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Coccolini F, Tarasconi A, Petracca GL, Perrone G, Giuffrida M, Disisto C, Sartelli M, Carcoforo P, Ansaloni L, Catena F. PROPHYlactic Implantation of BIOlogic Mesh in peritonitis (PROPHYBIOM): a prospective multicentric randomized controlled trial. Trials 2022; 23:198. [PMID: 35246206 PMCID: PMC8895107 DOI: 10.1186/s13063-022-06103-4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 02/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients undergoing emergency surgery for peritonitis are at increased risk of abdominal wall-related complications. In patients with peritonitis, the risk of incisional hernia (IH) is extremely elevated. The evaluation of quality of life of patients with incisional hernia showed lower mean scores on physical components of health-related quality of life and body image. Furthermore, the arise of a post-operative abdominal wall complication (i.e., wound dehiscence, evisceration and IH) greatly increases morbidity and mortality rates and prolongs the hospitalization. METHODS The present study aims to evaluate the efficacy of the use of a swine dermal collagen prosthesis implanted preperitoneally as a prophylactic procedure in urgency/emergency setting against abdominal wall complications in patients operated with contaminated/infected field in peritonitis. The sample size was defined in 90 patients divided in two arms (prosthesis positioning versus normal wall abdominal closure). The follow-up will be performed at 3, 6, and 12 months after surgery. The percentage of incisional hernias, wound infections, and adverse events will be investigated by physical examination and ultrasound. DISCUSSION The objective is to evaluate the possibility to reduce the incisional hernia rate in patients undergoing urgent/emergent laparotomy in contaminated/infected field with peritonitis by using swine dermal collagen prosthesis preperitoneal positioning as a prophylactic procedure. TRIAL REGISTRATION ClinicalTrials.gov NCT04681326. Registered (retrospectively after first patient recruited) on 23 December 2020.
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Affiliation(s)
- F Coccolini
- General Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - A Tarasconi
- Emergency Surgery Department, Parma University Hospital, Parma, Italy
| | - G L Petracca
- Emergency Surgery Department, Parma University Hospital, Parma, Italy.
| | - G Perrone
- Emergency Surgery Department, Parma University Hospital, Parma, Italy
| | - M Giuffrida
- Emergency Surgery Department, Parma University Hospital, Parma, Italy
| | - C Disisto
- Emergency Surgery Department, Parma University Hospital, Parma, Italy
| | - M Sartelli
- Department of Surgery, Macerata Hospital, Macerata, Italy
| | - P Carcoforo
- Department of Surgery, S. Anna University Hospital and University of Ferrara, Ferrara, Italy
| | - L Ansaloni
- General Surgery, Pavia University Hospital, Pavia, Italy
| | - F Catena
- Emergency Surgery Department, Parma University Hospital, Parma, Italy
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2
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Medas F, Ansaldo GL, Avenia N, Basili G, Bononi M, Bove A, Carcoforo P, Casaril A, Cavallaro G, Conzo G, De Pasquale L, Del Rio P, Dionigi G, Dobrinja C, Docimo G, Graceffa G, Iacobone M, Innaro N, Lombardi CP, Novelli G, Palestini N, Pedicini F, Perigli G, Pezzolla A, Pezzullo L, Scerrino G, Spiezia S, Testini M, Calò PG. Impact of the COVID-19 pandemic on surgery for thyroid cancer in Italy: nationwide retrospective study. Br J Surg 2021; 108:e166-e167. [PMID: 33659983 PMCID: PMC7989577 DOI: 10.1093/bjs/znab012] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/19/2020] [Accepted: 01/06/2021] [Indexed: 12/25/2022]
Affiliation(s)
- F Medas
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - G L Ansaldo
- Endocrine Surgery Unit, Ospedale Policlinico San Martino, Genoa, Italy
