Search

Your search keyword '"Dicarlo V"' showing total 119 results
Start Over Author "Dicarlo V"
119 results on '"Dicarlo V"'

3. Comparison between pylorus‐preserving and Whipple pancreatoduodenectomy

Author

Zerbi, A, Balzano, G, Patuzzo, R, Calori, G, Braga, M, Dicarlo, V, ZERBI A, BALZANO G, PATUZZO R, CALORI G, BRAGA M, DICARLO V, Zerbi, A, Balzano, G, Patuzzo, R, Calori, G, Braga, M, Dicarlo, V, ZERBI A, BALZANO G, PATUZZO R, CALORI G, BRAGA M, and DICARLO V

Abstract

Between 1989 and 1993, 62 patients underwent Whipple pancreatoduodenectomy and 75 pylorus‐preserving pancreatoduodenectomy (PPPD); 35 patients in the first group and 37 in the second had pancreatic adenocarcinoma while 17 and 21 patients respectively had periampullary adenocarcinoma. The aim of this retrospective study was the comparison of operative outcome, nutritional recovery and survival of patients who underwent these two operations. No significant differences were found between the two groups in operative mortality or morbidity, duration of gastric aspiration and time to start of solid meals. Patients who underwent PPPD had a better nutritional recovery: the increase of both body‐weight and serum albumin level at 6 months after discharge was significantly higher for those who had preservation of the whole stomach (P < 0.001 and P < 0.05 respectively). No significant difference in survival was found between the two procedures when patients with pancreatic or periampullary adenocarcinoma were analysed separately.

Published
1995

4. Impact of a programme of autologous blood donation on the incidence of infection in patients with colorectal cancer

Author

Vignali, A, Braga, M, Dionigi, P, Radaelli, G, Gentilini, O, Bellini, A, Jemos, V, Dicarlo, V, VIGNALI A, BRAGA M, DIONIGI P, RADAELLI G, GENTILINI O, BELLINI A, JEMOS V, DICARLO V, Vignali, A, Braga, M, Dionigi, P, Radaelli, G, Gentilini, O, Bellini, A, Jemos, V, Dicarlo, V, VIGNALI A, BRAGA M, DIONIGI P, RADAELLI G, GENTILINI O, BELLINI A, JEMOS V, and DICARLO V

Abstract

Objective: To assess the effects of both autologous and homologous blood transfusion on the incidence of infective complications after elective operations for colorectal cancer. Design: Prospective open study. Setting: University hospital, Italy. Interventions: Recording of variables known to influence the development of infection. Main outcome measures: Infective morbidity and mortality. Results. Fifty-three patients (33%) deposited their own blood. Eighty-six of the 161 (53%) patients were transfused, 36 were given autologous blood, 48 homologous blood and 2 both autologous and homologous blood. These two were excluded from the analysis. Infective complications developed in 28 patients (17%), of which 7/75 (9%) were in patients who had not been transfused, 5/56 (14%) in patients given autologous transfusion, and 16/48 (33%) in patients given homologous transfusions (p <0.001). Multivariate analysis identified homologous blood transfusion as the only variable significantly associated with the development of postoperative infective complications. No patient died. Conclusion: Transfusion of autologous blood was associated with significantly fewer postoperative infective complications than transfusion of homologous blood or no blood transfusion.

Published
1995

6. Fat absorption and gastroenteric ph profile in postsurgical pancreatic insufficiency: Role of the association of H2-receptor antagonists with pancreatic enzymes

Author

Braga, M, Zerbi, A, Malesci, A, Dalcin, S, Valentini, A, Tacconi, M, Erenbourg, L, Paganelli, M, Dicarlo, V, BRAGA M, ZERBI A, MALESCI A, DALCIN S, VALENTINI A, TACCONI M, ERENBOURG L, PAGANELLI M, DICARLO V, Braga, M, Zerbi, A, Malesci, A, Dalcin, S, Valentini, A, Tacconi, M, Erenbourg, L, Paganelli, M, Dicarlo, V, BRAGA M, ZERBI A, MALESCI A, DALCIN S, VALENTINI A, TACCONI M, ERENBOURG L, PAGANELLI M, and DICARLO V

