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Carcinoma colorettale: nuove metodiche diagnostiche.Ricerche sperimentali con spettroscopia di risonanza magnetica
Full text linkABSTRACT
Questa tesi di dottorato è stata elaborata nella prospettiva di studiare l’applicazione della spettroscopia di risonanza magnetica protonica (1H MRS) nella possibile diagnosi istologica non invasiva dei polipi e del carcinoma colorettale.
In particolare, la sua utilizzazione nella stadiazione del cancro del retto dopo trattamento neoadiuvante (chemioradioterapia concomitanti), che risulta fortemente deficitaria con le metodiche tradizionali (EUS, MRI, TC e PET- TC), potrebbe consentire diagnosi più accurate soprattutto di risposte cliniche complete o di residuo minimo di malattia.
A tale scopo sono stati dapprima ricordati nella letteratura i risultati dell’uso delle metodiche di imaging tradizionali che non consentono scelte terapeutiche adeguate alla presenza della neoplasia, scelte che variano dalla astensione chirurgica ad interventi allargati e mutilanti.
E’ stata rivista la utilizzazione su tumori umani (in vivo, ex-vivo e in studi sperimentali) della MRS, in modo specifico e più dettagliato, sul carcinoma colorettale.
Infine nell’ultima parte della tesi sono stati riportati scopi, metodi, apparati tecnologici e risultati della ricerca attuata, costituita dall’uso della 1H MRS su pezzi operatori umani.
Parole chiave: spettroscopia di risonanza magnetica, carcinoma colorettaleThis PhD thesis has been prepared with a view to the study of the application of proton magnetic resonance spectroscopy (1H MRS) in the possible non-invasive histological diagnosis of colorectal polyps and cancer.
In particular, its use in staging of rectal cancer after neoadjuvant treatment (concurrent chemoradiotherapy), which is heavily deficient with traditional methods (EUS, MRI, CT and PET-CT), could allow more accurate diagnosis, overall of clinical complete responses or minimal residual disease.
choices ranging from abstention widened and mutilating surgical interventions.For this purpose, the results of the use of traditional imaging methods have been first of all remembered in the literature, results which do not allow appropriate therapeutic choices for cancer, ranging from surgical abstention to extended operations.
The use of the MRS on human tumors (in vivo, ex vivo and in experimental studies) was reviewed, in a more specific and detailed matter, on colorectal carcinoma.
Finally in the last part of the thesis aims, methods, technological equipments and results of implemented research, made of use of 1H MRS on human surgical specimens, have been reported
Minimally Invasive Treatment of Portal Hypertension, Abdominal Aortic Aneurysm, and Colon Cancer: A Case Report
No full textSurgical therapy in cirrhotic patients has high morbidity and mortality. Hepatic function and complexity of surgical procedures strongly influence postoperative results. We report the case of a cirrhotic patient with portal hypertension, abdominal aortic aneurysm (AAA), and right colon cancer. After neoadjuvant transjugular intrahepatic portosystemic shunt, we performed 1-stage endovascular aneurysm repair and laparoscopic right colectomy. Minimally invasive surgery allows the effective treatment of high-risk patients with severe comorbidities that some years ago would not have been operated on
Laparoscopic hepatic resection
No full textBackground: Although laparoscopy in general surgery is increasingly being performed, only recently has liver surgery been performed with laparoscopy. We critically review our experience with laparoscopic liver resections.Methods: From January 2000 to April 2004, we performed laparoscopic hepatic resection in 16 patients with 18 hepatic lesions. Nine lesions were benign in seven patients (five hydatid cysts, three hemangiomas, and one simple cyst), five were malignant in five patients (five hepatocarcinoma), and four patients had an uncertain preoperative diagnosis (one suspected hemangioma and three suspected adenomas). The mean lesion size was 5.2 cm (range, 1-12). Twelve lesions were located in the left lobe, three were in segment VI, one was in segment V, one was in segment IV, and one was in the subcapsular part of segment VIII.Results: The conversion rate was 6.2%; intraoperative bleeding requiring blood transfusions occurred in two patients. Mean operative time was 120 min. Mean hospital stay was 4 days (range, 2 7). There were no major postoperative complications and no mortality.Conclusions: Hepatic resection with laparoscopy is feasible in malignant and benign hepatic lesions located in the left lobe and anterior inferior right lobe segments (IV, V, and VI). Results are similar to those of the open surgical technique in carefully selected cases, although studies with large numbers of patients are necessary to drawn definite conclusions
Perianal Paget's disease: presentation of six cases and literature review.
No full textPURPOSE:Extramammary Paget's disease (EMPD) is frequently associated with adnexal or visceral synchronous or metachronous malignancies. Our purpose was to evaluate, retrospectively, the results obtained in six cases of EMPD and to review the literature.METHODS:Six patients with the perianal Paget's disease had been treated in our division between March 1996 and December 2006. In three cases, the disease was confined in the epidermis; in one case, there was a microinvasion of the dermis, while in another one the dermis was infiltrated. The last case was associated to a low rectal adenocarcinoma. All patients underwent wide perianal excision and reconstruction with skin graft. We performed a transanal resection of the rectal adenocarcinoma. A review of the literature from 1990 to 2008 revealed 193 cases of perianal EMPD, 112 were intraepithelial/intradermal while 81 were associated with malignancies. Anorectal adenocarcinoma was already existing in two cases, synchronous in 48, and subsequent to diagnosis in 11.RESULTS:In three cases, the disease recurred locally, but no patient developed metastatic spread. Five patients survived and are free of disease. The review of the literature allows a clear identification of the primitive EMPD and the form associated to anorectal adenocarcinoma and little information about cases associated with synchronous adnexal adenocarcinoma. The Paget's disease can relapse after radical surgery and has a capacity of metastatic spread.CONCLUSIONS:Up to now, no clear guidelines have been established for the diagnosis of EMPD. The association with synchronous or metachronous carcinomas imposes a long-term follow-up with frequent clinical, radiological, and endoscopical controls
Approccio diagnostico alle occlusioni ileali non neoplastiche.