| | - N Avenia
- General Surgery and Surgical Specialties Unit, Santa Maria University Hospital Terni and University of Perugia, Medical School, Terni, Italy
| | - G Basili
- General Surgery Department, Endocrine Surgery Unit, Azienda USL Toscana Nord-Ovest, Pontedera, Italy
| | - M Bononi
- Department of Surgery, Pietro Valdoni, Sapienza University of Rome, Rome, Italy
| | - A Bove
- Department of Medicine, Dentistry and Biotechnology, University 'G. D'Annunzio', Chieti, Italy
| | - P Carcoforo
- Department of Surgery, Unit of General Surgery, University Hospital of Ferrara and University of Ferrara, Ferrara, Italy
| | - A Casaril
- Endocrine Surgery Unit, Pederzoli Hospital, Peschiera del Garda, Italy
| | - G Cavallaro
- Department of Surgery, Pietro Valdoni, Sapienza University of Rome, Rome, Italy
| | - G Conzo
- Division of General and Oncological Surgery, Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - L De Pasquale
- Endocrine Surgery, ASST Santi Paolo e Carlo University of Milan, Milan, Italy
| | - P Del Rio
- General Surgery Unit, Parma University Hospital, Parma, Italy
| | - G Dionigi
- Division for Minimally Invasive and Endocrine Surgery, University of Messina, Messina, Italy
| | - C Dobrinja
- Department of Medicine, Surgery and Health Sciences, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - G Docimo
- Division of Thyroid Surgery, Department of Medical and Advanced Surgical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - G Graceffa
- Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy
| | - M Iacobone
- Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - N Innaro
- Unit of Endocrine Surgery, AOU Mater Domini, Catanzaro, Italy
| | - C P Lombardi
- Division of Endocrine Surgery, Department of Gastroenterological, Endocrine-Metabolic and Nephro-Urologic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - G Novelli
- Endocrine Surgery Unit, Department of Oncological-Mininvasive Surgery, Niguarda Hospital, Milan, Italy
| | - N Palestini
- Head and Neck Oncological Surgery, Candiolo Cancer Institute, Candiolo, Italy
| | - F Pedicini
- Thyroid Endocrine Surgery, Sant'Eugenio Hospital, Rome, Italy
| | - G Perigli
- Endocrine Surgery Unit, University of Florence, Florence, Italy
| | - A Pezzolla
- Division of Videolaparoscopic Surgery, Department of Emergency and Organ Transplantation, University of Bari 'A. Moro', Bari, Italy
| | - L Pezzullo
- Thyroid Surgery Unit, INT IRCSS Fondazione Pascale, Naples, Italy
| | - G Scerrino
- Department of Surgical Oncology and Oral Sciences, Unit of General and Emergency Surgery, University of Palermo, Palermo, Italy
| | - S Spiezia
- Endocine and Ultrasound-Guided Surgery Operative Unit, Ospedale del Mare, Naples, Italy
| | - M Testini
- Unit of Academic General Surgery 'V. Bonomo', Department of Biomedical Sciences and Human Oncology, University of Bari 'A. Moro', Bari, Italy
| | - P G Calò
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
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3
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Sun H, Carcoforo P, Dionigi G. Prerequisites for introducing neural monitoring in thyroid surgery. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 137:91. [PMID: 31699621 DOI: 10.1016/j.anorl.2018.05.015] [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] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 05/04/2018] [Accepted: 05/17/2018] [Indexed: 10/25/2022]
Affiliation(s)
- H Sun
- Jilin Provincial Key Laboratory of Surgical Translational Medicine, China Japan Union Hospital of Jilin University, Division of Thyroid Surgery, Changchun, Jilin, China
| | - P Carcoforo
- Department of Surgery, S. Anna University Hospital, Department of Morphology, Surgery, and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - G Dionigi
- Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital G. Martino, University of Messina, Via C. Valeria 1, 98125, Messina, Italy.