Abstract

The complete control of steatorrhea in postsurgical exocrine pancreatic insufficiency is difficult. The aim of this study was to evaluate the effect of the association of ranitidine with pancrelipase on fecal fat excretion in patients who had undergone a pancreatoduodenectomy with suppression of the exocrine pancreatic secretion by Neoprene injection. Ten patients were studied 1 year after surgery. Steatorrhea was measured as an integrated test of 3-day stools, while patients were kept on a diet of 100 g lipid/day, with their usual enzyme supplementation therapy (16,050 USP units of lipase/meal). A basal 24-h gastroenteric pH profile was also obtained. In the following month, patients had ranitidine (150 mg twice a day) in addition to pancrelipase. Then steatorrhea and gastroenteric pH were reassessed. Mean fecal fat was 26.9 (SD 13.7) g/day without ranitidine and 30.5 (SD 13.9) g/day during combined treatment. Body weight and nutritional parameters did not show any significant variation after ranitidine administration. Even in the absence of ranitidine, postprandial gastroenteric pH values were always >4; the H2-receptor antagonist only reduced fasting gastric acidity. In conclusion, the gastroenteric pH and fecal fat determinations showed that ranitidine is not useful in patients with total postsurgical exocrine pancreatic insufficiency.

Published
1993

7. Role of bioelectrical impedance analysis in acutely dehydrated subjects

Author

Dalcin, S, Braga, M, Molinari, M, Cristallo, M, Dicarlo, V, DALCIN S, BRAGA M, MOLINARI M, CRISTALLO M, DICARLO V, Dalcin, S, Braga, M, Molinari, M, Cristallo, M, Dicarlo, V, DALCIN S, BRAGA M, MOLINARI M, CRISTALLO M, and DICARLO V

Abstract

15 young healthy volunteers were studied to assess the reliability of bioelectrical impedance analysis (BIA) to determine body composition during acute dehydration. Body weight (BW), resistance and reactance measurements were performed before and 4h after a 40 mg intravenous administration of furosemide. BW decreased on average from 69.09 ± 9.83 kg to 67.43 ± 9.72 kg (p < 0·001), while resistance, reactance, and phase angle showed significant increases. The individual variations in bioelectrical parameters were not related to the BW loss. Formulae to derive body composition predicted poorly the true water loss (mean individual error: 40% of real loss). The errors in body composition prediction were unrelated to basal percentage of fat free mass, to body mass index, or to BW loss after furosemide administration. In conclusion, BIA proved unreliable in calculating the body composition of acutely dehydrated subjects.

Published
1992

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

Author

Braga, M, Vignali, A, Radaelli, G, Gianotti, L, Dicarlo, V, BRAGA , MARCO, VIGNALI , ANDREA, RADAELLI G, GIANOTTI L, DICARLO V., Braga, M, Vignali, A, Radaelli, G, Gianotti, L, Dicarlo, V, BRAGA , MARCO, VIGNALI , ANDREA, RADAELLI G, GIANOTTI L, and DICARLO V.

Abstract

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

Published
1992

9. Catabolic response and parenteral nutrition after simultaneous kidney-pancreas transplantation

Author

Braga, M, Castoldi, R, Cristallo, M, Valeri, R, Pozza, G, Dicarlo, V, BRAGA M, CASTOLDI R, CRISTALLO M, VALERI R, POZZA G, DICARLO V, Braga, M, Castoldi, R, Cristallo, M, Valeri, R, Pozza, G, Dicarlo, V, BRAGA M, CASTOLDI R, CRISTALLO M, VALERI R, POZZA G, and DICARLO V

