoms such as constipation and meteorism. Ultrasonography and CT scan showed the presence of a voluminous cystic mass, with fluid content, displacing other intra-abdominal organs. The patient underwent elective surgical excision, and there were no complications. Definitive pathological examination showed a metaplastic benign Brenner tumor. The largest benign Brenner tumors reported in literature have been up to 30 cm in size, and greater size has been thought to be a predictor of malignancy. We have seen, however, that it is possible for larger lesions of this type to have a completely benign behavior; consequently, a benign nature should not be excluded even in the event of a large ovarian lesion.
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- 2010
170. First experience for the laparoscopic treatment of parastomal hernia with the use of Parietex composite mesh
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Roberto Coppola, Sergio Valeri, V. Ripetti, Pierfilippo Crucitti, and Gabriella Teresa Capolupo
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,General surgery ,medicine.medical_treatment ,Colostomy ,Postoperative complication ,Surgical Mesh ,medicine.disease ,Parastomal hernia ,Hernia, Ventral ,Surgery ,Ileostomy ,Surgical mesh ,medicine ,Humans ,Hernia ,Laparoscopy ,business ,Laparoscopic treatment ,Herniorrhaphy - Abstract
Parastomal herniation is a postoperative complication after colostomy or ileostomy with an incidence rate of 0–48.1% [1]. Its repair is indicated in approximately 10–15% of cases [3]; however, this surgery has been associated with a significant degree of morbidity and recurrence. We describe, for the first time in literature, an experience using a new technique, and a new type of mesh. This new type of laparoscopic parastomal hernia repair appears to be easier and faster. The follow-up was about 240 days. Our preliminary experience in using this technique and mesh appears to be possibly leading to a reduction of recurrences and complications. Randomized multicenter studies are required to assess the true effectiveness of the technique.
- Published
- 2010
171. Results of mitral valve repair for Barlow disease (bileaflet prolapse) via right minithoracotomy versus conventional median sternotomy: a randomized trial
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Luigi Tavazzi, Giampiero Esposito, Roberto Coppola, Flavio Fiore, Giuseppe Nasso, Ernesto Greco, Massimiliano Conte, Giuseppe Speziale, Khalil Fattouch, Mauro Del Giglio, Speziale, G., Nasso, G., Esposito, G., Conte, M., Greco, E., Fattouch, K., Fiore, F., Del Giglio, M., Coppola, R., and Tavazzi, L.
- Subjects
Male ,Time Factors ,medicine.medical_treatment ,Kaplan-Meier Estimate ,law.invention ,law ,Risk Factors ,Mitral valve ,Cardiac Surgical Procedure ,Hospital Mortality ,Prospective Studies ,Ultrasonography ,Pain, Postoperative ,Mitral Valve Prolapse ,Atrial fibrillation ,Genetic Diseases, X-Linked ,Middle Aged ,medicine.anatomical_structure ,Treatment Outcome ,Italy ,Thoracotomy ,Cardiology ,Mitral Valve ,Female ,Cardiology and Cardiovascular Medicine ,Human ,Pulmonary and Respiratory Medicine ,Adult ,Reoperation ,medicine.medical_specialty ,Time Factor ,Context (language use) ,Risk Assessment ,Internal medicine ,Cardiopulmonary bypass ,medicine ,Humans ,Cardiac Surgical Procedures ,Mechanical ventilation ,Mitral valve repair ,Mitral regurgitation ,Chi-Square Distribution ,business.industry ,Risk Factor ,Patient Selection ,Settore MED/23 - Chirurgia Cardiaca ,medicine.disease ,Sternotomy ,Surgery ,Prospective Studie ,Median sternotomy ,business - Abstract
Objective: The results of mitral repair for complex Barlow valves are adequate and support earlier intervention. It is unknown whether these results are reproducible in the context of minimally invasive surgery via right minithoracotomy. Methods: We randomized patients with Barlow mitral disease (bileaflet prolapse) to have conventional open repair via median sternotomy (MS group) or minimally invasive (MI group) repair. Repair was done using polytetrafluoroethylene chordal reimplantation for both leaflets. In the MI group, we adopted right minithoracotomy, peripheral cannulation, external aortic clamping, and surgery under direct vision. Results: Both groups comprised 70 patients. The operative and the cardiopulmonary bypass times were significantly longer in the MI group (P = .003 and P = .012). Mitral repair was successful in 98.5% MI patients and 100% MS patients. Operative mortality was comparable. The mean mechanical ventilation time, intensive care unit stay, and hospital stay were lower in the MI group (P = .014, P =.02, and P = .03,). Mean pain score was lower in the MI group at postoperative days 2 and 4. At follow-up, the freedom from moderate (2+) or severe (3+ or 4+) mitral regurgitation was 98% versus 97% (P = .9). Two patients underwent reoperation (1 in each group) for late failure of repair. The Kaplan-Meier analysis confirmed these results. Conclusions: Our data indicate that the optimal standard-of-care results of mitral repair for complex disease (Barlow) are reproducible in the minimally invasive settings through right minithoracotomy and direct vision. The minimally invasive technique can be proposed for complex mitral disease and early referral of these patients can be encouraged. Copyright © 2011 by The American Association for Thoracic Surgery.
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- 2010
172. Esophageal diverticula *1Physiopathological basis for surgical management
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Roberto Coppola, Pierluigi Granone, Aurelio Picciocchi, Giuseppe Cardillo, Domenico D'Ugo, and Stefano Margaritora
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Pulmonary and Respiratory Medicine ,Motor disorder ,Myotomy ,medicine.medical_specialty ,Extended esophageal myotomy ,Motor dysfunction ,business.industry ,medicine.medical_treatment ,General Medicine ,medicine.disease ,Nissen fundoplication ,Dysphagia ,Therapeutic goal ,Surgery ,medicine ,Cricopharyngeal myotomy ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
From 1980 to 1990, 31 patients were treated surgically in our department for esophageal diverticula: 12 Zenker's diverticula (ZD); 11 mid-thoracic diverticula (MTD); 8 epiphrenic diverticula (ED). Cricopharyngeal dysfunction was detectable in 8 of 12 ZD patients (66.6%). Cricopharyngeal myotomy with diverticulectomy was performed in all cases. There were no deaths. Relief of dysphagia was obtained in all cases. No recurrences of dysphagia or diverticulum were observed at a mean follow-up of 3 years. A motility disorder was observed in 10 of 11 MTD (90.9%). An extended esophageal myotomy with diverticulectomy was performed in 3 cases, an extended myotomy alone in 3 cases, a diverticulectomy alone in 5 cases; an anti-reflux procedure was added in 6 cases. One patient died on the 7th postoperative day. All remaining patients were free of symptoms at a mean follow-up of 3.2 years. A motor dysfunction was detected in all 8 ED patients (100%). No diverticulectomy was performed. Six patients underwent Heller-Dor myotomy and 2 underwent Nissen fundoplication. There were no deaths. Relief of symptoms was obtained in all patients, at a mean follow-up of 3.1 years. Myotomy with diverticulectomy represents the treatment of choice in ZD. As regards MTD and ED, the treatment of the underlying motor disorder is the main therapeutic goal, whereas diverticulectomy is reserved to selected patients.
- Published
- 1992
173. Recurrent Peptic Stenosis of the Esophagus: Treatment With a Self-Expanding Metallic Stent
- Author
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Roberto Coppola, C. Pintus, Sergio Valeri, Marilena Riccioni, Perrelli L, and S. Ciletti
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,Peptic ,medicine.medical_treatment ,Contrast Media ,Fundoplication ,Recurrence ,medicine ,Humans ,Esophagus ,Child ,Neurologically impaired ,business.industry ,Stent ,medicine.disease ,digestive system diseases ,Surgery ,Radiography ,Stenosis ,Treatment Outcome ,medicine.anatomical_structure ,Esophageal Stenosis ,Gastroesophageal Reflux ,Stents ,Barium Sulfate ,business - Abstract
A 12-year-old neurologically impaired boy with recurrent peptic stenosis of the esophagus was treated successfully with use of a self-expanding metallic stent that remained for 3 months.
