Antonio Basoli - Università degli Studi "La Sapienza" di Roma (original) (raw)

Papers by Antonio Basoli

Annals of Surgery, 1975

A critical evaluation is made of 131 patients submitted to choledocho or hepaticojejunostomy. The... more A critical evaluation is made of 131 patients submitted to choledocho or hepaticojejunostomy. The main indications for hepaticojejunostomy were iatrogenic strictures of CBD (60 patients), and choledocholithiasis with markedly dilated duct (41 patients). The overall mortality rate was 4% representing principally renal hepatic failure, bile peritonitis and bleeding. The complications following hepaticojejunostomy included only in one case biliary fistula which required reoperation. The longterm results of 80 patients available for a followup study were as follows: 63 patients (78.7%) were symptom-free at 2-13 years followup; 8 patients had brief episodes of cholangitis which responded to antibiotic and corticosteroid treatment; 9 patients re(quired reoperation for stricture of anastomosis. These overall results are a strong argument for hepaticojejunostomy which, compared with 'choledochoduodenostomy, avoids the hazards of the so-called sump syndrome and of the reflux of enteric contents in the CBD. An increased incidence of peptic ulcer disease in the patients submitted to hepaticojejunostomy was not observed. In very high strictures and in reinterventions anastomosis between left hepatic duct and Roux-en-Y jejunal limb was carried out. The results achieved with this techni(lue, which was performed in 26 patients, were about the same following hepaticojejunostomy. D sisrirv voluiminouis literatuire on the treatment of choledocholithiasis and benign obstructions of common bile duict (CBD), there are few studies in which an attempt has been made to suggest the indications for each suirgical procedure. Three operations have been commonly employed for the correction of these lesions, namely sphincteroplasty, choledochoduiodenostomy and hepaticojejtunostomy. It is generally agreed that sphincteroplasty is the procedture of choice in the treatment of lithiasis of distal CBD and stenosis at the sphincter of Oddi.91520,26 Conversely, choledochodtiodenostomy is uisually advised in patients with choledocholithiasis, iatrogenic strictuire, inflammatory stenosis and chronic pancreatitis.1,4,7,8,22 Moreover, there is a fairly tuniform pattern in limiting the extent of indications of hepaticojejiunostomy only to the strictures in the proximal CBD cauised by suirgical tratima.3'17

Annals of Surgery, 1974

On the bases of personal experience and the series of 148 cases from an international inquiry and... more On the bases of personal experience and the series of 148 cases from an international inquiry and a review of the literature, the relation between insular hyperplasia and hypoglycemia was examined. The fundamental points in this investigation included: age, diagnostic investigations, histological findings and postoperative results. The data on the patients with insular hyperplasia indicates that 83% were of adult age. Insular hyperplasia was the only abnormal factor determined to be present. Through treatment a high percentage of cases (71% ) was cured. From a practical surgical point of view, differentiation between occult insulomas and insular hyperplasia is not critical. Consequently, good results can be achieved in botlh diseases by practicing a progressive blind resection guided by examination of the operated specimen and by intra-operative blood sugar levels.

The surgical treatment of occult insulinomas: A review of the problem

British Journal of Surgery, 1974

The data from a previously reported large series (1067 cases) of insulin tumours of the pancreas ... more The data from a previously reported large series (1067 cases) of insulin tumours of the pancreas have allowed study of the problem of management of so-called ‚occult’ tumours. Of the occult tumours in the whole series, 54 per cent were situated in the head of the pancreas, as opposed to 26.5 per cent similarly located at the initial operation.Analysis of the records of 542 single benign beta-cell adenomas showed no correlation between the size of the tumour and the duration of symptoms. There were 168 cases of single benign tumours which could not be located at the first operation, but which were cured at a subsequent operation. In 65 per cent of these cases the tumour could not be located at the subsequent operation and was only found after blind resection.These results indicate that the growth of these tumours is not regular and constant. They lend no support to the suggestion that if an insulin tumour cannot be located blind resection should be avoided in the hope that after 1-2 years, during which symptoms can be controlled by diazoxide, the tumour is likely to he located at a second operation. It is concluded that if the tumour cannot be located the treatment likely to give the best results is progressive blind pancreatic resection from left to right, with careful examination of the excised specimen and frequent estimation of the blood sugar concentration.

Journal of Gastrointestinal Surgery, 2008

Severe secondary peritonitis is diagnosed in only 20–30% of all patients, but studies to date hav... more Severe secondary peritonitis is diagnosed in only 20–30% of all patients, but studies to date have persisted in using a standard fixed duration of antibiotic therapy. This prospective, double-blind, multicenter, randomized clinical study compared the clinical and bacteriological efficacy and tolerability of ertapenem (1 g/day) 3 days (group I) vs ≥5 days (group II) in 111 patients with localized peritonitis (appendicitis vs non-appendicitis) of mild to moderate severity, requiring surgical intervention. In evaluable patients, the clinical response as primary efficacy outcome were assessed at the test-of-cure 2 and 4 weeks after discontinuation of antibacterial therapy. Ninety patients were evaluable. In groups I and II, 92.9 and 89.6% of patients were cured, respectively; 95.3% in group I and 93.7% in group II showed eradication. These differences were not statistically significant. The most frequent bacteria recovered were Escherichia coli and Bacteroides fragilis. A wound infection developed in seven patients (7.7%) and an intraabdominal infection in one patient (1.1%). There was a low frequency of drug-related clinical or laboratory adverse effects in both groups. Our study demonstrated that, in patients with localized community-acquired intraabdominal infection, a 3-day course of ertapenem had the same clinical and bacteriological efficacy as a standard duration.

