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Frattini F, Pino A, Matarese A, Carrano FM, Gambetti A, Boni L, Ierardi AM, Carrafiello G, Rausei S, Bertoli S, Dionigi G. Portomesenteric vein thrombosis following sleeve gastrectomy: Case report focusing on the role of pathogenetic factors. Obes Res Clin Pract 2022; 16:170-173. [PMID: 35396195 DOI: 10.1016/j.orcp.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/21/2022] [Accepted: 03/25/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Sleeve gastrectomy has currently become the most commonly performed bariatric. procedure worldwide according to the last IFSO survey, overtaking gastric bypass with. a share of more than 50% of all primary bariatric-metabolic surgery. Gastric leak, intraluminal bleeding, bleeding from the staple-line and strictures are the most common complications. Portomesenteric vein thrombosis (PMVT)after sleeve gastrectomy is. another complication that has been increasingly reported in case-series in recent.years, although it remains uncommon. In this case report is described an extended portomesenteric vein thrombosis after. sleeve gastrectomy interesting splenic vein too with a favorable course and an. uneventful follow-up. We try to search in this case for pathogenetic factors involved in. this complication. CASE REPORT A 42-year old man, with a body mass index (BMI) of 45 kg/m2, with a medical history of Obstructive Sleep Apnea Sindrome (OSAS) underwent laparoscopic sleeve gastrectomy. Early postoperative course was uneventful. Six days after discharge he complained abdominal pain and was admitted at the Emergency Department. A CT scan with intravenous contrast showed an occlusion of the portal vein, of the intrahepatic major branches and an extension to the superior mesenteric vein and the splenic vein. The patient received heparin and oral anticoagulation together with intravenous hydration and proton pump inhibitors. Considering the favourable course the patient was discharged after six days with long-term oral anticoagulation therapy. Anticoagulation with acenocumarol was continued for six months after a CT scan showed resolution of the PMVT without cavernoma. He had no recurrence of symptoms. DISCUSSION Porto-mesenteric thrombosis after sleeve gastrectomy is a rare complication but it has been increasingly reported over the last 10 years along with the extensive use of sleeve gastrectomy. Because PMVT is closely associated with sleeve gastrectomy in comparison with other bariatric procedures, we need to investigate what pathogenetic factors are involved in sleeve gastrectomy. Thrombophylic state, prolonged duration of surgery, high levels of pneumoperitoneum, thermal injury of the gastroepiploic vessels during greater curvature dissection, high intragastric pressure, inadequate antithrombotic prophylaxis and delayed mobilization of the patient after surgery have been reported as pathogenetic factors of portmesenteric vein thrombosis. Most of the cases presented in the literature such as our clinical case resolve with medical therapy, although portal vein thrombus extends into the superior mesenteric vein and the splenic vein. CONCLUSION Portomesenteric venous thrombosis is a rare but serious complication of bariatric surgery, especially associated with sleeve gastrectomy. Diagnosis is based on CT examination with intravenous contrast, and initial therapy is anticoagulation. Etiologic factors reported in the literature include a long duration of surgery, a high degree of pneumoperitoneum, high intragastric pressure after sleeve gastrectomy and thermal injury to the short gastric vessels and gastroepiploic arcade. Limited operative time, controlled values of pneumoperitoneum, careful dissection with energy device of gastric greater curvature, appropriate prophylaxis with low molecular weight heparin may be useful tools to prevent and limit this complication. Nonetheless we have to search which factors may condition the evolution of an extended PMVT as that described in this case towards resolution or to a further worsening clinical state. Early diagnosis? Correct treatment? Undiscovered patientrelated factors?
