Renzo Dionigi

Clinical-pharmacological aspects, application and effectiveness of total parenteral nutrition in surgical patients

PubMed, Mar 1, 1979

The term "total parenteral nutrition" (TPN) refers to the maintenance of an adequate nutritional ... more The term "total parenteral nutrition" (TPN) refers to the maintenance of an adequate nutritional status, normal body weight and positive nitrogen balance solely by intravenous means. It requires solutions providing calories, amino acids and other nutrients in amounts much greater than those indicated for maintenance of normal body weight. Nutrient solutions have been studied, selected and prepared in our Hospital Pharmacological Service utilizing a sterile closed system, which allows large-volume filtering, sterilizing and bottling devices. For maintenance of weight gain in adults, a basic formula is employed, which provides 1,100 Kcal/1 with pure crystalline amino acids mixed with 50% anhydrous dextrose in water in a ratio of 5.8:1 (160 Kcal:1 g nitrogen). Minerals and vitamins are added to the base solution prior to use and may be increased or decreased by simple addition or omission depending on the patient's condition. This paper is based on 192 surgical patients who received TPN and have been followed in strict cooperation between the Hospital Pharmacological Service and the Surgical Department. The patients, ranging from 23 to 79 years of age, with life threatening diseases and unable to maintain adequate nutrition by the oral route, received TPN through a central catheter inserted via subclavian puncture (146 cases) or through a surgically created internal A-V fistula (46 cases). The condition of the patients generally improved within a few days after starting TPN; and weight gain, wound healing, general improvement and a shorter period of hospitalization were observed. TPN could be efficiently combined with oncologic treatment, and a significant improvement of the patients' performance status and decrease of toxic side-effects due to chemotherapeutic agents were observed. TPN has been successfully applied also in patients with fistulas of the alimentary tract obtaining spontaneous closure and in patients with ulcerative colitis, showing its beneficial effect in allowing complete bowel rest for healing. No major complications or deaths could be attributed to TPN or to the route of administration.

Clinical-pharmacological aspects, application and effectiveness of total parenteral nutrition in surgical patients

PubMed, Mar 1, 1979

The term "total parenteral nutrition" (TPN) refers to the maintenance of an adequate nutritional ... more The term "total parenteral nutrition" (TPN) refers to the maintenance of an adequate nutritional status, normal body weight and positive nitrogen balance solely by intravenous means. It requires solutions providing calories, amino acids and other nutrients in amounts much greater than those indicated for maintenance of normal body weight. Nutrient solutions have been studied, selected and prepared in our Hospital Pharmacological Service utilizing a sterile closed system, which allows large-volume filtering, sterilizing and bottling devices. For maintenance of weight gain in adults, a basic formula is employed, which provides 1,100 Kcal/1 with pure crystalline amino acids mixed with 50% anhydrous dextrose in water in a ratio of 5.8:1 (160 Kcal:1 g nitrogen). Minerals and vitamins are added to the base solution prior to use and may be increased or decreased by simple addition or omission depending on the patient's condition. This paper is based on 192 surgical patients who received TPN and have been followed in strict cooperation between the Hospital Pharmacological Service and the Surgical Department. The patients, ranging from 23 to 79 years of age, with life threatening diseases and unable to maintain adequate nutrition by the oral route, received TPN through a central catheter inserted via subclavian puncture (146 cases) or through a surgically created internal A-V fistula (46 cases). The condition of the patients generally improved within a few days after starting TPN; and weight gain, wound healing, general improvement and a shorter period of hospitalization were observed. TPN could be efficiently combined with oncologic treatment, and a significant improvement of the patients' performance status and decrease of toxic side-effects due to chemotherapeutic agents were observed. TPN has been successfully applied also in patients with fistulas of the alimentary tract obtaining spontaneous closure and in patients with ulcerative colitis, showing its beneficial effect in allowing complete bowel rest for healing. No major complications or deaths could be attributed to TPN or to the route of administration.

Testimonianze

Incontri di studio, Mar 4, 2020

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Testimonianze

Incontri di studio, Mar 4, 2020

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Chirurgia. Basi teoriche e chirurgia generale-Chirurgia specialistica. Vol. 1-2

l'ischemia cronica degli arti inferiori \ue8 una comune causa di morbilit\ue0 e mortalit\ue0,... more l'ischemia cronica degli arti inferiori \ue8 una comune causa di morbilit\ue0 e mortalit\ue0, con una frequenza in grande sviluppo ormai in tutto il mondo a causa dell'innalzarsi dell'et\ue0 media. Tale patologia \ue8 causata dall'arteriopatia ostruttiva cronica periferica (AOCP), una malattia caratterizzata dall'occlusione delle arterie degli arti inferiori: dall'aorta alle arterie iliache, femorali, poplitea e tibiali, sino all'arcata plantare, tutte le arterie periferiche possono essere coinvolte dalla malattia. L'obiettivo che deve ispirare la terapia \ue8 da un aparte interferire sull'evoluzione della malattie e dall'altra ridurre l'incidenza di complicanze cardiovascolar