- Published
- 2000
174. Surgical treatment of locally advanced anal cancer after male-to-female sex reassignment surgery
- Author
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Roberto Coppola, Lucio Trodella, Ilaria Cipollone, Marco Caricato, Paolo Persichetti, Giovanni Francesco Marangi, Gerardo Flammia, and Fabio Ausania
- Subjects
Male ,medicine.medical_specialty ,Locally advanced ,Case Report ,Postoperative Complications ,medicine ,Anal cancer ,Humans ,Sex organ ,Surgical treatment ,business.industry ,Gastroenterology ,Sex reassignment surgery (female-to-male) ,General Medicine ,Middle Aged ,Plastic Surgery Procedures ,Sexual reassignment ,medicine.disease ,Anus Neoplasms ,Surgery ,Transsexual ,Carcinoma, Squamous Cell ,Female ,Neoplasm Recurrence, Local ,Male to female ,business ,Transsexualism - Abstract
We present a case of a transsexual patient who underwent a partial pelvectomy and genital reconstruction for anal cancer after chemoradiation. This is the first case in literature reporting on the occurrence of anal cancer after male-to-female sex reassignment surgery. We describe the surgical approach presenting our technique to avoid postoperative complications and preserve the sexual reassignment.
- Published
- 2009
175. Cystic Neoplasms of the Pancreas
- Author
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Roberto Coppola, Pierfilippo Crucitti, Garberini A, and Sergio Valeri
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Pancreatic parenchyma ,Pathology ,medicine.medical_specialty ,endocrine system diseases ,Intraductal papillary mucinous neoplasm ,business.industry ,medicine.disease ,Cystic Neoplasm ,stomatognathic diseases ,Serous fluid ,medicine.anatomical_structure ,Pancreatic tumor ,Cystadenoma ,Medicine ,business ,Pancreas ,Cystadenocarcinoma - Abstract
Cystic neoplasms of the pancreas are a particular category of pancreatic tumor. They are commonly classified into serous types, mucinous types, and intraductal papillary mucinous neoplasms (IPMNs). The serous types account for 35% of cystic neoplasms and 1–2% of all neoplasms of the exocrine pancreas [1]. The mucinous types account for 1% of all exocrine pancreatic tumors and 27% of cystic neoplasms of the pancreas (20.1% cystadenoma and 7.0% cystadenocarcinoma) [2]. Then there are the IPMNs, which account for 0.5–9.8% of all tumors of the pancreatic parenchyma [3, 4].
- Published
- 2009
176. MUC2 but not MUC5 expression correlates with prognosis in radically resected pancreatic cancer patients
- Author
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Francesco Pantano, Michele Caraglia, Federica Castri, Armando Antinori, Alfonso Baldi, Domenico Borzomati, Paolo Magistrelli, Roberto Coppola, Bruno Vincenzi, Daniele Santini, Fabio Maria Vecchio, Giuseppe Tonini, Pantano, F, Baldi, Alfonso, Santini, D, Vincenzi, B, Borzomati, D, Vecchio, Fm, Castri, F, Antinori, A, Caraglia, Michele, Magistrelli, P, Coppola, R, and Tonini, G.
- Subjects
Oncology ,Adult ,Male ,Cancer Research ,medicine.medical_specialty ,Prognosi ,Kaplan-Meier Estimate ,Adenocarcinoma ,medicine.disease_cause ,digestive system ,Cohort Studies ,Pancreatic cancer ,Internal medicine ,medicine ,Biomarkers, Tumor ,Humans ,Gastrointestinal cancer ,Aged ,Pharmacology ,Aged, 80 and over ,Univariate analysis ,Mucin-2 ,pancreas cancer ,surgery ,prognosis ,business.industry ,Proportional hazards model ,respiratory system ,Middle Aged ,medicine.disease ,Prognosis ,Immunohistochemistry ,Mucin-5B ,digestive system diseases ,Pancreatic Neoplasms ,MUC5 ,MUC2 ,Mucin ,Molecular Medicine ,CA19-9 ,Female ,Pancreatic ductal ,business ,Carcinogenesis - Abstract
Introduction: Pancreatic cancer is one of the most aggressive gastrointestinal cancer with less than 10% long-term survivors. The apoptotic pathway deregulation is a postulated mechanism of carcinogenesis of this tumor. The present study investigated the prognostic role of MUC2 and MUC5 apomucin expression in a series of surgically resected pancreatic cancer patients. Results: By univariate analysis, survival was influenced by MUC2 expression but not by MUC5 expression. The MUC2 overexpression was associated with better prognosis (p = 0.003). By a multivariate Cox regression analysis, MUC2 overexpression maintained the prognostic statistical value. In particular, patients with high MUC2 staining showed a longer survival. Moreover the present study does report the absence of a prognostic role of MUC5 expression in this type of cancer. Material and methods: All patients affected by pancreatic ductal adenocarcinoma and treated with surgical resection from 1988-2003 were considered for the study. MUC2 and MUC5 expression were evaluated by immunohistochemical staining. Tumor specimens of 59 resected patients were included in the study. Conclusions: the study demonstrated the prognostic relevance of MUC2 expression in pancreatic cancer and underlined its potential role as target gene in the field of therapy research. ©2009 Landes Bioscience.
- Published
- 2009
177. Bevacizumab in association with de Gramont 5-fluorouracil/folinic acid in patients with oxaliplatin-, irinotecan-, and cetuximab-refractory colorectal cancer: a single-center phase 2 trial
- Author
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Antonio Russo, Sergio Valeri, Giuseppe Tonini, Roberto Coppola, Marco Caricato, Bruno Beomonte Zobel, Olga Venditti, Daniele Santini, Sergio Rizzo, Chiara Spoto, Simona Gasparro, Bruno Vincenzi, Vincenzi, B, Santini, D, Russo, A, Spoto, C, Venditti, O, Gasparro, S, Rizzo, S, Zobel, BB, Caricato, M, Valeri, S, Coppola, R, and Tonini, G
- Subjects
Adult ,Male ,Cancer Research ,medicine.medical_specialty ,Bevacizumab ,Colorectal cancer ,Settore MED/06 - Oncologia Medica ,Leucovorin ,Cetuximab ,Antibodies, Monoclonal, Humanized ,Gastroenterology ,Drug Administration Schedule ,Folinic acid ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,medicine ,Humans ,Aged ,business.industry ,Cancer ,Antibodies, Monoclonal ,Middle Aged ,medicine.disease ,Surgery ,Oxaliplatin ,Irinotecan ,Regimen ,Bevacizumab,colorectal cancer ,Oncology ,Drug Resistance, Neoplasm ,Retreatment ,Female ,Fluorouracil ,business ,cancer combination chemotherapy ,Colorectal Neoplasms ,medicine.drug - Abstract
BACKGROUND: The aim of the current study was the investigation of the value of bevacizumab + 5-fluorouracil(5–FU)/folinic acid in patients with advanced colorectal cancers who have exhausted standard chemotherapy options. METHODS: The authors included 48 heavily pretreated patients (colon:rectum, 33:15; men:women, 23:25; median age, 63 years; range, 27-79 years) whose disease had progressed during or within an oxaliplatin-based first-line chemotherapy, an irinotecan-based second-line regimen, and a third-line treatment with cetuximab plus weekly irinotecan. Bevacizumab was given at a dose of 5 mg/kg. 5-FU/folinic acid was administered according to the de Gramont schedule. RESULTS: The response rate was 6.25%, and 30.4% of patients demonstrated stable disease as the best response. The median time to disease progression was 3.5 months (95% confidence interval [95% CI], 2.3-6.9 months), and the median survival time was 7.7 months (95% CI, 3.9-11.9 months). The most common grade 3 to 4 side toxicities (graded according to the National Cancer Institute Common Toxicity Criteria [version 2.0]) were: diarrhea (20.8%), fatigue (14.5%), and stomatitis (12.5%). Grade 3 to 4 hemorrhage occurred in 8 patients (16.6%), including 4 cases of bleeding in the gastrointestinal tract. Other relatively common adverse events such as hypertension, thrombosis, and bowel perforation were reported in 50%, 18.7%, and 4.16%, of patients respectively. CONCLUSIONS: The data from the current study suggest a modest but significant clinical benefit of bevacizumab + de Gramont schedule in heavily pretreated colorectal cancer patients. Cancer 2009. © 2009 American Cancer Society.
