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Bilora F, Veronese F, Zancan A, Biasiolo M, Pomerri F, Muzzio PC. Autonomic dysfunction in Hodgkin and non-Hodgkin lymphoma. A paraneoplastic syndrome? Hematol Rep 2010; 2:e8. [PMID: 22184521 PMCID: PMC3222264 DOI: 10.4081/hr.2010.e8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Revised: 11/11/2010] [Accepted: 11/20/2010] [Indexed: 11/23/2022] Open
Abstract
We wanted to determine whether autonomic dysfunction in patients with lymphoma is related to chemotherapy or represent a paraneoplastic syndrome. 40 patients with current or cured Hodgkin or non-Hodgkin lymphoma and 40 healthy controls, matched for age, gender, hypertension and diabetes mellitus underwent autonomic evaluation (Deep Breath, Valsalva Maneuver, Hand Grip, Lying to Standing, Tilt Test). Current patients also suffering from diabetes or hypertension, or still on chemotherapy revealed autonomic changes, while cured or healthy subjects did not. Autonomic dysfunction in lymphoma is a transient manifestation of a paraneoplastic syndrome.
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Pomerri F, Pucciarelli S, Maretto I, Zandonà M, Del Bianco P, Amadio L, Rugge M, Nitti D, Muzzio PC. Prospective assessment of imaging after preoperative chemoradiotherapy for rectal cancer. Surgery 2010; 149:56-64. [PMID: 20452636 DOI: 10.1016/j.surg.2010.03.025] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2009] [Accepted: 03/25/2010] [Indexed: 02/06/2023]
Abstract
BACKGROUND The aim of the study was to assess the accuracy of imaging techniques in predicting pathologic tumor (ypT), node (ypN) stages and the circumferential resection margin (ypCRM) status of rectal cancers after preoperative chemoradiotherapy (CRT). METHODS Using pelvic computed tomography (CT), magnetic resonance imaging (MRI), and endorectal ultrasound (ERUS), 90 consecutive patients with locally advanced mid-to-low rectal cancer were prospectively assessed. Postirradiation T and N stages and infiltration of the CRM, as assessed by CT, MRI and ERUS, were compared with histopathologic findings. RESULTS The accuracy of ypT staging was low, whatever the imaging technique used (37% by CT, 34% by MRI, and 27% by ERUS), the most frequent inaccuracy being overstaging. Imaging showed a good specificity and good negative predictive values (NPV) when mural staging was grouped into ypT ≤ 3 and ypT4 categories; in particular, ERUS achieved a 92% specificity and 95% NPV. CRM involvement was correctly predicted in 71% of patients by CT (74% specificity; 93% NPV) and in 85% by MRI (88% specificity; 95% NPV). The accuracy for nodal staging was 62%, 68%, and 65% by CT, MRI and ERUS, respectively; the corresponding NPV were 88%, 78%, and 76%. CONCLUSION Current imaging techniques are inaccurate in restaging rectal cancer after CRT but are useful in predicting T ≤ 3 tumors, cases with negative nodes and tumor-free CRM. These findings may be of clinical relevance for planning less invasive surgery.
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Bilora F, Pietrogrande F, Campagnolo E, Rossato A, Polato G, Pomerri F, Muzzio PC. Are Hodgkin and non-Hodgkin patients at a greater risk of atherosclerosis? A follow-up of 3 years. Eur J Cancer Care (Engl) 2009; 19:417-9. [PMID: 19709173 DOI: 10.1111/j.1365-2354.2008.01048.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Aims and background are to ascertain whether Hodgkin and non-Hodgkin patients are more affected by atherosclerotic process. We studied 96 patients during a period of 3 years (2003-2007). Patients were assessed in the first year soon after receiving radiotherapy and chemotherapy and then reassessed in the third year. All the cases underwent echo-colour Doppler of the carotid axis, and the intima-media thickness (IMT) was measured. When the two time points were compared, the IMT was greater in the arterial district examined at the first assessment; while at the second there was a reduction in the IMT, so patients seemed to improve with time. Flow-mediated dilatation did not improve. Hodgkin and non-Hodgkin patients experience an increase in IMT during treatment, but afterwards they return in their precedent condition. They seem to have a persistently reduced flow-mediated dilatation. Lymphoma therapy probably predisposes patients to early atherosclerosis, and it would be worth trying to reverse this tendency by administering antioxidant therapy.