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Affiliation(s)
- F Frattini
- Department of Surgery, ASST Settelaghi, Varese, Italy.
| | - A Pino
- Division of Surgery, IRCCS Istituto Auxologico Italiano Milan, Università di Messina, Italy.
| | - A Matarese
- Division of Surgery, IRCCS Istituto Auxologico Italiano Milan, Università di Milano, Italy.
| | - F M Carrano
- Department of Surgical Sciences, University of Rome "Tor Vergata", Rome, Italy.
| | - A Gambetti
- Division of Surgery, IRCCS Istituto Auxologico Italiano Milan, Italy.
| | - L Boni
- Department of Surgery, IRCCS Fondazione Cà granda, Policlinico Hospital of Milan, University of Milan, Italy.
| | - A M Ierardi
- Operative Unit of Radiology, IRCCS Fondazione Cà Granda, Policlinico Hospital of Milan, University of Milan, Italy.
| | - G Carrafiello
- Operative Unit of Radiology, IRCCS Fondazione Cà Granda, Policlinico Hospital of Milan, University of Milan, Italy.
| | - S Rausei
- Department of Surgery, ASST Valleolona, Gallarate, Italy.
| | - S Bertoli
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Obesity Unit and Laboratory of Nutrition and Obesity Research, University of Milan, Milan, Italy.
| | - G Dionigi
- Division of Surgery, Endocrine Surgery Unit, IRCCS, Istituto Auxologico Milan, University of Milan, Italy.
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Polistina GE, Matarese A, Cariello P, Caroppo D, Zamparelli AS. Cavitary lung metastasis as relapse of prostate cancer. Respir Med Case Rep 2019; 29:100973. [PMID: 31879588 PMCID: PMC6920085 DOI: 10.1016/j.rmcr.2019.100973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 11/24/2019] [Accepted: 11/26/2019] [Indexed: 01/15/2023] Open
Abstract
Prostate cancer is the most common non-cutaneous malignancy diagnosed in men. It usually metastasizes to bone as osteoblastic lesions on radiographs and regional lymph nodes, and uncommonly to lung, liver and brain. Metastatic prostate cancer recurrence after definitive local therapy can occur in any tissue. The role of fine needle aspiration cytology (FNAC) for diagnosis of metastatic malignancies is well established in literature. We describe a 74 years old male, previously treated for localized prostate cancer, admitted to our Department after total body computed tomography revealed multiple irregular lung lesions some of which had an excavated appearance.
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Affiliation(s)
- G E Polistina
- Dipartimento Medicina Clinica e Chirurgia, Sezione di Malattie dell'Apparato Respiratorio, University Federico II, Monaldi Hospital, Napoli, Italy
| | - A Matarese
- Dipartimento Medicina Clinica e Chirurgia, Sezione di Malattie dell'Apparato Respiratorio, University Federico II, Monaldi Hospital, Napoli, Italy
| | - P Cariello
- Dipartimento Medicina Clinica e Chirurgia, Sezione di Malattie dell'Apparato Respiratorio, University Federico II, Monaldi Hospital, Napoli, Italy
| | - D Caroppo
- Dipartimento di Anatomia Patologica, Monaldi Hospital, Napoli, Italy
| | - A S Zamparelli
- Director of the School of Specialization in Diseases of the Respiratory System, University of Naples "Federico II", A.O.R.N. Monaldi-Cotugno-CTO, Piazzale Ettore Ruggieri, 80131, Naples, Italy
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Losi M, Bocchino M, Matarese A, Bellofiore B, Roversi P, Rumpianesi F, Alma M, Chiaradonna P, Del Giovane C, Altieri A, Richeldi L, Sanduzzi A. Role of the Quantiferon-TB Test in Ruling Out Pleural Tuberculosis: A Multi-Centre Study. Int J Immunopathol Pharmacol 2011; 24:159-65. [DOI: 10.1177/039463201102400118] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Diagnosing pleural tuberculosis (plTB) might be difficult due to limited sensitivity of conventional microbiology tools. As M. tuberculosis (MTB)-specific T cells are recruited into pleural space in plTB, their detection may provide useful clinical information. To this aim, in addition