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排序方式: 共有216条查询结果,搜索用时 11 毫秒
101.
Doglietto GB Alfieri S Pacelli F Mutignani M Costamagna G Carriero C Di Giorgio A Papa V 《Hepato-gastroenterology》2000,47(32):349-354
BACKGROUND/AIMS: This study was designed to evaluate the effectiveness of a diagnostic and therapeutic approach adopted in 118 consecutive patients affected by primary malignancy of the extrahepatic bile duct. METHODOLOGY: After diagnostic procedures were performed (ultrasound examination, endoscopic retrograde cholangiopancreatography and computed tomography scan) 25 patients underwent surgical resection. For the remaining 93 patients considered unresectable for cure, stenting by endoscopic means was almost always the only palliative treatment performed. RESULTS: The morbidity and mortality rates were 28% and 8% for patients treated with surgical resection and the curative and overall 3-year survival rate was 30% and 22% respectively. The procedure related morbidity and mortality rates were 13% and 4% for patients endoscopically treated and the median survival rate was 7.3 months. The quality of life evaluated in 68 patients out of 93 was good in 57% of cases, fair in 19% and poor in the remaining 22%. CONCLUSIONS: The results of the present study demonstrate the safety and efficacy of endoscopic stenting in the palliative treatment of extrahepatic bile duct cancer while potential cure can only be achieved by radical surgical resection. 相似文献
102.
Pacelli F Di Giorgio A Papa V Tortorelli AP Covino M Ratto C Bossola M Valentini V Sofo L Miccichè F Gambacorta MA Doglietto GB 《Diseases of the colon and rectum》2004,47(2):170-179
PURPOSE: The survival advantage of preoperative radiotherapy
in patients with rectal cancer is still a matter of
debate, because its incremental benefit in the total mesorectal
excision setting is unclear. This study was designed to
evaluate early and long-term results of preoperative radiotherapy
plus intraoperative radiotherapy in a homogeneous
population of T3 middle and lower rectal cancer patients
submitted to total mesorectal excision. METHODS: A series
of 113 patients with middle and lower T3 rectal cancer
consecutively submitted to total mesorectal excision at a
single surgical unit from 1991 to 1997 were divided into
two groups according to type of neoadjuvant treatment:
preoperative radiotherapy (38 Gy) plus intraoperative radiotherapy
(10 Gy; n = 69), and no preoperative treatment
(total mesorectal excision; n = 44). Standard statistical
analyses were used to evaluate early (downstaging, intraoperative
factors, hospital morbidity, and mortality rates) and
long-term results (recurrence and survival). RESULTS: Overall,
68.2 percent of patients were downstaged by the preoperative
regimens (T0 specimens in 3 cases). Postoperative
complications were comparable in the two groups. Five-year,
disease-specific survival was 81.4 and 58.1 percent in
preoperative radiotherapy plus intraoperative radiotherapy
group and total mesorectal excision group, respectively (P
= 0.052). Corresponding figures for disease-free survival
were 73.1 and 57.2 percent in the two groups, respectively
(P = 0.096). The rates of local recurrence at five years were
6.6 and 23.2 percent in preoperative radiotherapy plus intraoperative
radiotherapy and total mesorectal excision
groups, respectively (P = 0.017). CONCLUSIONS: Preoperative
radiotherapy plus intraoperative radiotherapy associated
with total mesorectal excision reduce local recurrence
rate and improve survival in T3 rectal cancer compared with
total mesorectal excision alone. 相似文献
103.
