Papers by Roberto Tersigni
The Japanese Journal of Surgery, 1989
A case of a 73 year old man who was preoperatively diagnosed as possibly having adrenal myelolipo... more A case of a 73 year old man who was preoperatively diagnosed as possibly having adrenal myelolipoma is presented herein. Adrenal myelolipoma is an uncommon benign tumor of which only 74 foreign cases and 43 Japanese cases have been previously reported in the literature dealing with surgically removed myelolipomas. The most consistent complaint of the adrenal myelolipoma sufferer is abdominal pain, caused by hemorrhaging in the tumor, and many cases are associated with obesity, hypertension and/or diabetes mellitus. There is now an increasing number of such cases being diagnosed during abdominal scanning with ultrasonography or computerized tomography for unrelated problems, whereupon the myelolipoma is usually surgically resected. With the availability of modern scanning techniques and fine needle biopsy, however, it should be possible to adopt a more conservative approach to the management of asymptomatic adrenal myelolipoma. Nevertheless, symptomatic or large tumors, must be removed since there is a high risk of spontaneous hemorrhage.
Journal of Clinical Oncology, 1986
Twenty-nine patients with advanced colorectal carcinoma were entered in this study to evaluate th... more Twenty-nine patients with advanced colorectal carcinoma were entered in this study to evaluate the efficacy and toxicity of a sequential chemotherapeutic schedule with methotrexate (MTX), 200 mg/m2 intravenously (IV) (push injection) and 5-fluorouracil (5-FU), 1,200 mg/m2 in continuous IV infusion, using a 20-hour time interval. All patients received calcium leucovorin (LV), 25 mg, intramuscularly (IM) every six hours for eight doses beginning 24 hours after methotrexate administration. Courses were administered every 15 days. Of the 24 patients evaluable for response, 11 (46%) had major objective regressions (one complete remission [CR] and ten partial remissions [PR]). The survival rate of patients who responded to treatment was 60% at 16 months, whereas patients with no change and those in whom the disease progressed had a median survival of 9 months and 3 months, respectively. The median duration of response has not yet been reached in patients who presented objective tumor regr...
Transplantation proceedings, 1979
Minerva chirurgica, 2010
Several randomized trials on conservative surgery compared with mastectomy in early-stage breast ... more Several randomized trials on conservative surgery compared with mastectomy in early-stage breast cancer have validated this technique in terms of local and distant relapse and survival of patients. Standard conservative approach includes surgical removal of the cancer with adequate cancer-free margins, axillary dissection, postoperative breast irradiation and adjuvant treatments when required. From 1987 to 2003, 500 early stage breast carcinoma were treated on 494 patients with conservative surgery and postoperative radiotherapy. Surgery consisted in a wide tumorectomy, with intraoperative control of R0 margins. The total postoperative radiation dosage was 50 Gy on the whole breast, associated with a boost of 10 Gy on tumor bed (20 Gy in T2 neoplasms). Before 1997 node-positive patients were treated with axillary irradiation with 50 Gy. Postoperative chemotherapy and/or hormonal therapy were administered to patients according with node-involvement, age and menopausal status. AJCC-st...
Minerva chirurgica, 2004
Surgery is, at present, the only potentially curative treatment for gastric carcinoma. The curabi... more Surgery is, at present, the only potentially curative treatment for gastric carcinoma. The curability depends upon the extension and localization of the tumor and, particularly, the lymphatic involvement and the presence of distant metastases. The aim of this paper is to describe the personal experience during the last 2 decades and analyze the results of the surgical approach which has changed over the time. One-hundred and ninety-four consecutive patients have been reported (127 male and 67 female, with a median age of 65.8 years), affected by gastric carcinoma and subjected to surgical procedures from 1987 to 2000. Because of the wide period of time which it refers to, this study is overlapped by a radical change in the staging rules of gastric carcinoma, according to the publication, in 1997, of the 5th edition of the TNM. This has made necessary to divide the series into 2 different groups. The 1st group is composed of 123 patients (63.4%), staged according to TNM-1987; the 2(n...