to standard diagnostic tests, we used the QuantiFERON-TB Gold In-Tube (QFT-IT) test in blood and pleural effusion (PE) samples from 48 patients with clinical suspicion of plTB, 18 (37.5%) of whom had confirmed plTB. Four of them (22.2%) tested positive with a nucleic acid amplification test for MTB. The tuberculin skin test was positive in most confirmed plTB cases (88.9%). Positive QFT-IT tests were significantly more frequent in patients with confirmed plTB, as compared to patients with an alternative diagnosis, both in blood (77.7 vs 36.6%, p=0.006) and in PE samples (83.3% vs 46.6%, p=0.02). In addition, both blood and PE MTB-stimulated IFN-γ levels were significantly higher in plTB patients (p=0.03 and p=0.0049 vs non-plTB, respectively). In blood samples, QFT-IT had 77.8% sensitivity and 63.3% specificity, resulting in 56.0% positive (PPV) and 82.6% negative (NPV) predictive values. On PE, QFT-IT sensitivity was 83.3% and specificity 53.3% (PPV 51.7% and NPV 84.2%). The optimal AUC-derived cut-off for MTB-stimulated pleural IFN-γ level was 3.01 IU/mL (77.8% sensitivity, 80% specificity, PPV 68.4% and NPV 82.8%). These data suggest that QFT-IT might have a role in ruling out plTB in clinical practice.
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Affiliation(s)
- M. Losi
- Section of Respiratory Diseases, Department of Oncology, Haematology and Respiratory Diseases, University of Modena and Reggio Emilia, Modena
| | - M. Bocchino
- Section of Respiratory Diseases, Department of Experimental and Clinical Medicine, “Federico II” University of Naples, Naples
| | - A. Matarese
- Section of Respiratory Diseases, Department of Experimental and Clinical Medicine, “Federico II” University of Naples, Naples
| | - B. Bellofiore
- Section of Respiratory Diseases, Department of Experimental and Clinical Medicine, “Federico II” University of Naples, Naples
| | - P. Roversi
- Section of Respiratory Diseases, Department of Oncology, Haematology and Respiratory Diseases, University of Modena and Reggio Emilia, Modena
| | - F. Rumpianesi
- Department of Microbiology and Virology, University of Modena and Reggio Emilia, Modena
| | - M.G. Alma
- Microbiology and Virology Service, S. Camillo-Forlanini Hospital, Rome
| | - P. Chiaradonna
- Division of Broncho-pneumology and Tisiology, S. Camillo-Forlanini Hospital, Rome
| | - C. Del Giovane
- Section of Statistics, Department of Oncology, Haematology and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - A.M. Altieri
- Microbiology and Virology Service, S. Camillo-Forlanini Hospital, Rome
| | - L. Richeldi
- Section of Respiratory Diseases, Department of Oncology, Haematology and Respiratory Diseases, University of Modena and Reggio Emilia, Modena
| | - A. Sanduzzi
- Section of Respiratory Diseases, Department of Experimental and Clinical Medicine, “Federico II” University of Naples, Naples
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Bocchino M, Matarese A, Bellofiore B, Giacomelli P, Russo A, Signoriello G, Galati D, Sanduzzi A. Usefulness of Ifn-Gamma Release Assays in Clinical Management of Difficult TB Cases: Evidence from Clinical Practice. EUR J INFLAMM 2010. [DOI: 10.1177/1721727x1000800107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Performance of T-SPOT.TB™ (TS-TB) and QuantiFERON TB Gold- In tube (QFT-IT) assays was evaluated for detection of M. tuberculosis (Mtb) infection in patients with suspected extra-pulmonary or smear-negative pulmonary tuberculosis (TB) in a low prevalence country. Twenty-one out of 35 patients were affected by active TB. Mtb culture isolation was achieved in 76% of cases. Tuberculin skin testing (TST), TS-TB, and QFT-IT yielded a positive result in 67%, 95% and 81% of cases, respectively. Agreement of interferon-γ release assays and TST was 70% (κ=0.18 for TS-TB; κ=0.46 for QFT-IT). Increased sensitivity of blood assays (>80%) improved diagnostic evaluation of difficult TB cases.
