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Campobasso D, Zizzo M, Biolchini F, Castro-Ruiz C, Frattini A, Giunta A. Laparoscopic management of colovesical fistula in different clinical scenarios. J Minim Access Surg 2024; 20:175-179. [PMID: 37148104 PMCID: PMC11095798 DOI: 10.4103/jmas.jmas_245_22] [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] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/18/2022] [Accepted: 03/03/2023] [Indexed: 05/07/2023] Open
Abstract
INTRODUCTION Colovesical fistula (CVF) is a condition with various aetiologies and presentations. Surgical treatment is necessary in most cases. Due to its complexity, open approach is preferred. However, laparoscopic approach is reported in the management of CVF due to diverticular disease. The aim of this study was to analyse the management and outcome of patients with CVF of different aetiologies treated with laparoscopic approach. PATIENTS AND METHODS This was a retrospective study. We retrospectively reviewed all patients undergoing elective laparoscopic management of CVF from March 2015 to December 2019. STATISTICAL ANALYSIS USED None. RESULTS Nine patients underwent laparoscopic management of CVF. There were no intraoperative complications or conversions to open surgery. A sigmoidectomy was performed in eight cases. In one patient, a fistulectomy with sigmoid and bladder defect closure was performed. In two cases of locally advanced colorectal cancer with bladder invasion, a multi-stage procedure with temporary colostomy was chosen. In three cases, with no intraoperative leakage, we did not perform bladder suture. Four Clavien I-II complications were recorded. Two fragile patients died in the post-operative period. No patients required re-operation. At a median follow-up of 21 months (interquartile range: 6-47), none of the patients had recurrence of fistula. CONCLUSIONS CVF can be managed with laparoscopic approach by skilled laparoscopic surgeons in different clinical scenarios. Bladder suture is not necessary if leakage is absent. Informed counselling to the patient must be guaranteed concerning the risk of major complications and mortality in case of CVF due to malignant disease.
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Affiliation(s)
- Davide Campobasso
- Department of Surgical, Urology Unit, Civil Hospital of Guastalla, Reggio Emilia, Italy
| | - Maurizio Zizzo
- Department of Oncology and Advanced Technologies, Surgical Oncology Unit, ASMN-IRCCS Di Reggio Emilia, Reggio Emilia, Italy
- Department of Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Federico Biolchini
- Department of Oncology and Advanced Technologies, Surgical Oncology Unit, ASMN-IRCCS Di Reggio Emilia, Reggio Emilia, Italy
| | - Carolina Castro-Ruiz
- Department of Oncology and Advanced Technologies, Surgical Oncology Unit, ASMN-IRCCS Di Reggio Emilia, Reggio Emilia, Italy
- Department of Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Antonio Frattini
- Department of Surgical, Urology Unit, Civil Hospital of Guastalla, Reggio Emilia, Italy
| | - Alessandro Giunta
- Department of Oncology and Advanced Technologies, Surgical Oncology Unit, ASMN-IRCCS Di Reggio Emilia, Reggio Emilia, Italy
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Giuffrida M, Biolchini F, Capelli P, Banchini F, Perrone G. Botulinum Toxin and Progressive Pneumoperitoneum in Loss of Domain Ventral Hernias: A Systematic Review. J Abdom Wall Surg 2024; 3:12650. [PMID: 38572390 PMCID: PMC10990139 DOI: 10.3389/jaws.2024.12650] [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] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 03/06/2024] [Indexed: 04/05/2024]
Abstract
Introduction: Preoperative progressive pneumoperitoneum (PPP) and botulinum toxin A (BTX) have been used together in the preoperative preparation of patients with loss of domain hernias. This study aims to evaluate the efficacy and safety of the combined use of PPP and BTX. Methods: A systematic electronic search was performed according to the PRISMA criteria. A literature search of scientific articles was conducted up to December 2023. Articles were chosen based on the reference to BTX and PPP in loss of domain ventral hernias with a defect width greater than 10 cm before surgery. The GRADE methodology and the modified Newcastle-Ottawa scale were used to assess the quality of the studies. Results: The research yielded seven articles, with 217 patients analysed in total. BTX was performed 29.5 ± 1.7 days before surgery and PPP was inflated 14.8 ± 5.8 days before surgery. PPP complications were reported in 25.6% of patients, The average reduction of the volume of hernia (VH)/volume of the abdominal cavity (VAC) ratio was 7.6% (range 0.9%-15%). Only 40 patients (18.4%) required a PCS or TAR to repair the loss of domain hernias. The SSI and SSO rates were 17.5% and 26.2%, respectively. No differences in SSI and SSO rates were found between the different repair techniques. The recurrence rate was 5.9% (13/217). Recurrence was significantly higher in patients who underwent IPOM repair than other techniques (p < 0.001). Conclusion: BTX and PPP may be useful tools for the management of loss of domain hernias presenting lower SSI and SSO. The combination of BTX and PPP reduces the use of more invasive repair techniques.
