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Rosa F, Marrelli D, Morgagni P, Cipollari C, Vittimberga G, Framarini M, Cozzaglio L, Pedrazzani C, Berardi S, Baiocchi G, Roviello F, Portolani N, De Manzoni G, Costamagna G, Doglietto G, Pacelli F. Krukenberg tumours of gastric origin: The rationale of surgical resection and perioperative treatments in a multicenter western experience. A Gircg/Sico study (Gruppo Italiano di Ricerca per il Cancro Gastrico/Società Italiana di Chirurgia Oncologica). Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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2
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Biondi A, D'Ugo D, Cananzi F, Papa V, Borasi A, Sicoli F, Degiuli M, Doglietto G, Persiani R. Does a minimum number of 16 retrieved nodes affect survival in curatively resected gastric cancer? Eur J Surg Oncol 2015; 41:779-86. [DOI: 10.1016/j.ejso.2015.03.227] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 02/21/2015] [Accepted: 03/13/2015] [Indexed: 12/14/2022] Open
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3
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Sicoli F, Persiani R, Cananzi F, Biondi A, Degiuli M, Doglietto G, Marra A, D'Ugo D. Adequacy and impact on survival of lymph node harvesting in gastric cancer. Eur J Surg Oncol 2013. [DOI: 10.1016/j.ejso.2013.07.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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4
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Biondi A, Degiuli M, Persiani R, Cananzi F, Tufo A, Santullo F, D'Angelo F, Sicoli F, Doglietto G, D'Ugo D. 106. Adequacy and Impact on Survival of Lymph Node Harvesting in Gastric Cancer. Eur J Surg Oncol 2012. [DOI: 10.1016/j.ejso.2012.06.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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5
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Alfieri S, Di Miceli D, Menghi R, Quero G, Cina C, Pericoli Ridolfini M, Doglietto G. Role of oxidized regenerated cellulose in preventing infections at the surgical site: prospective, randomized study in 98 patients affected by a dirty wound. MINERVA CHIR 2011; 66:55-62. [PMID: 21389925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
AIM The aim of this study was to evaluate whether oxidized regenerated cellulose (ORC), applied to "dirty" surgical wounds, is able to reduce the microbial load and, consequently, the infection rate as compared to conventional local wound treatment. METHODS The study included 98 patients who underwent intestinal recanalization procedures between December 2003 and December 2008, with the stoma as the surgical site. Authors considered several risk factors for SSI. The patients were divided into two groups. In group A (50 patients), the surgical wound, previous site of the stoma, was packed with ORC, whereas in group B (48 patients) gauze soaked in iodine was used. Microbial contamination was evaluated with three swabs (in subcutaneous tissue and the dermis), in the operating room before wound packing and on the 2nd and 3rd postoperative day (before suturing the skin). RESULTS There were no cases of wound dehiscence and no clinically evident superficial or deep surgical site infections in either group. Analysis of all data revealed that there was no or reduced bacterial contamination in the second and third swab in 33 patients (66%) of Group A versus 12 patients (25%) of Group B. CONCLUSION Although it is necessary to consider all factors which can have an influence on SSI and use all the means shown to be effective to reduce the risk of SSI, there is a rationale for using ORC to prevent this kind of infection, especially in patients who undergo "dirty" surgery.
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Affiliation(s)
- S Alfieri
- Department of Digestive Surgery, Catholic University of Sacred Heart, Rome, Italy.