Abstract

The aim of the study was to quantify the catabolism rate induced by simultaneous kidney-pancreas transplantation and to evaluate the impact of parenteral nutrition (PN) on recovery of graft function. Twenty-six diabetic uremic patients were studied. The average urea nitrogen production (UNP) was 5.2 +/- 1.7 g during the first 24 h after transplantation, while patients did not receive energy and nitrogen support. Energy (30 kcal.kg-1.day-1) and nitrogen (0.15 g.kg-1.day-1) intake started 24 h after surgery. In 14 patients, a mixed regimen was adopted (70% carbohydrates, 30% lipids), and 12 patients received only hypertonic glycidic solutions. The recovery of kidney function was immediate in all cases, with a prompt decrease in blood urea nitrogen and serum creatinine levels. C-peptide levels rose immediately after the revascularization of the pancreas graft and remained within the normal range during the PN period. No significant difference was observed in UNP or glucose tolerance between the mixed-regimen and glycidic groups. However, on average 6.6, and 1.5 hyperglycemic episodes occurred during the 1st wk of PN in the glycidic and mixed-regimen groups, respectively. The posttransplantation catabolism rate was similar to that induced by an elective major surgical procedure. Eucaloric PN did not affect the recovery of kidney and pancreas graft function. A mixed energy regimen seems to be most suitable for kidney-pancreas transplant patients because it prevents hyperglycemia which might be misdiagnosed as rejection.

Published
1992

10. Bleeding gastric polyposis-like metastases of hepatocellular carcinoma

Author

Denardi, P, Braga, M, Zerbi, A, Sassi, I, Mangili, F, Cristallo, M, Dicarlo, V, DENARDI P, BRAGA M, ZERBI A, SASSI I, MANGILI F, CRISTALLO M, DICARLO V, Denardi, P, Braga, M, Zerbi, A, Sassi, I, Mangili, F, Cristallo, M, Dicarlo, V, DENARDI P, BRAGA M, ZERBI A, SASSI I, MANGILI F, CRISTALLO M, and DICARLO V

Abstract

The first case ever described of symptomatic gastric polypoid metastases in a 62-year-old patient, who had undergone right hepatectomy for hepatocellular carcinoma (HCC) 2 years before, is reported. The patient presented recurrences of gastrointestinal bleeding. Barium meal and endoscopy showed multiple gastric polyps extending from the cardia to the pylorus. Histological examination of biopsies of these polyps resulted consistent with metastases of HCC. A total gastrectomy was performed for palliation of symptoms. Histo-pathological examination confirmed the presence of metastatic HCC: neoplastic nests implanted in the submucosa and extending towards the mucosa. The above observation supports that the possible route of spread in our patient could be hematogenous from reversed portal blood flow. The patient died 20 months after surgery, with liver recurrence of the tumor.

Published
1992

12. Metabolic effects of islet graft: Comparison with segmental and whole pancreas graft

Author

Secchi A, Taglietti MV, Maffi P, Socci C, Caldara R, LaRocca E, Bertuzzi F, Ferrari G, Castoldi R, DeNittis P, DiCarlo V, Pozza G., PIEMONTI , LORENZO, Secchi, A, Taglietti, Mv, Maffi, P, Socci, C, Caldara, R, Larocca, E, Bertuzzi, F, Ferrari, G, Castoldi, R, Piemonti, Lorenzo, Denittis, P, Dicarlo, V, and Pozza, G.

Published
1996

13. Surgical treatment of gastric adenocarcinoma: impact on survival and quality of life. A prospective ten year study

Author

BRAGA , MARCO, Molinari M, Zuliani W, Foppa L, Gianotti L, Radaelli G, Cristallo M, DiCarlo V., Braga, M, Molinari, M, Zuliani, W, Foppa, L, Gianotti, L, Radaelli, G, Cristallo, M, Di Carlo, V, Braga, Marco, and Dicarlo, V.

Subjects
Adult, Aged, 80 and over, Male, Adenocarcinoma, Middle Aged, Survival Rate, Prospective Studie, Stomach Neoplasm, Gastrectomy, Stomach Neoplasms, Quality of Life, Humans, Female, Nutritional Physiological Phenomena, Prospective Studies, Human, Aged
Abstract

The objective of this prospective study was to compare the results of total (TG) versus subtotal (SG) gastrectomy in patients with adenocarcinoma of the lower two-thirds of the stomach.Two hundred and twenty-seven patients underwent curative operation. Preoperative nutritional assessment, postoperative tumor stage, postoperative morbidity/mortality, five-year survival, postgastrectomy dietary intake and nutritional sequelae were recorded in all patients.Postoperative mortality rate was 2.8% in the TG group and 1.1% in the SG group. The number of reoperations, anastomotic dehiscence rate and the length of postoperative stay were higher in the TG group. Five-year survival was closely related to lymph node involvement and gastric wall invasion. The extent of gastric resection did not influence survival when patients were matched for cancer stage. In the SG group, no recurrence in the gastric stump was observed. SG group showed a higher dietary energy intake than the TG group (p0.01). This might explain the ability of the SG group to increase body weight more than the TG group (p0.01). Only the TG group needed a monthly parenteral vitamin B12 supplements starting 36 months after surgery.The results suggest that SG should be considered the treatment of choice of the gastric adenocarcinoma when a cancer-free proximal resection margin can be guaranteed.