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Carcoforo P, Bergossi L, Basaglia E, Soliani G, Querzoli P, Zambrini E, Pozza E, Feggi L. Prognostic and Therapeutic Impact of Sentinel Node Micrometastasis in Patients with Invasive Breast Cancer. Tumori 2018; 88:S4-5. [PMID: 12365385 DOI: 10.1177/030089160208800319] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and Background Locoregional lymph node status is one of the most important prognostic factors determining the need for adjuvant chemotherapy in patients with breast cancer. Many authors have reported that micrometastases were not detected by routine sectioning of lymph nodes but were identified by multiple sectioning and additional staining. Among lymph node-negative patients 15-20% had an unfavorable outcome at five years from primary surgery. Sentinel lymph node (SLN) biopsy is an accurate technique for identifying axillary metastases because the pathologist utilizes hematoxylin-eosin (H-E) staining together with immunohistochemistry (IH) to examine all lymph node sections. Sentinel node micrometastasis has therefore become an important tumor-related prognostic factor. Methods and Study Design From November 1997 to October 2001 we examined in 210 patients the pathological features of primary breast lesions and SLN metastases and we correlated these with the tumor status of non-SLNs in the same axillary basin. We applied IH examination to both SLNs and non-SLNs of patients who were negative for metastasis by standard H-E examination. Results In this study lymph node staging was based on SLN findings, primary tumor size, and the presence of peritumoral lymphovascular invasion (LVI). We found 18 SLN micrometastases (9%) in 210 patients and one of these (5.5% of patients with SLN micrometastasis) also had one non-SLN metastasis: this patient had LVI and a larger primary tumor than patients with SLN micrometastasis without non-SLN metastasis. We also found 24 SLN macrometastases (11.5%) in 210 patients and 13 of these (54.2% of patients with SLN macrometastases) had one or more non-SLN metastases. Conclusions According to the results reported in the literature, tumor cells are unlikely to be found in non-SLNs when the primary lesion is small and SLN involvement micrometastatic (5.5% in our experience, 7% in Giuliano's). Our findings suggest that axillary lymph node dissection may not be necessary in patients with SLN micrometastasis from T1 lesions.
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Affiliation(s)
- P Carcoforo
- Department of Surgical Sciences, University of Ferrara, Italy
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Carcoforo P, Soliani G, Bergossi L, Basaglia E, Virgili AR, Pagani W, Pozza E, Feggi LM. Reliability and Accuracy of Sentinel Node Biopsy in Cutaneous Malignant Melanoma. Tumori 2018; 88:S14-6. [PMID: 12365371 DOI: 10.1177/030089160208800325] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and Background The aims of this study were 1) to investigate whether sentinel lymph node (SLN) biopsy could become the method of choice for the early detection of metastatic disease in patients with malignant melanoma and 2) to identify those patients with lymph node metastases who could benefit from regional lymphadenectomy. Methods and Study Design Our study started in March 1998 and involved 110 patients with primary cutaneous malignant melanoma stage I or II (AJCC) in whom the primary lesion had been surgically removed no more than 90 days previously. On the day of lymph node dissection patients were given an intradermal injection of colloid particles of human serum albumin labeled with technetium-99m and an injection of isosulfan blue. The surgical procedure was usually performed with local anesthesia but in some cases locoregional or general anesthesia was preferred. Contralateral and ipsilateral lymphatic areas were scanned with a hand-held gamma camera (Scintiprobe MR 100) to measure the background and identify the hot point indicating the location of the sentinel node to direct the incision. Results The combined use of lymphoscintigraphy, isosulfan blue and gamma probe allowed us to identify sentinel nodes in 108 of 110 patients (98.18%) while the SLN was blue in only 90 cases (81.81%). The SLN was positive for metastases in 13 of the 108 patients (12.03%) and regional and distal lymphadenectomy was performed in all of them. The distribution of positive SLNs by primary lesion thickness was as follows: 0.76-1.5 mm: one positive SLN/44 patients (2.27%); 1.51-4 mm: six positive SLNs/51 patients (11.7%); >4 mm: six positive SLNs/15 patients (40%). Only four of 12 patients with ulcerated cutaneous melanoma had positive SLNs. The patients in our study underwent follow-up visits every four months. The median follow-up was 481 days (range, 97-1271 days). Conclusions In patients with primary cutaneous melanoma the histological status of the SLN accurately reflects the presence or absence of metastatic disease in the relevant regional lymph node basin. Complete lymph node dissection should only be performed in patients with positive SLNs. Patients with lesions >4 mm are likely to develop recurrences and to die of systemic disease, so in these patients the usefulness of SLN biopsy is questionable. In conclusion, sentinel node mapping is a rational approach for the selection of patients who might benefit from early lymph node dissection of the affected basin.
