1
|
Pucciarelli S, Del Bianco P, Pace U, Bianco F, Restivo A, Maretto I, Selvaggi F, Zorcolo L, De Franciscis S, Asteria C, Urso EDL, Cuicchi D, Pellino G, Morpurgo E, La Torre G, Jovine E, Belluco C, La Torre F, Amato A, Chiappa A, Infantino A, Barina A, Spolverato G, Rega D, Kilmartin D, De Salvo GL, Delrio P. Multicentre randomized clinical trial of colonic J pouch or straight stapled colorectal reconstruction after low anterior resection for rectal cancer. Br J Surg 2019; 106:1147-1155. [PMID: 31233220 DOI: 10.1002/bjs.11222] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 03/30/2019] [Accepted: 04/02/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Colonic J pouch reconstruction has been found to be associated with a lower incidence of anastomotic leakage than straight anastomosis. However, studies on this topic are underpowered and retrospective. This randomized trial evaluated whether the incidence of anastomotic leakage was reduced after colonic J pouch reconstruction compared with straight colorectal anastomosis following anterior resection for rectal cancer. METHODS This multicentre RCT included patients with rectal carcinoma who underwent low anterior resection followed by colorectal anastomosis. Patients were assigned randomly to receive a colonic J pouch or straight colorectal anastomosis. The main outcome measure was the occurrence of major anastomotic leakage. The incidence of global (major plus minor) anastomotic leakage and general complications were secondary outcomes. Risk factors for anastomotic leakage were identified by regression analysis. RESULTS Of 457 patients enrolled, 379 were evaluable (colonic J pouch arm 190, straight colorectal arm 189). The incidence of major and global anastomotic leakage, and general complications was 14·2, 19·5 and 34·2 per cent respectively in the colonic J pouch group, and 12·2, 19·0 and 27·0 per cent in the straight colorectal anastomosis group. No statistically significant differences were observed between the two arms. In multivariable logistic regression analysis, male sex (odds ratio 1·79, 95 per cent c.i. 1·02 to 3·15; P = 0·042) and high ASA fitness grade (odds ratio 2·06, 1·15 to 3·71; P = 0·015) were independently associated with the occurrence of anastomotic leakage. CONCLUSION Colonic J pouch reconstruction does not reduce the incidence of anastomotic leakage and postoperative complications compared with conventional straight colorectal anastomosis. Registration number NCT01110798 (http://www.clinicaltrials.gov).
Collapse
Affiliation(s)
- S Pucciarelli
- First Surgical Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - P Del Bianco
- Clinical Trials and Biostatistics Unit, Istituto Oncologico Veneto IOV - IRCCS, Padua, Italy
| | - U Pace
- Department of Colorectal Surgical Oncology, Istituto Nazionale Tumori - IRCCS Fondazione G. Pascale, Naples, Italy
| | - F Bianco
- Department of Abdominal Oncology, Istituto Nazionale Tumori - IRCCS Fondazione G. Pascale, Naples, Italy
| | - A Restivo
- Colorectal Surgery, Azienda Ospedaliero-Universitaria di Cagliari, Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - I Maretto
- First Surgical Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - F Selvaggi
- Colorectal Surgery Unit, Department of Medical, Surgical, Neurological, Metabolic and Ageing Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - L Zorcolo
- Colorectal Surgery, Azienda Ospedaliero-Universitaria di Cagliari, Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - S De Franciscis
- Department of Abdominal Oncology, Istituto Nazionale Tumori - IRCCS Fondazione G. Pascale, Naples, Italy
| | - C Asteria
- Department of General Surgery, Ospedale Carlo Poma, Mantua, Italy
| | - E D L Urso
- First Surgical Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - D Cuicchi
- General Surgery Unit, Department of Alimentary Tract, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - G Pellino