Published
1996

15. Islet and kidney transplantation using ATG and cyclosporin monotherapy and a central facility for islet isolation and purification

Author

Birkeland SA, BeckNielsen H, Rohr N, Socci C, Christensen J, Dieperink H, Jorgensen KA, Knudsen DU, Larsen KE, Sjolie AK, Tofte H, Yderstraede K, Bertuzzi F, Birkeland P, DiCarlo V, Pozza G., SECCHI , ANTONIO, Birkeland, Sa, Becknielsen, H, Rohr, N, Socci, C, Christensen, J, Dieperink, H, Jorgensen, Ka, Knudsen, Du, Larsen, Ke, Sjolie, Ak, Tofte, H, Yderstraede, K, Bertuzzi, F, Birkeland, P, Secchi, Antonio, Dicarlo, V, and Pozza, G.

Published
1995

20. LIPOPROTEIN PROFILE AFTER COMBINED KIDNEY-PANCREAS TRANSPLANTATION IN INSULIN-DEPENDENT DIABETES-MELLITUS

Author

LAROCCA E, PARLAVECCHIA M, BONFATTI D, RAGOGNA F, DICARLO V, POZZA G, RUOTOLO G., SECCHI , ANTONIO, Larocca, E, Secchi, Antonio, Parlavecchia, M, Bonfatti, D, Ragogna, F, Dicarlo, V, Pozza, G, and Ruotolo, G.

Abstract

In order to evaluate the effect of a combined kidney-pancreas (KP) transplantation in insulin-dependent diabetes mellitus (IDDM) patients on the lipid and lipoprotein profile, 15 KP patients were compared with 11 kidney (K)-transplanted IDDM patients, 19 IDDM patients on hemodialysis (HD), and 15 nondiabetic control subjects. Cholesterol, triglycerides, apo AI, and apo B were measured in total plasma and in VLDL, LDL. and HDL of all participants, VLDL-cholesterol, VLDL-triglycerides, and VLDL-apo B were significantly lower in KP patients, but not in K patients, than in HD patients. In addition, patients in the K, but not in the KP, group showed high levels of apo B in LDL and an increased triglyceride/apo B ratio in VLDLI compared with patients in the HD group. The percentage of apo AI associated with HDL was significantly higher in both transplanted groups than in the HD group, However, compared with a nondiabetic control population, an increase in VLDL particles and in triglyceride content in LDL and HDL still persisted following combined KP transplantation. Insulin resistance (probably due to steroid therapy) associated with high peripheral and potentially low hepatic insulin levels (due to the systemic drainage of the transplanted pancreas! could be the main causes of the remaining lipoprotein abnormalities.

Published
1995

21. THE ROLE OF INTRAOPERATIVE THERAPY BY ELECTRON-BEAM AND COMBINATION OF ADJUVANT CHEMOTHERAPY AND EXTERNAL RADIOTHERAPY IN CARCINOMA OF THE PANCREAS

Author

FOSSATI V, CATTANEO GM, ZERBI A, GALLI L, BORDOGNA G, RENI M, PAROLINI D, CARLUCCI M, BISSI A, STAUDACHER C, DICARLO V, CALANDRINO R, Fossati, V, Cattaneo, Gm, Zerbi, A, Galli, L, Bordogna, G, Reni, M, Parolini, D, Carlucci, M, Bissi, A, Staudacher, C, Dicarlo, V, and Calandrino, R