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- 2009
178. Gallstone ileus: a rare cause of colon obstruction. Report of a case
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Sergio, Valeri, Andrea, Garberini, Rossana, Alloni, and Roberto, Coppola
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Aged, 80 and over ,Colonic Diseases ,Humans ,Female ,Gallstones ,Intestinal Obstruction - Abstract
The colon is a rare site of gallstone ileus. We report the case of a woman with cholelithiasis who underwent a total colectomy and cholecystectomy for colon obstruction due to a gallstone impacted in the sigmoid colon narrowed by diverticulitis.
- Published
- 2008
179. Experience with two cases of intestinal tuberculosis: utility of the QuantiFERON-TB Gold test for diagnosis
- Author
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Damiano Caputo, Giovanni Gherardi, Elisabetta Ferraro, Roberto Coppola, Silvia Angeletti, Rossana Alloni, Garberini A, and Giordano Dicuonzo
- Subjects
Microbiology (medical) ,Adult ,Male ,medicine.medical_specialty ,Abdominal pain ,Weakness ,Tuberculosis ,Nausea ,Colon ,Gastroenterology ,Inflammatory bowel disease ,Interferon-gamma ,Colon surgery ,Internal medicine ,medicine ,Ascitic Fluid ,Humans ,Abscess ,Aged ,Inflammation ,business.industry ,Mycobacterium tuberculosis ,medicine.disease ,Surgery ,Infectious Diseases ,Blood ,Tuberculosis, Gastrointestinal ,Vomiting ,Reagent Kits, Diagnostic ,medicine.symptom ,business - Abstract
Intestinal tuberculosis is rare in Western countries, with incidence rates of 35.7 and 0.43 per 100,000 per year for the immigrant and native populations, respectively. Despite a clear increase in the frequency of extrapulmonary tuberculosis in immunosuppressed patients, the clinical features of intestinal tuberculosis are seen rarely. A typical clinical presentation includes abdominal pain, weight loss, fever, weakness, nausea, vomiting, obstruction, and bleeding. Intestinal tuberculosis often mimics inflammatory bowel disease or malignant neoplasia, and its preoperative diagnosis is a challenge. Microbiologic diagnosis often is difficult because the causative microorganism requires a long incubation period.Two case reports and review of the pertinent literature.We report two cases of colonic tuberculosis mimicking cecal carcinoma in one patient and periappendiceal abscess in the other. A 75 year-old man underwent right hemicolectomy for a right colon mass. Preoperative laboratory, radiologic, and endoscopic evaluations were negative for tuberculosis and carcinoma. The QuantiFERON-TB Gold test was positive. Surgical specimen histologic review showed non-caseating granulomas and rare Ziehl-Neelsen-positive bacilli. A 35 year-old man, born in Sri Lanka but living in Italy for 10 years, came to our attention for a periappendiceal abscess. Multiple peritoneal micro-nodules were found at laparotomy. Their extemporaneous histologic examination showed granulomas and giant-cell inflammation. A right hemicolectomy was performed. The QuantiFERON-TB Gold test, performed on peritoneal fluid and blood, was positive in both.The QuantiFERON-TB Gold test may hold promise for use in intestinal inflammatory diseases when tuberculosis is suspected but conventional workup is not diagnostic.
- Published
- 2008
180. Laparoscopic transperitoneal right adrenalectomy for 'large' tumors
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Giuseppe Simone, C. Leonardo, Rosario Sacco, Roberto Coppola, Salvatore Guaglianone, M. Gallucci, Rocco Papalia, and A. Loreto
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Adult ,Male ,adrenal tumor ,medicine.medical_specialty ,Right adrenalectomy ,Urology ,medicine.medical_treatment ,Adrenal Gland Diseases ,Adrenal Gland Neoplasms ,laparoscopy ,Administration, Oral ,adrenal gland ,adrenalectomy ,Adrenal Glands ,medicine ,Humans ,Intraoperative Complications ,Laparoscopy ,Aged ,medicine.diagnostic_test ,Adrenal gland ,business.industry ,Adrenalectomy ,Middle Aged ,Treatment Outcome ,medicine.anatomical_structure ,Surgical Procedures, Operative ,Female ,business - Abstract
Objectives: We compared two different approaches to right laparoscopic transperitoneal adrenalectomy for large tumors (>5 cm): the anterior transperitoneal (AT) and lateral transperitoneal (LT) approaches. Methods: 40 patients with a right large adrenal mass >5 cm underwent right adrenalectomy: 20 patients underwent the AT procedure and 20 patients the LT procedure. Preoperative characteristics were similar for both groups: mean tumor size for the AT and LT groups was 6.52 cm (range 5.2–8.5) and 6.59 cm (range 5.4–8.1), respectively. Mean patient’s age was 53 years (23–75 in the AT group and 20–77 in the LT group). AT and LT approaches were compared in terms of operative time, intraoperative blood loss, time to first oral intake and postoperative convalescence. Results: No difference was found between two groups in terms of estimated blood (100 ml for the AT group and 105.3 ml for the LT group), time to first oral intake (2.0 days for both groups) and convalescence (3.5 and 3 days, respectively). The mean operative times of the AT and LT procedures were 75.25 and 84.75 min, respectively: this difference was statistically significant at the Student’s t test (p = 0.0423). Conclusions: Both approaches proved to be safe and minimally invasive. We believe that the shorter operative time of AT procedures was related to the better visibility of familiar anatomic landmarks, easier access to the vessels and a larger operative field. For these reasons, we prefer the AT approach in the management of large adrenal masses.
- Published
- 2008
181. Human equilibrative nucleoside transporter 1 (hENT1) protein is associated with short survival in resected ampullary cancer
- Author
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Bruno Vincenzi, Sergio Morini, Paolo Magistrelli, Roberto Coppola, Rossana Alloni, Carla Rabitti, Daniele Santini, Carol E. Cass, Fabio Maria Vecchio, John R. Mackey, Giuseppe Tonini, Armando Antinori, Raymond Lai, and Giuseppe Perrone
- Subjects
Oncology ,Adult ,Male ,medicine.medical_specialty ,Pathology ,Ampulla of Vater ,medicine.medical_treatment ,Common Bile Duct Neoplasms ,Decision Making ,Antineoplastic Agents ,Adenocarcinoma ,Equilibrative nucleoside transporter 1 ,Disease-Free Survival ,Equilibrative Nucleoside Transporter 1 ,Predictive Value of Tests ,Internal medicine ,medicine ,Biomarkers, Tumor ,Humans ,Aged ,Neoplasm Staging ,Retrospective Studies ,Chemotherapy ,Univariate analysis ,Analysis of Variance ,biology ,business.industry ,ampulla of vater ,hent 1 ,prognosis ,Cancer ,Hematology ,Middle Aged ,medicine.disease ,Prognosis ,Chemotherapy regimen ,Immunohistochemistry ,Survival Analysis ,Gemcitabine ,Up-Regulation ,Gene Expression Regulation, Neoplastic ,Ki-67 Antigen ,Lymphatic Metastasis ,biology.protein ,Female ,business ,Immunostaining ,medicine.drug - Abstract
Background Gemcitabine is an acceptable alternative to best supportive care in the treatment of advanced biliary tract cancers. The human equilibrative nucleoside transporter 1 (hENT1) is a ubiquitous protein and is the major means by which gemcitabine enters human cells. Moreover, recent reports indicate a significant correlation between immunohistochemical variations of hENT1 in tumor samples and survival after gemcitabine therapy in patients with solid tumors. Materials and methods We used immunohistochemistry to assess the abundance and distribution of hENT1 in tumor samples from radically resected cancer of the ampulla, and sought correlations between immunohistochemical results and clinical parameters including disease outcomes. Results In the 41 individual tumors studied, 12 (29.3%) had uniformly high hENT1 immunostaining. Statistical analysis showed a significant correlation between hENT1 and Ki-67 (P = 0.04). No statistical significant differences were found between immunohistochemical findings and patient characteristics (sex, age, and tumor–node–metastasis). On univariate analysis, hENT1 and Ki-67 expression were associated with overall survival (OS). Specifically, those patients with overexpression of hENT1 showed a shorter OS (P = 0.022) and those with high Ki-67 staining showed a shorter survival (P = 0.05). Conclusions hENT1 expression is a molecular prognostic marker for patients with resected ampullary cancer and holds promise as a predictive factor to assist in chemotherapy decisions.