- Colorectal Surgery Unit, Department of Medical, Surgical, Neurological, Metabolic and Ageing Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - E Morpurgo
- Department of Surgery, Regional Centre for Laparoscopic and Robotic Surgery, Camposampiero Hospital, Padua, Italy
| | - G La Torre
- Abdominal Surgical Oncology, Department of Surgery, IRCCS, Centro di Riferimento oncologico della Basilicata, Rionero in Vulture, Italy
| | - E Jovine
- General Surgery and Emergency, Maggiore Hospital, Azienda Sanitaria Locale di Bologna, Bologna, Italy
| | - C Belluco
- Department of Surgical Oncology, Centro di Riferimento Oncologico -IRCCS, National Cancer Institute, Aviano, Italy
| | - F La Torre
- Division of Emergency and Trauma Surgery, Emergency Department, Policlinico Umberto I, College of Medicine and Dentistry, Sapienza University, Rome, Italy
| | - A Amato
- Department of Coloproctology, Sanremo Hospital, Sanremo, Italy
| | - A Chiappa
- Innovative Techniques in Surgery Unit, European Institute of Oncology, University of Milan, Milan, Italy
| | - A Infantino
- Surgical Unit, Department of General Surgery, Santa Maria dei Battuti Hospital, San Vito al Tagliamento, Italy
| | - A Barina
- First Surgical Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - G Spolverato
- First Surgical Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - D Rega
- Department of Colorectal Surgical Oncology, Istituto Nazionale Tumori - IRCCS Fondazione G. Pascale, Naples, Italy
| | - D Kilmartin
- Clinical Trials and Biostatistics Unit, Istituto Oncologico Veneto IOV - IRCCS, Padua, Italy
| | - G L De Salvo
- Clinical Trials and Biostatistics Unit, Istituto Oncologico Veneto IOV - IRCCS, Padua, Italy
| | - P Delrio
- Department of Colorectal Surgical Oncology, Istituto Nazionale Tumori - IRCCS Fondazione G. Pascale, Naples, Italy
| |
Collapse
|
2
|
Baldan N, Munegato G, Di Leo A, Lauro E, Morpurgo E, Pianigiani S, Briscolini D, Ferrara R, Fiscon V, Brolese A, De Manzoni G, Baldazzi G, Snidero D, Merigliano S, Ricci F, Laterza E, Merenda R, Gianesini R. Lessons learned from 227 biological meshes used for the surgical treatment of ventral abdominal defects. Hernia 2019; 24:57-65. [PMID: 30661179 DOI: 10.1007/s10029-019-01883-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 10/25/2018] [Indexed: 01/07/2023]
Abstract
PURPOSE The advantages of biological meshes for ventral hernia repair are still under debate. Given the high financial cost, the proper indications for biological meshes should be clarified to restrict their use to properly selected patients. METHODS A retrospective database was instituted to register all cases of abdominal wall defect treated with biological meshes from 1/2010 to 3/2016. RESULTS A total of 227 patients (mean age: 64 years) whose ventral abdominal defects were reconstructed with a biological mesh were included in the study. Patients were divided according to the 2010 four-level surgical-site complication risk grading system proposed by the Ventral Hernia Working Group (VHWG): Grade 1 (G1, 12 cases), Grade 2 (G2, 68 cases), Grade 3 (G3, 112 cases), and Grade 4 (G4, 35 cases). The surgical site complication rate was higher in patients with one or more risk factors (33.6% vs 19% in patients with no risk factors) (P = 0.68). Statistically significant risk factors associated with the onset of one or more postoperative surgical site complications included: diabetes, coronary artery disease, immunosuppression, and obesity. Recurrence was more common in patients with surgical site complications and mainly associated with infection (38.9%) and wound necrosis (44.4%), and in cases of inlay positioning of the mesh (36%). CONCLUSIONS Due to their high costs, biological mesh should not be used in G1 patients. In infected fields (G4), they should only be used if no other surgical solution is feasible. There is a clear need to prospectively evaluate the performance of biological meshes.
Collapse
Affiliation(s)
- N Baldan
- Clinica Chirurgica 3, Azienda Ospedaliera Università di Padova, Padua, Italy.