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6
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Gambacorta M, Valentini V, Barba M, Mantini G, Barbaro B, Pacelli F, Persiani R, Crucitti A, Coco C, Doglietto G. What We Learn from a Large Database: Correlation between Progressive Intensified Preoperative Treatments and 5-years Survival in Rectal Cancer Patients. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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7
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Valentini V, Coco C, Rizzo G, Manno A, Crucitti A, Mattana C, Ratto C, Verbo A, Vecchio FM, Barbaro B, Gambacorta MA, Montoro C, Barba MC, Sofo L, Papa V, Menghi R, D'Ugo DM, Doglietto G. Outcomes of clinical T4M0 extra-peritoneal rectal cancer treated with preoperative radiochemotherapy and surgery: a prospective evaluation of a single institutional experience. Surgery 2009; 145:486-94. [PMID: 19375606 DOI: 10.1016/j.surg.2009.01.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2008] [Accepted: 01/23/2009] [Indexed: 02/07/2023]
Abstract
BACKGROUND Our objective was evaluate the outcome of primary clinical T4M0 extraperitoneal rectal cancer treated by neoadjuvant radiochemotherapy. Prognosis of clinical T4 rectal cancer is poor. Preoperative chemoradiation therapy may be beneficial. The results obtained are unclear due to lack of objective and strictly applied staging methods. METHODS Patients with primary, clinical, T4MO, extraperitoneal rectal cancer, defined by transrectal ultrasonography, computed tomography or magnetic resonance imaging, were considered. Intraoperative radiotherapy and adjuvant chemotherapy were employed in some patients after curative resection (R0). Variables influencing the possibility to perform an R0 resection and a sphincter-saving procedure were investigated as predictors of outcome. RESULTS 100 patients were included. R0 resection was performed in 78 patients. R0 resection rate was greater in females (93% vs 67%) and in responders to neoadjuvant chemoradiation (94% vs 60%). The ability to perform a sphincter-saving procedure was 57%, greater in middle rectal location (85% vs 51%) and in responders to the chemoradiation (70% vs 47%). Median follow-up was 31 months (range, 4-136). Local recurrences were found in 7 patients (10%). Five-year local control in R0 patients was 90% and better in the IORT group (100%). Distant relapse occurred in 24 patients (30%). Five-year overall survival was 59%, and was better after an R0 versus an R1 or R2 resection (68% vs 22%). Overall and disease free survival in R0 patients improved after overall downstaging. Adjuvant chemotherapy given in addition to the neoadjuvant therapy did not appear to offer benefit in improving survival. CONCLUSION A multimodal approach enabled us to obtain a 5-year overall survival of about 60%. IORT increased local control. The role of adjuvant chemotherapy needs to be further investigated.
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Affiliation(s)
- Vincenzo Valentini
- Department of Radiation Therapy, Università Cattolica del Sacro Cuore, Rome, Italy
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8
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Valentini V, Morganti AG, Macchia G, Mantini G, Mattiucci GC, Brizi MG, Alfieri S, Bossola M, Pacelli F, Sofo L, Doglietto G, Cellini N. Intraoperative radiation therapy in resected pancreatic carcinoma: long-term analysis. Int J Radiat Oncol Biol Phys 2008; 70:1094-9. [PMID: 18313525 DOI: 10.1016/j.ijrobp.2007.07.2346] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2007] [Revised: 07/16/2007] [Accepted: 07/16/2007] [Indexed: 12/30/2022]
Abstract
PURPOSE The combination of external radiotherapy (RT) plus intraoperative radiotherapy (IORT) in patients with pancreatic cancer is still debated. This study presents long-term results (minimum follow-up, 102 months) for 26 patients undergoing integrated adjuvant RT (external RT+IORT). METHODS AND MATERIALS From 1990 to 1995, a total of 17 patients with pancreatic cancer underwent IORT (10 Gy) and postoperative external RT (50.4 Gy). Preoperative "flash" RT was included for the last 9 patients. The liver and pancreatic head received 5 Gy (two 2.5-Gy fractions) the day before surgery. In the subsequent period (1996-1998), 9 patients underwent preoperative concomitant chemoradiation (39.6 Gy) with 5-fluorouracil, IORT (10 Gy), and adjuvant chemotherapy. RESULTS Preoperative chemoradiation was completed in all patients, whereas postoperative therapy was completed in 13 of 17 patients. All 26 patients underwent pancreatectomy (25 R0 and one R1 resections). One patient died of postoperative complications (3.8%) not related to IORT. The 9 patients undergoing concomitant chemoradiation were candidates for adjuvant chemotherapy; however, only 4 of 9 underwent adjuvant chemotherapy. At last follow-up, 4 patients (15.4%) were alive and disease free. Disease recurrence was documented in 20 patients (76.9%). Sixteen patients (61.5%) showed distant metastasis, and 5 patients (19.2%) showed local recurrence. The incidence of local recurrence in R0 patients was 4 of 25 (16.0%). The overall 5-year survival rate was 15.4%. There was significant correlation with overall survival of tumor diameter (p=0.019). CONCLUSIONS The incidence of local recurrence in this long follow-up series (19.2%) was definitely less than that reported in other studies of adjuvant RT (approximately 50%), suggesting a positive impact on local control of integrated adjuvant RT (IORT+external RT).