Cost-Effectiveness Study of Imipenem/Cilastatin versus Meropenem in Intra-Abdominal Infections

Digestive Surgery, 2000

The efficacy of two carbapenems, imipenem/cilastatin (I/C, 1.5 g daily) versus meropenem (3 g dai... more The efficacy of two carbapenems, imipenem/cilastatin (I/C, 1.5 g daily) versus meropenem (3 g daily) in intra-abdominal infections was assessed in a recent multicenter randomized clinical trial. The aim of this article is to perform a cost-effectiveness analysis as in real-world practice according to the findings of this clinical trial. A decision tree was used to estimate the clinical outcomes and direct costs of treating intra-abdominal infections using the two carbapenems from the perspective of the Italian National Health Service (INHS) or a private insurance company (PIC). In a population of 30,000 patients with intra-abdominal infections in Italy, it was estimated that 97 potential deaths/year could be avoided if these patients were treated with I/C versus meropenem. In addition, from the perspective of INHS, the total costs of treatment were estimated as ITL 106,874 million and 134,042 million for I/C and meropenem, respectively. In favor of the PIC point of view, the total costs were estimated as ITL 110,500 million and 135,899 million for I/C and meropenem, respectively. The treatment of intra-abdominal infections with I/C is shown to be more effective (97 deaths avoided/year) and less costly than with meropenem (with a saving of ITL 27,168 and 25,399 million/year for INHS and PIC, respectively).

Microbial Ecology in Health and Disease, 2008

Endoscopic stenting is a standard palliative approach for the treatment of a variety of diseases ... more Endoscopic stenting is a standard palliative approach for the treatment of a variety of diseases involving biliary obstruction. However, the major limitation of this approach is represented by stent occlusion followed by life-threatening cholangitis, often requiring stent removal and replacement with a new one. Although it is generally believed that microbial colonization of the inner surface of the stent plays an important role in initiating the clogging process, so far available data are not enough for a full understanding of this phenomenon. In fact, it is known that when a biliary stent is inserted across the sphincter of Oddi, the loss of the antimicrobial barrier represented by the sphincter itself and the low pressure in the common bile duct allow reflux of duodenal content, thus promoting an ascending microbial colonization. The sessile mode of growth and the exopolysaccharide production, which leads to the subsequent establishment of a thick biofilm, provides microorganisms with an efficient protection from both antibacterial agents and phagocytic cells. The aim of this study was to analyze the tridimensional structure of the microbial biofilm grown in the lumen of 15 clogged biliary stents and to identify the microbial species involved in the clogging process. Scanning electron microscopy investigations revealed that sludge present in the stent lumen consist of a rich and assorted microbial flora, including aerobic and anaerobic species, mixed with a large amount of amorphous material containing dietary fibres, crystals of cholesterol and other precipitates of bacteria-driven bile salts.

American Journal of Surgery, 1979

Clinical Medicine & Research, 2007

Biliary Pseudocyst. A Rare Consequence of an latrogenic Lesion of the Bile Ducts

Endoscopy, 1988

A patient with a biliary pseudocyst due to an iatrogenic lesion of the hepatic duct is reported. ... more A patient with a biliary pseudocyst due to an iatrogenic lesion of the hepatic duct is reported. The pseudocyst caused compression of the bile duct with progressive jaundice. Diagnostic problems and the utility of ERCP and PTC in determining the exact site of the lesion for surgical treatment are reported.

Imipenem/cilastatin (1.5 g daily) versus Meropenem (3.0 g daily) in Patients with Intra-abdominal Infections: Results of a Prospective, Randomized, Multicentre Trial

Scandinavian Journal of Infectious Diseases, 1997

An open-label prospective, randomized, parallel multicentre study was undertaken to compare the e... more An open-label prospective, randomized, parallel multicentre study was undertaken to compare the efficacy and tolerability of 1.5 g/day intravenous imipenem/cilastatin with 3 g/day intravenous meropenem in the treatment of intra-abdominal infections. A total of 287 patients were enrolled: 201 patients, divided between the 2 treatment groups, were evaluable. Clinical outcome, bacteriological outcome, untoward microbiological effects, and clinical and laboratory adverse experiences were evaluated. 98% of patients receiving imipenem/cilastatin therapy were cured, with 96% showing eradication of infection. 95% of those on meropenem were cured, with 98% showing eradication. These differences in clinical and bacteriological outcome between the 2 treatments were not statistically significant. Two patients receiving imipenem/cilastatin and 5 receiving meropenem had untoward microbiological effects. There was a 0.7% frequency (1/139 patients) of possibly or probably drug-related clinical or laboratory adverse experiences with imipenem/cilastatin and a 2.7% frequency (4/148) with meropenem. The mean time to defervescence was significantly less for patients in the imipenem/cilastatin treatment group than for those receiving meropenem. This study shows that 1.5 g/day of imipenem/cilastatin is equivalent to 3.0 g/day meropenem in clinical and bacteriological outcome, as well as in incidence of side effects.

Background: It is presently unknown if stents used in the correction of artery stenosis are fully... more Background: It is presently unknown if stents used in the correction of artery stenosis are fully hemocompatible or if their implantation causes alterations at the level of the plasma membrane in red blood cells. Methods: We addressed this important issue by measuring the passive electrical properties of the erythrocyte membrane before and after stent insertion by means of dielectric relaxation spectroscopy in the radiowave frequency range in a series of patients who were undergoing standard surgical treatment of arterial disease. Results: Our findings provide evidence that full hemocompatibility of stents has not yet been reached, and that there are some measurable alterations in the passive electrical behavior of the red blood cell membrane induced by the presence of the stent. Conclusion: It is possible that these changes do not have any physiological significance and simply reflect the intrinsic variability of biological samples. However, caution is urged, and the technique we describe here should be considered when investigating the hemocompatibility of a medical device at a cell membrane level.