- Published
- 2008
182. Pancreatitis after percutaneous ethanol injection into HCC: a minireview of the literature
- Author
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Marco Caricato, Enrico Maria Zardi, Valentina Uwechie, Antonio Picardi, Roberto Coppola, Daniele Santini, Francesco Maria Di Matteo, Giuseppe Tonini, Massimiliano Carassiti, Antonella Afeltra, Pierfilippo Crucitti, and Eleonora Perrella
- Subjects
Cancer Research ,medicine.medical_specialty ,Abdominal pain ,liver cell carcinoma ,Carcinoma, Hepatocellular ,acute pancreatitis ,medicine.medical_treatment ,macromolecular substances ,Review ,lcsh:RC254-282 ,Gastroenterology ,Internal medicine ,medicine ,Humans ,Infusions, Intra-Arterial ,Hemoperitoneum ,percutaneous ethanol injection ,Ethanol ,business.industry ,Liver Neoplasms ,technology, industry, and agriculture ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,medicine.disease ,Surgery ,Oncology ,Pancreatitis ,Hepatocellular carcinoma ,Acute pancreatitis ,Percutaneous ethanol injection ,medicine.symptom ,business ,Varices ,Complication - Abstract
Deaths after percutaneous ethanol injection (PEI) into hepatocellular carcinoma (HCC) may occur within a few hours to a few days following the procedure because of hemoperitoneum and haemorrhage from oesophageal varices or hepatic insufficiency. Pancreatitis has been recently reported as a rare lethal complication of intra-arterial PEI, another modality for treating HCCs. In this minireview, we analyze the literature concerning the development of acute pancreatitis after PEI. Pathogenesis of pancreatitis from opioids and ethanol is also addressed. Treatment with opioids to reduce the patient's abdominal pain after PEI in combination with the PEI itself may lead to direct toxic effects, thus favouring the development of pancreatitis.
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- 2008
183. Percutaneous ultrasound-guided ablation of BW7756-hepatoma using ethanol or acetic acid in a rat model
- Author
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Enrico Maria Zardi, Domenico Borzomati, Tommaso Galeotti, Antonella Afeltra, Roberto Coppola, Sergio Valeri, G. Coppolino, Antonella Bianchi, Fabio Cacciapaglia, and Antonio Picardi
- Subjects
Male ,medicine.medical_specialty ,Cirrhosis ,Percutaneous ,Dose ,Autopsy ,Administration, Cutaneous ,Gastroenterology ,Injections ,Acetic acid ,chemistry.chemical_compound ,Liver Neoplasms, Experimental ,Internal medicine ,medicine ,Animals ,lcsh:RC799-869 ,Acetic Acid ,Ultrasonography ,Ethanol ,business.industry ,General Medicine ,Hepatology ,medicine.disease ,Drug Therapy, Computer-Assisted ,Rats ,chemistry ,Solvents ,Tumor necrosis factor alpha ,lcsh:Diseases of the digestive system. Gastroenterology ,business ,Research Article - Abstract
Background To compare tumor necrosis in hepatoma induced in rats by a single percutaneous injection of ethanol (PEI) or acetic acid (PAI). Methods BW7756 hepatomas of 1 mm3 were implanted in the liver of 40 male healthy rats. After 14 days, the 36 surviving rats were treated, in a single session, by ultrasound-guided injection of 300 μl of 95% ethanol (n = 17) or 100 μl of 50% acetic acid (n = 19). They were sacrificed 14 days after treatment and explanted tumoral livers were examined. The same PAI procedure was repeated on 13 additional rats to exclude a suspected occurrence of technical failures during the experiment, due to a surprisingly high rate of deaths within 30 minutes after PAI. Results Four rats died within four days after tumor implantation; after PEI, 1/17 (6%) died, whereas after PAI 9/19 (47%) died. The remaining 26 rats, after 14 days post-percutaneous ablation, were sacrificed. Gross and microscopic examinations showed that the hepatoma's nodules treated with PEI had 45.3 ± 19.4% tumor necrosis compared to 49 ± 23.3% (P = NS) for those treated with PAI. Complete tumor necrosis was not found in any animal. Peritoneal invasion was present in 4/16 (25%) and 2/10 (20%) rats treated with PEI or PAI, respectively (P = NS). Autopsy was performed in the 5 additional rats that died within 30 minutes after PAI. Conclusion Our results show that there is no significant difference in the percentage of tumor necrosis between two local ablation methods in spite of the different dosages used. However, mortality in the PAI-treated group was greater than in PEI-treated group, presumably due to greater acetic acid systemic diffusion and its metabolic side effects. In human subjects, HCC occurs in the setting of cirrhosis, where the non-tumoral tissue is firmer than the tumor structure, with consequent reduction of drug diffusion. This could be the reason why some human studies have concluded similar or even better safety and efficacy with PAI compared to PEI.
- Published
- 2007
184. Ruptured aortic arch aneurysm: transposition of aortic arch branches after insertion of thoracic endovascular stent with extra-anatomic brain perfusion
- Author
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Raffaele Bonifazi, Paolo Pantaleo, Roberto Coppola, and Marco Gucciardo
- Subjects
Pulmonary and Respiratory Medicine ,Aortic arch ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Aortic Rupture ,law.invention ,Blood Vessel Prosthesis Implantation ,Aneurysm ,law ,medicine.artery ,Ascending aorta ,Cardiopulmonary bypass ,Medicine ,Thoracic aorta ,Humans ,cardiovascular diseases ,Aortic rupture ,Aged ,business.industry ,Anastomosis, Surgical ,Stent ,medicine.disease ,Femoral Artery ,Carotid Arteries ,cardiovascular system ,Deep hypothermic circulatory arrest ,Surgery ,Stents ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Tomography, X-Ray Computed ,Aortic Aneurysm, Abdominal - Abstract
Conventional surgical treatment of a ruptured aortic arch aneurysm is a challenging approach with a high rate of adverse outcomes. The midsternotomy can be complicated by total aortic disruption with often fatal massive hemorrhage. A preliminary cardiopulmonary bypass with peripheral cannulation and cooling is often preferred. Endovascular stents have been used in patients with thoraco-abdominal aneurysms, with good results. Its lone utilization for rupture of aortic arch aneurysm is not feasible because of the unavoidable occlusion of cerebral vessels' origins. A previous aorto-bicarotid bypass is mandatory and it requires the midsternotomy. Hence, we developed a combined technique. We performed a hybrid approach in a 74-year-old patient, affected by an aortic arch aneurysm, ruptured in its antero-inferior portion. First we ensured brain perfusion with a temporary surgical extra-anatomic (femoral-bicarotid) bypass. Then an endovascular stent graft was expanded from the distal portion of ascending aorta to the proximal one of the thoracic aorta, thus excluding the ruptured portion of the aortic arch. Then the patient underwent the definitive aorto-carotid bypass. This specific combined technique allows the complete treatment of a ruptured arch aneurysm, lowering the risks connected with sternothomic approach, mainly with previous cardiopulmonary bypass and deep hypothermic circulatory arrest.