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Affiliation(s)
- Vincenzo Valentini
- Department of Radiotherapy, Policlinico Universitario A. Gemelli, Catholic University, Rome, Italy
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9
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Gambacorta M, Valentini V, Coco C, Doglietto G, Cosimelli M, Micciche F, Mangiacotti M, Petrone A, Mantini G, Balducci M, Barbaro B, Picciocchi A. Sphincter preservation after preoperative chemoradation on 247 T3 rectal cancer patients: Analysis in four consecutive phase II studies. Int J Radiat Oncol Biol Phys 2004. [DOI: 10.1016/j.ijrobp.2004.07.094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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10
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Abstract
PURPOSE Fistula-in-ano anatomy and its relationship with anal sphincters are important factors influencing the results of surgical management. Preoperative definition of fistulous track(s) and the internal opening play a primary role in minimizing iatrogenic damage to the sphincters and recurrence of the fistula. METHODS Physical examination and endoanal ultrasound (performed with a 10 MHz endoprobe), either conventionally or with an injection of hydrogen peroxide, were performed in 26 consecutive patients. Results were matched with surgical features to establish their accuracy in preoperative fistula-in-ano assessment. RESULTS Accuracy rates of clinical examination endoanal ultrasound, and hydrogen peroxide-enhanced ultrasound were 65.4, 50, and 76.9 percent for primary tracks, 73.1, 65.4, and 88.5 percent for secondary tracks, and 80.8, 80.8, and 92.3 percent for horseshoe extensions, respectively. Compared with physical examination and endoanal ultrasound, accuracy of hydrogen peroxide-enhanced ultrasound was higher for transsphincteric and intersphincteric primary tracks and horseshoe extensions. Both endoanal ultrasound and hydrogen peroxide-enhanced ultrasound displayed a significantly higher accuracy in detecting the internal openings (53.8 and 53.8 percent, respectively) compared with clinical evaluation (23.1 percent; P = 0.027). CONCLUSIONS Our data suggest that hydrogen peroxide-enhanced ultrasound can be very reliable and useful in the definition of fistula anatomy, its relationship with anal sphincters, and, hence, surgical strategy. It also improves identification of secondary extensions, particularly horseshoe tracks. This method, besides being safe, economic and reputable, both preoperatively and postoperatively, could be helpful in checking operative results and recurrence.