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Affiliation(s)
- P Carcoforo
- Department of Surgical Science, Clinical Surgery Section, University of Ferrara, Italy.
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6
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Carcoforo P, Basaglia E, Soliani G, Bergossi L, Corcione S, Pozza E, Feggi L. Sentinel Node Biopsy in the Evaluation of the Internal Mammary Node Chain in Patients with Breast Cancer. Tumori 2018; 88:S5-7. [PMID: 12365391 DOI: 10.1177/030089160208800320] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and Background In patients with breast cancer the presence of internal mammary chain (IMC) metastases changes tumor staging, and the occurrence of IMC drainage is quite common in breast cancer. Nevertheless, IMC dissection is not a routine procedure in modern surgical approaches towards breast cancer. We therefore need minimally invasive techniques for accurate assessment of the IMC nodal basin. The aim of this study was to investigate whether sentinel node biopsy (SLNB) could offer a solution. Methods and Study Design From November 1997 to June 2001 143 female patients who were eligible for breast cancer surgery were included in the study. All patients had T1 breast cancer and clinically negative axillae. Patients were submitted to preoperative lymphoscintigraphy with subsequent SLNB. We used a 99m-technetium nanocolloid tracer (Nanocoll®) that was injected peritumorally so as to have about 10 MBq of radioactivity at the time of surgery. Scintigraphy was performed about 17 hours after tracer administration. During surgery, lymphoscintigraphic imaging and a gamma ray detection probe were used to locate the sentinel node. Histological examination after embedding in paraffin was usually requested and multilevel sectioning of the sentinel node (SLN) was performed, with hematoxylin and eosin staining and immunohistochemistry. Results Preoperative lymphoscintigraphy localized SLNs in the IMC basin in 27 of 143 patients (18.9%). Harvesting of IMC-SLNs based on lymphoscintigraphy results was successful in 20 of 27 patients (74.1 %). Histological examination revealed micrometastases in four of the 20 harvested nodes. One of these patients showed no axillary drainage and no axillary lymph node dissection was therefore performed. In the remaining three patients also axillary SLNs were harvested, which turned out be free from metastatic involvement. Conclusions In our experience lymphoscintigraphy with SLNB was an accurate method to detect IMC metastases in patients with breast cancer. We recommend peritumoral tracer injection and a reasonable interval between injection and scintigraphy. IMC-SLN biopsy did not result in any serious additional complications or morbidity. In our study this approach led to improved cancer staging: four of 20 harvested IMC-SLNs proved to be micrometastatic. None of these four patients had metastatic axillary SLNs. Exclusive drainage to the IMC is present in only a small number of breast cancer patients, and our results suggest that it is possible to avoid unnecessary axillary node dissection in such cases.