Abstract

Aims and background: In the treatment of pancreatic carcinomas, one modality is intraoperative radiotherapy (IORT). A study was carried out to assess the feasibility of IORT alone or in a multimodality approach with postoperative adjuvant chemotherapy and external radiotherapy and to compare local control and survival of patients. Another objective of this retrospective study was to verify prognostic factors in resected patients treated with IORT. Methods: From January 1985 through September 1992, 54 adenocarcinomas of the pancreas (unresectable and resected patients) were treated with IORT by electron beam at the San Raffaele Hospital and then analyzed. Comparison was also carried out between IORT-treated resected patients and a non-randomized control group of resected patients treated without IORT in the same period. Results: In unresectable patients treated by laparotomy bypass and IORT, overall median survival was 6 months and 8 months in non-metastatic patients. Relief of severe pain present in 14 patients was observed in 85% within 12 days of IORT. As regards resected patients, the most important finding was that significantly better local control resulted from IORT. In fact, overall, local relapses were 25% in the IORT group and 55.8% in the non-IORT group (control group); instead, survival of the IORT group was not significantly longer than that of the control group. From a statistical analysis of resected patients treated with IORT and performed on prognostic factors on the basis of available data, survival was significantly influenced by tumor pathologic grading and diameter; postoperative adjuvant therapy was not a significant prognosis factor. Conclusions: IORT has a role in local control of unresectable pancreatic carcinomas and in control of resultant severe pain, In resected patients, IORT is effective in decreasing local recurrences but has little impact on survival. To obtain more satisfactory results, new and more effective adjuvant therapies and better abdominal prophylaxis should be tested.

Published
1995

24. PERCUTANEOUS MICROBIOPSY FAR THE DIAGNOSIS OF REJECTION IN WHOLE BLADDER-DIVERTED PANCREAS TRANSPLANTATION

Author

Martinenghi S, Dellantonio G, Bernardi M, Faravelli T, Castoldi R, Angeli E, Staudacher C, Gallioli G, Dicarlo V, Cantaboni A, DEL MASCHIO, ALESSANDRO, Pozza G., SECCHI , ANTONIO, Martinenghi, S, Dellantonio, G, Secchi, Antonio, Bernardi, M, Faravelli, T, Castoldi, R, Angeli, E, Staudacher, C, Gallioli, G, Dicarlo, V, Cantaboni, A, DEL MASCHIO, Alessandro, and Pozza, G.

Published
1994

28. LIFE SURVIVAL AND TRANSPLANTED KIDNEY SURVIVAL AFTER PANCREAS TRANSPLANTATION IN UREMIC DIABETIC-PATIENTS

Author

SECCHI , ANTONIO, LAROCCA E, MARTINENGHI S, CALDARA R, BERNARDI M, BONFATTI D, SPOTTI D, MELANDRI M, FERRARI G, CASTOLDI R, STAUDACHER C, GALLIOLI G, GIUDICI D, TORRI G, BIANCHI G, DICARLO V, POZZA G., Secchi, Antonio, Larocca, E, Martinenghi, S, Caldara, R, Bernardi, M, Bonfatti, D, Spotti, D, Melandri, M, Ferrari, G, Castoldi, R, Staudacher, C, Gallioli, G, Giudici, D, Torri, G, Bianchi, G, Dicarlo, V, and Pozza, G.

Published
1993

29. ALLOTRANSPLANTATION OF FRESH AND CRYOPRESERVED ISLETS IN PATIENTS WITH TYPE-I DIABETES - 2-YEAR EXPERIENCE

Author

SOCCI C, DAVALLI AM, MAFFI P, FALQUI L, SECCHI , ANTONIO, BERTUZZI F, VIGNALI , ANDREA, MAGISTRETTI P, ZAMMARCHI O, SCAGLIA L, GAVAZZI F, PIEMONTI , LORENZO, DENITTIS P, FERRARI P, DICARLO V, POZZA G., Socci, C, Davalli, Am, Maffi, P, Falqui, L, Secchi, Antonio, Bertuzzi, F, Vignali, Andrea, Magistretti, P, Zammarchi, O, Scaglia, L, Gavazzi, F, Piemonti, Lorenzo, Denittis, P, Ferrari, P, Dicarlo, V, and Pozza, G.