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Pomerri F, Dodi G, Nardin M, Muzzio P. Colonic total and segmental transit times in healthy Italian adults. Radiol Med 2009; 114:925-34. [DOI: 10.1007/s11547-009-0409-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Accepted: 11/03/2008] [Indexed: 12/15/2022]
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Pomerri F, Zandonà M, Barusco A, Razzoli M, Muzzio P. Comparison of fluoroscopy and radiography in the assessment of colonic transit time using radio-opaque markers. Clin Radiol 2008; 63:1019-25. [DOI: 10.1016/j.crad.2008.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2008] [Accepted: 05/08/2008] [Indexed: 12/13/2022]
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Pomerri F, Foletto M, Bernante P, Tonello E, Muzzio PC. Radiological assessment of complications after laparoscopic suprabursal adjustable gastric banding for morbid obesity. Obes Surg 2008; 19:146-152. [PMID: 18685904 DOI: 10.1007/s11695-008-9632-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2008] [Accepted: 06/27/2008] [Indexed: 11/28/2022]
Abstract
BACKGROUND The purpose of this study was to investigate the clinical impact of radiological assessment on delivery of therapy in patients with laparoscopic adjustable gastric banding for morbid obesity who have developed gastroesophageal symptoms or have inadequate excess weight loss. METHODS Institutional review board approval and informed consent were obtained from all patients. Suprabursal banding was performed in 373 patients who underwent 869 upper gastrointestinal series. The control group comprised 59 asymptomatic subjects from the study population with satisfactory weight loss at follow-up. RESULTS There were no intra-operative deaths or gastric perforations. A small gastric pouch was found above the band in 13 (22.03%) of the 59 control subjects; the upper limit of the gastric pouch volume was 9.85 ml (mathematical formula for a sphere used). The main postoperative complications included: 21 of 373 (5.63%) gastric portions above the band with a mean volume of 137.98 ml and narrowed stoma of 0.99 mm; 15 of 373 (4.02%) gastric portions above the band with a mean volume of 33.27 ml and open stoma of 4.95 mm; and 16 of 373 (4.28%) tubing disconnection and displacement into the peritoneal cavity. Twenty-one of 21 narrowed-stoma and eight of 15 open-stoma gastric portions underwent repeat surgery, upward herniation of the stomach (from below the band) being found in all 29 cases. CONCLUSION Our main findings following the use of the suprabursal approach for surgical band positioning suggest that repeat surgery may be worthwhile for all gastric upper portions >10 ml in patients with gastroesophageal symptoms or inadequate excess weight loss.