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Affiliation(s)
- P Carcoforo
- Dipartimento di Scienze Chirurgiche, Università di Ferrara, Italy
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7
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Abstract
Since October 1997 60 patients with early breast cancer (T <3 cm) were studied. All patients underwent lymphoscintigraphy with two types of colloid: the first (17 pts) with a particle size <1000 nm; the second (43 pts) with a particle size <80 nm. The standard procedure consists of injection, on the day before surgery, of 70 MBq of the smaller nanocolloid in 0.4 cc saline divided over four sites, around the lesion or subdermally around the surgical scar. We utilize a low-energy, high-resolution LFOV camera for scintigraphy and a probe specific for the sentinel node during surgery. In 56/60 patients (93.3%) lymphoscintigraphy showed the sentinel node (SN). In two cases the SN was not detected presumably because of lymphatic interruption by an old surgical scar; in the other two cases the sites of injection were too close to the SN, thus masking it. In five cases (9%) the SN was not visualized with the surgical probe but in two of these drainage to the internal mammary chain was observed. The apparently lower sensitivity of intraoperative localization was due to the extra-axillary lymphatic drainage or to the vicinity of the SN to the primary lesion. The SN proved to be metastatic in 12 cases. No false-negative SNs were found. In five cases (10%) the radiolabeled lymph node was the only node containing tumor cells (micrometastases): this result depends on the combined use of hematoxylin-eosin and rapid cytokeratin staining. The application of blue dye was useful for easier identification of the SN but did not allow detection of more SNs. Our preliminary results are extremely encouraging. Considering that at the early stages of breast cancer the likelihood of lymph node metastases is low (20% in our series) and no false negative were reported in this study, we conclude that with SN biopsy axillary lymph node dissection can be avoided, making surgery less aggressive but maintaining accuracy.
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Affiliation(s)
- L M Feggi
- Department of Nuclear Medicine and Senology of the Azienda Ospedaliera Arcispedale S. Anna, Ferrara, Italy
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8
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Soliani G, De Troia A, Portinari M, Targa S, Carcoforo P, Vasquez G, Fisichella PM, Feo CV. Laparoscopic versus open incisional hernia repair: a retrospective cohort study with costs analysis on 269 patients. Hernia 2017; 21:609-618. [PMID: 28396956 DOI: 10.1007/s10029-017-1601-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 05/06/2016] [Accepted: 03/30/2017] [Indexed: 01/29/2023]
Abstract
PURPOSE To compare clinical outcomes and institutional costs of elective laparoscopic and open incisional hernia mesh repairs and to identify independent predictors of prolonged operative time and hospital length of stay (LOS). METHODS Retrospective observational cohort study on 269 consecutive patients who underwent elective incisional hernia mesh repair, laparoscopic group (N = 94) and open group (N = 175), between May 2004 and July 2014. RESULTS Operative time was shorter in the laparoscopic versus open group (p < 0.0001). Perioperative morbidity and mortality were similar in the two groups. Patients in the laparoscopic group were discharged a median of 2 days earlier (p < 0.0001). At a median follow-up over 50 months, no difference in hernia recurrence was detected between the groups. In laparoscopic group total institutional costs were lower (p = 0.02). At Cox regression analysis adjusted for potential confounders, large wall defect (W3) and higher operative risk (ASA score 3-4) were associated with prolonged operative time, while midline hernia site was associated with increased hospital LOS. Open surgical approach was associated with prolongation of both operative time and LOS. CONCLUSIONS Laparoscopic approach may be considered safely to all patients for incisional hernia repair, regardless of patients' characteristics (age, gender, BMI, ASA score, comorbidities) and size of the wall defect (W2-3), with the advantage of shorter operating time and hospital LOS that yields reduced total institutional costs. Patients with higher ASA score and large hernia defects are at risk of prolonged operative time, while an open approach is associated with longer duration of surgical operation and hospital LOS.