- Published
- 2007
185. Solitary splenic metastasis of ovarian carcinoma: report of two cases
- Author
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Garberini A, Roberto Coppola, Damiano Caputo, and Rossana Alloni
- Subjects
Oncology ,medicine.medical_specialty ,Pathology ,medicine.medical_treatment ,Splenectomy ,Breast Neoplasms ,Adenocarcinoma ,Surgical oncology ,Internal medicine ,Ovarian carcinoma ,Parenchyma ,medicine ,Humans ,Ovarian Neoplasms ,business.industry ,Splenic Neoplasms ,Carcinoma, Ductal, Breast ,Neoplasms, Second Primary ,General Medicine ,Middle Aged ,medicine.disease ,Debulking ,Magnetic Resonance Imaging ,Chemotherapy, Adjuvant ,Positron-Emission Tomography ,Surgery ,Female ,Laparoscopy ,Ovarian cancer ,business ,Tomography, X-Ray Computed ,Splenic metastasis - Abstract
Capsular splenic metastasis from ovarian cancer, which is associated with peritoneal spread, is not uncommon. Conversely, solitary involvement of the splenic parenchymal is unusual, and secondary debulking may improve the prognosis if there is no sign of residual disease. Thus, splenectomy is indicated for this type of isolated splenic metastasis. We report two cases of successful splenectomy for solitary splenic metastasis of ovarian carcinoma and review the relevant literature.
- Published
- 2007
186. Retrospective analysis of long-term defunctioning stoma complications after colorectal surgery
- Author
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Marco Caricato, Francesco Bartolozzi, G. Campoli, V. Ripetti, Roberto Coppola, and Fabio Ausania
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Enterostomal therapist ,Ileostomy ,Postoperative Complications ,Risk Factors ,Colostomy ,medicine ,Diverticulosis, Colonic ,Humans ,Peritoneal Neoplasms ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,General surgery ,Gastroenterology ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Defunctioning stoma ,Colorectal surgery ,Surgery ,Stenosis ,surgical procedures, operative ,Female ,business ,Complication ,Colorectal Neoplasms - Abstract
Objective Defunctioning stoma is a common surgical procedure, but the choice of stoma remains controversial. The preference for colostomy or ileostomy depends on the type of surgery and on the surgeon who performs the procedure. Stoma reversal is often performed a few weeks after colorectal resection but few studies have analysed the long-term complications of different types of stoma. This study aims to determine which type of stoma is associated with a lower rate of long-term complications. Method A retrospective study of patients undergoing colorectal surgery from 1998 to 2004 with stoma creation after was conducted. Only patients followed up by our enterostomal therapist for a minimum of 3 months were included. Both emergency and elective procedures were considered. All stoma-related complications were recorded. Kruskal–Wallis and Mann-Whitney U-test were used for statistical analysis (Reviewer 2, n. 5). Results 132 patients were considered suitable for the analysis. Patients were divided into loop ileostomy (44), loop colostomy (77) and end colostomy (11) group. Mean age was 68 years. Mean follow up was 4 months (range: 3–23). The overall complication rate was 60%. The most common complication included dermatitis, parastomal hernia, leakage and stenosis. The stoma with the lowest complications rate was end colostomy (P = 0.026). Age
- Published
- 2007
187. Molecular prognostic factors in patients with pancreatic cancer
- Author
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Bruno Vincenzi, Francesco Pantano, Giuseppe Tonini, Daniele Santini, Armando Gabbrielli, and Roberto Coppola
- Subjects
Oncology ,medicine.medical_specialty ,Clinical Biochemistry ,Resection ,pancreas cancer ,Internal medicine ,Pancreatic cancer ,Drug Discovery ,Biomarkers, Tumor ,medicine ,Humans ,In patient ,Ductal adenocarcinoma ,Surgical treatment ,Pharmacology ,biology ,prognosis ,Tumor ,business.industry ,Incidence (epidemiology) ,Mortality rate ,medicine.disease ,Prognosis ,Pancreatic Neoplasms ,medicine.anatomical_structure ,Molecular Medicine ,Pancreas ,business ,Biomarkers - Abstract
Pancreatic cancer is the fourth most common cause of cancer death in Western society and is a leading cause of cancer death worldwide. Its incidence and mortality rates are almost identical. Surgery is the only treatment theoretically curative, but20% of all patients admitted with ductal adenocarcinoma of the pancreas undergo resection and at best, 25% of those survive for 5 years. The identification of prognostic factors that are able to stratify patient populations recognizing those that could able to benefit by a radical surgical treatment and/or a chemotherapeutic treatment. This paper is a not only a detailed review of existing studies evaluating pancreatic cancer biomarkers, but also a critical evaluation of the real clinical use of these kinds of prognostic factors with the purpose to help discriminate between a variety of factors which, so far, can be considered really useful in everyday clinical practice. Although no single marker has been shown to be perfect in predicting patient outcome, a profile based on the best of these markers may prove useful in directing patient therapy. The markers with the strongest evidence as independent predictors of patient outcome include, p16, MMP7 and vascular endothelial growth factor.
- Published
- 2007
188. Mucin 2 (MUC2) and mucin 5 (MUC5) expression is not associated with prognosis in patients with radically resected ampullary carcinoma
- Author
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Paolo Magistrelli, Roberto Coppola, Pasquale Mellone, Mara Campioni, Alfonso Baldi, Domenico Borzomati, Daniele Santini, Armando Antinori, Bruno Vincenzi, Giuseppe Tonini, Santini, D, Baldi, Alfonso, Vincenzi, B, Mellone, P, Campioni, M, Antinori, A, Borzomati, D, Coppola, R, Magistrelli, P, and Tonini, G.
- Subjects
Adult ,Male ,ampulla of vater cancer ,surgery ,prognosis ,medicine.medical_specialty ,Pathology ,Ampulla of Vater ,Common Bile Duct Neoplasms ,Mucin 2 ,Biology ,digestive system ,Pathology and Forensic Medicine ,Short Reports ,medicine ,Biomarkers, Tumor ,Humans ,Cell adhesion ,MUC1 ,Aged ,chemistry.chemical_classification ,Aged, 80 and over ,Mucin-2 ,Mucin ,Mucins ,Anatomical pathology ,General Medicine ,Middle Aged ,Mucin-5B ,Survival Analysis ,Epithelium ,Neoplasm Proteins ,medicine.anatomical_structure ,chemistry ,Immunohistochemistry ,Female ,Glycoprotein - Abstract
Mucins are glycoproteins that are common on the surfaces of many epithelial cells. Under normal circumstances, mucins are known to play a protective role for epithelial tissues. In addition, their involvement in the differentiation of the epithelium, modulation of cell adhesion, as well as cell signalling has also been proposed.1 Two main families can be distinguished: secreted mucins or gel-forming mucins (MUC2, MUC5AC, MUC5B, MUC6), and membrane-bound mucins (MUC1, MUC3, MUC4, MUC12, MUC17).2 Alterations in the expression and in the structure of mucins have been reported in both pre-neoplastic and neoplastic lesions.3 The production of MUC2 or MUC5AC has been correlated, by a majority of non-invasive type tumours, with the expansive growth of the tumours that display lower levels of invasion and metastasis.4 A broad histomorphological spectrum of ampullary carcinomas of Vater make a reproducible histological classification difficult. Ampullary carcinomas positive for MUC2 have been associated with intestinal type tumour, whereas MUC5AC-positive ampullary carcinomas were related to pancreaticobiliary type.5–7 In ampullary carcinoma, immunohistochemical expression …
- Published
- 2007
189. Long non-coding RNA HSAT II as a new biomarker for the identification of high risk intraductal papillary mucinous neoplasms (IPMNs)
- Author
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Giuseppe Perrone, Giulia Ribelli, Daniele Santini, Bruno Vincenzi, G. Tonini, Michelina Amato, Gennaro Nappo, Michele Iuliani, Domenico Borzomati, Roberto Coppola, F.M. Di Matteo, Lucio Trodella, Claudio Pellegrini, Andrea Onetti-Muda, Marco Fioramonti, Daniela Righi, Francesco Pantano, and Alice Zoccoli
- Subjects
Cancer Research ,Pathology ,medicine.medical_specialty ,Heterogeneous group ,business.industry ,Hematology ,Computational biology ,Biology ,Non-coding RNA ,Long non-coding RNA ,pancreas ,cancer ,ipmn ,Oncology ,medicine ,Cancer research ,Biomarker (medicine) ,Identification (biology) ,Pancreatic carcinoma ,business - Abstract
e15246 Background: Satellite repeat RNAs HSAT II belongs to an heterogeneous group of non-coding transcripts, namely long non-coding RNAs. HSAT II transcripts, recently found in pancreatic ductal a...