Transplantation proceedings, 1984
Minerva chirurgica, Jan 31, 1980
Arylsulfatase A and B activities have been determined in urine samples from four patients who rec... more Arylsulfatase A and B activities have been determined in urine samples from four patients who received a Kidney allograft from living donors as a treatment for terminal uraemia. The values have been compared with those obtained in the urine of the respective donors. Two patients, with optimal renal functionality, the enzymatic activities were in the order of that observed in the urine of the donor in one case and lower than that of the donor in the other case. A patient showing kidney rejection episodes, reversed by the specific therapy, had the enzymatic activities higher than those shown by the donor. Another patient who suffered for two rejections, the last one irreversible, showed a constant higher value of the two enzymatic activities compared with those of the donor and a further increase during the rejection period. In the light of these preliminary results it seems that the determination of the arylsulfatase activities in the urine of transplanted subjects could contribute t...
Surgery, gynecology & obstetrics, 1976
Extra-abdominal pancreatic transplantation is a feasible surgical procedure. Transplantation of t... more Extra-abdominal pancreatic transplantation is a feasible surgical procedure. Transplantation of the pancreas without duodenum and with pancreatic duct-to-ureter anastomosis had better results than combined pancreaticoduodenal transplantation in the same position. The alternative extra-abdominal approach offers more definite advantages, such as ease of performance, location and identification of complications, than does the usual intra-abdominal technique.
Techniques in Coloproctology, 2011
Background Perianal fistulas are frequent complications of Crohn's disease. Intravenous inflixima... more Background Perianal fistulas are frequent complications of Crohn's disease. Intravenous infliximab can control perianal disease and promote perianal fistula closure. Perifistular infliximab injections have been proposed for patients who are intolerant or unresponsive to intravenous therapy. The aim of this study was to assess the long-term efficacy of surgical treatment combined with local infliximab therapy. Methods A prospective cohort study was designed. Twelve patients with Crohn's disease and high/complex transphincteric and intrasphincteric perianal fistulas refractory to other treatment were submitted to core-out fistulectomies, plus perifistular injections of infliximab (20-25 mg in 15-20 ml of 5% glucose) every 4-6 weeks. The main outcome measure was the clinical closure of all perianal fistulas. A 95% confidence interval was calculated for short-and long-term fistula closure rates. Results None of the procedures were associated with local or systemic adverse effects. Four patients did not complete treatment, two because of relapse of intestinal symptoms, which required intravenous infliximab. In one case, treatment with intravenous infliximab was complicated by a hypersensitivity reaction. Eight patients continued treatment until all perianal fistulas were closed and setons were removed (median: 5 sessions). Persistent closure was observed in seven (87.5%, 95% CI: 47.4-99.6) of the eight patients 12 months after completion of treatment and in five (62.5%; 95% CI: 24.5-91.5) of eight at the end of follow-up (range: 19-43 months, median: 35 months). Conclusions The cohort we examined is small, but fistulectomy combined with repeated perifistular injections of infliximab appears to be safe and may help in fistula healing. However, in most patients, permanent closure of all fistulas is not achieved.
Biochemical and Biophysical Research Communications, 2013
Although the association of Apo AI with HDLs has been proposed to activate LCAT activity, the det... more Although the association of Apo AI with HDLs has been proposed to activate LCAT activity, the detailed molecular mechanisms involved in the process are not known. Therefore, in this study we have investigated how conformational changes in several exposed regions of Apo-AI might cause LCAT activation and for this purpose, designed a strategy to investigate three Apo AI-derived peptides. Since these peptides present the ability to adopt several secondary structure conformations, they were used to determine whether LCAT activity could be modulated in the presence of a particular conformation. Circular dichroism experiments showed that Apo AI-derived peptides in PBS displayed a disordered arrangement, with a strong tendency to adopt b-sheet and random conformational structures as a function of concentration. However, in the presence of Lyso-C 12 PC, maximal percentages of a-helical structures were observed. Performed in human plasma, time-course experiments of LCAT activity under control conditions reached the highest level of 3 H-cholesteryl esters after 2.5 h incubation. In the presence of Apo AI-derived peptides, a significant increase in the production of 3 H-cholesteryl esters was observed. The present study provides an important insight into the potential interactions between LCAT and lipoproteins and also suggests that peptides, initially present in a disordered conformation, are able to sense the lipid environment provided by lipoproteins of plasma and following a disorder-to-order transition, change their conformation to an ordered a-helix.