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Angriman I, Scarpa M, Ruffolo C, Pomerri F, Filosa T, Polese L, Pagano D, Norberto L, D’Amico DF. Double contrast small-bowel radiography in the preoperative assessment of Crohn’s disease: Is it still useful? Surg Today 2008; 38:700-4. [DOI: 10.1007/s00595-007-3700-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2007] [Accepted: 08/23/2007] [Indexed: 12/22/2022]
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Bilora F, Pietrogrande F, Campagnolo E, Rossato A, Polato G, Pomerri F, Pagnan A. A RE HODGKIN AND NON HODGKIN PATIENTS TO A GREATER RISK OF ATHEROSCLEROSIS? A FOLLOW UP OF 3YEARS. ATHEROSCLEROSIS SUPP 2008. [DOI: 10.1016/s1567-5688(08)70320-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Foletto M, Bernante P, Busetto L, Pomerri F, Vecchiato G, Prevedello L, Famengo S, Nitti D. Laparoscopic Gastric Rebanding for Slippage with Pouch Dilation: Results on 29 Consecutive Patients. Obes Surg 2008; 18:1099-103. [DOI: 10.1007/s11695-008-9458-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2008] [Accepted: 01/31/2008] [Indexed: 11/30/2022]
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Pomerri F, Maretto I, Pucciarelli S, Rugge M, Burzi S, Zandonà M, Ambrosi A, Urso E, Muzzio PC, Nitti D. Prediction of rectal lymph node metastasis by pelvic computed tomography measurement. Eur J Surg Oncol 2008; 35:168-73. [PMID: 18359603 DOI: 10.1016/j.ejso.2008.02.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2007] [Accepted: 02/14/2008] [Indexed: 12/31/2022] Open
Abstract
AIM Rectal cancer staging represents a crucial step to select the best treatment for this tumour. Particularly after neo-adjuvant chemoradiotherapy (CRT), it may influence the surgical procedure (e.g. radical resection vs. local excision). The aim of this study was to determine the best lymph node size cut-off at computed tomography (CT) to predict nodal metastasis in rectal cancer patients with and without preoperative CRT. METHODS A consecutive series of patients operated on for primary mid-low rectal adenocarcinoma, all staged with pelvic CT scan, were subdivided as follows: those who underwent surgery alone treatment without CRT (Group A) and those who underwent preoperative CRT (Group B). All CT scans were re-viewed by a single radiologist and, based on the lymph node size, findings were compared with pathologic lymph node status (pN). At each lymph node size cut-off value, the following were calculated: accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). The best cut-off value was defined as having an accuracy >or=70% with the highest NPV. RESULTS The study population consisted of 162 patients: Group A (n=52) and Group B (n=110). Patients classified as pN-positive (n=45) had a higher number of and larger sized lymph nodes by CT scan than patients classified as pN-negative (n=117). The cut-off values with an accuracy >or=70% ranged between 7 and 11 mm in Group A and between 9 and 14 mm in Group B. The cut-off with the best NPV was 7 mm for Group A and 10mm for Group B. CONCLUSIONS Acknowledging the limitations of the dimensional criterion, lymph node size cut-off values found in our study may be useful for planning rectal cancer treatment using CT scan.
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Pomerri F, Frigo AC, Grigoletto F, Dodi G, Muzzio PC. Error Count of Radiopaque Markers in Colonic Segmental Transit Time Study. AJR Am J Roentgenol 2007; 189:W56-9. [PMID: 17646438 DOI: 10.2214/ajr.07.2278] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of our study was to evaluate the feasibility and efficacy of a radiologic technique in increasing colon visibility in colonic transit time studies. Three radiologists counted segmental colonic radiopaque markers in two patient groups, based on classic criteria in the first group and also on a colonic barium trace in the second. Agreement between marker counts was assessed using method comparison analysis. CONCLUSION With the barium trace technique, the anatomic conspicuity of colonic segments is improved, a correct segmental marker count can be obtained, and colonic inertia can be more easily distinguished from distal constipation.
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D'Incà R, Pomerri F, Vettorato MG, Dal Pont E, Di Leo V, Ferronato A, Medici V, Sturniolo GC. Interaction between rifaximin and dietary fibre in patients with diverticular disease. Aliment Pharmacol Ther 2007; 25:771-9. [PMID: 17373915 DOI: 10.1111/j.1365-2036.2007.03266.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cyclic administration of rifaximin in association with dietary fibre achieves symptomatic relief in uncomplicated diverticular disease (DD) by means of a still undefined mechanism. AIM To investigate the effects of a combination of rifaximin and fibre on both hydrogen production by intestinal microflora and oro-anal transit time. METHODS In a controlled, double-blind crossover trial, 64 patients with uncomplicated DD were given bran (20 g/day) and randomly treated with rifaximin (1200 mg/day) or a placebo for 14 days. Evaluation was based on clinical status, breath test, oro-anal transit time and faecal weight. RESULTS The global symptomatic score was significantly reduced after rifaximin (7.1 +/- 4.1 to 4.1 +/- 3.3; P < 0.005) but not after placebo (6.8 +/- 3.8 to 6.1 +/- 3.5). Hydrogen production significantly increased after placebo from 198 +/- 134 to 267 +/- 161 ppm/min, while Rifaximin reduced it from 222 +/- 187 to 166 +/- 131 ppm/min (P = 0.05). The total oro-anal transit time decreased from 56.1 +/- 28.2 to 51.3 +/- 28.0 h in placebo and from 54.4 +/- 31.9 to 45.1 +/- 32.4 h (P < 0.05) in rifaximin-treated patients. CONCLUSIONS The administration of rifamixin improves the benefits of dietary fibre in uncomplicated DD by preventing its bacterial degradation.