- Published
- 2015
190. Tumor regression in mesorectal lymphnodes after neoadjuvant chemoradiation for rectal cancer
- Author
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Roberto Coppola, Bruno Vincenzi, Carla Rabitti, F. Cellini, Giuseppe Tonini, Marco Caricato, E. De Dominicis, and Fabio Ausania
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Oncology ,Male ,Neoplasm, Residual ,Colorectal cancer ,medicine.medical_treatment ,Tumor regression grade ,Antineoplastic Combined Chemotherapy Protocols ,Medicine ,Lymphnode regression grade (LRG) ,Rectal cancer ,Dose Fractionation ,Neoadjuvant therapy ,Adjuvant ,Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA ,Tumor Regression Grade ,Radiation ,Remission Induction ,General Medicine ,Primary tumor ,Neoadjuvant Therapy ,medicine.anatomical_structure ,Treatment Outcome ,Chemotherapy, Adjuvant ,Residual ,Lymphatic Metastasis ,Female ,Peritoneum ,medicine.medical_specialty ,Rectum ,Mesorectum ,Lymphnodes metastasis ,Internal medicine ,Chemotherapy ,Humans ,Mesorectal ,Neoplasm Staging ,Retrospective Studies ,Radiotherapy ,business.industry ,Rectal Neoplasms ,Dose fractionation ,medicine.disease ,Chemoradiation therapy ,Fibrosis ,Radiation therapy ,Neoplasm ,Surgery ,Radiotherapy, Adjuvant ,Dose Fractionation, Radiation ,Lymph Nodes ,business - Abstract
Aims The histological modification produced by neoadjuvant chemoradiation on primary rectal cancer has been investigated by many authors, and a prognostic value of tumor regression grade (TRG) has been identified. Tumor regression grade on metastatic mesorectal lymphnodes has been never evaluated. The purpose of this study is to analyse the TRG on mesorectal lymphnodes (lymphnode regression grade, LRG) after preoperative chemoradiation in rectal cancer patients and to determine the correlation with TRG of primary tumor. Methods Surgical specimens from 35 patients who underwent chemoradiation were included. LRG on mesorectal lymphnodes was assessed by immunohistochemistry. Response to treatment was evaluated by a 5-point LRG based on the ratio of residual tumor to fibrosis. Results Complete pathologic response (LRG 1) was observed in 18 patients (51%). In 4 patients (11%) no regression was observed (LRG 5). In 4 cases only reactive lymphnodes were found. LRG on lymphnodes significantly correlated with TRG on primary tumor (p Conclusions Neoadjuvant chemoradiation determines a tumor regression on mesorectal lymphnodes as on primary tumor; further studies are needed to evaluate the prognostic value of LRG.
- Published
- 2006
191. Same-day endoscopic retrograde cholangiopancreatography after transduodenal endoscopic ultrasound-guided needle aspiration: do we need to be cautious?
- Author
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Lalit Shimpi, Roberto Coppola, Armando Gabbrielli, M. Martino, F.M. Di Matteo, Marco Caricato, Alessandro Esposito, M. L. De Cicco, and Guido Costamagna
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Endoscopic ultrasound ,medicine.medical_specialty ,Time Factors ,complications ,Duodenum ,medicine.medical_treatment ,echoendoscopy ,digestive system ,Endosonography ,Postoperative Complications ,Pancreatic tumor ,Laparotomy ,medicine ,Retroperitoneal space ,Bile ,Humans ,Pancreas ,ercp ,Cholangiopancreatography, Endoscopic Retrograde ,Endoscopic retrograde cholangiopancreatography ,medicine.diagnostic_test ,Bile duct ,business.industry ,Biopsy, Needle ,Gastroenterology ,Middle Aged ,medicine.disease ,digestive system diseases ,Endoscopy ,Pancreatic Neoplasms ,surgical procedures, operative ,medicine.anatomical_structure ,Surgery, Computer-Assisted ,Biliary tract ,Female ,Radiology ,business - Abstract
Patients who are undergoing endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for suspected pancreatic tumors frequently undergo endoscopic retrograde cholangiopancreatography (ERCP) for palliation of their symptoms. Performing EUS-FNA and ERCP in tandem may be cost-effective and may reduce procedure time, but the potential risks associated with this approach have not been clearly defined in the literature. We report two patients who underwent same-day therapeutic ERCP after transduodenal EUS-FNA for pancreatic tumors. Endoscopic biliary manipulation during ERCP aggravated an inadvertent and subclinical needle puncture injury to the bile duct sustained during the preceding EUS-FNA. This resulted in leakage of bile into the retroperitoneal space, and both patients required laparotomy and surgical drainage. Additional clinical evidence is needed to clarify these issues and to determine whether it would be prudent to perform therapeutic ERCP prior to diagnostic transduodenal EUS-FNA when these two procedures are planned as sequential or same-day procedures.
- Published
- 2006
192. Impaired contractility of colonic muscle cells in a patient with chronic intestinal pseudo-obstruction
- Author
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Roberto Corinaldesi, Vincenzo Stanghellini, Michele Pier Luca Guarino, Annamaria Altomare, R. De Giorgio, Michele Cicala, Rossana Alloni, E. Tarquini, Rosanna Cogliandro, Roberto Coppola, Giovanni Barbara, Simone Carotti, Guarino MP., Carotti S., Cogliandro R., Stanghellini V., De Giorgio R., Barbara G., Alloni R., Altomare A., Tarquini E., Coppola R., Corinaldesi R., and Cicala M.
- Subjects
Agonist ,Intestinal pseudo-obstruction ,Adult ,Pathology ,medicine.medical_specialty ,medicine.drug_class ,Colon ,Manometry ,medicine.medical_treatment ,Colonic Pseudo-Obstruction ,Cholinergic Agents ,urologic and male genital diseases ,Severity of Illness Index ,NO ,Contractility ,medicine ,Pressure ,Myocyte ,Humans ,Pathological ,Colectomy ,Hepatology ,business.industry ,Gastroenterology ,Muscle, Smooth ,medicine.disease ,digestive system diseases ,Acetylcholine ,Chronic Disease ,Cholinergic ,Female ,business ,Gastrointestinal Motility ,medicine.drug ,Muscle Contraction - Abstract
Chronic intestinal pseudo-obstruction represents a cause of persistent functional intestinal failure either "secondary" to specific conditions or "chronic intestinal idiopathic pseudo-obstruction" in origin. The diagnosis is mainly clinical, supported by radiological and/or endoscopic findings excluding any mechanical cause of intestinal obstruction. We reported a case of a 39-year-old woman with chronic intestinal idiopathic pseudo-obstruction, who underwent colectomy with ileorectal anastomosis; histological examination of the surgical specimen did not reveal myogenic or neurogenic defects or other pathological abnormalities indicative of an underlying neuromuscular impairment. Because of the apparent integrity of the gut neuromuscular layer, we tested whether a functional impairment affected colonic single smooth muscle cells. Muscle cells were isolated from the right colon and their contractile response to a receptor-dependent agonist evaluated in comparison to that obtained from controls. The cell contraction induced by acetylcholine in a dose response manner was markedly decreased in the patient affected by chronic intestinal idiopathic pseudo-obstruction compared with cells from controls (percentage of cell shortening with maximal dose of acetylcholine [10(-6)M]: 10.7+/-3% versus 34.2+/-4%, respectively). The present findings indicate a specific defect of colonic smooth muscle cells likely related to an ineffective response to acetylcholine.
- Published
- 2006
193. Sems (self expanding metal stents) in a patient with esophagogastric cancer and esophagorespiratory fistula (ERF)
- Author
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Montesano, M., Crucitti, P., Pandolfi, M., Zanca, A., Gabbrielli, A., and Roberto Coppola
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Male ,metal stent ,Esophageal Neoplasms ,Palliative Care ,Stomach Neoplasms ,esophageal cancer ,esophagorespiratory fistula ,Carcinoma, Squamous Cell ,Humans ,Stents ,Tomography, X-Ray Computed ,Aged ,Tracheoesophageal Fistula - Abstract
Esophagorespiratory fistulas, especially in the upper third of the esophagus, are a complication of malignant esophageal tumors, whose management is difficult and prognosis is poor. Treatment is palliative and involves restoration of the ability to ingest food and prevention of aspiration by insertion of esophageal or tracheobronchial stents. In selected patients the insertion of a single stent may be insufficient for pallation therefore the placement of parallel stents may be indicated in patients with symptoms caused by malignant esophagorespiratory fistula. A case of esophagorespiratory fistula managed with insertion of parallel stents is presented.