| | - G Munegato
- Ospedale "S. Maria dei Battuti", Conegliano, TV, Italy
| | - A Di Leo
- Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - E Lauro
- Ospedale "S. Maria del Carmine" di Rovereto, Rovereto, TV, Italy
| | - E Morpurgo
- Ospedale di Camposampiero, Camposampiero, PD, Italy
| | - S Pianigiani
- Department of Industrial Engineering, Centre for Mechanics of Biological Materials, Università di Padova, Padua, Italy
| | - D Briscolini
- Clinica Chirurgica 3, Azienda Ospedaliera Università di Padova, Padua, Italy
| | | | - V Fiscon
- Ospedale di Cittadella, Cittadella, PD, Italy
| | - A Brolese
- Ospedale "Santa Chiara", Trento, Italy
| | - G De Manzoni
- Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - G Baldazzi
- ASST NORD MILANO Presidio Ospedaliero di Sesto San Giovanni, Sesto San Giovanni, MI, Italy
| | - D Snidero
- Ospedale di San Daniele del Friuli, San Daniele del Friuli, UD, Italy
| | - S Merigliano
- Clinica Chirurgica 3, Azienda Ospedaliera Università di Padova, Padua, Italy
| | - F Ricci
- Ospedale "S. Maria del Carmine" di Rovereto, Rovereto, TV, Italy
| | - E Laterza
- Ospedale di Legnago, Legnago, VR, Italy
| | - R Merenda
- Ospedale "SS. Giovanni e Paolo", Venice, Italy
| | | | | |
Collapse
|
3
|
Barina A, De Paoli A, Delrio P, Guerrieri M, Muratore A, Bianco F, Vespa D, Asteria C, Morpurgo E, Restivo A, Coco C, Pace U, Belluco C, Aschele C, Lonardi S, Valentini V, Mantello G, Maretto I, Del Bianco P, Perin A, Pucciarelli S. Rectal sparing approach after preoperative radio- and/or chemotherapy (RESARCH) in patients with rectal cancer: a multicentre observational study. Tech Coloproctol 2017; 21:633-640. [PMID: 28755256 DOI: 10.1007/s10151-017-1665-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 07/19/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND Rectum-sparing approaches appear to be appropriate in rectal cancer patients with a major (mCR) or complete clinical response (cCR) after neoadjuvant therapy. The aim of the present study is to evaluate the effectiveness of rectum-sparing approaches at 2 years after the completion of neoadjuvant treatment. STUDY DESIGN Patients with rectal adenocarcinoma eligible to receive neoadjuvant therapy will be prospectively enrolled. Patients will be restaged 7-8 weeks after the completion of neoadjuvant therapy and those with mCR (defined as absence of mass, small mucosal irregularity no more than 2 cm in diameter at endoscopy and no metastatic nodes at MRI) or cCR will be enrolled in the trial. Patients with mCR will undergo local excision, while patients with cCR will either undergo local excision or watch and wait policy. The main end point of the study is to determine the percentage of rectum preservation at 2 years in the enrolled patients. CONCLUSION This protocol is the first prospective trial that investigates the role of both local excision and watch and wait approaches in patients treated with neoadjuvant therapy for rectal cancer. The trial is registered at clinicaltrials.gov (NCT02710812).
Collapse
Affiliation(s)
- A Barina
- Department of Surgical, Gastroenterological and Oncological Sciences (DiSCOG), Clinica Chirurgica I, University of Padua, Padua, Italy.
| | - A De Paoli
- Department of Radiation Oncology, Centro di Riferimento Oncologico, National Cancer Institute, Aviano, Italy
| | - P Delrio
- National Cancer Institute, IRCCS Fondazione "G.Pascale", Naples, Italy
| | - M Guerrieri
- Surgery Clinic, Marche Polytechnic University, Ancona, Italy
| | - A Muratore
- E. Agnelli Hospital, Pinerolo, TO, Italy
| | - F Bianco
- Abdominal Surgical Oncology Unit, IRCCS Fondazione "G.Pascale", Naples, Italy
| | - D Vespa
- General Surgery Unit, San Bortolo Hospital, Vicenza, Italy
| | - C Asteria
- Department of Surgery and Orthopaedics, General Surgery Units of Asola, Mantua, Italy
| | - E Morpurgo
- Department of Surgery, Regional Center for Laparoscopic and Robotic Surgery, Camposampiero Hospital, Padua, Italy
| | - A Restivo
- Department of Surgery, Colorectal Surgery Center, University of Cagliari, Cagliari, Italy
| | - C Coco
- Department of Surgical Sciences, Catholic University of Rome, Rome, Italy
| | - U Pace