Chirurgia. Basi teoriche e chirurgia generale-Chirurgia specialistica. Vol. 1-2

l'ischemia cronica degli arti inferiori \ue8 una comune causa di morbilit\ue0 e mortalit\ue0,... more l'ischemia cronica degli arti inferiori \ue8 una comune causa di morbilit\ue0 e mortalit\ue0, con una frequenza in grande sviluppo ormai in tutto il mondo a causa dell'innalzarsi dell'et\ue0 media. Tale patologia \ue8 causata dall'arteriopatia ostruttiva cronica periferica (AOCP), una malattia caratterizzata dall'occlusione delle arterie degli arti inferiori: dall'aorta alle arterie iliache, femorali, poplitea e tibiali, sino all'arcata plantare, tutte le arterie periferiche possono essere coinvolte dalla malattia. L'obiettivo che deve ispirare la terapia \ue8 da un aparte interferire sull'evoluzione della malattie e dall'altra ridurre l'incidenza di complicanze cardiovascolar

Splenectomia Laparoscopica in Urgenza Per Infarto Splenico Massivo in Milza Ectopica (Pelvica)

La tecnica della terracotta invetriata

Single access cholecystectomy using standard laparoscopic instruments

Updates in Surgery, Jan 26, 2011

The aim of this study was to verify feasibility and safety of single incision laparoscopic cholec... more The aim of this study was to verify feasibility and safety of single incision laparoscopic cholecystectomy using conventional surgical instruments. Twenty patients underwent single incision laparoscopic cholecystectomy. Indications for cholecystectomy were symptomatic cholelithiasis. Operative time, postoperative length of stay, intraoperative and postoperative complications, postoperative pain (by visual analogue scale), and patient cosmetic satisfaction were considered. All 20 procedures were successfully concluded without additional skin incisions. The mean operative time was 69 ± 16 min with a trend toward a reduction in operating time with increasing surgical experience. Intraoperative bile leakages for gallbladder rupture were observed in only three cases. No postoperative complications were recorded. The median pain scale value was 3 and the median value of cosmetic satisfaction was 3. The mean postoperative length of stay was 1.3 ± 0.9 days. Single incision laparoscopic cholecystectomy with conventional surgical instruments is a feasible and safe procedure, but additional studies in larger series are needed to confirm our results.

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Single access cholecystectomy using standard laparoscopic instruments

Updates in Surgery, Jan 26, 2011

The aim of this study was to verify feasibility and safety of single incision laparoscopic cholec... more The aim of this study was to verify feasibility and safety of single incision laparoscopic cholecystectomy using conventional surgical instruments. Twenty patients underwent single incision laparoscopic cholecystectomy. Indications for cholecystectomy were symptomatic cholelithiasis. Operative time, postoperative length of stay, intraoperative and postoperative complications, postoperative pain (by visual analogue scale), and patient cosmetic satisfaction were considered. All 20 procedures were successfully concluded without additional skin incisions. The mean operative time was 69 ± 16 min with a trend toward a reduction in operating time with increasing surgical experience. Intraoperative bile leakages for gallbladder rupture were observed in only three cases. No postoperative complications were recorded. The median pain scale value was 3 and the median value of cosmetic satisfaction was 3. The mean postoperative length of stay was 1.3 ± 0.9 days. Single incision laparoscopic cholecystectomy with conventional surgical instruments is a feasible and safe procedure, but additional studies in larger series are needed to confirm our results.

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Predictors of Loco-Regional Recurrence and Cancer-Related Death after Breast Cancer Surgery

Breast Journal, Sep 1, 2010

To determine which tumor-related factors might predispose the patient to loco-regional recurrence... more To determine which tumor-related factors might predispose the patient to loco-regional recurrence or death and the impact of these factors on the different types of events. We retrospectively analyzed the data of 1991 women between January 1998 and March 2010 for a first primary nonmetastatic breast cancer and treated with surgery and neoadjuvant ⁄ adjuvant therapy. The overall survival distribution was estimated using the Kaplan-Meier method. The prognostic impact of several factors on cumulative overall and loco-regional recurrence free survival was evaluated by univariate (logrank test) and multivariate analysis (Cox regression). At log-rank test, pT, nodal status, histotype, grading, lymphangioinvasive growth, tumor diameter, estrogen receptors (ER) status, progesterone receptors (PR) status, expression of Ki67, and expression of Her2 ⁄ neu had a prognostic value on loco-regional recurrence or overall survival. In the multivariate analysis grading remained the only independent predictor of loco-regional recurrences. With regard to overall survival, the Cox model selected grading along with nodal status and PR status. Loco-regional recurrences after breast cancer surgery are not frequent events. They are markers of tumor aggressiveness and predictor of an increased likelihood of cancer-related death. However, loco-regional recurrence and systemic tumor progression are partially independent events, since some prognostic factors differ. n