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Affiliation(s)
- C Ratto
- Department of Clinica Chirugica, Catholic University, Rome, Italy
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11
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Pietrabissa A, Merigliano S, Montorsi M, Poggioli G, Stella M, Borzomati D, Ciferri E, Rossi G, Doglietto G. Reducing the occupational risk of infections for the surgeon: multicentric national survey on more than 15,000 surgical procedures. World J Surg 1997; 21:573-8. [PMID: 9230652 DOI: 10.1007/s002689900275] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The objective of this study was to find the incidence of accidental exposures to blood and body fluids among surgeons during operations and to describe their dynamics. A probabilistic model was also used to predict the cumulative 30-year risk to the surgeon of contracting hepatitis B and C viruses (HBV, HCV) or human immunodeficiency virus (HIV) infection and estimate the effect of preventive strategies in reducing this risk. A multicentric prospective survey, based on self-administered questionnaires, was conducted during a period of 6 months in 39 Italian hospitals. As accidental exposure to blood or body fluids occurred in 9.2% of 15,375 operations. In about 2% of procedures a parenteral-type injury, such as actual skin puncture or eye contamination, was suffered by the operating surgeon. A needle-stick injury was the commonest accident, and its occurrence was found to vary with the phase of the procedure and its length. The current lifetime risk of acquiring HBV, HCV, and HIV infection in our regions was estimated to be as high as 42.7%, 34.8%, and 0.54%, respectively. The adoption of preventive strategies is expected to reduce this risk to 21% for HBV, 16.6% for HCV, and 0.23% for HIV infection. Active immunization of surgeons against HBV is strongly recommended. The case is also made for the use of a face-shield combined with a permanent change in our surgical practice capable of reducing the current high rate of parenteral injuries.
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Affiliation(s)
- A Pietrabissa
- Istituto di Chirurgia Generale e Sperimentale, Università di Pisa, Ospedale di Cisanello, Italy
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12
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Frontera D, Doglietto G, Viola G, Crucitti F. Carcinoma of the pancreatic head area. Epidemiology, natural history and clinical findings. Rays 1995; 20:226-36. [PMID: 8559966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- D Frontera
- Istituto di Clinica Chirurgica, Università Cattolica del S. Cuore, Policlinico A. Gemelli, Roma
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13
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Crucitti F, Doglietto G, Frontera D, Viola G, Buononato M. Carcinoma of the pancreatic head area. Therapy: resectability and surgical management of resectable tumors. Rays 1995; 20:304-15. [PMID: 8559972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Surgical resection is being increasingly performed for carcinomas of the area of the head of the pancreas with curative intent. Pre-and intraoperative assessment of the site of origin and the stage of the lesion is of the utmost importance for a more favorable prognosis of non pancreatic forms and for a better evaluation of long term results of treatment adopted. Staging of non pancreatic periampullary tumors is usually very precise since they are most often shown to be resectable on laparotomy. Surgical resection by pancreaticoduodenectomy is the treatment of election based on good long term results. To the contrary, problems involved in the carcinoma of the head of the pancreas are non negligible. Some aspects related to the criteria of resectability of these tumors (diameter of primary lesion, infiltration of adjacent organs and large vessels, lymph node involvement) are discussed. How extensive pancreatic resection (subtotal, total or regional pancreatectomy) should be, is still a debated subject. In fact, it is not directly proportional to an improvement in prognosis. Complementary treatments directed to the improvement of the disappointing results at present achieved with surgery alone, are desirable.
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Affiliation(s)
- F Crucitti
- Istituto di Clinica Chirurgica, Università Cattolica del S. Cuore, Policlinico A. Gemelli, Roma
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14
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Trodella L, Morganti AG, Valentini V, Doglietto G, Cellini N, Crucitti F. Carcinoma of the pancreatic head area. Therapy: intraoperative radiotherapy. Rays 1995; 20:316-25. [PMID: 8559973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Pancreatic tumors represent a major field of application of intraoperative radiotherapy (IORT) with electron beams. First clinical studies were carried out principally on unresectable tumors and control of pain was observed in most of them. However, as for prognosis, IORT alone has yielded disappointing results. The use of IORT to boost external beam radiotherapy (ERT) frequently applied in recent trials, has improved local control but not survival rate because of the high incidence of abdominal metastasis. To-date, results of IORT used as an adjuvant to radical surgery have been controversial. As in unresectable tumors, studies have been focused on the combination IORT+ERT, however the intensification of the dose delivered to the tumor bed and the consequent better local control has not resulted in a better prognosis. A more significant contribution of IORT to the treatment of pancreatic tumors may come in the future from the combination of IORT with more effective methods in the control of the abdominal disease ("prophylactic" ERT to the liver or upper abdomen, intra-arterial or intraperitoneal chemotherapy) or from variously timed combinations with ERT (neoadjuvant ERT+IORT).