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Affiliation(s)
- G Soliani
- University of Ferrara, Ferrara, Italy.,Department of Surgery, S. Anna University Hospital, Via Aldo Moro 8, 44124, Ferrara, Italy
| | - A De Troia
- University of Ferrara, Ferrara, Italy.,Department of Surgery, S. Anna University Hospital, Via Aldo Moro 8, 44124, Ferrara, Italy
| | - M Portinari
- University of Ferrara, Ferrara, Italy.,Department of Surgery, S. Anna University Hospital, Via Aldo Moro 8, 44124, Ferrara, Italy
| | - S Targa
- University of Ferrara, Ferrara, Italy.,Department of Surgery, S. Anna University Hospital, Via Aldo Moro 8, 44124, Ferrara, Italy
| | - P Carcoforo
- University of Ferrara, Ferrara, Italy.,Department of Surgery, S. Anna University Hospital, Via Aldo Moro 8, 44124, Ferrara, Italy
| | - G Vasquez
- University of Ferrara, Ferrara, Italy.,Department of Surgery, S. Anna University Hospital, Via Aldo Moro 8, 44124, Ferrara, Italy
| | - P M Fisichella
- Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA.,Boston VA Healthcare System, 1400 VFW Parkway (112), West Roxbury, MA, 02132, USA
| | - C V Feo
- University of Ferrara, Ferrara, Italy. .,Department of Surgery, S. Anna University Hospital, Via Aldo Moro 8, 44124, Ferrara, Italy.
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10
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Carcoforo P, Raiji MT, Palini GM, Pedriali M, Maestroni U, Soliani G, Detroia A, Zanzi MV, Manna AL, Crompton JG, Langan RC, Stojadinovic A, Avital I. Primary anorectal melanoma: an update. J Cancer 2012. [PMID: 23193431 PMCID: PMC3508425 DOI: 10.7150/jca.5187] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The anorectum is a rare anatomic location for primary melanoma. Mucosal melanoma is a distinct biological and clinical entity from the more common cutaneous melanoma. It portrays worse prognosis than cutaneous melanoma, with distant metastases being the overwhelming cause of morbidity and mortality. Surgery is the treatment of choice, but significant controversy exists over the extent of surgical resection. We present an update on the state of the art of anorectal mucosal melanoma. To illustrate the multimodality approach to anorectal melanoma, we present a typical patient.
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Affiliation(s)
- P Carcoforo
- 1. Section of General Surgery, Department of Surgical, Anaesthesiological and Radiological Sciences, University of Ferrara, Ferrara, Italy
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Carcoforo P, Raiji MT, Langan RC, Lanzara S, Portinari M, Maestroni U, Palini GM, Zanzi MV, Bonazza S, Pedriali M, Feo CV, Stojadinovic A, Avital I. Infiltrating lobular carcinoma of the breast presenting as gastrointestinal obstruction: a mini review. J Cancer 2012; 3:328-32. [PMID: 22866167 PMCID: PMC3408697 DOI: 10.7150/jca.4735] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 07/03/2012] [Indexed: 12/18/2022] Open
Abstract
One in twelve American women will develop breast cancer, with infiltrating lobular carcinoma (ILC) comprising approximately 15% of these cases. The incidence of ILC has been increasing over the last several decades. It has been hypothesized that this increase is associated with combined replacement hormonal therapy. Although pathologically distinct from infiltrating ductal carcinoma (IDC), ILC is treated in the same manner as IDC. However, ILC demonstrates significantly different patterns of late local recurrence and distant metastasis. The incidence of extra-hepatic gastrointestinal metastases is reported to be 6% to 18%, with stomach being most common. Herein, we present a brief review of the literature and a typical case involving ILC initially presenting as a small bowel obstruction. Evidence suggests that the late clinical patterns of ILC are distinctly separate from IDC and physicians need be cognizant of its late local recurrence and unique late metastatic pattern. Different follow up strategy should be entertained in patients with ILC.