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Predictors of Loco-Regional Recurrence and Cancer-Related Death after Breast Cancer Surgery

Breast Journal, Sep 1, 2010

To determine which tumor-related factors might predispose the patient to loco-regional recurrence... more To determine which tumor-related factors might predispose the patient to loco-regional recurrence or death and the impact of these factors on the different types of events. We retrospectively analyzed the data of 1991 women between January 1998 and March 2010 for a first primary nonmetastatic breast cancer and treated with surgery and neoadjuvant ⁄ adjuvant therapy. The overall survival distribution was estimated using the Kaplan-Meier method. The prognostic impact of several factors on cumulative overall and loco-regional recurrence free survival was evaluated by univariate (logrank test) and multivariate analysis (Cox regression). At log-rank test, pT, nodal status, histotype, grading, lymphangioinvasive growth, tumor diameter, estrogen receptors (ER) status, progesterone receptors (PR) status, expression of Ki67, and expression of Her2 ⁄ neu had a prognostic value on loco-regional recurrence or overall survival. In the multivariate analysis grading remained the only independent predictor of loco-regional recurrences. With regard to overall survival, the Cox model selected grading along with nodal status and PR status. Loco-regional recurrences after breast cancer surgery are not frequent events. They are markers of tumor aggressiveness and predictor of an increased likelihood of cancer-related death. However, loco-regional recurrence and systemic tumor progression are partially independent events, since some prognostic factors differ. n

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Infections in Cancer Patients

Surgical Clinics of North America, Feb 1, 1980

Some of the factors that predispose cancer patients to infections are related to the malignant di... more Some of the factors that predispose cancer patients to infections are related to the malignant disease and the tumor mass itself; others include age, length and type of surgery, degree of nutritional deprivation, and alterations of host defense mechanisms secondary to the type of cancer and treatment. Cancer patients who are preoperatively anergic to skin tests are at greater risk of developing postoperative infection. Administration of opsonic proteins may benefit patients with severe infections.

Infections in Cancer Patients

Surgical Clinics of North America, Feb 1, 1980

Some of the factors that predispose cancer patients to infections are related to the malignant di... more Some of the factors that predispose cancer patients to infections are related to the malignant disease and the tumor mass itself; others include age, length and type of surgery, degree of nutritional deprivation, and alterations of host defense mechanisms secondary to the type of cancer and treatment. Cancer patients who are preoperatively anergic to skin tests are at greater risk of developing postoperative infection. Administration of opsonic proteins may benefit patients with severe infections.

The surgeon's approach to preoperative evaluation of esophageal cancer: recent developments

PubMed, Jun 24, 2006

Esophageal resection for cancer is still associated with high morbidity and mortality. Postoperat... more Esophageal resection for cancer is still associated with high morbidity and mortality. Postoperative complications may be either patient- or surgeon-related. Patient-related factors include age, malnutrition, immunodepression and associated diseases. Surgeon-related factors are surgical experience, hospital volume and multidisciplinary approach. In the last 20 years major improvements and new technologies have been proposed and applied in esophageal surgery: its evolution depended on a thorough knowledge of surgical anatomy and technique, as well as on important developments in pre- and postoperative care. Preoperative evaluation is defined as the process of clinical assessment that precedes the induction of anesthesia. The principle is to gain information about the patient that could lead to modify his/her management, and improve outcome.

The surgeon's approach to preoperative evaluation of esophageal cancer: recent developments

PubMed, Jun 24, 2006

Esophageal resection for cancer is still associated with high morbidity and mortality. Postoperat... more Esophageal resection for cancer is still associated with high morbidity and mortality. Postoperative complications may be either patient- or surgeon-related. Patient-related factors include age, malnutrition, immunodepression and associated diseases. Surgeon-related factors are surgical experience, hospital volume and multidisciplinary approach. In the last 20 years major improvements and new technologies have been proposed and applied in esophageal surgery: its evolution depended on a thorough knowledge of surgical anatomy and technique, as well as on important developments in pre- and postoperative care. Preoperative evaluation is defined as the process of clinical assessment that precedes the induction of anesthesia. The principle is to gain information about the patient that could lead to modify his/her management, and improve outcome.

Early Postoperative Variations of Markers Cyfra 21-1 and Cea in Stage I-II Non-Small Cell Lung Cancer (NSCLC) Undergoing Radical Resection

日本外科学会雑誌, Mar 10, 1998

Early Postoperative Variations of Markers Cyfra 21-1 and Cea in Stage I-II Non-Small Cell Lung Cancer (NSCLC) Undergoing Radical Resection

日本外科学会雑誌, Mar 10, 1998

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