- Published
- 2006
194. Superficial temporal artery pseudoaneurysm: a conservative approach in a critically ill patient
- Author
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Roberto Coppola, Pierfilippo Crucitti, Bruno Beomonte Zobel, Carlo Cosimo Quattrocchi, Rosario Francesco Grasso, and Giampiero Carboni
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Male ,medicine.medical_specialty ,Critical Illness ,Pseudoaneurysm ,Aneurysm ,medicine.artery ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Accidental fall ,Ultrasonography, Doppler, Color ,Ligation ,Aged ,business.industry ,Critically ill ,Ultrasound ,Color doppler ultrasound ,medicine.disease ,Superficial temporal artery ,Bandages ,Surgery ,Temporal Arteries ,medicine.anatomical_structure ,Scalp ,cardiovascular system ,Accidental Falls ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Tomography, X-Ray Computed ,Aneurysm, False - Abstract
A 71-year-old man affected by cardio- and cerebrovascular disease experienced an accidental fall and trauma to the fronto-temporal area of the head. A few weeks later a growing mass appeared on his scalp. A diagnosis of superficial temporal artery pseudoaneurysm was made following CT and color Doppler ultrasound. His clinical condition favoured a conservative approach by ultrasound-guided compression and subsequent surgical resection. A conservative approach should be considered the treatment of choice in critically ill patients affected by superficial temporal artery pseudoaneurysm.
- Published
- 2006
195. [Education in postgraduate surgical schools: the role of the surgical tutor as supervisor in the operating room]
- Author
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Rossana, Alloni, Paola, Binetti, Roberto, Coppola, and Augusto, Arullani
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Operating Rooms ,Faculty, Medical ,Italy ,General Surgery ,Surveys and Questionnaires ,Teaching ,Mentors ,Humans ,Internship and Residency ,Guidelines as Topic ,Physician's Role ,Schools, Medical - Abstract
The Postgraduate Surgical education is in an era of transition, in order to create physicians with skills and attitudes needed by modern health care. Many studies have examined the impact of surgical tutoring in surgical residency programs in USA Medical Schools, while few experiences are reported from European Universities. The new Italian guidelines for post-graduate education require a structured clinical learning with the supervision of a tutor ("attending surgeon" for surgical residency); it is a challenge to describe the role of this teacher and educator, and to implement an effective evaluation of operating room teachers. Confidential survey was administered to 14 surgical residents of the Authors' University. Questions were related to their surgical activity and their perception of educational role of tutors in operating room and tutors' teaching behaviors. Residents pointed out five behaviors they perceive as signs of tutor excellence in clinical and operating room setting. According with studies from other Universities, residents need a tutor with competency but also with good teaching skills and a mature self-perception as educator. Faculty would provide training programs for surgeons in order to improve their teaching skills and behaviors.
- Published
- 2006
196. Chronomodulated administration of oxaliplatin plus capecitabine (XELOX) as first line chemotherapy in advanced colorectal cancer patients: phase II study
- Author
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Bruno Vincenzi, Marco Caricato, Vladimir Virzì, Daniele Santini, Giuseppe Tonini, Marisa Di Seri, Gaia Schiavon, Bruno Spalletta, and Roberto Coppola
- Subjects
Adult ,Male ,Cancer Research ,medicine.medical_specialty ,Antimetabolites, Antineoplastic ,Organoplatinum Compounds ,Oxaloacetates ,Colorectal cancer ,Phases of clinical research ,colorectal cancer ,Antineoplastic Agents ,Neutropenia ,chemotherapy ,Toxicology ,Gastroenterology ,Deoxycytidine ,Metastasis ,Capecitabine ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,medicine ,Humans ,Pharmacology (medical) ,Prodrugs ,Neoplasm Metastasis ,Survival analysis ,Aged ,Pharmacology ,treatment ,business.industry ,Middle Aged ,medicine.disease ,Survival Analysis ,Oxaliplatin ,Surgery ,Regimen ,Drug Combinations ,Treatment Outcome ,Oncology ,Sample Size ,Disease Progression ,Female ,Fluorouracil ,business ,Colorectal Neoplasms ,medicine.drug - Abstract
The combination of 5-fluorouracil (5-FU), leucovorin (LV), and oxaliplatin (I-OHP) was shown to be both more active against metastatic colorectal carcinoma and better tolerated if the drug delivery rate was chronomodulated according to circadian rhythms rather than constant. The aim of the present study was to define the feasibility and efficacy of XELOX administered through a new chronomodulated schedule in untreated advanced colorectal cancer (CRC) patients. Chemotherapy-naive patients with advanced CRC were considered eligible for the study accrual. Treatment: oxaliplatin 70 mg/m2 continuous infusion (c.i.) for 12 h (8:00 a.m. to 8:00 p.m.) days 1, 8 plus chronomodulated oral capecitabine 1,750 mg/m2/die (h 8:00 a.m. 25% of total dose; h 6:00 p.m. 25% of total dose; h 11:00 p.m. 50% of total dose), days 1–14 every 21 days. Forty-six patients were evaluated for safety and efficacy (male/female, 20/26). Median age was 64 years (range 28–77 years). Median Eastern Cooperative Oncology Group performance status (PS) was 0 (range 0–1). A total of 324 cycles have been administered: median per patient 6 (range 3–10 courses). Median number of metastatic sites was 1. Metastatic sites distribution was as follows: liver (65.2%), lung (34.8%), and nodes (32.6%). Median follow-up was 14 months (range 6.0–40.3 months). In an intent-to-treat efficacy analysis, objective response and stable disease were recorded in 27 (58.6%) and in 16 patients (34.9%), respectively. The median response duration was 8.0 months (95% CI; 5.03–10.96 months). The median time to progression (TTP) was 9.0 months (95% CI; 6.47–11.52 months). The overall survival (OS) was not reached, with a median value > 24 months (95% CI; 23.66–36.30 months). The grade 3 toxicities were diarrhea (8.7%), liver toxicity (13.1%), fatigue (8.7%), neurotoxicity (2.2%), neutropenia (8.7%), and thrombocytopenia (2.2%). This regimen resulted of particular interest for patients with untreated metastatic CRC.
- Published
- 2006
197. Cerebellar metastasis from pancreatic adenocarcinoma. A case report
- Author
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Marco, Caricato, Domenico, Borzomati, Fabio, Ausania, Andrea, Garberini, Carla, Rabitti, Giuseppe, Tonini, and Roberto, Coppola
- Subjects
Male ,Pancreatic Neoplasms ,Antimetabolites, Antineoplastic ,Recurrence ,Humans ,Adenocarcinoma ,Cerebellar Neoplasms ,Tomography, X-Ray Computed ,Deoxycytidine ,Gemcitabine ,Aged ,Pancreaticoduodenectomy - Abstract
The first discovery of a cerebellar metastasis of pancreatic carcinoma in a living patient is described. Two years earlier the patient had undergone a pancreaticoduodenectomy for an adenocarcinoma of the head of the pancreas with a lymph node metastasis. After complete surgical removal of the tumor, he underwent adjuvant chemoradiation. Two years later the patient presented with intractable vomiting, which was attributed to peritoneal carcinomatosis. Clinical evaluation revealed an intracranial tumor without signs of pancreatic recurrence. The tumor was surgically removed. One year later the patient developed multiple brain metastases and he is currently undergoing gemcitabine-based chemotherapy.