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Bernante P, Foletto M, Busetto L, Pomerri F, Pesenti FF, Pelizzo MR, Nitti D. Feasibility of laparoscopic sleeve gastrectomy as a revision procedure for prior laparoscopic gastric banding. Obes Surg 2007; 16:1327-30. [PMID: 17059742 DOI: 10.1381/096089206778663797] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG), initially described by Gagner's group as the first stage of the laparoscopic duodenal switch in super-obese patients, is now gaining wide diffusion among bariatric surgeons as a new restrictive operation. METHODS From January 2005 to January 2006, 8 obese patients with BMI 37-74 kg/m(2) underwent LSG for conversion from a prior complicated or failed laparoscopic adjustable gastric banding (LAGB). Three patients had severe symptomatic esophageal dilation, while 5 patients had unsuccessful weight loss with poor "band compliance". After de-banding, LSG was calibrated upon a 34-Fr gastric bougie, and blue and green linear staplers were used. The staple-line was buttressed by placing a sero-serosal running suture in all but one patient, and methylene blue dye was used to test for leaks. All the patients underwent upper GI series with water-soluble contrast medium 2 days after the surgery. RESULTS The average operating-time for LSG was 90 minutes (range 60-120 min). The average hospital stay was 4 days (range 3-7). There were no perioperative complications, no conversion, and no mortality. No intraoperative or postoperative blood transfusions were required. CONCLUSIONS LSG proved to be feasible and safe after LAGB. Longer follow-up and larger series are needed to assess weight loss results.
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Maretto I, Pomerri F, Pucciarelli S, Mescoli C, Belluco E, Burzi S, Rugge M, Muzzio PC, Nitti D. The potential of restaging in the prediction of pathologic response after preoperative chemoradiotherapy for rectal cancer. Ann Surg Oncol 2006; 14:455-61. [PMID: 17139456 DOI: 10.1245/s10434-006-9269-4] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2006] [Revised: 10/17/2006] [Accepted: 10/18/2006] [Indexed: 12/16/2022]
Abstract
BACKGROUND We performed this study to prospectively evaluate the postchemoradiotherapy performance of transrectal ultrasonography (TRUS), pelvic computed tomography (CT) scan and magnetic resonance imaging (MRI), and endoscopic biopsies for predicting the pathologic complete response of rectal cancer patients. METHODS Four weeks after completion of preoperative chemoradiotherapy, 46 consecutive patients with mid to low rectal cancer were prospectively evaluated by proctoscopy, TRUS, and pelvic CT scan and MRI. On the basis of T and N status, patients were classified as T0 or T1-4 and N-negative or N-positive. For each staging modality used, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated. Findings were compared with the pathologic tumor-node-metastasis stage. RESULTS On histopathologic analysis, 12 patients had pT0 and 34 had pT1-4 lesions; out of 45 assessable patients, 9 were N-positive. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in predicting T status (T0 vs. T >or=1) were 77%, 33%, 74%, 36%, and 64%, respectively, for TRUS; 100%, 0%, 74%, not assessable, and 74% for CT; and 100%, 0%, 77%, not assessable, and 77% for MRI. The corresponding figures in predicting N status (N-negative vs. N-positive) were, respectively, 37%, 67%, 21%, 81%, and 61% for TRUS; 78%, 58%, 32%, 91%, and 62% for CT; and 33%, 74%, 25%, 81%, and 65% for MRI. CONCLUSIONS Current rectal cancer staging modalities after chemoradiotherapy allow good prediction of node-negative cases, although none of them is able to predict the pathologic complete response on the rectal wall.
