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1

Electronic Resource

Somatostatin in the management of gastrointestinal fistulas

Torres, A. ; Landa, J. ; Moreno, M. ; [et al.]

Amsterdam : Elsevier

Regulatory Peptides 40 (1992), S. 262

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ISSN: 0167-0115

Source: Elsevier Journal Backfiles on ScienceDirect 1907 - 2002

Topics: Medicine

Type of Medium: Electronic Resource

URL: http://linkinghub.elsevier.com/retrieve/pii/0167-0115(92)90442-W

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2

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Continent perineal colostomy by transposition of gracilis muscles (1994)

Santoro, Emanuele ; Tirelli, C. ; Scutari, F. ; [et al.]

Springer

Diseases of the colon & rectum 37 (1994), S. S73

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ISSN: 1530-0358

Keywords: Abdominoperineal resection ; Colostomy ; Gracilis muscles ; Neoanal sphincter

Source: Springer Online Journal Archives 1860-2000

Topics: Medicine

Notes: Abstract We herein present a study conducted on 14 patients presenting cancer of the lower rectum or of the anal canal (10 adenocarcinomas and 4 squamous-cell carcinomas) and submitted to the Miles abdominal perineal resection in which a new perineal sphincter was constructed. PURPOSE: The aim of this study was to evaluate the efficacy of this new perineal sphincter constructed by transposing the gracilis muscles around an orthotopic colostomy in the attempt to avoid a permanent abdominal colostomy. METHODS: In all cases both gracilis muscles were employed. The right one was placed along the posterior wall of the pelvis and fixed to the controlateral ischiatic tuberosity, creating a sling comparable to the levator ani muscles. The left gracilis was passed around the colon and attached to the ipsilateral or controlateral tuberosity according to its length, reconstructing a muscular ring. The entire procedure was performed in one step in nine cases and in more steps in the remaining five. RESULTS: Of the 14 operated patients, 2 died of vascular disease and 1 developed necrosis of the colonic stump which required reconversion to an abdominal colostomy. Of the remaining 11 patients available for long-term evaluations, 8 showed adequate stool control. The remaining three manifested an incomplete level of continence. During the three-year follow-up period, all patients were evaluated by clinical examination, defecography, endoluminal ultrasonography, nuclear magnetic resonance, CT scan, and endoluminal manometry. CONCLUSION: This neosphincter realizes an elastic stenosis responsible for an efficient level of continence. Best results are observed in the young and educated patients submitted to surgery in two steps. Contraindications to this surgery seem to be advanced cancer, old age, and obesity.

Type of Medium: Electronic Resource

URL: http://dx.doi.org/10.1007/BF02048436

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3

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Role of prostaglandins in the early phases of experimental gastric carcinogenesis in the rat (1989)

Materia, A. ; Silecchia, G. ; Spaziani, E. ; [et al.]

Springer

Journal of cancer research and clinical oncology 115 (1989), S. 253-258

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ISSN: 1432-1335

Keywords: Gastric experimental carcinogenesis ; N-Methyl-N-nitro-N-nitrosoguanidine ; Prostaglandins ; Prostaglandin analogues ; Gastric juice

Source: Springer Online Journal Archives 1860-2000

Topics: Medicine

Notes: Summary The study was initiated to evaluate the effect of N-methyl-N-nitro-N-nitrosoguanidine (NG) on gastric intraluminal prostaglandin release during a 30-day treatment period and to investigate the effect of a stable prostaglandin E1 analogue (misoprostol) on NG-induced gastric mucosal damage during the same time period. Samples of gastric juice (1 h) were obtained from 40 male Sprague-Dawley rats with chronic gastric fistulas, in basal conditions and after 5, 15 and 30 days of continuous oral administration of NG (120 mg/l) or tap water. Aliquots of gastric juice were titrated with 0.1 M NaOH. Other aliquots were extracted with ethyl acetate and subjected to specific radioimmunoassay for prostaglandin E2. The severity of gastric mucosal lesions was evaluated in 60 rats after 5 days and 30 days of continuous oral administration of NG (120 mg/l) or NG plus misoprostol (200 μg/kg-1/day-1) or tap water, and a histological study was carried out. Administration of NG induced a significant decrease of gastric intraluminal prostaglandin E2 concentration at 15 and 30 days. Oral administration of misoprostol, at non-antisecretory doses, protected the rats against NG-induced gastric mucosal damage. Prostaglandins may be involved in the early phases of experimental gastric carcinogenesis.