- National Cancer Institute, IRCCS Fondazione "G.Pascale", Naples, Italy
| | - C Belluco
- Department of Radiation Oncology, Centro di Riferimento Oncologico, National Cancer Institute, Aviano, Italy
| | - C Aschele
- Medical Oncology Unit, S. Andrea Hospital, La Spezia, Italy
| | - S Lonardi
- Medical Oncology Unit 1, Istituto Oncologico Veneto, IRCCS, Padua, Italy
| | - V Valentini
- Institute of Radiotherapy, Catholic University of Rome, Rome, Italy
| | - G Mantello
- Department of Radiotherapy, Ospedali Riuniti, Ancona, Italy
| | - I Maretto
- Department of Surgical, Gastroenterological and Oncological Sciences (DiSCOG), Clinica Chirurgica I, University of Padua, Padua, Italy
| | | | - A Perin
- Department of Surgical, Gastroenterological and Oncological Sciences (DiSCOG), Clinica Chirurgica I, University of Padua, Padua, Italy
| | - S Pucciarelli
- Department of Surgical, Gastroenterological and Oncological Sciences (DiSCOG), Clinica Chirurgica I, University of Padua, Padua, Italy
| |
Collapse
|
4
|
Baig M, Larach J, Chang S, Long C, Weiss E, Nogueras J, Wexner S, Bouchoucha M, Devroede G, Dorval E, Faye A, Arhan P, Arsac M, Zbar A, Oyetunji R, Gill R, D’Annibale A, Morpurgo E, Fiscon V, Termini B, Serventi A, Sovernigo G, Orsini C, Fa-Si-Oen P, van de Gender P, Putter H, Ectors N, D’Hoore A, Topal B, Penninckx F, Marques C, Nahas S, Nahas C, Sobrado C, Habr-Gama A, Kiss D, Verdaasdonk E, Bueno de Mesquita J, Stassen L, Nano M, Prunotto M, Ferronato M, Solej M, Galloni M, Pigot F, Dao-Quang M, Castinel A, Juguet F, Bouchard D, Bockle J, Allaert F, de la Portilla F, Zbar A, Rada R, Vega J, Cisneros N, Maldonado V, Utrera A, Espinosa E, Trecca A, Gaj F, Di Lorenzo G, Ricciardi M, Silano M, Bella A, Sperone M, Vorobiev G, Tsarkov P, Sorokin E. Erratum. Tech Coloproctol 2009. [DOI: 10.1007/s10151-006-0317-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
5
|
D'Annibale A, Morpurgo E, Fiscon V, Termini B, Serventi A, Sovernigo G, Orsini C. Minimally invasive resection for colorectal cancer: perioperative and medium-term results in an unselected patient group at a single institution. Tech Coloproctol 2006; 10:303-7. [PMID: 17115319 DOI: 10.1007/s10151-006-0297-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2005] [Accepted: 05/27/2006] [Indexed: 11/27/2022]
Abstract
BACKGROUND The use of laparoscopy for colorectal cancer resection is still controversial. METHODS We prospectively analyzed the outcome of minimally invasive resection for colorectal cancer, performed at our institution from 1998, when laparoscopic surgery became the treatment of choice for colorectal cancer, until 2004. All patients undergoing elective resection were assessed in terms of perioperative results (duration of surgery, number of lymph nodes removed, length of specimen, rate of conversion, complications) and survival. Patients were assessed yearly with follow-up visits and telephone interviews. RESULTS In the study period, 302 patients (mean age 66.1 years; range, 32-93 years) underwent 114 left hemicolectomies, 108 low anterior resections, 61 right hemicolectomies, 12 Miles procedures, 4 subtotal colectomies, and 3 transverse colon resections. Surgery took an average of 226 minutes (SD=71 min). The number of lymph nodes removed was 14+/-8. The conversion rate was 10%; most of the conversions were due to locally advanced cancer (15 cases) and bowel distension (7 cases). Fifteen anastomotic leaks were observed (5%). Twenty patients needed reoperation and two died: one of septic shock due to an anastomotic leak; the other of electrolyte imbalance and dehydration after peritonitis due to a bowel loop injury. Follow-up was available for 91% of patients. Cancer-related survival curves showed a 90% survival for stage II, 85% for stage III, and 10% for stage IV disease, 30 months after surgery. CONCLUSIONS Minimally invasive laparoscopic resection for colorectal cancer enables an oncologically adequate resection with complication and survival rates that are no worse than are to be expected after traditional open surgery. Locally advanced tumor and bowel distension are the most frequent reasons for conversion to open surgery.
