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NUOVI ORIENTAMENTI NELLA CURA DEI TUMORI STROMALI GASTROENTERICI (GIST) AVANZATI E METASTATICI: TRATTAMENTO COMBINATO INTERVENTO CHIRURGICO-TERAPIA SISTEMICA CON IMATINIB IN UN CASO A LOCALIZZAZIONE PRIMITIVA GASTRICA
No full textGastrointestinal stromal tumours (GIST) are rare neoplasms originating from connective tissue in the digestive tract with an incidence of less than 1% and account for most non-epithelial primitive digestive tumours. Metastasis diagnosed at the time of disease discovery confirms GIST malignancy. Kit protein, a trans-membrane tyrosine kinase receptor of staminal cells, is characteristically expressed by GIST. Most GIST have a mutation in the kit proto-oncogene. Resistance to conventional chemotherapy is commonly shown by malignant GIST. Most patients with advanced malignant GIST achieve clinical benefit with imatinib mesilate, an orally administered selective inhibitor of the tyrosine kinase receptor. We treated a 43-year-old male patient suffering from a gastric GIST diagnosed during a surgical emergency operation for peritonitis caused by gastric perforation. At the time of the first operation the patient had lost 10 kg body weight over the previous months and was seriously cachectic. During the emergency operation the perforation was sutured. The biopsy results showed the presence of CD1 17 (c-kit) and CD34 markers. A total body CT scan documented the substantial size of the gastric wall lesion, an increased volume of abdominal lymph nodes and compression of the splenic vein with alternative collateral circulation. The liver presented no less than 5 large metastases distributed in both the left and right lobes. There was also a pulmonary metastasis. Because of frequent spontaneous bleeding and starvation the patient was seriously anaemic. Considering the action mechanism of imatinib and the extent of the lesion we decided to perform a total gastrectomy procedure. At the time of the operation the stomach seemed to have a modified volume and shape: it appeared to be divided into two sacs, the larger and deeper of which was the original gastric cavity, while the superficial, smaller one seemed to be a protrusion of the organ. The stomach was indistinguishable from the spleen, the transverse colon and the distal pancreatic tract. The neoplasm was directly linked to the left liver and to the inferior diaphragmatic surface. We performed total gastrectomy and resection of the tail of the pancreas, the spleen, and the transverse colon all in one and the same session. The patient was discharged on postoperative day 8 and commenced imatinib therapy 30 days after the operation with 4 tablets per day. In the following months the patient repeated the CT scan to monitor the progressive volume reduction of the liver and lung lesions and a PET scan confirmed that the lesions were not active; the patient experienced a 13 kg body weight increase. One year after the operation the outcome appears to be lasting and the patient has tolerated the drug treatment well
Disordini funzionali dell'intestino
No full textmalattie funzionali dell'intestino, incontinenza, prolasso del rett
Dissezione dei linfonodi pelvici e retroperitoneali per via laparoscopica
No full textinfonodi retroperitoneali, approccio laparoscopico, laparoscopia diagnostica, laparoscopia operativ
La laparoscopia nella diagnosi e nel trattamento di un raro caso di emorragia digestiva da gastrointestinal stromal tumor (GIST).
No full textLaparoscopy represents, for general surgery, the newest innovative technique: it allows diagnosis and therapy at the same time. This technique allows a wide application field in abdominal surgery both in elective and emergency settings, for the possibility to explore easily, rapidly and completely the peritoneal cavity. A case of laparoscopic diagnosis of a rare case of upper intestinal bleeding due to GIST is reported
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Octogenarians: an increasing challenge for acute care and colorectal surgeons. An outcomes analysis of emergency colorectal surgery in the elderly
No full textAim Emergency surgery is associated with higher mortality rates, especially in elderly patients presenting with emergent colorectal disease. The aim of this study was to determine the outcomes in elderly patients following emergency colorectal resection, with particular focus on octogenarians who presented a sixfold higher mortality rate with respect to other patients. Method This study examined 355 patients who underwent surgery at an Emergency Department for complications of colorectal disease between January 2007 and December 2009. Morbidity and mortality were analyzed on the basis of patients characteristics and presentation. Univariate and logistic regression analyses were performed on morbidity and mortality risk factors. Results Two-hundred and fifteen patients of > 65 years of age were included, 93 of whom were = 80 years of age. The global mortality rate was 16%. In patients = 80 years of age the mortality rate was 30%. The difference in mortality rate between patients < 80 years of age vs patients = 80 years of age was 24%. In resected patients = 80 years of age, American Society of Anesthesiology grade, colonic ischaemia, neurological comorbidity and anastomotic dehiscence were identified as independent risk factors in both univariate and logistic regression analyses. The morbidity rate was approximately 17%, and no significant difference in morbidity was found between the two groups. Conclusion The results of this study show that fitness status and micro vascular impairment impact significantly on mortality in the elderly, particularly in octogenarians. Although the outcomes observed were compatible with the literature, the six fold higher mortality rate observed in the most elderly patients identifies a group for which death prevention is best achieved with aggressive resuscitation and intensive postoperative care, rather than timing of surgery
Laparoscopic repair of a giant hernia of Morgagni
No full textMorgagni's hernia presents with acute complication of the hernia itself like bowel obstruction or strangulation, or respiratory symptoms. Open or laparoscopic, trans-abdominal, trans-thoracic or combined surgical techniques have been used for defect reparing. We report a case of a 73-year-old woman, presenting with respiratory symptoms, affected by a Morgagni's Hernia containing the whole omentum and with the initial involving of transverse colon, which determined severe impairment of respiratory function. The patient underwent a laparoscopic approach, the sac was explored and partially retracted in abdomen but no dissection was tempted. A not preformed polypropylene mesh was placed upon the defect with at least 3 cm of overlapping. The post operative course was uneventful, the patient was discharged on IV post operative day. The debate on the safest and most effective modality to repair this rare hernia is still on the way. Since Morgagni' s hernia is a rarity, every single surgeon approaches it on the basis of his own preferences, so we believe no evidence based surgery will ever be applied to this rare defect. We report our experience, the surgical strategy and a review the literature on the outlined topics
Reusable versus disposable laparoscopic instrumentation at an Emergency Department: a costs analysis.
No full textin pres
[Laparoscopy in emergency: treatment of choice in acute abdomen].
No full textFrom 1992 to November 1999, 225 consecutive cases of acute abdomen were observed: 163 suspicious acute appendicitis, 7 ovarian cysts with suspect torsion, 4 intestinal occlusions, 1 digestive hemorrhage due GIST (Gastro-Intestinal Stromal Tumor), 1 case of hemoperitoneum after laparoscopic appendectomy and 49 cases of acute cholecystitis. In the 225 cases of emergency laparoscopic operations for acute abdomen the diagnostic accuracy has been of 99.5%, with only one case of conversion in to laparotomy for diagnosis. The conversion from laparoscopic to laparatomic surgical technique was registers in 2 cases (1%). The realimentation started in all the cases with a liquid diet as soon as 6 hours after the operation and with solid foods the following morning. The Authors haven't registered wound contaminations. The patients of working age rehabilitated in 8 days (between 7 and 21 days). In the athletic patients the average rehabilitation time was 15 days. On the base of the results obtained with their video-laparoscopy experience in acute abdomen emergency surgery, the Authors confirm that this technique can be advised as Emergency Surgery's first choice treatment
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