Type of Medium: Electronic Resource

URL: http://dx.doi.org/10.1007/BF00391698

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4

Electronic Resource

Basso, N. ; Materia, A. ; Silecchia, G. ; [et al.]

Springer

Journal of cancer research and clinical oncology 118 (1992), S. 441-446

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ISSN: 1432-1335

Keywords: Nitroso compounds ; Gastric carcinogenesis ; Misoprostol

Source: Springer Online Journal Archives 1860-2000

Topics: Medicine

Notes: Summary The purpose of this study was to investigate the effect of long-term misoprostol administration, at non-antisecretory doses, onN-methyl-N′-nitro-N-nitrosoguanidine(MNNG)-induced gastric carcinogenesis. The incidence of gastric carcinomas and precancerous lesions was evaluated in 50 male 250-g Sprague-Dawley rats after 52 weeks of continuous oral administration of MNNG (120 mg/l;n=20), MNNG plus misoprostol (2 mg kg−1 day−1;n=20) or tap water (n=10) (experiment 1), and in 30 rats treated with MNNG for 30 weeks followed by tap water (n=15) or by misoprostol (n=15) for 22 weeks; a third group (n=10) received tap water only for 52 weeks (experiment 2). After sacrifice, gastric mucosal lesions were macroscopically evaluated and their histology obtained. MNNG consumption was comparable in all groups (6.5±1.1 mg rat−1 day−1). Misoprostol consumption was 180±0.25 mg kg−1 day−1 rat−1. In experiment 1 the incidence of gastric carcinomas was 60% in the MNNG group and 25% in the group treated with MNNG plus misoprostol (P〈0.05). Cytotoxic and hyperplastic gastric mucosal lesions were also significantly reduced by misoprostol. In experiment 2 the incidence of carcinomas was 31% and 38.6% respectively. Misoprostol significantly decreased the incidence of gastric cancer formation when given from the beginning of the experiment. By contrast, when administered after 30 weeks of MNNG treatment it did not interfere with experimental gastric cancer formation. Exogenous prostaglandins are able to prevent the early MNNG-induced gastric mucosal lesions, thus interfering with gastric carcinogenesis.

Type of Medium: Electronic Resource

URL: http://dx.doi.org/10.1007/BF01629427

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5

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Laparoscopic colorectal resection (1996)

Huscher, C. ; Silecchia, G. ; Croce, E. ; [et al.]

Springer

Surgical endoscopy and other interventional techniques 10 (1996), S. 875-879

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ISSN: 1432-2218

Keywords: Key words: Laparoscopic colorectal surgery — Minimally invasive surgery — Colorectal diseases

Source: Springer Online Journal Archives 1860-2000

Topics: Medicine

Notes: Abstract Background. The aim of the present study was to evaluate retrospectively the experience of six surgical units currently performing laparoscopic colorectal surgery. Methods. From November 1991 to January 1994, 200 patients (103 male, 97 female; mean age 62.5 years) were candidates for, and received, laparoscopic colorectal resection for benign (54) or malignant (196) lesions. All the units excluded patients with locally advanced organ tumors and all cases with suspected perforation and ascites. One center submitted to laparoscopic resection only stage I and IV adenocarcinoma. All surgeons considered obesity a relative contraindication. The following data were analyzed: indications, conversion rate to open surgery, operative time, morbidity and mortality, resumption of gastrointestinal function, number of lymph nodes harvested, hospital stay. Results. Twenty-one out of 200 patients were converted to open surgery (10.5%); 37 patients had a complete laparoscopic procedure (17.1%); 137 had an assisted resection (68.5%); and the remaining 5 patients had a facilitated resection. The mean operative time was 208 min (90–480) for assisted resection and 275 min (54–550) for complete laparoscopic resection. The mortality rate was 1.7%; the overall morbidity was 19.6% (major complications 11.2%). All patients quickly became ambulatory and showed a prompt resumption of gastrointestinal functions, and less postoperative pain if compared with converted cases. The average number of lymph nodes was 12.1 (range 1–32). The mean hospital stay was 8.6 days (range 5–14.5). The mean follow-up was 16 months (range 6–24). The recurrence rate 11.7%. Conclusions: Laparoscopy seems to offer the possibility of minimally invasive treatment, but long-term follow-up is needed to evaluate the efficacy of laparoscopic surgery in the treatment of colorectal cancer.