Carlo Ratto M.D. Giovanna Flamini Ph.D. Luigi Sofo M.D. Paolo Nucera M.D. Massimo Ippoliti M.D. Giuseppe Curigliano M.D. Gianluigi Ferretti M.D. Alessandro Sgambato M.D. Marta Merico M.D. Giovanni Battista Doglietto M.D. Achille Cittadini M.D. Francesco Crucitti M.D. 《Diseases of the colon and rectum》1996,39(11):1238-1244
Purpose: Best chances of a cure from colorectal cancer are obtained before metastatic spread. Lack of specific tests allowing early diagnosis of the tumor accounts for investigation of gene alterations involved in carcinogenesis by a noninvasive method. In the present study, K-ras
codons 12 and 13 mutations were studied in neoplastic cells shed from the bowel into the stool and those contained in the tumor and normal mucosa. Moreover, healthy patients and a few others with precancerous conditions were examined. METHODS: Stool, tumor, and mucosa samples were taken from 25 patients with colorectal adenocarcinoma. Stool and mucosa samples were obtained from 11 healthy patients, and stool, pathologic bowel tissue, and normal mucosa samples were obtained from 3 patients with adenoma (1) or ulcerative colitis (2). Polymerase chain reaction amplification and restriction enzyme analysis were performed. RESULTS: K-ras
codon 12 mutations were detected in both tumor and stool samples of 10 cancer patients, and no gene alterations were observed in 14 patients. In one patient with a tumor, a mutation was shown in only the tumor tissue. The agreement rate in tumor and stool analysis was 96 percent. A normal pattern of K-ras
codons 12 and 13 was observed in the bowel mucosa. All stool and mucosa samples from healthy patients were not altered in K-ras.Agreement was registered between samples taken from patients with preneoplastic lesions. CONCLUSIONS: These preliminary findings show a high rate of accuracy in the investigation of K-ras
alterations in the colorectal cells shed into the feces, suggesting that such an approach could be used to study other gene alterations and, prospectively, to identify early colorectal cancers.Read at the meeting of The American Society of Colon and Rectal Surgeons, Montreal, Quebec, Canada, May 7 to 12, 1995. 相似文献
104.
Sergio Alfieri Fausto Rosa Caterina Cina Antonio Pio Tortorelli Andrea Tringali Vincenzo Perri Guido Costamagna Giovanni Battista Doglietto 《Surgical endoscopy》2013,27(6):2005-2012
Background
The management of post-endoscopic retrograde cholangiopancreatography (ERCP) perforation is often unknown by many physicians, and there is a paucity of literature regarding the best surgical management approach.Patients and methods
A retrospective review of ERCP-related perforations to the duodeno-pancreato-biliary tract observed at the Digestive Surgery Department of the Catholic University of Rome was conducted to identify their optimal management and clinical outcome.Results
From January 1999 to December 2011, 30 perforations after ERCP were observed. Seven patients underwent ERCP at another institution, and 23 patients underwent an endoscopic procedure at our hospital. Diagnosis of perforation was both clinical and instrumental. Fifteen patients (50 %) were successfully treated conservatively. Fifteen patients (50 %) underwent surgery after a mean time of 8.1 days (range 1–26 days) from ERCP: ten received a retroperitoneal laparostomy approach, three of them both an anterior and posterior laparostomy approach, and two an anterior laparostomy approach. Duodenal leak closure was observed after a mean (±standard deviation, SD) of 12.6 (±4.6) and 24.6 (±7.9) days after conservative and surgical treatment, respectively (p < 0.001). The overall and postoperative mortality rates were 13.3 % (4 of 30 patients) and 26.6 % (4 of 15 patients), respectively.Conclusions
Post-ERCP perforation is burdened by a high risk of mortality. Early clinical and radiographic features have to be used to determine which type of surgical or conservative treatment is indicated. Half of patients can be treated conservatively, but in case of sepsis or unstable general conditions, early surgical procedure is indicated as the only possible chance of recovery. 相似文献105.
106.