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Affiliation(s)
- Mario Giuffrida
- Department of General Surgery, Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | - Federico Biolchini
- General Surgery Unit, Department of Surgery, Azienda USL—IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Patrizio Capelli
- Department of General Surgery, Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | - Filippo Banchini
- Department of General Surgery, Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | - Gennaro Perrone
- Department of Emergency Surgery, Parma University Hospital, Parma, Italy
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3
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Zizzo M, Tumiati D, Bassi MC, Zanelli M, Sanguedolce F, Porpiglia F, Fiori C, Campobasso D, Castro Ruiz C, Bergamaschi FA, Maestroni UV, Carrieri G, Cormio L, Biolchini F, Palicelli A, Soriano A, Sassatelli R, Ascani S, Annessi V, Giunta A. Management of colovesical fistula: a systematic review. Minerva Urol Nephrol 2021; 74:400-408. [PMID: 34791866 DOI: 10.23736/s2724-6051.21.04750-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Colovesical fistulas (CVFs) account for approximately 95% enterovesical fistulas (EVFs). About 2/3 CVF cases are diverticular in origin. It mainly presents with urological signs such as pneumaturia and fecaluria. Diagnostic investigations aim at confirming the presence of a fistula. Although conservative management can be chosen for selected individuals, most patients are mainly treated through surgical interventions. CVF represents a challenging condition, which records high rates of morbidity and mortality. Our systematic review aimed at achieving deeper knowledge of both indications, in addition to short- and long-term outcomes related to CVF management. EVIDENCE ACQUISITION We performed a systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines. Pubmed/MEDLINE, Embase, Scopus, Cochrane Library and Web of Science databases were used to search all related literature. EVIDENCE SYNTHESIS The 22 included articles covered an approximately 37 years-study period (1982-2019), with a total 1,365 patient population. CVF etiology was colonic diverticulitis in most cases (87.9%). Pneumaturia (50.1%), fecaluria (40.9%) and urinary tract infections (46.6%) were the most common symptoms. Abdomen computed tomography (CT) scan (80.5%), colonoscopy (74.5%) and cystoscopy (55.9%) were the most frequently performed diagnostic methods. Most CVF patients underwent surgery (97.1%) with open approach (63.3%). Almost all patients had colorectal resection with primary anastomosis with or without ostomy and 53.2% patients underwent primary repair or partial/total cystectomy. 4% anastomotic leak, 1.8% bladder leak and 3.1% reoperations rates were identified. In an average 5-68 month follow-up, overall morbidity, overall mortality and recurrences rates recorded were 8%-49%, 0%-63% and 1.2%, respectively. CONCLUSIONS CVF mainly affects males and has diverticular origin in almost all cases. Pneumaturia, fecaluria and urinary tract infections are the most characteristic symptoms. Endoscopic tests and imaging are critical tools for diagnostic completion. Management of CVFs depends on the underlying disease. Surgical treatment represents the final approach and consists of resection and re-anastomosis of offending intestinal segment, with or without bladder closure. In many cases, a single-stage surgical strategy is selected. Perioperative and long-term outcomes prove good.
