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1.
Article in English | MEDLINE | ID: mdl-27726223

ABSTRACT

The Multidimensional Geriatric Assessment (MGA) is currently used for assessing geriatric oncological patients, but a new prognostic index - the Multidimensional Prognostic Index (MPI) - has a demonstrated prognostic value in cancer patients too. The present work was designed to compare the MPI and MGA as predictors of 12-month mortality. 160 patients ≥70 years old with locally-advanced or metastatic solid cancers consecutively joining our Geriatric Oncology Program were administered a Comprehensive Geriatric Assessment to calculate their MGA and MPI scores. SETTINGS: Geriatric Clinic, Geriatric Surgery Clinic, Medical Oncology Unit, Padova Hospital, Italy. Using Cohen's Kappa coefficient, there was a poor concordance between the MPI and MGA. Severe MPI being associated with a higher mortality risk than Frail in the MGA. The ROC curves indicated that the MPI had a greater discriminatory power for 12-month mortality than the MGA. In our population of elderly cancer patients, the MPI performed better than the MGA in predicting mortality. Further evidence from larger prospective trials is needed to establish whether other geriatric scales, such as the GDS and CIRS-SI, could enhance the value of prognostic indexes applied to elderly cancer patients.


Subject(s)
Geriatric Assessment/methods , Neoplasms/mortality , Severity of Illness Index , Aged , Aged, 80 and over , Female , Humans , Italy/epidemiology , Male , Prognosis , Prospective Studies , ROC Curve
2.
Acta Biomed ; 76 Suppl 1: 49-51, 2005.
Article in English | MEDLINE | ID: mdl-16450511

ABSTRACT

Poor survival rate of elderly patients affected by locally advanced or metastatic gastric cancer is related to primary tumour complications. Bleeding is the most important adverse event, other major complications are gastric outlet obstruction and nutritional deprivation. Rarely the patients will perforate the stomach cancer and there is a sudden end to their life; contamination of the ascites result in a rapid death. Thus, an aggressive approach toward palliation of this condition is resection: in this manner the expected survival is approximately one year. Derivation techniques or endoscopic treatments are applied in those patients whose operative risk is inacceptable; in these cases poor median survival is expected. The aim of this report in to refer about the experience in palliative surgery for gastric cancer in the Department of Geriatric Surgery of the University of Padua.


Subject(s)
Palliative Care , Stomach Neoplasms/surgery , Aged , Aged, 80 and over , Female , Humans , Male
3.
Ann Ital Chir ; 74(3): 261-4, 2003.
Article in Italian | MEDLINE | ID: mdl-14677279

ABSTRACT

The sepsis is a bacterial invasion of the organism producing many manifestations which are able to amplify themselves. In the United States of America there are 100,000 death per year and the incidence is among 300,000-500,000 cases. The major surgery in the elder (especially if it is in emergency) has a great percental of risk because the preoperative study isn't often complete. Fever, agitation, panting, bullation, abdominal splinting, enteroplegia, are signals of evolving inflammatory situation. Moreover there are disorders of biochemical values: leukocytosis, thrombocytopenia, increased levels of VES, PCR, amylase and biliribinaemia. The more common radiological examinations are the straight radiography of abdomen and horax, abdomen ultrasonography, CT or MRI. In the last years pro-calcitonin, interleukin-6 , C-reactive protein, and nitric oxide from endothelial and muscularis cells have been evaluated as prognostic factors in the septic shock.


Subject(s)
Postoperative Complications/diagnosis , Shock, Septic/diagnosis , Aged , Biomarkers , Blood Proteins/analysis , Diagnostic Imaging , Humans , Incidence , Postoperative Complications/blood , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Postoperative Complications/therapy , Prognosis , Shock, Septic/blood , Shock, Septic/epidemiology , Shock, Septic/etiology , Shock, Septic/therapy
4.
Ann Ital Chir ; 74(3): 269-74, 2003.
Article in Italian | MEDLINE | ID: mdl-14677281

ABSTRACT

The major symptoms of periampullary neoplasia are jaundice, lowering of weight, abdominal pain extending behind; diabetes, pancreatitis or exocrine pancreatic failure are uncommon. In the last years, surgery has been considered as the gold standard of the therapy because new technologies are able to reduce morbility and mortality. In the too advanced neoplasia, palliative surgical care permits better survival and quality of life. The duodenopancreatectomy today has a low perioperative mortality (0-3%) and an acceptable survival (15.25%). Good results were found for palliative surgery in unresectable neoplasms while in the inoperable patients we consider endoscopic and radiological treatments better than chemotherapy because they are able to correct the jaundice, improving quality of life (but not survival).