No full textApproccio diagnostico alle occlusioni ileali non neoplastiche
1 H-MR spectroscopy characterization of the adipose tissue associated with colorectal tumor.
No full textPURPOSE: To investigate colorectal tumor by looking at the lipid tissue around the lesion. Adipose tissue is not only an inert storage system for excess calories, but is involved in several pathological processes linked to tumor development.
MATERIALS AND METHODS: We obtained 24 colorectal specimens after surgical excision from patients affected by colorectal cancer at different tumor stages. 1 H-MR spectoscopy (MRS) spectra were collected from two voxels, in proximity of the lesion and far from it, in each specimen with a preclinical scanner. We differentiated patients by pathological tumor stage, and we compared the chemical composition of adipose tissue between patient groups, both close the tumor and far from it.
RESULTS: Monounsaturated fatty acids (MUFA) close the lesion are increased at higher tumor stages, while MUFA far from the lesion do not follow this trend. This study is really explorative due to the small numbers of subjects and we are cautious on the interpretation of the results. However, the approach of the present work allows a further insight in the tumor characterization.
CONCLUSION: Looking at the lipid tissue around a lesion through 1 H-MRS can return important information regarding its genesis and development
Iatrogenic axillary artery injury from humeral neck fracture repair. A rare and unusual event in which and aggressive strategy was mandatory to save a child limb
No full text[Treatment of the peritoneal carcinomatosis by cytoreductive surgery and intraperitoneal hyperthermic chemotherapy (IHPC): postoperative morbidity and mortality and short-term follow-up]
No full textTreatment of the peritoneal carcinomatosis by cytoreductive surgery and intraperitoneal hyperthermic chemotherapy (IHPC): postoperative morbidity and mortality and short-term follow-u
Morphogenetic events in the perinodal connective tissue in a metastatic cancer model.
No full textBackground: The modifications of connective tissue surrounding metastatic lymph nodes in a murine model of rectal cancer are described. Methods: Athymic nude mice (n = 36) were inoculated with 10 × 10 5 ht-29 cancer cells into the submucosal layer of the rectum. Control mice (n = 5) were treated with a sterile buffer. Tumor and the involved lymph nodes were visualized in vivo by magnetic resonance imaging at 1 to 4 weeks after cell injection. After the sacrifice, the excised samples were processed for histology. Results: After one week from cell injection all treated animals developed rectal cancer. Since the first week, neoplastic cells were visible in the nodes. In the surrounding connective tissue, the diameter of the adipocytes was reduced and a mesenchymal-like pattern with stellate cells embedded in an oedematous environment was visible. Since the second week, in the perinodal connective an enlargement of the stroma was present. The tissue was organized in cords and areas with extracellular accumulation of lipids were found. At the fourth week, we observed an enlargement of multilocular areas and lobules of elongated elements almost devoid of lipid droplets. In control animals, in absence of neoplastic masses, pelvic nodes were surrounded by a typical connective tissue characterized by unilocular adipocytes with groups of multilocular adipocytes. Conclusions: We have developed a model of rectal cancer with nodal metastases. Using this model, the work demonstrates that around secondary lesions, the morphogenetic events follow a standard evolution characterized by an early phase with lipolysis and mesenchymalization and later phases with a brown-like phenotype acquisition
Significance of super-extended (D3) lymphadenectomy in gastric cancer surgery
No full textBackground: The extension of lymphadenectomy is a matter of debate in gastric cancer surgery. The purpose of the present study was to analyse our experience on D3 lymphadenectomy in the treatment of gastric cancer with special reference to post-operative morbidity and mortality, incidence of para-aortic nodal metastases and long-term prognosis. Methods: The results of 201 patients who underwent potentially curative gastrectomy with D3 lymphadenectomy for non-metastatic gastric adenocarcinoma at the First Department of General Surgery, University of Verona, from January 1988 to December 2004, were analysed statistically. The analysis did not include gastric stump and linitis plastica type tumors. Results: Twenty-six out of the 201 patients (12.9%) showed para-aortic nodal metastases. Para-aortic node involvement was significantly higher in upper third tumors (29.1%) with respect to middle (6.1%) and lower third (7.5%) (P<0.001). Sixty-two patients (30.8%) developed post-operative complications with pulmonary affections (7%), pancreatic fistulas (4.5%) and abdominal abscesses (4.5%) as the most frequently observed complaints. In-hospital mortality was 1.5%. Overall 5-year survival rate for R0-patients was 53.6%. Considering survival in relation to nodal involvement, interestingly, patients with non-regional lymph node metastases (M1a) showed a slightly better prognosis with respect to pN3 patients (3-year survival: 13.9% and 19.4% for pN3 and M1a classes, respectively). Conclusions: D3 lymphadenectomy should be considered in curative surgery for advanced gastric cancer, especially for upper third tumors, with an acceptable morbidity and no increase in mortality. Further studies with a larger number of patients are required to confirm its prognostic value
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