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Bilora F, Pietrogrande F, Petrobelli F, Polato G, Pomerri F, Muzzio PC. Is radiation a risk factor for atherosclerosis? An echo-color Doppler study on Hodgkin and non-Hodgkin patients. TUMORI JOURNAL 2006; 92:295-8. [PMID: 17036519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
AIMS AND BACKGROUND The aim of the present paper was to study the role of irradiation in the atherosclerotic process in patients affected by Hodgkin and non-Hodgkin lymphoma. METHODS We studied 84 subjects, 42 with Hodgkin or non-Hodgkin disease and 42 controls. All 42 cases had been irradiated and were comparable in terms of risk factors for atherosclerosis. All 84 subjects underwent echo-color Doppler of the arterial axis (carotids, abdominal aorta, and femoral arteries), and the intima-media thickness was measured. RESULTS The irradiated cases had a greater intima-media thickness in the carotid district, even after dividing them according to age and sex; males were affected more than females. The irradiated patients were at greater risk of developing cardiovascular events than the controls. CONCLUSIONS An echo-color Doppler of the carotid district is advisable in all patients who have been submitted to radiotherapy, and the patients with a significantly greater than normal intima-media thickness need a strict follow-up, and antioxidant or antiaggregant therapy should be considered.
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Foletto M, De Marchi F, Bernante P, Busetto L, Pomerri F. Late Gastric Pouch Necrosis after Lap-Band®, Treated by an Individualized Conservative Approach. Obes Surg 2005; 15:1487-90. [PMID: 16354532 DOI: 10.1381/096089205774859272] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Late band slippage has occurred in nearly 3-10% of patients after laparoscopic adjustable gastric banding (LAGB) with an average delay of 13 months. Band slippage can rarely lead to necrosis of the enlarged pouch, a potentially life-threatening condition. We report a female (BMI 39.92 with co-morbidities) who developed acute outlet obstruction 2 years after LAGB placement. After prompt band deflation, an urgent Gastrografin swallow showed stomach slippage without emptying. At re-operation pouch strangulation was discovered. The pouch appeared to be ill-fated, but as no tear was evident on intra-operative assessment, we decided to simply remove the band and drain. The patient was successfully discharged after 8 days, and the last upper endoscopy showed only a large ulcer in the fundus that was healing. Proper and prompt management of symptomatic patients with stomach slippage, with early operation when acute obstruction is evident, can enable a successful stomach-sparing approach.
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Bernante P, Francini Pesenti F, Toniato A, Zangrandi F, Pomerri F, Pelizzo MR. Obstructive symptoms associated with the 9.75-cm Lap-Band in the first 24 hours using the pars flaccida approach. Obes Surg 2005; 15:357-60. [PMID: 15826469 DOI: 10.1381/0960892053576541] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND For some patients, especially those with a higher BMI, a non-selective Lap-Band placement using the pars flaccida approach with application of the small-diameter bands (9.75 and 10 cm) may be too tight or may require significant gastroesophageal junction dissection and thinning. In such a case, the major perioperative complication is acute obstruction immediately after surgery. We review the etiology of obstructive complications that present postoperatively in the first 24 hours. CASE REPORTS Acute postoperative stoma obstruction (esophageal outlet stenosis) was observed in 5 patients who underwent 9.75-cm Lap-Band placement for morbid obesity. 2 of these patients had a postoperative upper GI series showing a misplaced band with gastric slippage, and repeat operation was required. 3 patients had gastric obstruction without slippage. Of the latter, 1 patient insisted that the band be removed rather than being replaced with a longer one, and the remaining 2 were managed with conservative treatment, involving extended hospitalization until the edema subsided and the patient slowly regained the ability to swallow. CONCLUSION Obstructive symptoms associated with the Lap-Band using the pars flaccida approach can be addressed conservatively in most patients or by minimally invasive surgery; however we believe that routine use of the 11-cm Lap-Band for the pars flaccida approach could easily prevent this early complication.
