1,721,022 research outputs found
Sentinel node biopsy in patients with cutaneous melanoma.Cafiero F, Peressini A, Gipponi M, Rainero ML, Villa G, Sertoli MR, Bertoglio S, Moresco L.
No full textAbstract
The role of elective lymph node dissection (ELND) for treatment of cutaneous melanoma is still debated. Initially, lymphatic mapping technique was performed by an intradermic injection of vital blue dye; subsequently, it was improved by the use of radioguided surgery (RGS). Preliminary experience with this technique proved effective for detection of clinical occult lymph node metastasis; it may also enable the surgeon to perform a selective lymph node dissection (SLND) to concentrate on pathologic node-positive patients for the same potential benefits that have been provided by ELND. We performed sentinel node biopsy on 48 patients with stage pT3N0M0 melanoma. Vital blue dye mapping only was carried out on 39 patients; the remaining nine patients had a combined lymphatic mapping with both blue dye and RGS. The sentinel lymph node (SLN) was identified in 46 of 48 patients (95.8%). Ten patients (20.8%) were found to have metastatic melanoma cells in their SLN(s); all these patients underwent SLND of the affected basin. Our findings confirm that the intraoperative lymphatic mapping of the SLN using both blue dye and radiodetection is an appropriate and simple technique for selecting patients who are more likely to benefit from lymph node dissection
[Bacterial control in the operating room].
No full textThirty-nine patients with liver tumours have been submitted to regional arterial
chemotherapy by means of either totally implantable Infusaid-400 pumps (22 c.) or
implantable ports (17 c.). The latter were subsequently perfused with external
pumps. There was one single major operative complication and no operative deaths.
Most patients underwent continuous Fudr infusion. Access related complications
occurred in both groups. Treatment was stopped for access related complications
in 18.4% and 29.4% of cases out of the pump and port groups respectively. In most
of those cases, however, several cycles of chemotherapy had already been
performed. The Infusaid-400 pumps showed a 12-month functional duration of 57%
with a 13-month median, the 10-month duration of ports being 67%. The difference
was not significant. The new implantable systems give better results in
comparison with traditional regional access methods, the functional performances
of the port systems appearing very similar to the totally implantable pumps, with
an obvious advantage for the pumps as far as quality of life is concerned
[Clinical evaluation of the tolerability of imipenem in the treatment of postoperative infections in oncologic surgery].
No full textFifteen neoplastic patients were examined in a pilot study to evaluate side
effects and efficacy of imipenem (three doses of 500 mg/die, e.v.) as
monochemotherapy of post-operative septic complications. These infections
included: two wound infections, nine lung infections, one case of mixed infection
(spread purulent peritonitis associated with lung infection), one case of urinary
tract infection, one chronic suppurative malleolar ulcer in a patient with
Kaposi's sarcoma, and one case of mediastinitis due to oesophageal perforation
during endoscopic dilatation. Antibiotic treatment was successful in 14 patients,
apyrexia being reached within 2nd to 13th day of treatment (median: 4th day) with
negative microbiologic and radiologic assessment; only in the patient with
chronic suppurative malleolar ulcer, notwithstanding apyrexia, microbiologic
culture indicated the persistence of a pre-treatment pathogen (P. mirabilis).
Side effects included only a slight and transient increase of serum transaminases
in one patient
Integrated treatment with stapled haemorrhoidopexy and proctonorm® of haemorrhoidal disease
No full textBackground/Aim: This retrospective study was performed in patients undergoing Stapled Haemorrhoidopexy (SH) who were post-operatively treated with Proctonorm® with the aim of assessing its effect on early and late haemorrhoidalrelated symptoms. Patients and Methods: Forty-six males and 54 females received Proctonorm® (one tablet twice daily for 14 days) and Ketoprofene R (200 mg, one tablet twice daily, as requested). Results: "Early Complication Score" (0-12) two days after surgery was 2.02±1.03; pain VAS (Visual Analogue Scale) (0-10) was 1.21±0.89, and the number of antiinflammatory tablets was 4.24±1.06. At 40-day post-operative assessment, seven patients had post-operative complications with "Late Complication Score" (0-20) of 0.34±0.68. At sixmonth follow-up, a high index of patient satisfaction (VAS=9.39±0.24) was self-reported with 75% reduction in CSS (Constipation Scoring System) (1.95±2.58) compared to preoperative scores; "Late Complication Score" was 0. Conclusion: The specific target activity of Proctonorm® at the microcircular level may be effective in patients undergoing SH in order to reduce the inflammatory response of residual haemorrhoids while waiting for stable resolution of symptoms within one or two weeks