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Affiliation(s)
- Maurizio Zizzo
- Surgical Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy - .,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy -
| | - David Tumiati
- Surgical Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Maria C Bassi
- Medical Library, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Magda Zanelli
- Pathology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesca Sanguedolce
- Pathology Unit, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Foggia, Foggia, Italy
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Cristian Fiori
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | | | - Carolina Castro Ruiz
- Surgical Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Franco A Bergamaschi
- Urology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Giuseppe Carrieri
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Luigi Cormio
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy.,Department of Urology, Bonomo Teaching Hospital, Andria, Barletta-Andria-Trani, Italy
| | - Federico Biolchini
- Surgical Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Palicelli
- Pathology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Alessandra Soriano
- Gastroenterology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Department of Pathology, Case Western Reserve University, Cleveland, OH, USA
| | - Romano Sassatelli
- Gastroenterology and Digestive Endoscopy Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Stefano Ascani
- Hematology Unit, CREO, Azienda Ospedaliera di Perugia, University of Perugia, Perugia, Italy.,Pathology Unit, Azienda Ospedaliera S. Maria di Terni, University of Perugia, Terni, Italy
| | - Valerio Annessi
- Surgical Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Alessandro Giunta
- Surgical Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Zizzo M, Zanelli M, Sanguedolce F, Castro Ruiz C, Biolchini F, Giunta A. Complete mesocolic excision (CME) and D3-lymphadenectomy (D3) for right-sided colon cancers: a potentially prognostic surgical approach. Surg Today 2021; 51:1723-1724. [PMID: 34021799 DOI: 10.1007/s00595-021-02306-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 03/28/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Maurizio Zizzo
- Surgical Oncology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy. .,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.
| | - Magda Zanelli
- Pathology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesca Sanguedolce
- Pathology Unit, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Foggia, Foggia, Italy
| | - Carolina Castro Ruiz
- Surgical Oncology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Federico Biolchini
- Surgical Oncology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Alessandro Giunta
- Surgical Oncology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
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5
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Zizzo M, Tumiati D, Mereu F, Castro Ruiz C, Biolchini F, Zanelli M, Sanguedolce F, Annessi V. Intraoperative lymph nodes status evaluation and lymphadenectomy in pancreaticoduodenectomy: surgical considerations based on the current literature. Minerva Surg 2020; 76:196-198. [PMID: 33179468 DOI: 10.23736/s2724-5691.20.08594-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Maurizio Zizzo
- Unit of Surgical Oncology, Department of Oncology and Advanced Technologies, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy - .,University of Modena and Reggio Emilia, Modena, Italy -
| | - David Tumiati
- Unit of Surgical Oncology, Department of Oncology and Advanced Technologies, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Federica Mereu
- Unit of Surgical Oncology, Department of Oncology and Advanced Technologies, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Carolina Castro Ruiz
- Unit of Surgical Oncology, Department of Oncology and Advanced Technologies, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy.,University of Modena and Reggio Emilia, Modena, Italy
| | - Federico Biolchini
- Unit of Surgical Oncology, Department of Oncology and Advanced Technologies, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Magda Zanelli
- Unit of Pathology, Department of Oncology and Advanced Technologies, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Valerio Annessi
- Unit of Surgical Oncology, Department of Oncology and Advanced Technologies, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