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Pomerri F, Bilora F, Muzzio PC. A gastric hiatal hernia may make abdominal pain disappear. JOURNAL OF MEDICINE 2004; 35:257-263. [PMID: 18084882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Recurrent abdominal pain developed in a 74-year-old woman that chronically suffered from retrosternal pain and regurgitation. An erect abdominal plain film showed a fluid level in the ascending colon and an enlargement of the posterior lower mediastinum containing gas on the right. Unexpectedly, the patient reported that abdominal pain disappeared after meals. Double contrast enema and contemporaneous barium swallow showed herniation of the left colonic flexure into the left lower mediastinum and a gastric hernia within the right lower mediastinum, respectively. The hernias were in the same site of the enlargement of the mediastinum seen on the plain abdominal film. The colonic hernia partially reduced when the gastric hernia was filled with barium. We postulate that these findings could explain the disappearance of the colic obstruction and abdominal pain after meals.
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Pomerri F, De Marchi F, Barbiero G, Di Maggio A, Zavarella C. Radiology for Laparoscopic Adjustable Gastric Banding: a Simplified Follow-up Examination Method. Obes Surg 2003; 13:901-8. [PMID: 14738679 DOI: 10.1381/096089203322618740] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to identify factors which allow a reliable, standardized and simplified approach for the radiologic follow-up of obese patients who have undergone surgery for laparoscopic adjustable gastric banding (LAGB) placement. METHODS A study was made of 370 consecutive single-contrast upper gastrointestinal series in 159 consecutive patients (122 women, 31 men; mean age 40.6 years; mean body weight 135.8 kg) who had undergone LAGB for morbid obesity and were symptomatic or had inadequate weight loss. The control group consisted of 38 subjects who had undergone LAGB, had satisfactory weight loss and were asymptomatic at follow-up. RESULTS Each gastric portion above the band was satisfactorily evaluated by measuring its vertical diameter. The optimal projection for measurement of stoma size was predicted before administration of the contrast agent and was achieved when the band was visualized in profile. The clinical pictures were not always related to stoma size. Surgical complications were gastric herniation (8 patients, twice in 1 patient, 5.7%), malpositioned band (1 patient, 1.6%), port twisting (13 patients, 8.2%), and disconnection or leakage of the device (8 patients, 5.0%). CONCLUSION Essential criteria for the radiologic evaluation of LAGB are: position of port and tubing; stoma size; and volume of each upper gastric portion.
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Bilora F, Petrobelli F, Boccioletti V, Pomerri F. Treatment of heart failure and ascites with ultrafiltration in patients with intractable alcoholic cardiomyopathy. Panminerva Med 2002; 44:23-5. [PMID: 11887087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
BACKGROUND In Western countries the excess of alcohol intake causes, secondary, non ischaemic cardiomyopathy and cirrhosis. Frequently, therapy is not effective so ultrafiltration was tried on patients affected, with positive effects on life quality. We tried to verify utility and tolerance to peritoneal ultrafiltration in a group of subjects affected by heart failure secondary to alcoholic cardiomyopathy, refractory to conventional therapy. METHODS Sixteen patients (14 males, 2 females) with heart failure and ascites affected by alcoholic cardiomyopathy were studied. All subjects were in IV class NYHA (New York Heart Association); ejection fraction (EF) was evaluated by echocardiogram and ascites by abdominal ultrasound. Patients were submitted to clinical exam, body weight, abdominal circumference, diuresis and routine biohumoral exams, electrocardiogram and chest X-ray. Subsequently they underwent intermittent nocturnal peritoneal dialysis with a changing cycle of 6-12 hours per session. After 5 days, subjects were checked through echocardiogram and abdominal ultrasound. RESULTS The patients mean age was 56.7 +/- 3.2 years. After ultrafiltration, all subjects showed decreased body weight, abdominal circumference and urea; there was an increase of diuresis and Natriuria. Fifteen subjects entered III NYHA class without variation of EF; all of them showed clinical and echographic reduction of ascites. Mean ultrafiltration quantity was 6.084 ml with mean dialysis hours 20; 7.36% of patients had fever that disappeared within 24 hours with antibiotic therapy. All subjects referred to feel well and the mean hospitalization period was of 7 day in spite of the usual 22 days.