Collapse
Affiliation(s)
- A D'Annibale
- Department of Surgery, Camposampiero Hospital, Camposampiero (PD), Italy
| | | | | | | | | | | | | |
Collapse
|
6
|
D'Annibale A, Serventi A, Orsini C, Morpurgo E. Locating polyps by endoscopy with or without videolaparoscopy, radioguided occult colonic lesion identification or magnetic endoscopic imaging: the way forward to complete polyp removal. Tech Coloproctol 2005; 8 Suppl 2:s295-9. [PMID: 15666110 DOI: 10.1007/s10151-004-0180-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Endoscopic polypectomy is the gold standard for the treatment of colorectal polyps. In the case of non-palpable lesions or to complete polyp removal, the lesions are located intra-operatively. With the advent of laparoscopy, identifying their position is even more important because there is no opportunity for intestinal palpation. Several methods of preoperative endoscopic marking have been proposed using different types of tattooing and recently using clips followed by ultrasonography detection. Innovative methods are analysed; magnetic endoscopic imaging is a reliable and accurate method for determining the anatomical position of the tip of the endoscope during colonoscopy. Radioguided colonic lesion identification needs a gamma detection probe. Endoscopic removal can be converted to endo-laparoscopic rendezvous, failing which, laparoscopic resection is a reliable and safe choice, offering all the advantages of minimally invasive surgical techniques.
Collapse
Affiliation(s)
- A D'Annibale
- Department of Surgery and Center for Minimally Invasive and Robotic Surgery, Hospital of Camposampiero, Via Cosma 1, I-35102 Camposampiero, Padua, Italy.
| | | | | | | |
Collapse
|
7
|
Morpurgo E, Cadrobbi R, Morpurgo M, Rigotti P, Schiavon F, Schiavon O, Caliceti P, Ancona E, Veronese FM. Protective effect of superoxide dismutase and polyethylene glycol-linked superoxide dismutase against renal warm ischemia/reperfusion injury. Transplantation 1996; 62:1221-3. [PMID: 8932260 DOI: 10.1097/00007890-199611150-00006] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The protective effect of oxygen free radical scavenger superoxide dismutase (SOD) against the warm ischemic damage that occurs in kidneys harvested from non-heart-beating donors is controversial because of its short half-life. In this model, we compared the protective effect of SOD and two longer lasting polyethylene glycol (PEG)-linked forms of SOD in a model of renal ischemia induced by 60 min of arterial clamping in rats. Rats treated with PEG1-SOD and PEG2-SOD had a better renal function than controls, with significantly lower serum creatinine levels throughout the follow-up period and a significantly higher creatinine clearance on postoperative days 1, 2, and 4. In native SOD treated-rats, serum creatinine was lower than in controls, though not significantly so, and creatinine clearance was significantly higher on postoperative day 4. Our results indicate that the protective effect of SOD against renal warm ischemia can be enhanced by prolonging its half-life by binding the enzyme to PEG.
Collapse
Affiliation(s)
- E Morpurgo
- Istituto di Chirurgia Generale II, Ospedale Giustinianeo, University of Padova, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Kozlowski T, Tibell A, Morpurgo E, Sundberg B, Sundin U, Groth C. Suppression of immunoglobulin resynthesis after plasmapheresis: efficacy of various immunosuppressive drugs--a study in rats. Transplant Proc 1995; 27:3545-6. [PMID: 8540094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- T Kozlowski
- Department of Transplantation Surgery, Karolinska Institute, Huddinge Hospital, Sweden
| | | | | | | | | | | |
Collapse
|
9
|
Rigotti P, Ferraresso M, Morpurgo E, Cadrobbi R, Menon F, Bacelle L, Calabrese F, Valente ML, Gatta A, Ancona E. Prevention of renal ischemic damage by endothelial protecting agents. Transplant Proc 1995; 27:749-51. [PMID: 7879170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- P Rigotti
- Istituto Chirurgia Generale II, University of Padua Medical School, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Morpurgo E, Rigotti P, Ancona E. Is warm ischemia the main limiting factor in the use of non-heart-beating donors in renal transplantation? Transplant Proc 1993; 25:1509-10. [PMID: 8442168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- E Morpurgo
- Institute of Semeiotica Chirurgica, University of Padova, Italy
| | | | | |
Collapse
|
11
|
Morpurgo E, Rigotti P, Capalbo M, Baldan N, Pittoni G, Valente ML, Bindoli A, Ancona E. Transplantation of warm ischemia damaged kidneys: an experimental study in pigs. Ren Fail 1993; 15:581-5. [PMID: 8290703 DOI: 10.3109/08860229309069407] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
This study evaluated renal function and histological and oxidative injury in transplanted kidneys harvested after prolonged warm ischemia in pigs. In 8 donor pigs, kidneys were perfused in situ 120 min after cardiac arrest. One of each pair of kidneys was used for histological and biochemical studies while the other was transplanted into a recipient undergoing bilateral nephrectomy. In 6 cases, renal function was satisfactory 14 days after transplantation. Histologically, a reversible acute tubular necrosis was observed with partial recovery at the 14th postoperative day. A moderate oxidation was revealed by decreased glutathione and increased malondialdehyde levels. In spite of this ischemic injury, these findings suggest that kidneys harvested after prolonged warm ischemia can still recover after transplantation, and that non-heart-beating donors may be considered as an alternative organ source for kidney transplantation.