Published
1993

34. ALLOTRANSPLANTATION OF FRESH ISLETS IN 4 TYPE-I DIABETIC-PATIENTS

Author

SOCCI C, FALQUI L, DAVALLI AM, RICORDI C, BERTUZZI F, BRAGHI S, MAFFI P, GAVAZZI F, FRESCHI M, MAGISTRETTI P, DICARLO V, POZZA G., SECCHI , ANTONIO, Socci, C, Falqui, L, Davalli, Am, Ricordi, C, Bertuzzi, F, Braghi, S, Maffi, P, Secchi, Antonio, Gavazzi, F, Freschi, M, Magistretti, P, Dicarlo, V, and Pozza, G.

Published
1992

37. FRESH HUMAN ISLET TRANSPLANTATION TO REPLACE PANCREATIC ENDOCRINE FUNCTION IN TYPE-1 DIABETIC-PATIENTS - REPORT OF 6 CASES

Author

SOCCI C, FALQUI L, DAVALLI AM, RICORDI C, BRAGHI S, BERTUZZI F, MAFFI P, GAVAZZI F, FRESCHI M, MAGISTRETTI P, SOCCI S, VIGNALI, ANDREA, DICARLO V, POZZA G., SECCHI , ANTONIO, Socci, C, Falqui, L, Davalli, Am, Ricordi, C, Braghi, S, Bertuzzi, F, Maffi, P, Secchi, Antonio, Gavazzi, F, Freschi, M, Magistretti, P, Socci, S, Vignali, Andrea, Dicarlo, V, and Pozza, G.

Abstract

The aim of this study was to evaluate the feasibility of islet allografts in patients with type 1 diabetes mellitus. Six patients received human islets from either one or two donors via the portal vein, after (n = 4) or simultaneously with (n = 2) a kidney graft. The patients with functioning kidney grafts (nos. 1 -4) were already on triple immunosuppressive therapy (cyclosporine A, azathioprine, prednisone). Prednisone was increased to 60 mg/day for 15 days after the islet transplant in patient 1. Patients 2-4 and the patients who underwent a simultaneous kidney-islets graft (nos. 5, 6) also received antilymphocyte globulin. Intravenous insulin was given for the first 15 days to maintain blood glucose concentrations within the normal range. Patient 1 rejected the islets within 15 days of islet transplantation. In patient 2, a 25% reduction in insulin requirement was observed and 12 months after transplantation post-prandial serum C-peptide was 1.5 ng/ml. In patient 3, the insulin requirement decreased from 40 to 8 units/day with a post-prandial serum C-peptide of 4.1 ng/ml 12 months after islet transplantation. In patient 4 the post-prandial secretion of C-peptide increased to 6.4 ng/ml. Six months after the islet infusion, insulin therapy was discontinued and HbA1c, 24-h metabolic profile and oral glucose tolerance test remained within the normal range. He had remained off insulin for 5 months until recently, when foot gangrene paralleled a worsening of post-prandial glycaemic control. Twelve months after transplantation he is receiving 8 units insulin/day. Patients 5 and 6 received a simultaneous kidney and islet graft and 6 months after transplantation their post-prandial C-peptide secretion peaks were 2.5 and 1.9 ng/ml respectively. Their daily insulin requirement was not significantly modified. In conclusion, these results show that an adequate number of human islets injected intraportally in type 1 diabetic patients can replace the pancreatic endocrine function and can lead to insulin independence.

Published
1991

38. Standard versus extended lymphadenectomy associated with pancreatoduodenectomy in the surgical treatment of adenocarcinoma of the head of the pancreas

Author

Pedrazzoli, S, Dicarlo, V, Dionigi, R, Mosca, Franco, Pederzoli, P, Pasquali, C, Kloppel, G, Dhaene, K, Michelassi, F., Supporting clinical sciences, and Experimental Pathology

Subjects
Adult, Male, Survival Rate, Adenocarcinoma/mortality, Lymph Node Excision/methods, Humans, Pancreatic Neoplasms/mortality, Female, Prospective Studies, Middle Aged, aged, 80 and over, Aged, Pancreaticoduodenectomy
Abstract