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Affiliation(s)
- L Trodella
- Istituto di Radiologia, Università Cattolica del S. Cuore, Policlinico A. Gemelli, Roma
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Crucitti F, Doglietto G, Bellantone R, Miggiano GA, Frontera D, Ferrante AM, Castelli A. Digestive and nutritional consequences of pancreatic resections. The classical vs the pylorus-sparing procedure. Int J Pancreatol 1995; 17:37-45. [PMID: 8568333 DOI: 10.1007/bf02788357] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Digestive and nutritional alterations are a common occurrence after pancreatic resections. The authors report the results of a multiparametric evaluation performed in a group of 26 patients submitted to total or cephalic pancreatectomy. Patients were divided into two groups according to the surgical procedure; group A (n = 13) included gastroresected patients and group B (n = 13) included those submitted to pylorus-sparing pancreatic resection. Subclinical digestive and absorptive impairment has been found in 61.5% of group A patients; the nutritional status was clinically poor in four cases from the same group. Digestive alterations have also been found in 69.2% of group B cases, but nutritional status was always satisfactory in the whole group. The more positive results obtained with the pylorus-sparing technique encourage wider adoption of this procedure.
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Affiliation(s)
- F Crucitti
- Department of Surgery, Catholic University School of Medicine, Rome, Italy
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Frontera D, Ferrante A, Viola G, Bellantone R, Doglietto G, Crucitti F. [Carcinoid neoplasms of Vater;'s ampulla. Apropos a case examined]. Ann Ital Chir 1993; 64:79-82. [PMID: 8101070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Carcinoid tumors of the ampulla are an uncommon finding. The authors report an asymptomatic case of ampullary carcinoid in which the diagnosis was obtained only with definitive histology after radical surgery. The differential diagnosis of these tumors is quite difficult, mostly because they are often asymptomatic. Surgery seems to be the only effective therapy of these lesions; a wide resection with regional lymphectomy should be performed in all cases. Although the prognosis of ampullary carcinoids looks better than for adenocarcinoma and it is related to the tumor size, the history in this case suggests a more extensive indication for radical surgery.
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Affiliation(s)
- D Frontera
- Istituto di Clinica Chirurgica, Università Cattolica del Sacro Cuore
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Crucitti F, Doglietto G, Bellantone R, Frontera D, Ferrante A. [Controversies about reconstruction after pancreatic resections in neoplasms of the periampullary area]. G Chir 1991; 12:97-102. [PMID: 1873191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Extended pancreatic resections have still a significative morbidity: this explains all the technical alternatives proposed to the Whipple procedure. Treatment of the pancreatic stump after cephalic resection and the need of gastric resection are particularly debated today. The Authors, together with a wide literature review, report their experience with 45 patients who underwent cephalic (28 cases), subtotal (4 cases) or total (13 cases) pancreatectomy. Telescope pancreaticojejunostomy showed overall satisfying results (7% of dehiscences), inducing the Authors to use it in all cases. The role of pyloric preservation as proposed by Traverso and Longmire, which strongly reduces nutritional sequelae of pancreatectomy without negative effects on oncological radicality, is emphasized.
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Cotroneo AR, Patane D, de Cinque M, Doglietto G, Falappa P. Therapeutic embolization of renal artery to control severe hypertension due to renal trauma. Eur J Radiol 1987; 7:147-8. [PMID: 3595625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
In a young patient with a post-traumatic renal hematoma, severe systemic hypertension, secondary to the activation of the renin-angiotensin axis, developed. Because of persistent hypertension, after 3 months of drug therapy, selective percutaneous embolization of the damaged vessels was performed. One year after procedure, the patient is normotensive without drugs.
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