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6
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Zizzo M, Tumiati D, Mereu F, Castro Ruiz C, Biolchini F, Zanelli M, Sanguedolce F, Annessi V. Intraoperative lymph nodes status evaluation and lymphadenectomy in pancreaticoduodenectomy: surgical considerations based on the current literature. Minerva Surg 2020. [PMID: 33179468 DOI: 10.23736/s0026-4733.20.08594-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Maurizio Zizzo
- Unit of Surgical Oncology, Department of Oncology and Advanced Technologies, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy - .,University of Modena and Reggio Emilia, Modena, Italy -
| | - David Tumiati
- Unit of Surgical Oncology, Department of Oncology and Advanced Technologies, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Federica Mereu
- Unit of Surgical Oncology, Department of Oncology and Advanced Technologies, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Carolina Castro Ruiz
- Unit of Surgical Oncology, Department of Oncology and Advanced Technologies, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy.,University of Modena and Reggio Emilia, Modena, Italy
| | - Federico Biolchini
- Unit of Surgical Oncology, Department of Oncology and Advanced Technologies, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Magda Zanelli
- Unit of Pathology, Department of Oncology and Advanced Technologies, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Valerio Annessi
- Unit of Surgical Oncology, Department of Oncology and Advanced Technologies, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Biolchini F, Castro Ruiz C, Pavesi E, Musci G, Zizzo M, Ugoletti L, Annessi V. Diagnostic challenges in synchronous ovarian metastasis from rectal cancer: A case report. Medicine (Baltimore) 2019; 98:e17782. [PMID: 31689847 PMCID: PMC6946346 DOI: 10.1097/md.0000000000017782] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 09/05/2019] [Accepted: 10/03/2019] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Ovarian metastases from rectal cancer are infrequent; thus it might be hard to diagnose and treat them. Our study introduces a challenging case which highlights our method in addressing such an issue. PATIENTS CONCERNS A 74-year-old woman was admitted to our Unit showing abdominal pain, vomit, and a gross abdominal mass located in the right iliac fossa and mesogastrium. Oncological markers recorded following abnormalities: carbohydrate antigen 19.9 (Ca19.9) = 453.40 U/mL, carbohydrate antigen 125 (Ca125) = 88.3 U/mL. DIAGNOSIS Such a metastatic tumor being difficult to diagnose, we could not achieve a precise preoperative diagnosis. We entered the operating room with a histologic diagnosis that was highly suspicious of colon adenocarcinoma. During surgery, frozen section analysis was positive for primary ovarian cancer. Thanks to the immunohistochemistry test on the histologic specimen, which might be very helpful in diagnosing such metastatic tumor, final pathology report documented ovarian metastasis from rectal cancer. INTERVENTIONS We performed total hysterectomy with bilateral salpingo-oophorectomy and low anterior resection of the rectum with a terminal colostomy. Adjuvant chemotherapy was administered for 6 months using FOLFOX plus panitumumab in first-line therapy. OUTCOME At 8 months from surgery, during follow-up, a local pelvic progression of disease was detected, leading to second-line chemotherapy treatment. CONCLUSION Correct differential diagnosis between primary and metastatic ovarian tumors is paramount in choosing the best treatment which leads to the best possible outcome. In ovarian metastatic tumors, immunohistochemistry could represent an optimal diagnostic tool.
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Affiliation(s)
| | | | - Erica Pavesi
- Department of General Surgery, Chirurgia Area Nord
| | | | - Maurizio Zizzo
- Surgical Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Zizzo M, Castro Ruiz C, Ugoletti L, Pavesi E, Biolchini F, Mariani L, Annessi V. 'Back-handed, left-to-right' intracorporeal anastomosis technique during laparoscopic right hemicolectomy: a safe and reproducible approach. Colorectal Dis 2019; 21:967-968. [PMID: 31059205 DOI: 10.1111/codi.14667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 04/02/2019] [Indexed: 02/08/2023]
Affiliation(s)
- M Zizzo
- Surgical Oncology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Arcispedale Santa Maria Nuova di Reggio Emilia, Reggio Emilia, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - C Castro Ruiz