Collapse
Affiliation(s)
- E Morpurgo
- University of Padua, Institute of General Surgery II, Italy
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Rigotti P, Morpurgo E, Comandella MG, Pittoni G, Baldan N, Ganz E, Piazza L, Capalbo M, Valente ML, Ancona E. Non--heart-beating donors: an alternative organ source in kidney transplantation. Transplant Proc 1991; 23:2579-80. [PMID: 1926489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- P Rigotti
- Istituto di Semeiotica Chirurgica, Universitá di Padova, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Ancona E, Rigotti P, Zaninotto G, Comandella MG, Morpurgo E, Costantini M. Treatment of lymphocele following renal transplantation by laparoscopic surgery. Int Surg 1991; 76:261-3. [PMID: 1838103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
We describe a new technique for internal drainage of lymphocele following renal transplantation performed by laparoscopy. After induction of the pneumoperitoneum, using the cautery hook, a wide opening in the lymphocele peritoneal wall has been performed allowing the lymph flow to enter the peritoneal cavity. A portion of the omentum has been pushed inside the lymphocele cavity and fixed to the parietal peritoneum in order to avoid closure of the peritoneal window. A postoperative CT scan control has shown the complete disappearance of the fluid collection. Internal drainage of lymphocele performed by laparoscopy allows a radical treatment with minimal trauma for the patient and has therefore potential advantages over the other current procedures.
Collapse
Affiliation(s)
- E Ancona
- Institute of Semeiotica Chirurgica, University of Padua, Italy
| | | | | | | | | | | |
Collapse
|
14
|
Rigotti P, Amodio P, Sacerdoti D, Ferraresso M, Borsato M, Morpurgo E, Menon F, Angeli P. Effects of defibrotide on renal function and urinary prostanoid excretion in ciclosporin-treated rats. Nephron Clin Pract 1991; 59:477-81. [PMID: 1758541 DOI: 10.1159/000186612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Defibrotide (DF) has been proposed as a new antithrombotic agent in renal transplantation. Because it was also found to increase prostacyclin synthesis, a reduction in ciclosporin (CS) nephrotoxicity could be supposed. To ascertain this hypothesis, renal function and urinary prostanoids were evaluated in four groups of rats after 10 days of oral treatment (doses in mg/kg/day): CS 50 (group A), CS 50 + DF 400 (group B), DF 400 (group C) and controls (group D). Compared to controls, creatinine clearance (CCR) was significantly lower in groups A and B (In CCr: A = 6.62 +/- 0.28, B = 6.83 +/- 0.24 vs. 8.17 +/- 0.13 microliters/min, p less than 0.01), whereas it did not change in group C (8.03 +/- 0.24 microliters/min). The urinary excretion of prostaglandin E2 (PGE2) was significantly (p less than 0.05) higher in group A (In PGE2: 3.98 +/- 0.98 nmol/mol Cr) and more evidently in groups B and C (6.89 +/- 0.38 and 6.01 +/- 0.32 nmol/mol Cr, respectively) compared to controls (1.43 +/- 0.45 nmol/mol Cr). The urinary excretion of 6-keto-PGF1 alpha and of thromboxane B2 (TxB2) were higher only in groups A and B (ln 6-keto-PGF1 alpha and ln TxB2: A = 6.45 +/- 0.22 and 4.97 +/- 0.20, B = 7.06 +/- 0.31 and 5.43 +/- 0.41 vs. group D = 5.53 +/- 0.22 and 3.79 +/- 0.42 nmol/mol Cr; p less than 0.05). The 6-keto-PGF1 alpha/Tx molar ratio was not significantly affected, although a trend for a reduction in the ratio was found in the treated rats.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- P Rigotti
- Institute of Semeiotica Chirurgica, University of Padua, Italy
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Morpurgo E. English Physicians-"Doctorati"-at the University of Padua in the "Collegio Veneto Artista" (1617-1771). Proc R Soc Med 1927; 20:1369-1380. [PMID: 19985950 PMCID: PMC2101443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
|