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Affiliation(s)
| | | | | | | | - A. Russo
- Thisiology Division, Monaldi hospital, Naples
| | - G. Signoriello
- Department of Medicine and Public Health, Second University of Naples, Naples
| | - D. Galati
- Immunology Section, National Cancer Institute “G. Pascale”, Naples, Italy
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Balato N, Ayala F, Gaudiello F, Monfrecola G, Cimmino G, Ponticiello A, Bocchino M, Matarese A, Sanduzzi A. Comparison of tuberculin skin test and interferon-gamma assays in patients with moderate to severe psoriasis who are candidates for antitumour necrosis factor-alpha therapy. Br J Dermatol 2008; 158:847-9. [PMID: 18241281 DOI: 10.1111/j.1365-2133.2007.08408.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Beomonte Zobel B, Giammarile F, Di Renzi P, Matarese A, Masciocchi C, Gallucci M, Splendiani G, Casciani CU, Passariello R. [Magnetic resonance study of renal function. Preliminary evaluation]. Radiol Med 1988; 75:501-4. [PMID: 3287502] [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] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The amount of functioning renal parenchyma can be estimated by MRI by considering the ratio between the mean intensities of cortical and medullar zones of the kidney. Fifty-six patients and 5 healthy volunteers were studied by MRI in our department. Scanning was performed with a superconductive magnet system operating at 0.5 Tesla. Pulse sequence was Spin-Echo with TR 300/TE 30 ms. The cortico-medullary ratio (CMR) and differentiation (CMD) were standardized and related with creatine blood levels. CMR data ranged from 1.05 to 3.00, while CMD data ranged from 0.04 to 0.50. High values (good cortico-medullary contrast) were observed in subjects with normal renal function. Patients with renal diseases had low CMR and CMD, proportionally to the degree of renal failure, as proved by laboratory findings. Our preliminary study seems to demonstrate that MRI is an useful technique in the follow-up of patients with chronic renal disease.
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Di Renzi P, Di Cesare E, Pavone P, D'Aroma A, Zobel BB, Matarese A, Passariello R. [Reliability and reproducibility of morphological and size assessments with nuclear magnetic resonance: measurements on animal hearts]. Cardiologia 1988; 33:385-92. [PMID: 3409262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Masciocchi C, Cutilli T, Fascetti E, Gallucci M, Matarese A, Corbacelli A, Passariello R. [Role of magnetic resonance in the staging and post-chemotherapeutic follow-up of malignant maxillo-facial tumors]. Radiol Med 1988; 75:88-93. [PMID: 3347789] [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] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Ten patients with squamous cell carcinomas located in the maxillo-facial region were studied. In all cases the staging by Computed Tomography (CT) and Magnetic Resonance (MRI) revealed metastatic lesions in stage T3-T4. All patients underwent polichemotherapy before surgery. MRI proved to be more accurate in the staging of tumors in 3 cases only, while in 7 cases both techniques showed the same diagnostic accuracy. In the follow-up, MRI allowed the evaluation of the effect of chemotherapy on the carcinomas: it demonstrated the regression and necrosis of 9 tumors out of 10 (the patients could undergo surgery), and the progression of the tumor in 1 case. The study of bioptic specimens demonstrated the lack of correlation between histological grading of the tumors with MRI signal intensity and T1, T2 relaxation time, as measured by spectroscopy.
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Di Renzi P, Giammarile F, Matarese A, D'Aroma A, Beomonte Zobel B. [Nuclear magnetic resonance in a case of cystic teratoma of the sacrum]. G Ital Oncol 1987; 7:196-9. [PMID: 3505912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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