- General Surgery Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Ospedale Civile di Guastalla, Guastalla, Reggio Emilia, Italy
| | - L Ugoletti
- General Surgery Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Ospedale Civile di Guastalla, Guastalla, Reggio Emilia, Italy
| | - E Pavesi
- General Surgery Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Ospedale Civile di Guastalla, Guastalla, Reggio Emilia, Italy
| | - F Biolchini
- General Surgery Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Ospedale Civile di Guastalla, Guastalla, Reggio Emilia, Italy
| | - L Mariani
- General Surgery Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Ospedale Civile di Guastalla, Guastalla, Reggio Emilia, Italy
| | - V Annessi
- General Surgery Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Ospedale Civile di Guastalla, Guastalla, Reggio Emilia, Italy
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Ugoletti L, Zizzo M, Castro Ruiz C, Pavesi E, Biolchini F, Annessi V. Gluteal, abdominal, and thoracic multiple impalement injuries: A case report on management of a complex polytrauma. Medicine (Baltimore) 2019; 98:e15824. [PMID: 31145320 PMCID: PMC6709277 DOI: 10.1097/md.0000000000015824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
RATIONALE Historically, traumatic injuries include penetrating and blunt lesions. Impalement injury represents one of the rarest and potentially dramatic forms of penetrating trauma. If patient reaches hospital alive and is hemodynamically stable, there is a good chance that patient overcomes the traumatic event. However, non-removal of foreign body represents the cornerstone in initial treatment of this type of patients. PATIENT CONCERNS A stable 55-year-old woman was admitted to the Emergency Department after falling out of a tree onto a wooden fence. One fence pole transfixed left gluteus, left abdominal wall, left abdominal cavity, and left thoracic wall by transdiaphragmatic way. DIAGNOSIS Due to patient stability, a chest-abdomen CT scan with contrast medium was performed. It showed multiple parietal and visceral traumatic penetrating injuries from a foreign object. INTERVENTIONS After primary and secondary advanced trauma life support (ATLS) assessment, patient underwent successful surgery. OUTCOMES Patient was discharged on 9th postoperative day in good general clinical condition. LESSONS Impalement injury represents a rare and potentially lethal traumatic event. Unstable patients rarely reach Emergency Department alive. On the contrary, stable patients have a good chance of successful treatment, if they are quickly taken to tertiary Trauma Center. In this case, chest X-ray and Focused Assessment with Sonography for Trauma (FAST) represent useful diagnosing investigations, although CT scan remains gold standard. Conservative treatment is not possible, while thoracoscopy/laparoscopy/laparotomy is/are mandatory.
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Affiliation(s)
- Lara Ugoletti
- General Surgery Unit, Azienda Unità Sanitaria Locale/IRCCS di Reggio Emilia, Ospedale Civile di Guastalla, Guastalla
| | - Maurizio Zizzo
- Surgical Oncology Unit, Azienda Unità Sanitaria Locale/IRCCS di Reggio Emilia, Arcispedale Santa Maria Nuova di Reggio Emilia, Reggio Emilia
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Carolina Castro Ruiz
- General Surgery Unit, Azienda Unità Sanitaria Locale/IRCCS di Reggio Emilia, Ospedale Civile di Guastalla, Guastalla
| | - Erica Pavesi
- General Surgery Unit, Azienda Unità Sanitaria Locale/IRCCS di Reggio Emilia, Ospedale Civile di Guastalla, Guastalla
| | - Federico Biolchini
- General Surgery Unit, Azienda Unità Sanitaria Locale/IRCCS di Reggio Emilia, Ospedale Civile di Guastalla, Guastalla
| | - Valerio Annessi
- General Surgery Unit, Azienda Unità Sanitaria Locale/IRCCS di Reggio Emilia, Ospedale Civile di Guastalla, Guastalla
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Rapicetta C, Paci M, Ricchetti T, Tenconi S, Biolchini F, Belluzzi E, Sgarbi G. Correction: Massive right hemothorax as the source of hemorrhagic shock after laparoscopic cholecystectomy - case report of a rare intraoperative complication. Patient Saf Surg 2013; 7:20. [PMID: 23738782 PMCID: PMC3693901 DOI: 10.1186/1754-9493-7-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 05/24/2013] [Indexed: 12/05/2022] Open
Affiliation(s)
- Cristian Rapicetta
- Thoracic Surgery Unit, Arcispedale Santa Maria Nuova, Viale Risorgimento 80, - Reggio nell'Emilia 42100, Italy.