Subject(s)
Ampulla of Vater/surgery , Common Bile Duct Neoplasms/surgery , Pancreatic Neoplasms/surgery , Aged , Antineoplastic Agents/therapeutic use , Combined Modality Therapy , Common Bile Duct Neoplasms/drug therapy , Common Bile Duct Neoplasms/mortality , Common Bile Duct Neoplasms/radiotherapy , Endoscopy , Female , Humans , Male , Palliative Care , Pancreatectomy , Pancreatic Neoplasms/drug therapy , Pancreatic Neoplasms/mortality , Pancreatic Neoplasms/radiotherapy , Pancreaticoduodenectomy , Quality of Life , Retrospective Studies , Stents , Survival Rate , Treatment Outcome
5.
Chir Ital ; 49(4-5): 5-10, 1997.
Article in Italian | MEDLINE | ID: mdl-10392176

ABSTRACT

A lot of mechanisms of healing of intestinal anastomoses has been explained. A leading role in the intestinal wall is made by the submucosal tunica, where collagen synthesis and degradation process take place, but local and systemic factors are present by a definite causal action. Technique of suture, materials and surgeon's experience are of fundamental importance for the success of operation, even if in some cases it is important to take in consideration the clinical situation: emergency or not, the patient's state and age, concomitant diseases, pharmacological or radiotherapeutic treatments. Nowadays surgical research tends towards biochemical and molecular field to identify the factors, that speed up the healing process to use them in suturing materials getting a quick healing as soon as possible.


Subject(s)
Intestines/physiopathology , Intestines/surgery , Surgical Wound Dehiscence/physiopathology , Adult , Aged , Anastomosis, Surgical/methods , Female , Humans , Male , Middle Aged , Retrospective Studies , Risk Factors
6.
Chir Ital ; 49(4-5): 31-6, 1997.
Article in Italian | MEDLINE | ID: mdl-10392181

ABSTRACT

Breast cancer represents an important epidemiological and clinical problem, and the elderly age represents a large proportion of women with breast cancer. In patients older than 65-year, the frequency of breast cancer is 50% and more. Early diagnosis and adequate therapy may play an important role also in the elderly. We performed a retrospective analysis of 146 women older than 65-year to determine the effect of age in management of the disease.


Subject(s)
Breast Neoplasms/diagnosis , Breast Neoplasms/therapy , Age Factors , Aged , Breast Neoplasms/pathology , Carcinoma, Ductal, Breast/diagnosis , Carcinoma, Ductal, Breast/pathology , Carcinoma, Ductal, Breast/therapy , Female , Humans , Neoplasm Staging , Retrospective Studies
7.
Chir Ital ; 49(4-5): 37-41, 1997.
Article in Italian | MEDLINE | ID: mdl-10392182

ABSTRACT

Peptic disease is even more described in the elderly patients. Is it different from the young people peptic disease? Is it a specific syndrome? These questions are debated by the authors from their experience about in the old age surgery. In 1997, out of 569 oesophago-gastro-duodenoscopies positive for peptic disease, about 2/5 of the patients were older than 65-year with a high percentage of hypersecretive patients. Also the incidence of complications is similar in the aged and young patients, but their course is much more serious in the elderly. NSAID therapy was not always demonstrated as a determining factor of complications in the elderly. The ulcer perforation is the most serious complication; in the over-70 year aged persons a very severe course is often demonstrated. In conclusion in the elderly a specific diagnostic and therapeutic care is recommended to avoid the high incidence of deadly complications.


Subject(s)
Peptic Ulcer/complications , Age Factors , Aged , Female , Humans , Male , Peptic Ulcer/mortality , Peptic Ulcer Hemorrhage/etiology , Peptic Ulcer Hemorrhage/mortality , Peptic Ulcer Perforation/etiology , Peptic Ulcer Perforation/mortality , Risk Factors
8.
Chir Ital ; 49(4-5): 47-9, 1997.
Article in Italian | MEDLINE | ID: mdl-10392184

ABSTRACT

Gastric cancer often affect very old patients even if it is not a typical disease of the elderly. The Authors report their experience on 108 patients (mean age of 77.8 years) affected by gastric cancer; early diagnosis and surgical technique are discussed.