Type of Medium: Electronic Resource

URL: http://dx.doi.org/10.1007/s004649900187

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6

Electronic Resource

Laparoscopic colorectal resection (1996)

Huscher, C. ; Silecchia, G. ; Croce, E. ; [et al.]

Springer

Surgical endoscopy and other interventional techniques 10 (1996), S. 875-879

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ISSN: 1432-2218

Keywords: Laparoscopic colorectal surgery ; Minimally invasive surgery ; Colorectal diseases

Source: Springer Online Journal Archives 1860-2000

Topics: Medicine

Notes: Abstract Background. The aim of the present study was to evaluate retrospectively the experience of six surgical units currently performing laparoscopic colorectal surgery. Methods. From November 1991 to January 1994, 200 patients (103 male, 97 female; mean age 62.5 years) were candidates for, and received, laparoscopic colorectal resection for benign (54) or malignant (196) lesions. All the units excluded patients with locally advanced organ tumors and all cases with suspected perforation and ascites. One center submitted to laparoscopic resection only stage I and IV adenocarcinoma. All surgeons considered obesity a relative contraindication. The following data were analyzed: indications, conversion rate to open surgery, operative time, morbidity and mortality, resumption of gastrointestinal function, number of lymph nodes harvested, hospital stay. Results. Twenty-one out of 200 patients were converted to open surgery (10.5%); 37 patients had a complete laparoscopic procedure (17.1%); 137 had an assisted resection (68.5%); and the remaining 5 patients had a facilitated resection. The mean operative time was 208 min (90–480) for assisted resection and 275 min (54–550) for complete laparoscopic resection. The mortality rate was 1.7%; the overall morbidity was 19.6% (major complications 11.2%). All patients quickly became ambulatory and showed a prompt resumption of gastrointestinal functions, and less postoperative pain if compared with converted cases. The average number of lymph nodes was 12.1 (range 1–32). The mean hospital stay was 8.6 days (range 5–14.5). The mean follow-up was 16 months (range 6–24). The recurrence rate 11.7%. Conclusions: Laparoscopy seems to offer the possibility of minimally invasive treatment, but long-term follow-up is needed to evaluate the efficacy of laparoscopic surgery in the treatment of colorectal cancer.

Type of Medium: Electronic Resource

URL: http://dx.doi.org/10.1007/BF00188473

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7

Electronic Resource

Complications after laparoscopic cholecystectomy (1995)

Bezzi, M. ; Silecchia, G. ; Orsi, F. ; [et al.]

Springer

Surgical endoscopy and other interventional techniques 9 (1995), S. 29-36

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ISSN: 1432-2218

Keywords: Complications ; Bile duct injuries ; Coordinated approach

Source: Springer Online Journal Archives 1860-2000

Topics: Medicine

Notes: Abstract The diagnostic and therapeutic approaches used for patients referred for bile duct injuries and other major complications after laparoscopic cholecystectomy (LC) were reviewed and the results of a coordinated radiologic, endoscopic, and surgical approach were assessed. From April 1991 to October 1993, 23 patients were observed. Seven patients had biliary strictures, five had biliary lesions, five presented with retained common bile duct (CBD) stones, and one had a minor cystic duct leak. Five patients had miscellaneous abdominal fluid collections; in addition, biloma or bile ascites were present in 10/23 cases. Correct definition of iatrogenic lesions was mainly made by endoscopic retrograde cholangiography (ERCP) (n=15), associated in six cases also with percutaneous cholangiography (PTC). “Minimally invasive” treatment included the full range of endoscopic and interventional radiological procedures. Six patients with biliary strictures, one patient with a biliary lesion, all five patients with residual CBD stones, and four patients with abdominal collections were treated by “minimally invasive” techniques: Therefore, laparotomy was avoided in 70% of cases (16/23 patients). Open surgery was necessary in 7/23 patients (30%), because of ductal lesion (n=4), ductal stricture by endoloop (n=1), iliac artery injury (n=1), and phlegmon of gallbladder bed (n=1). It appears that careful assessment of complications after LC is mandatory and often requires the combined use of ERCP/PTC and cross-sectional imaging. After a first diagnostic phase, complications should be managed by a multidisciplinary approach wherein the radiologist and the endoscopist strictly cooperate with the surgeon in order to obtain an immediate relief of the initial clinical problem, such as jaundice, bile leak, or infection, and then plan a definitive treatment which is tailored to each patient's problem. Using this approach the whole event of LC and its complications can be managed within the field of minimally invasive therapy in most cases.