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Pomerri F, Zuliani M, Mazza C, Villarejo F, Scopece A. Defecographic measurements of rectal intussusception and prolapse in patients and in asymptomatic subjects. AJR Am J Roentgenol 2001; 176:641-5. [PMID: 11222196 DOI: 10.2214/ajr.176.3.1760641] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The aim of this study was to provide measurements for the defecographic diagnosis of rectal intussusception and rectal prolapse. MATERIALS AND METHODS Four hundred thirty-seven consecutive patients with defecation and micturition disorders and gynecologic complaints were studied by means of defecography (120 patients), colpodefecography (17 patients), or cystocolpodefecography (300 patients). As a control group, 43 asymptomatic subjects underwent defecographic examination. RESULTS Thirty-five patients were found to have rectal intussusception and 18, to have rectal prolapse. Anterior and posterior rectal wall folding thickness, intussuscipiens diameter, intussusceptum lumen diameter, and the ratio between the intussuscipiens diameter and the intussusceptum lumen diameter were measured in all patients. The findings were compared with those obtained in 13 of 43 asymptomatic subjects with rectal outline changes mimicking intussusception. Rectal folding thickness and the ratio between the intussuscipiens diameter and the intussusceptum lumen diameter were significantly greater in subjects with rectal intussusception and rectal prolapse than in asymptomatic subjects with rectal mucosa folding. CONCLUSION Our findings suggest that dynamic evacuation radiology contributes to making a differential diagnosis between rectal intussusception and mucosal folds in the rectum.
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Bilora F, Manfredini R, Petrobelli F, Vettore G, Boccioletti V, Pomerri F. Chronobiology of non fatal pulmonary thromboembolism. Panminerva Med 2001; 43:7-10. [PMID: 11319511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND It as been demonstrated that acute myocardial infarction, sudden cardiac death, stroke, and fatal pulmonary embolism show an increased onset rate during certain periods of the day, week, or year. According to some authors, the highest risk appears to occur in the morning, on weekends and during winter. This paper, therefore, intends to examine whether a circadian, weekly, or annual rhythm in the incidence rate of deep vein thrombosis (DVT) and non-fatal pulmonary embolism (PE) in ageing patients does exists. METHODS A survey was conducted into 212 patients affected by DVT and PE, admitted to the Second Medicine Institute of Padua, Italy, over a period of two solar years. Thromboses were diagnosed via echo-Doppler examination of the legs and pulmonary embolism via perfusive and ventilatory scintiphotographs. RESULTS In the overall sample, a circadian variation was found, both for deep vein thrombosis (peak at 12:26 hrs, p=0.001), and pulmonary embolism (peak at 10:26 hrs, p=0.001). A weekly, rhythmic recurrence was also found for the two complaints, with a peak on Saturdays, while no significant annual rhythmic recurrence was found. There was, however, a tendency towards an increase during the winter and summer months. CONCLUSIONS The results may have important clinical applications, both in prevention and in the timing of drug dosage.
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Bilora F, Petrobelli F, Boccioletti V, Pomerri F. Moderate-dose intravenous immunoglobulin treatment of Job's syndrome. Case report. Minerva Med 2000; 91:113-6. [PMID: 11084845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Job's syndrome (or hyperimmunoglobulinemia E syndrome) is a rare genetic disease characterized by skin eczema, pyogenic "cold" abscesses, sinopulmonary recidivous infections and high IgE plasma concentrations. Job's syndrome treatment is not satisfactory and cases studied are still limited. To describe the effects of IVIG therapy in a 37-year-old woman with hyper IgE syndrome and pneumonia. We measured IgE serum by immuno-fluorometric test and neutrophil chemotaxis by migration in a Boyden chamber before and after IVIG therapy. A moderate dose of IVIG resolved the clinical-radiological signs of the S. aureus bronchopneumonia and improved cytologic and biohumoral parameters. Intravenous immunoglobulins represent a useful treatment for acute pneumonia in Job's syndrome.