Subject(s)
Stomach Neoplasms , Age Factors , Aged , Aged, 80 and over , Humans , Stomach Neoplasms/complications , Stomach Neoplasms/pathology , Stomach Neoplasms/surgery
9.
Chir Ital ; 49(4-5): 53-5, 1997.
Article in Italian | MEDLINE | ID: mdl-10392186

ABSTRACT

Old people are continuously increasing in frequency but age is not a significant factor to value the operative risk in hernia surgery. From June 1985 to December 1996, 189 patients, aged > 80-year, were submitted to hernia surgery. No complications were noted when elective surgery was performed. Emergent procedure was undertaken in 7% of the patients major perioperative complications and one death were registered in this group of patients. Mean hospital stay has decreased in the period of the study: was 2.2 days in the last two years. Local anesthesia permitted a day surgery procedure in 60% of cases.


Subject(s)
Hernia, Femoral/surgery , Hernia, Inguinal/surgery , Aged , Aged, 80 and over , Ambulatory Surgical Procedures , Anesthesia, Local , Elective Surgical Procedures , Emergency Treatment , Humans , Length of Stay , Retrospective Studies , Survival Analysis , Treatment Outcome
10.
Int Surg ; 74(4): 267-9, 1989.
Article in English | MEDLINE | ID: mdl-2625403

ABSTRACT

The Authors present their experience with anal fistulas with recess above the levators. They mainly analyze the diagnostic, clinical, instrumental and therapeutic problems which this type of anal fistula may present.


Subject(s)
Rectal Fistula , Humans , Rectal Fistula/diagnosis , Rectal Fistula/surgery
11.
Int Surg ; 74(2): 111-3, 1989.
Article in English | MEDLINE | ID: mdl-2753619

ABSTRACT

Local recurrences of rectal cancer after surgical therapy are a mainly diagnostic and therapeutic problem. The Authors report their experience in local recurrences of rectal cancer. They consider anterior resection versus abdomino-perineal resection, the type of anastomosis and the stage of primary disease. Follow-up is discussed emphasizing early diagnosis for local recurrences.


Subject(s)
Neoplasm Recurrence, Local , Rectal Neoplasms/surgery , Adult , Aged , Aged, 80 and over , Female , Humans , Lymphatic Metastasis , Male , Methods , Middle Aged , Rectal Neoplasms/pathology
12.
Int Surg ; 74(1): 13-6, 1989.
Article in English | MEDLINE | ID: mdl-2707992

ABSTRACT

Rectal injuries during barium enema are uncommon but not unusual complications. Radiologists and surgeons must be able to recognize them, as early diagnosis is essential for effective treatment. The Authors discuss various aspects of problems arising from rectal perforation, and report their experience on seven cases.


Subject(s)
Barium Sulfate , Enema/adverse effects , Intestinal Perforation/diagnostic imaging , Rectum/injuries , Aged , Extravasation of Diagnostic and Therapeutic Materials/diagnosis , Female , Gastrointestinal Diseases/diagnostic imaging , Humans , Intestinal Perforation/physiopathology , Intestinal Perforation/surgery , Male , Middle Aged , Prognosis , Radiography , Rupture
13.
Ital J Surg Sci ; 17(2): 123-9, 1987.
Article in English | MEDLINE | ID: mdl-3610601

ABSTRACT

The ideal surgical treatment for adenocarcinoma of the cardia is still controversial. Out of 168 consecutive patients resected in a 10-year period, 98 underwent esophagogastric resection (EGR) and 70 total gastrectomy with esophageal resection (TGER). Early and long-term results were compared in order to define specific indications for both surgical procedures. Abdominal nodes were metastatic in 62% of the cases; mediastinal nodes were metastatic in 20.3% of 138 thoracotomized patients. Neoplastic permeation of the section margin occurred in 4.7% of the patients. No positive section margins were found in the cases with 10 cm or more of uninvolved esophagus resected. The superiority of the thoracoabdominal approach was therefore evident in terms of oncologic radicality. Anastomotic leakages occurred in 13.3% of EGR and in 7.1% of TGER patients. No correlation between the stage of the tumor or the neoplastic permeation of the section margin and the incidence of leak was found. Operative mortality was 7.1% after EGR and 10% after TGER, which may suggest that EGR is the procedure of choice in poor-risk and elderly patients. Loco-regional or systemic neoplastic recurrence was responsible for long-term mortality in 70% of the cases. Anastomotic recurrence was found in 12.2% of EGR patients and in 1.4% of TGER patients. Overall five-year survival was 19.1%. Mean survival was 29.5 months, 30 after EGR and 27 after TGER (p = NS).(ABSTRACT TRUNCATED AT 250 WORDS)


Subject(s)
Adenocarcinoma/surgery , Stomach Neoplasms/surgery , Adult , Aged , Aged, 80 and over , Cardia/surgery , Esophagus/surgery , Female , Gastrectomy , Humans , Male , Middle Aged , Postoperative Complications/mortality , Prognosis
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