Fabio Pacelli Fausto Rosa Daniele Marrelli Paolo Morgagni Massimo Framarini Luigi Cristadoro Corrado Pedrazzani Riccardo Casadei Luca Cozzaglio Marcello Covino Annibale Donini Franco Roviello Giovanni de Manzoni Giovanni Battista Doglietto 《Gastric cancer》2014,17(4):725-732
Background
Only a few, small, monocentric randomized controlled trials (RCTs) have compared routine vs. no placement of a nasogastric or nasojejunal tube decompression (NG/NJT) in patients undergoing partial distal gastrectomy (PDG) for gastric cancer. However, to our knowledge, no multicenter prospective RCT has analyzed the role of decompression after both the Billroth II (BII) procedure and Roux-en-Y (RY) gastrojejunostomy. The aim of this study was to determine whether NG/NJT prevents the consequences of postoperative ileus after PDG for gastric cancer after both BII reconstruction and RY.Methods
Two hundred seventy patients undergoing PDG for gastric cancer were randomly assigned NG/NJT placement (NG/NJT group) or not (no-NG/NJT group) with either Billroth II gastrojejunostomy or Roux-en-Y gastrojejunostomy. The patients were monitored for postoperative complications, mortality, and postoperative course.Results
By January 2010 to June 2012, among 270 patients undergoing PDG for gastric cancer, 134 were randomly assigned to NG/NJT placement (NG/NJT group) and 136 to no decompression (no-NG/NJT group). Time to passage of flatus was significantly shorter in the NG/NJT group than in the no-NG/NJT group, but only after RY reconstruction (3.3 ± 1.5 vs. 4.3 ± 1.6 days, P < 0.001, respectively). Postoperative abdominal distention was significantly lower in the NG/NJT group than in the no-NG/NJT group after both BII and the RY procedure (P < 0.001). No significant differences in postoperative mortality or morbidity, especially anastomotic leakage or intra-abdominal sepsis, were observed between the groups.Conclusion
Routine placement of an NG/NJT after BII and RY PDG is not necessary in elective surgery for gastric cancer. 相似文献107.
Pacelli F Rotondi F Rosa F Bossola M Papa V Tortorelli AP Sollazzi L Doglietto GB 《JPEN. Journal of parenteral and enteral nutrition》2008,32(1):94-97
BACKGROUND: Emergency high-loop jejunostomies are seldom used for nutrition access in the clinical practice. METHODS: This paper describes the results of a simple and safe technique that uses emergency high-loop jejunostomy as an enteral feeding access. A feeding tube is inserted into the efferent loop of the jejunostomy and then subcutaneously tunneled. In this way, whenever it becomes necessary, the bag collecting fluids from the afferent loop can be changed without removing the tube, which remains permanently inserted into the efferent loop and secured to the skin in order to avoid displacements. RESULTS: Twenty-nine patients with high-loop jejunostomy were consecutively treated with the described technique during the period 2000-2006. The mean distance between the ligament of Treitz and tube was 38.3 +/- 16.2 cm. After an induction period, all patients received full-strength enteral nutrition and were discharged after a mean of 25.1 +/- 19.5 days of treatment. All patients were subsequently readmitted to our unit, and their ostomies were successfully closed. No major early and late complications were observed; particularly, no patient experienced local or systemic septic complications. Conclusion: From the analysis of our results, the described method for delivering enteral nutrition through an emergency high-loop ostomy proves easy to apply and clinically effective. Enteral nutrition can be started as soon as possible after operation through the efferent loop of the ostomy; the management of the jejunostomy is simple and safe, with no additional discomfort for the patients. 相似文献
108.
109.
Prognostic factors in colorectal cancer 总被引:13,自引:0,他引:13
Dr. Carlo Ratto M.D. Luigi Sofo M.D. Massimo Ippoliti M.D. Marta Merico M.D. Giovanni Battista Doglietto M.D. Francesco Crucitti M.D. 《Diseases of the colon and rectum》1998,41(8):1033-1049
PURPOSE: Identification of prognostic factors is a primary basis for planning the treatment and predicting the outcome of patients with colorectal cancer. Reviewing studies from the literature performed using univariate and multivariate analyses and their own study, the authors critically discuss the prognostic value of the clinicopathologic parameters of the tumor. METHODS: Among 853 patients with colorectal tumors seen at the Department of Clinical Surgery of the Catholic University of Rome, Italy, 690 cases that were curatively resected entered the study. Overall survival rate, related to the clinicopathologic variables, was calculated, and univariate and multivariate analyses were performed. RESULTS: Five-year and ten-year overall survival rates were 70 and 55 percent, respectively. Univariate and multivariate analyses showed that node involvement, distant metastases, bowel obstruction, and patient gender are factors independently related to outcome. CONCLUSIONS: Data from the literature and the present study suggest that only a few clinical parameters, particularly bowel obstruction, and some pathologic factors (tumor stage, vessels invasion, and tumor ploidy) are related to patient survival rate and are the most reliable prognostic criteria. In prospective clinical studies, any other new pathologic or molecular factors should be matched with these parameters to confirm their value in outcome prediction. 相似文献
110.