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Fries W, Pagiaro E, Canova E, Carraro P, Gasparini G, Pomerri F, Martin A, Carlotto C, Mazzon E, Sturniolo GC, Longo G. The effect of heparin on trinitrobenzene sulphonic acid-induced colitis in the rat. Aliment Pharmacol Ther 1998; 12:229-36. [PMID: 9570257 DOI: 10.1046/j.1365-2036.1998.00293.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Reduced blood coagulability seems to protect against inflammatory bowel disease; pilot studies using heparin in patients with inflammatory bowel disease have reported positive results. AIM To evaluate the effects of heparin treatment on microangiographic and on inflammatory parameters in experimental colitis, induced by trinitrobenzene sulphonic acid (TNBS)-ethanol. METHODS Four groups of rats: (i) controls (saline enema), TNBS-induced colitis with (ii) sham treatment (saline, s.c.), (iii) dexamethasone (0.25 mg/kg/day s.c.) and (iv) heparin (500 U/kg t.d.s., s.c.). Microangiography was performed 2 and 4 days after colitis induction. Partial thromboplastin time, colonic wet weight, macroscopic damage score and mucosal myeloperoxidase (MPO) activity were determined at day 4. RESULTS TNBS-induced colitis caused a reduction in visible bowel wall vessels, which was prevented by heparin (P < 0.05) but not by steroids. The macroscopic damage scores and colon wet weights were similar in all colitis groups. Compared to untreated colitis the MPO activity in heparin-treated animals was of borderline significance. CONCLUSIONS Heparin treatment improved microangiographic features and reduced inflammation to a certain degree. Steroids delayed development of colon hypoperfusion, but were ineffective on MPO activity. It remains to be determined if the observed effects are due to the antithrombotic activity of heparin or to an anti-inflammatory action.
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Piloni V, Pieri L, Pomerri F, Pittarello F, Salvetti M, Leo E, Brusori S, Bassi F, Rottoli ML, Pucciani F, Lazzini S, Minotto R, Postiglione C, Sacco P, Bernini A, Menchinelli S, Pescatori M, Marmorale C, Frascio M, Pitto G, Grassi R, Genovesi N, Basile M, Anselmetti G, Amadio L. [The 3rd national workshop on defecography: the functional radiology of (neo) rectal ampullae (ileal reservoir, colo-anal anastomosis, continent perineal colostomy)]. LA RADIOLOGIA MEDICA 1996; 91:66-72. [PMID: 8614735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A survey was made in 13 Italian centers with a questionnaire concerning the (a) indications, (b) postoperative complications, (c) functional results and (d) diagnostic imaging modalities related to the making of an ileal or colonic (neo) rectum. Ulcerative colitis (100%), familial polyposis (61.5%) and Crohn's disease (15.3%) were the most common indications for an ileal pouch; rectal cancer (7.96%), chronic inflammatory diseases (15.3%), diverticulosis, rectal prolapse, redundant colon and imperforate anus (7.6% each) were the most common indications for a colonic pouch. Postoperative complications included pelvic abscess (14%), sinus tract/dehiscence (10%) and bowel obstruction (9%). When compared with the S and W variants, the J-shaped ileoanal pouch proved superior because urgency and fecal retention rates were lower (18.4% vs. 44.4% and 23% vs. 28.6%, p < 0.01 and p < 0.05, respectively), despite slightly more frequent staining episodes (15.8% vs. 11.1%; p < 0.05). As for colonic ampullae, fecal retention and provoked evacuation were more frequent in the J pouch and after gracileplasty; urgency and incontinence in the straight colo-anal anastomosis (33.3% vs. 22.2% and 41.6% vs. 33.3%, respectively). The functional outcome was assessed by anal endosonography (available in 4/13 centers), defecography and anorectal manometry. Abnormal findings included: (a) reduced capacity, barium leakage, anal gaping, sphincter damage (urgency and incontinence); (b) barium retention, pouch dilatation, split evacuation, knobs and strictures (fecal retention).
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