International journal of surgery (London, England), Jan 21, 2016
The increasing elderly population is an inevitable trend worldwide in developed countries. Theref... more The increasing elderly population is an inevitable trend worldwide in developed countries. Therefore, we aimed to assess the experience of a tertiary pancreatic center with a very homogenous population comprising only patients diagnosed with PDAC of the pancreatic head in patients older than 75 years of age compared to their younger counterparts regarding the benefit in life expectancy and tumor biological aggressiveness. 300 patients underwent partial pancreaticoduodenectomy (PD) or pylorus preserving pancreaticoduodenectomy (PPPD) for PDAC of the pancreatic head between 2002 and 2012 and were evaluated with regard to their co-morbidities, clinicopathological and perioperative variables, postoperative morbidity, mortality and long term survival. Therefore, two groups according to the age at the procedure (A: <75 years, n = 241, B: ≥75 years, n = 59) were designed. There were no differences between groups with regard to gender, performed procedure (PPPD or PD), operation time, bl...
Il Giornale di chirurgia, 2003
si epatiche da carcinoma colorettale ha comportato un miglioramento significativo della sopravviv... more si epatiche da carcinoma colorettale ha comportato un miglioramento significativo della sopravvivenza dei Pazienti. Tale miglioramento è in gran parte sostenuto dalla chirurgia resettiva epatica che rappresenta, al momento attuale, l’unico trattamento potenzialmente curativo. Il 15-25% dei Pazienti con neoplasia colorettale presenta metastasi epatiche sincrone, mentre circa il 20% dei Pazienti sviluppa metastasi metacrone, usualmente entro un periodo di tre anni; circa un quarto di tali Pazienti è candidato ad un intervento di resezione epatica. Negli ultimi 10 anni varie casistiche hanno documentato una mortalità operatoria dei Pazienti inferiore al 5% nei Centri con maggiore esperienza ed una sopravvivenza a 5 anni, nei Pazienti sottoposti ad intervento curativo, del 35-40%. Tali risultati sono in netto contrasto con la storia naturale delle metastasi epatiche da neoplasia colorettale non resecate, che non consente sopravvivenza a 5 anni dei Pazienti. C o m p l e s s i vamente i r...
Anales del Sistema Sanitario de Navarra, 2006
Tabla 1. Frecuencia de las distintas lesiones perianales en la enfermedad de Crohn 2,5,6,12-20. L... more Tabla 1. Frecuencia de las distintas lesiones perianales en la enfermedad de Crohn 2,5,6,12-20. Lesión Frecuencia Colgajos 30-40% Fisuras 21-35% Abscesos perianales 23-62% Fístulas perianales 6-34% Fístulas rectovaginales 5-10% Estenosis anorrectales 5-10% Úlceras cavitadas 2-12% Hemorroides 2-7% Carcinomas anales 0-1% Figura 1. Fisura anal en paciente con enfermedad de Crohn.
Il Giornale di chirurgia
The authors report a case of alone right adrenal metastasis from colon carcinoma discovered incid... more The authors report a case of alone right adrenal metastasis from colon carcinoma discovered incidentally by CT scan imaging 4 years after colon resection in a 74-year-old man. The presence of metastasis in the adrenal glands represents the second most frequent cause of "adrenal incidentaloma", following cortical-adrenal adenomas. The most common primary tumors responsible for adrenal metastasis are carcinoma of the lung, breast and kidney. Alone adrenal metastases due to colon or rectal carcinoma is very rare. Due to their rarity, at present there are not randomised studies supporting the effectiveness of surgery. Nevertheless, on the basis of international Literature and our experience of adrenalectomy could represent the current "gold-standard" therapeutic approach.