Type of Medium: Electronic Resource

URL: http://dx.doi.org/10.1007/BF00187881

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8

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Laparoscopic treatment of gastric stromal tumors (2000)

Basso, N. ; Rosato, P. ; De Leo, A. ; [et al.]

Springer

Surgical endoscopy and other interventional techniques 14 (2000), S. 524 -526

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ISSN: 1432-2218

Keywords: Key words: Gastrointestinal stromal tumors — Laparoscopy — Leiomyoma — Schwannoma

Source: Springer Online Journal Archives 1860-2000

Topics: Medicine

Notes: Abstract Background: The laparoscopic resection of gastric stromal tumors (GST) is being performed with increased frequency. Methods: Between November 1993 and October 1998, nine consecutive patients with benign and low-grade gastric stromal tumors underwent laparoscopic resection using intraoperative endoscopy. For lesions located on the anterior wall (three cases), a direct approach was utilized. Lesions located on the posterior wall were resected via a transgastric approach (four cases) or through a small opening on the omentum or on the gastrocolic ligament (two cases). Excision of the lesions was performed manually by means of electrocautery and scissors in eight cases; the gastric incisions were closed by manual running suture. An endoscopic stapler device was used in one case only. Results: All patients were successfully treated laparoscopically; there were no conversions to open surgery. Operative time ranged from 75 to 120 min. There was one bleeding from the suture line of the gastric wall postoperatively that was treated conservatively. The average postoperative hospital stay was 4 days (range, 2–6). Conclusions: In light of the results reported in the literature and on the basis of the present work, it seems that laparoscopic resection of GST should be considered as the treatment of choice. Wedge resection of anterior wall lesions is generally performed. The treatment of posterior wall lesions is still controversial. In our opinion the direct approach should be reserved for lesions located on the posterior wall of the body, which can be easily reached through the greater omentum, while the transgastric approach should be preferred for lesions located on the fundus and antrum. Manual excision allows a tailored operation; hand-sewn sutures are always feasible, and they are cheaper than stapled ones.

Type of Medium: Electronic Resource

URL: http://dx.doi.org/10.1007/s004640000021

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9

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Estrogens, androgens, and EGF receptor expression in gastric carcinoma induced byN-methyl-N'-nitro-N-nitrosoguanidine (1994)

Polimeno, L. ; Silecchia, G. ; Spaziani, E. ; [et al.]

Springer

Digestive diseases and sciences 39 (1994), S. 635-640

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ISSN: 1573-2568

Keywords: experimental gastric carcinogenesis ; sex hormones ; EGF receptors

Source: Springer Online Journal Archives 1860-2000

Topics: Medicine

Notes: Abstract Complex and conflicting relationships between epidermal growth factor (EGF), estrogens (E), androgens (A), and related receptors (EGF-R, E-R, A-R) have been reported in different biological situations associated with cell proliferation. There is also evidence that EGF and sex hormone receptors may be involved in normal and neoplastic growth of the gastrointestinal mucosa. In this study, we investigated the behavior of EGF receptors and sex hormone and related receptors, duringN-methyl-N'-nitro-N-nitrosoguanidine (NG) -induced gastric carcinogenesis in Sprague-Dawley male rats. Four groups of 15 rats each (10 NG-treated and five controls) were sacrificed after 1, 20, 30, and 40 weeks of treatment. Gastric tissue from each rat was processed for receptor status (number and affinity) and proliferative activity. A significant and progressive decrease of A-R and EGF-R was observed starting from the 20th week, while no change of E-R occurred throughout the experiment. Cell proliferation in the gastric mucosa of NG-treated rats increased after 30 weeks of treatment. These data indicate that NG treatment is able to modify the receptor status of gastric mucosa in rats.

Type of Medium: Electronic Resource

URL: http://dx.doi.org/10.1007/BF02088353

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