The postoperative prevention of deep venous thrombosis and pulmonary embolism with defibrotide versus heparin-calcium: a randomized clinical multicenter study of 1296 patients undergoing major abdominal surgery
No full textPostoperative thromboembolic complications do present an underestimated problem whenever their detection simply relies upon individual clinical judgement. Major abdominal operations are at increased risk of pulmonary embolism (PE) and deep vein thrombosis (DVT), mostly in advanced age, overweight subject, and in patients with cardiac or malignant diseases, or with previous venous diseases. Such patients may benefit from a peri- and postoperative prophylaxis with chemical or mechanical procedures, as a recent meta-analysis seems to suggest. In our experience, a randomized, multicentric clinical trial with defibrotide (DF) versus calcium-heparin (CH) was realized with the aim of evaluating their effectiveness and side effects in the prophylaxis of PE and DVT after major abdominal surgery; 1296 patients were randomly assigned to i.v. DF (400 mg.) or subcutaneous CH (0.2 ml. = 5000 U.I.) given one hour prior to operation and twice daily for seven days postoperatively. Definitive evaluation was carried out on 1212 patients (610 patients in DF and 602 in CH group, respectively) who completed the prophylaxis and monitoring schedule acceptably. One PE (0.16%) and 38 DVT (6.2%) were detected in DF group while 2 PE (0.33%) and 40 DVT (6.6%) were reported in CH treated patients. Post-operative blood loss was 578 +/- 150 cc. (median +/- S.E.M.) in DF group and 604 +/- 123 in CH group (p = n.s.). Wound hematoma was observed in 69 patients (5.7%): 20 (3.2%) in DF and 49 (8.1%) in CH group of patients (CHI-Square = 12.44; p = 0.0005); a significant post-operative decrease of RBC, WBC, Platelet count, and Fibrinogen was computed in both groups (p less than 0.01)
[Value of antibiotic prophylaxis in elective surgery of tumors of the digestive tract in patients at risk of infection. Review of our experience].
No full textPreliminary analysis of a randomized clinical trial of adjuvant postoperative RT vs. postoperative RT plus 5-FU and levamisole in patients with TNM stage II-III resectable rectal cancer.
No full textOBJECTIVES:
Two-hundred eighteen patients with TNM stage II-III resectable rectal cancer, enrolled into a randomized clinical trial, were assessed for efficacy and toxicity of adjuvant postoperative radiation therapy (RT) vs. those of combined RT and chemotherapy (CT), with 5-fluorouracil (5-FU) plus levamisole. End points were overall survival, disease-free survival, the rate of loco-regional recurrence, and treatment-related toxicity.
METHODS:
Patients in arm I underwent RT (50 Gy) in daily fractions of 2 Gy, 5 days/week for 5 weeks. Patients in arm II began with 5-FU (450 mg/m(2)/day intravenous bolus, days 1-5) plus levamisole (150 mg/day orally, days 1-3); postoperative RT was delivered during week 2 at the same dosage and schedule as in arm I. The other five cycles of CT (5-FU every 28 days and levamisole every 15 days for the length of 5-FU administration) continued after the end of RT if clinical and hemato-biochemical parameters were normal.
RESULTS:
RT was completed or modified in 170 (90%) of 189 evaluable patients undergoing RT (both treatment groups). Only 44 (59%) of 75 evaluable patients of arm II completed or had an adjustment of the CT schedule; the remaining 31 patients (41%) had to stop or never started the CT regimen. Patients undergoing combined RT and CT had more severe toxicity (enteritis, P = 0.03). There was one CT-related death (gastrointestinal bleeding) in this subset. No significant difference was observed in outcome of patients in the two study groups, nor for pattern of recurrence (heterogeneity chi(2) = 4.82; d.f. = 2; P = 0.08).
CONCLUSIONS:
These preliminary findings suggest a similar efficacy, coupled with less morbidity, of postoperative RT alone compared with a combined regimen of postoperative RT and CT in patients undergoing radical surgery for stage II-III rectal cancer
Computerized procedure for the identification of healthy subjects at 'neoplastic risk'
No full textThe authors reviewed literature data regarding risk factors of cancer in order to produce a software that could identify asymptomatic subjects at 'neoplastic risk' by means of the analysis of the relative risk (RR) of each factors of his/her life-style. More in detail, the relationship between diet and cancer, tobacco use, alcohol consumption, sexual behaviour, parity and other obstetric-gynecologic aspects, medications, occupational hazards, environmental pollution and genetic susceptibility were reviewed. A complex multi-parametric evaluation system was realized to calculate risk of cancers through computerized elaboration. The program operates on anamnestic, objective and instrumental data derived from a clinical data-base
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