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11
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Azzolini F, Camellini L, Sassatelli R, Sereni G, Biolchini F, Decembrino F, De Marco L, Iori V, Tioli C, Cavina M, Bedogni G. Endoscopic submucosal dissection of scar-embedded rectal polyps: a prospective study (Esd in scar-embedded rectal polyps). Clin Res Hepatol Gastroenterol 2011; 35:572-9. [PMID: 21640691 DOI: 10.1016/j.clinre.2011.04.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 04/06/2011] [Accepted: 04/14/2011] [Indexed: 02/04/2023]
Abstract
BACKGROUND & AIMS Endoscopic submucosal dissection (ESD) was developed for en bloc resection of superficial neoplasm of the digestive tract. We evaluated feasibility and safety of ESD, as a salvage therapy of large refractory rectal polyps, in a tertiary care setting. METHODS We prospectively enrolled in the present study and treated by ESD 11 consecutive patients with rectal polyps (median diameter 3.5 cm; range 2-5 cm), who had previously undergone several attempts of endoscopic resection and not suitable for further standard endoscopic treatment. The ESD was carried out with a standard needle knife. Follow up examinations were scheduled at 3, 6, 12 and 24 months. RESULTS We achieved apparently complete resection of polyps in 10/11 patients. In one patient ESD was interrupted and the pathology of the resected fragment showed deep submucosal infiltration; this patient underwent surgery. Deep and lateral margins were shown to be free of neoplasm (radical resection) in six out of 11 patients. However all the 10 patients with apparently complete resection were free of recurrence after a mean follow up of 19.2 months (12-24). A T1 adenocarcinoma was radically resected by ESD, with no recurrence. We recorded 2 cases of subcutaneous emphysema, both treated conservatively. CONCLUSIONS Radical resection is difficult to be achieved by ESD in patients with rectal scar-embedded polyps. Nevertheless ESD may be proposed as a definitive treatment of selected patients with refractory polyps, avoiding surgery in the majority of them.
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Affiliation(s)
- F Azzolini
- Unit of Gastroenterology and Digestive Endoscopy, Arcispedale Santa Maria, Viale Risorgimento 80, 42100 Reggio Emilia, Italy.
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Biolchini F, Giunta A, Bigi L, Bertellini C, Pedrazzoli C. Emergency laparoscopic splenectomy for haemoperitoneum because of ruptured primary splenic pregnancy: a case report and review of literature. ANZ J Surg 2010; 80:55-7. [DOI: 10.1111/j.1445-2197.2009.05176.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Azzolini F, Biolchini F, Sassatelli R, Camellini L, Decembrino F, Iori V, Tioli C, Sereni G, Bedogni G. Endoscopic submucosal dissection for residual rectal polyps embedded in tissue scar: a "rescue therapy" to prevent surgical intervention? Endoscopy 2008; 40 Suppl 2:E222-3. [PMID: 18819067 DOI: 10.1055/s-2008-1077441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- F Azzolini
- Unit of Digestive and Biliopancreatic Endoscopy, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
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Jovine E, Smerieri E, Mulas MM, Mastrangelo L, Landolfo G, Biolchini F, Fornelli A. Muscle psoas metastasis from uterine squamous cell carcinoma. ANZ J Surg 2008; 78:213-4. [DOI: 10.1111/j.1445-2197.2007.04410.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Jovine E, Biolchini F, Talarico F, Lerro FM, Mastrangelo L, Selleri S, Landolfo G, Martuzzi F, Iusco DR, Lazzari A. Major hepatectomy in patients with synchronous colorectal liver metastases: whether or not a contraindication to simultaneous colorectal and liver resection? Colorectal Dis 2007; 9:245-52. [PMID: 17298623 DOI: 10.1111/j.1463-1318.2006.01152.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Synchronous hepatic lesions account for 15-25% of newly diagnosed colorectal cancer and its optimal timing to surgery is not completely defined, but simultaneous colorectal and liver resection is recently gaining acceptance, at least in patients with a right colonic primary and liver metastases that need a minor hepatectomy to be fully resected. METHOD From September 2002 to December 2004, 16 patients underwent simultaneous resection as treatment of synchronous colorectal liver resection; in 10 patients (62.5%) a major hepatectomy was performed. RESULTS The mean duration of intervention was 322.5 +/- 59.5 min, operative mortality and morbidity rates was 0% and 25% respectively; the hospitalization was 14.4 (range 8-60) days on average. Mean follow-up was 14 months and actuarial survival was 76.5% at 1 year and 63.5% at 2 years. CONCLUSION We concluded that simultaneous colonic and liver resection should be undertaken in selected patients with synchronous colorectal liver resection regardless of the extent of hepatectomy; major liver resection, in fact, seems capable of providing better oncological results, allowing resection of liver micrometastases that, in almost one-third of the patients, are located in the same liver lobe of macroscopic lesions, without increased morbidity rates.