Journal of Hepatology, 2006
Background/Aims: Hepatitis C virus (HCV) causes a chronic infection that can lead to fibrosis and... more Background/Aims: Hepatitis C virus (HCV) causes a chronic infection that can lead to fibrosis and carcinoma. Immune responses mediated by cytotoxic T lymphocytes (CTLs) could be involved in viral clearance or persistence, and therefore in determining the course of the disease. Methods: Intrahepatic and peripheral blood CD8CT cells were obtained from 32 HCV-chronically infected patients and analysed by flow-cytometry for surface markers of differentiation, IFNg and TNFa production, degranulation capacity and perforin content, after CD3 triggering. Results were compared with those obtained from 13 patients with a non-viral liver disease. Results: Intrahepatic CD8CT cells of HCV-infected patients, despite their phenotype of pre-terminally and terminally differentiated effectors (CCR7-CD45RAK/C), are poorly responsive to T cell receptor (TCR)-mediated stimulation compared with those obtained from uninfected subjects. This defect correlates with the severity of fibrosis, is more pronounced in patients with ALT!1.5!N than with ALTO1.5!N U/ml, and is not evident after mitogen stimulation. Conclusions: The present study describes the accumulation of hypo-responsive CD8CT cells in the liver of patients with chronic HCV infection. Understanding the mechanisms underlying this impairment may be helpful in the design of innovative strategies for HCV treatment.
Clinical and Experimental Immunology, 2003
SUMMARY Transforming growth factor-β (TGF-β) is an inhibitory cytokine recognized as a key regula... more SUMMARY Transforming growth factor-β (TGF-β) is an inhibitory cytokine recognized as a key regulator of immunological homeostasis and inflammatory responses. TGF-β is involved in experimental models of oral tolerance and in the pathogenesis of experimental colitis. Patients with inflammatory bowel disease (IBD) have inappropriate T cell responses to antigenic components of their own intestinal microflora, suggesting the presence of a disorder in the normal mucosal immune mechanism that ensures the down-regulation of responses to harmless constituents in the microflora. To evaluate the contribution of TGF-β to this imbalance, we measured TGF-β1 production by lamina propria mononuclear cells (LPMC) and T cells isolated from tissue specimens of patients with Crohn's disease (CD), ulcerative colitis (UC) and controls. Cells were cultured in the presence or absence of anti-CD2 plus anti-CD28 MoAbs and TGF-β1 production in culture supernatants was measured by ELISA. LPMC isolated from...
Il Giornale di chirurgia, 2006
In questo lavoro, gli Autori esaminano gli aspetti epidemiologici, clinici, anatomo-patologici, m... more In questo lavoro, gli Autori esaminano gli aspetti epidemiologici, clinici, anatomo-patologici, morfologico-strumentali e chimico-fisici propri di ogni singolo tipo di lesione cistica del pancreas e li paragonano tra di loro in maniera critica. In tal modo riescono ad individuare per ogni singola categoria le caratteristiche piu salienti. Un percorso composto di quattro gruppi principali di esami strumentali e di laboratorio (ecografia addominale standard / EUS, TC, RM, FNA / biopsia / dosaggio di oncomarkers ed amilasi del contenuto cistico) e stato prescelto per l’acquisizione di tutti questi dati in virtu di precisi criteri di specificita, sensibilita ed accuratezza diagnostica forniti dalla letteratura scientifica internazionale. Per ogni sottogruppo di tumore cistico del pancreas viene proposto, infine, il piano terapeutico accreditato di miglior successo, sempre secondo la comune opinione scientifica internazionale
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Papers by Roberto Tersigni