- Published
- 2006
198. COX-2 expression in ampullary carcinoma: correlation with angiogenesis process and clinicopathological variables
- Author
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Roberto Coppola, Alfio Verzì, Daniele Santini, Domenico Borzomati, Carla Rabitti, Bruno Vincenzi, Paolo Magistrelli, Giuseppe Perrone, Armando Antinori, Fabio Maria Vecchio, and Giuseppe Tonini
- Subjects
Adult ,Male ,Vascular Endothelial Growth Factor A ,medicine.medical_specialty ,Pathology ,Ampulla of Vater ,Angiogenesis ,Common Bile Duct Neoplasms ,Biology ,Statistics, Nonparametric ,Pathology and Forensic Medicine ,Neovascularization ,chemistry.chemical_compound ,ampulla of vater cancer ,cox-2 expression ,prognosis ,von Willebrand Factor ,Carcinoma ,medicine ,Humans ,Aged ,Neovascularization, Pathologic ,Anatomical pathology ,General Medicine ,Middle Aged ,medicine.disease ,Immunohistochemistry ,Endothelial stem cell ,Vascular endothelial growth factor ,Vascular endothelial growth factor A ,chemistry ,Cyclooxygenase 2 ,Original Article ,Female ,medicine.symptom ,Biomarkers - Abstract
Background: There is evidence that the anti-neoplastic effect of non-steroidal anti-inflammatory drugs is attributable to cyclooxygenase-2 (COX-2) inhibition, but the exact mechanisms whereby COX-2 can promote tumour cell growth remain unclear. One hypothesis is the stimulation of tumour angiogenesis by the products of COX-2 activity. To data, there have been few clinicopathological studies on COX-2 expression in human ampullary carcinoma and no data have been reported about its relation with tumour angiogenesis. Objective: To investigate by immunohistochemistry the expression of COX-2 and the angiogenesis process in a series of primary untreated ampullary carcinomas. Methods: Tissue samples from 40 archival ampullary carcinomas were analysed for COX-2, vascular endothelial growth factor (VEGF), and an endothelial cell marker von Willebrand factor (vWF) by immunohistochemistry, using specific antibodies. Results: COX-2 expression was detected in 39 tissue samples (97.5%), of which two (5%) were graded as weak, 26 (65%) as moderate, and 11 (27.5%) as strong. Only one lesion (2.5%) was negative for COX-2 expression. VEGF expression was detected in 36 tissue samples (90%). A significant positive correlation was found between COX-2 and VEGF expression. No statistic correlation was found between COX-2 expression and microvessel density. Conclusions: COX-2 is highly expressed in ampullary carcinomas. This suggests an involvement of the COX-2 pathway in ampullary tumour associated angiogenesis, providing a rationale for targeting COX-2 in the treatment of ampullary cancer.
- Published
- 2006
199. [Cardiac surgery in octogenarians: a six-year follow-up with a multidimensional intervention]
- Author
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Giuseppe, Speziale, Raffaele, Bonifazi, Paolo, Cavagnaro, Omar, Di Gregorio, Achille, Pasquè, Sabrina, Zanardi, Gianbattista, Ravera, Maurizio, Marini, and Roberto, Coppola
- Subjects
Aged, 80 and over ,Heart Valve Prosthesis Implantation ,Male ,Postoperative Care ,Cardiopulmonary Bypass ,Time Factors ,Age Factors ,Survival Analysis ,Treatment Outcome ,Aortic Valve ,Myocardial Revascularization ,Quality of Life ,Humans ,Mitral Valve ,Female ,Hospital Mortality ,Cardiac Surgical Procedures ,Coronary Artery Bypass ,Exercise ,Aged ,Follow-Up Studies - Abstract
Elderly subjects frequently experience a decline in function following hospitalization and surgery. Specific changes in the provision of acute hospital care can improve the ability of acutely ill older patients to perform activities of daily living at the time of discharge and the quality of life. The aim of this study was to investigate outcomes of older (ageor =80 years) cardiac surgery patients managed with multicomponent intervention.Between 1998 and 2004, we studied records of 193 octogenarian patients who underwent cardiac surgery and were treated with a multicomponent intervention that included: specially designed environment, patient-centered care, planning for patient discharge at home, and an interdisciplinary approach that incorporates in- and out-of-hospital health professionals.Mean follow-up was 26.4 months and 100% complete. Mean age of patients was 82.3 +/- 2 years. Eighty-nine patients had myocardial revascularization (CABG), 40 aortic valve replacement (AVR), 34 AVR + CABG, 8 mitral valve replacement (MVR), 11 MVR + CABG and 11 other interventions. Rates of hospital death, major complications and prolonged stay (14 days) were as follows: CABG 4 (4.4%), 3 (3.3%), 6 (6.4%); AVR 1 (2.5%), 3 (7.5%), 2 (5%); AVR + CABG 1 (2.9%), 2 (5.8%), 4 (11.7%); MVR 0 (0%), 0 (0%), 1 (12.5%); MVR + CABG 2 (18.1%), 2 (18.1%), 3 (27.2%). Multivariate predictors of hospital deaths were NYHA class, cardiopulmonary bypass and cross-clamping time, urgent procedure and ischemic mitral valve procedures. The actuarial 6-year survival was as follows: CABG 91%,AVR 92.5%, AVR + CABG 88.2%, MVR + CABG 81.8%. Total survival rate, free from rehospitalization and redo surgery, was 89.7, 69.8 and 99% respectively. Multivariate predictors of late death were urgent procedure and ischemic mitral valve procedures. At follow-up NYHA classification had improved a median of two classes. Global patients' satisfaction was excellent in 76.7% of survivors; 95.7% were autonomous, 40.5% live at home, 64% had a light-moderate physical activity, and 70% of patients had good social relationships and quality of life. Medical therapy was reduced in 29.3% and level of anxiety improved in 76%.An interdisciplinary approach and multicomponent intervention with an appropriate postoperative care, provides beneficial effects on outcome in geriatric cardiac surgery patients.
- Published
- 2005
200. Complementary use of local excision and transanal endoscopic microsurgery for rectal cancer after neoadjuvant chemoradiation
- Author
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Marco Caricato, Roberto Coppola, Fabio Ausania, Carla Rabitti, Lucio Trodella, V. Ripetti, Domenico Borzomati, Sergio Valeri, and Giuseppe Tonini
- Subjects
Male ,medicine.medical_specialty ,Microsurgery ,Colorectal cancer ,medicine.medical_treatment ,Rectum ,Anal Canal ,Proctoscopy ,Preoperative Care ,Medicine ,Humans ,Survival rate ,Neoadjuvant therapy ,Digestive System Surgical Procedures ,Aged ,Neoplasm Staging ,Transanal Excision ,business.industry ,Rectal Neoplasms ,Middle Aged ,medicine.disease ,Survival Analysis ,Neoadjuvant Therapy ,Surgery ,medicine.anatomical_structure ,Treatment Outcome ,Chemotherapy, Adjuvant ,Feasibility Studies ,Female ,Radiotherapy, Adjuvant ,business ,Chemoradiotherapy ,Abdominal surgery - Abstract
Neoadjuvant therapies have significantly improved local control and survival of patients with rectal cancer. Nevertheless, although a complete pathologic response can be achieved in 30% of cases, a transabdominal surgical resection is always required. This study aimed, for the first time, to test in the literature the feasibility of local excision combined with transanal endoscopic microsurgery (TEM) as a surgical option for patients treated with neoadjuvant chemoradiation. Between July 1997 and December 2002, 30 patients with rectal cancer affected by an extraperitoneal tumor entered a protocol consisting of neoadjuvant chemoradiation followed by surgery. The surgical treatment, consisting of open surgery, local excision, or TEM, was planned according to the patient’s clinical response after chemoradiation and distance from the anal verge. A significant clinical downstaging was observed in eight patients. Five of these patients underwent TEM, and three had local excision. Consequently, open surgery was performed for 22 patients. Histology showed six cases of complete pathologic response: three in the open surgery group and three in the transanal excision group. After a mean follow-up period of 47 months, the disease-free survival rate was 77% in the open surgery group and 100% in TEM or local excision group. The findings suggest the complementary feasibility of TEM and local excision after neoadjuvant chemoradiation. However, randomized trials are needed to confirm the oncologic safety of this approach.
- Published
- 2005
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