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Affiliation(s)
- E Jovine
- Surgical Department, Maggiore Hospital, Bologna, Italy.
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Biolchini F, Pollastri G, Figurelli S, Chiarini L. Carcinogen metabolism, DNA damage repair and oral head and neck squamocellular carcinoma (HNSCC). A review. Minerva Stomatol 2005; 54:405-14. [PMID: 16210999] [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: 05/04/2023]
Abstract
Head and neck squamocellular carcinoma (HNSCC) has now become the 6th most common cancer among men in the developed world and affects the oral cavity, salivary glands, larynx and pharynx. Tobacco chewing, alcohol consumption and last but not least, smoking seem to be the most important risk factors. In particular in non-drinkers, smoke increases the relative risk (RR) of developing HNSCC of the oral cavity and pharynx from 2 to 20 fold; especially in the oral cavity, the association between alcohol and smoke could have a multiplier effect. Cancer arises from damage to DNA of genes located at various points of the short (p) and long (q) arms of a number of chromosomes, caused by exposure to various carcinogens. Thus, the carcinogenic process requires continuous exposure to environmental carcinogens (i.e., longstanding history of smoking and drinking), an increased susceptibility to carcinogens (induced by xenobiotic metabolizing enzyme polymorphism) and an impaired DNA repair capacity (both inherited and acquired). Our purpose in this paper is to review advances in the understanding of the role of the European or Caucasian genetic aberrations that affect carcinogen metabolism and DNA repair genes in oral HNSCC development: we consider that those abnormalities will be useful in assessing individuals at risk.
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Affiliation(s)
- F Biolchini
- Dentistry and Oral Maxillofacial Surgery Unit, University of Modena and Reggio Emilia, Polyclinic Hospital, Modena, Italy
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Jovine E, Biolchini F, Talarico F, Lazzari A, Lerro FM, Selleri S, Landolfo G, Martuzzi F. Intrahepatic rupture of a caudate lobe adenoma in liver adenomatosis. ACTA ACUST UNITED AC 2004; 11:324-9. [PMID: 15549431 DOI: 10.1007/s00534-003-0891-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2003] [Accepted: 11/21/2003] [Indexed: 10/26/2022]
Abstract
Hepatic adenomatosis is a rare benign disease that is more common in young and middle-aged women who are non-steroid dependent; it is usually symptomatic, progressive, and susceptible to hemorrhagic complications. Malignant transformation within adenomas is rare. The management of hepatic adenomatosis remains difficult due to the absence of predictive signs of complications, other than the size of the adenomas. Resective surgery is usually indicated, but liver transplantation could be an indication in highly symptomatic or progressive forms of the disease and represents the treatment of choice in cases of malignant transformation. We report a case of intrahepatic rupture of a caudate lobe adenoma which occurred in an adolescent with hepatic adenomatosis; we also present a brief review of the literature.
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Affiliation(s)
- Elio Jovine
- Modena and Reggio Emilia, University School of Medicine, Italy
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Jovine E, Biolchini F, Cuzzocrea DE, Lazzari A, Martuzzi F, Selleri S, Lerro FM, Talarico F. Spleen-preserving total pancreatectomy with conservation of the spleen vessels:: operative technique and possible indications. Pancreas 2004; 28:207-10. [PMID: 15028954 DOI: 10.1097/00006676-200403000-00013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Conventional distal pancreatectomy (cDP) and total pancreatectomy (cTP) also involve removal of the spleen. The spleen, however, is an important organ in the immunologic defense of the host and is worthy of preservation if this can be safely achieved. We performed a spleen-preserving total pancreatectomy (SPTP), with good results, in a Caucasian woman, 66-year-old, affected by pancreatic metastases of renal clear cell carcinoma. This is the first report of a SPTP for pancreatic metastases to our knowledge, and we therefore wish to describe the surgical technique and to suggest the possible indications for this new technique.
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Affiliation(s)
- Elio Jovine
- From Modena and Reggio Emilia University School of Medicine, Modena, Italy.
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