OBJECTIVE: The study was conducted to determine whether the performance of an extended lymphadenectomy and retroperitoneal soft-tissue clearance in association with a pancreatoduodenal resection improves the long-term survival of patients with a potentially curable adenocarcinoma of the head of the pancreas. SUMMARY BACKGROUND DATA: The usefulness of performing an extended lymphadenectomy and retroperitoneal soft-tissue clearance in conjunction with a pancreatoduodenal resection in the treatment of ductal adenocarcinoma of the head of the pancreas is still unknown. Published studies suggest a benefit for the procedure in terms of better long-term survival rates; however, these studies were retrospective or did not prospectively evaluate large series of patients. MATERIALS AND METHODS: Eighty-one patients undergoing a pancreatoduodenal resection for a potentially curable ductal adenocarcinoma of the head of the pancreas were randomized to a standard (n = 40) or extended (n = 41) lymphadenectomy and retroperitoneal soft-tissue clearance in a prospective, multicentric study. The standard lymphadenectomy included removal of the anterior and posterior pancreatoduodenal, pyloric, and biliary duct, superior and inferior pancreatic head, and body lymph node stations. In addition to the above, the extended lymphadenectomy included removal of lymph nodes from the hepatic hilum and along the aorta from the diaphragmatic hiatus to the inferior mesenteric artery and laterally to both renal hila, with circumferential clearance of the origin of the celiac trunk and superior mesenteric artery. Patients did not receive any postoperative adjuvant therapy. RESULTS: Demographic (age, gender) and histopathologic (tumor size, stage, differentiation, oncologic clearance) characteristics were similar in the two patient groups. Performance of the extended lymphadenectomy added time to the procedure, although the difference did not reach statistical significance (397 +/- 50 minutes vs. 372 +/- 50 minutes, p > 0.05). Transfusion requirements, postoperative morbidity and mortality rates, and overall survival did not differ between the two groups. When subgroups of patients were analyzed, using an a posteriori analysis that was not planned at the time of study design, there was a significantly (p < 0.05) longer survival rate in node positive patients after an extended rather than a standard lymphadenectomy. The survival curve of node positive patients after an extended lymphadenectomy could be superimposed onto the curves of node negative patients. Survival curves in node negative patients did not differ according to the magnitude of the lymphadenectomy. Multivariate analysis of all patients showed that long-term survival was affected by tumor differentiation (well vs. moderately vs. poorly differentiated, p > 0.001), diameter (< or = 2.0 cm. vs. > 2.0 cm., p < 0.01), lymph node metastasis (absent vs. present, p < 0.01) and need for 4 or more units of transfused blood (< 4 vs. > or = 4, p

Published
1998
Full Text
View/download PDF

39. Standard versus extended lymphadenectomy associated with pancreatoduodenectomy in the surgical treatment of adenocarcinoma of the head of the pancreas: a multicenter, prospective, randomized study. Lymphadenectomy Study Group

Author

Pedrazzoli, Sergio, Dicarlo, V, Dionigi, R, Mosca, F, Pederzoli, P, Pasquali, Claudio, Klöppel, G, Dhaene, K, Michelassi, F, Lymphadenectomy Study Group, and Sperti, Cosimo

Subjects
Adult, Aged, 80 and over, Male, Adenocarcinoma, Middle Aged, Pancreaticoduodenectomy, Pancreatic Neoplasms, Survival Rate, Humans, Lymph Node Excision, Female, Prospective Studies, Aged, Research Article
Abstract

OBJECTIVE: The study was conducted to determine whether the performance of an extended lymphadenectomy and retroperitoneal soft-tissue clearance in association with a pancreatoduodenal resection improves the long-term survival of patients with a potentially curable adenocarcinoma of the head of the pancreas. SUMMARY BACKGROUND DATA: The usefulness of performing an extended lymphadenectomy and retroperitoneal soft-tissue clearance in conjunction with a pancreatoduodenal resection in the treatment of ductal adenocarcinoma of the head of the pancreas is still unknown. Published studies suggest a benefit for the procedure in terms of better long-term survival rates; however, these studies were retrospective or did not prospectively evaluate large series of patients. MATERIALS AND METHODS: Eighty-one patients undergoing a pancreatoduodenal resection for a potentially curable ductal adenocarcinoma of the head of the pancreas were randomized to a standard (n = 40) or extended (n = 41) lymphadenectomy and retroperitoneal soft-tissue clearance in a prospective, multicentric study. The standard lymphadenectomy included removal of the anterior and posterior pancreatoduodenal, pyloric, and biliary duct, superior and inferior pancreatic head, and body lymph node stations. In addition to the above, the extended lymphadenectomy included removal of lymph nodes from the hepatic hilum and along the aorta from the diaphragmatic hiatus to the inferior mesenteric artery and laterally to both renal hila, with circumferential clearance of the origin of the celiac trunk and superior mesenteric artery. Patients did not receive any postoperative adjuvant therapy. RESULTS: Demographic (age, gender) and histopathologic (tumor size, stage, differentiation, oncologic clearance) characteristics were similar in the two patient groups. Performance of the extended lymphadenectomy added time to the procedure, although the difference did not reach statistical significance (397 +/- 50 minutes vs. 372 +/- 50 minutes, p > 0.05). Transfusion requirements, postoperative morbidity and mortality rates, and overall survival did not differ between the two groups. When subgroups of patients were analyzed, using an a posteriori analysis that was not planned at the time of study design, there was a significantly (p < 0.05) longer survival rate in node positive patients after an extended rather than a standard lymphadenectomy. The survival curve of node positive patients after an extended lymphadenectomy could be superimposed onto the curves of node negative patients. Survival curves in node negative patients did not differ according to the magnitude of the lymphadenectomy. Multivariate analysis of all patients showed that long-term survival was affected by tumor differentiation (well vs. moderately vs. poorly differentiated, p > 0.001), diameter (< or = 2.0 cm. vs. > 2.0 cm., p < 0.01), lymph node metastasis (absent vs. present, p < 0.01) and need for 4 or more units of transfused blood (< 4 vs. > or = 4, p

Published
1998

48. Prognostic ability of nutritional assessment methods in surgical cancer patients

Author

Braga, M, Baccari, P, Radaelli, G, Dicarlo, V, Gianotti, L, Cristallo, M, DiCarlo, V, GIANOTTI, LUCA VITTORIO, Cristallo, M., Braga, M, Baccari, P, Radaelli, G, Dicarlo, V, Gianotti, L, Cristallo, M, DiCarlo, V, GIANOTTI, LUCA VITTORIO, and Cristallo, M.

Abstract

To identify patients at high-risk for post-operative infections, several methods have been proposed, including prognostic nutritional index (PNI), instant nutritional assessment (INA) and nutritional assessment (NA). Weight loss (WL) has also been related to post-operative morbidity. We have evaluated the prognostic ability of PNI, INA, NA and WL in a prospective study carried out in 94 patients affected by gastro-intestinal malignancy, who underwent major surgery. Post-operative infections occurred in 26 (27.7%) patients. PNI, INA and NA identified classes of patients with a progressive risk of septic complications. To determine the prognostic ability of PNI, INA, NA and WL, sensitivity, specificity, Youden index and predictive values were evaluated. All methods had a Youden index greater than one, with a positive predictive value ranging from 0.33 to 0.36. Since all the methods studied showed a similar predictive ability, it seems reasonable to identify the high-risk surgical patient by using weight loss in association with those nutritional parameters derived from routine hospital laboratory tests.

Published
1989

50. Biliary Cystadenoma: An Uncommon Cause of Recurrent Cholestatic Jaundice.

Author

Beretta, E., De Franchis, R., Staudacher, C., Faravelli, A., Primignani, M., Vecchi, M., Conti, E., and DiCarlo, V.

Subjects
BILIOUS diseases & biliousness, CHOLESTASIS, OBSTRUCTIVE jaundice, SURGICAL excision, CYSTS (Pathology)
Abstract

The clinical history of a patient with intermittent jaundice is presented. The diagnostic work up, including ultrasound, laparoscopy, and endoscopic retrograde cholangiography, revealed a multiloculated cystic mass in the left lobe of the liver. At laparotomy, a multicystic lesion invading the left hepatic duct and protruding into the common bile duct was found. Histological examination revealed a biliary cystadenoma. Complete excision is the treatment of choice of such lesions. [ABSTRACT FROM AUTHOR]

Published
1986

Catalog

Books, media, physical & digital resources
See catalog results