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Affiliation(s)
- P Carcoforo
- 1. Section of General Surgery, Department of Surgical, Anaesthesiological and Radiological Sciences, Azienda Ospedaliero-Universitaria, Arcispedale Sant'Anna, Ferrara, Italy
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12
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Preta G, Marescotti D, Fortini C, Carcoforo P, Castelli C, Masucci M, Gavioli R. Inhibition of serine-peptidase activity enhances the generation of a survivin-derived HLA-A2-presented CTL epitope in colon-carcinoma cells. Scand J Immunol 2008; 68:579-88. [PMID: 19000094 DOI: 10.1111/j.1365-3083.2008.02175.x] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Cytotoxic T lymphocytes eliminate tumor cells expressing antigenic peptides in the context of MHC-I molecules. Peptides are generated during protein degradation by the proteasome and resulting products, surviving cytosolic amino-peptidases activity, may be presented by MHC-I molecules. The MHC-I processing pathway is altered in a large number of malignancies and modulation of antigen generation is one strategy employed by cells to evade immune control. In this study we analyzed the generation and presentation of a survivin-derived CTL epitope in HLA-A2-positive colon-carcinoma cells. Although all cell lines expressed the anti-apoptotic protein survivin, some tumors were poorly recognized by ELTLGEFLKL (ELT)-specific CTL cultures. The expression of MHC-I or TAP molecules was similar in all cell lines suggesting that tumors not recognized by CTLs may present defects in the generation of the ELT-epitope which could be due either to lack of generation or to subsequent degradation of the epitope. The cells were analyzed for the expression and the activity of extra-proteasomal peptidases. A significant overexpression and higher activity of TPPII was observed in colon-carcinoma cells which are not killed by ELT-specific CTLs, suggesting a possible role of TPPII in the degradation of the ELT-epitope. To confirm the role of TPPII in the degradation of the ELT-peptide, we showed that treatment of colon-carcinoma cells with a TPPII inhibitor resulted in a dose-dependent increased sensitivity to ELT-specific CTLs. These results suggest that TPPII is involved in degradation of the ELT-peptide, and its overexpression may contribute to the immune escape of colon-carcinoma cells.
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Affiliation(s)
- G Preta
- Department of Biochemistry and Molecular Biology, University of Ferrara, Ferrara, Italy
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13
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Panareo S, Carcoforo P, Lanzara S, Corcione S, Bagatin E, Casali M, Costanzo A, Basaglia E, Feggi LM. Radiolabelled somatostatin analogs for diagnosis and radio-guided surgery of neuroendocrine breast cancer undetectable with conventional imaging procedures. Breast 2008; 17:111-4. [PMID: 17869107 DOI: 10.1016/j.breast.2007.08.002] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Received: 04/18/2007] [Revised: 07/11/2007] [Accepted: 08/06/2007] [Indexed: 11/30/2022] Open
Abstract
Some neoplasms are classified as primary neuroendocrine tumours (NETs) because of their positivity for neuroendocrine markers [chromogranins A and B (CgA, CgB) and neuron-specific enolase (NSE)]. Neuroendocrine differentiation has been reported, for example, in both "in situ" and infiltrating breast cancer. Diagnosis of NET is bio-humoral (CgA, NSE, synaptophysin) and instrumental. Even if the final diagnosis is made by open biopsy, radionuclide imaging using radiolabelled somatostatin analogs, such as In-111 pentetreotide, may detect neuroendocrine primary tumours and metastases before they become detectable using traditional and advanced imaging modalities [mammography (MX), ultrasound (US) and magnetic resonance imaging (MRI)]. When neuroendocrine breast lesions are not detectable, radio-guided surgery (RGS) is able to localise cancer. We report a case of a woman with a palpable lymph node in the left axilla. She underwent a US-guided lymph node biopsy, which was positive for massive metastases, probably of neuroendocrine breast origin. Mammary plus axillary US showed only lymphadenopathy in the left axilla. MX and breast MRI were negative. Neoplastic markers (CEA, CA 15.3, CA 125 and CA 19.9) were negative too. On the other hand, neuroendocrine markers (NSE and CgA) were positive. A whole body scintigraphic scan plus thorax and abdomen single photon emission computed tomography (SPECT) with In-111 pentetreotide (222 MBq; 6 mCi) showed an uptake in the left mammary gland. No other pathological localisations were observed. The day after the intravenous injection of In-111 pentetreotide, the patient underwent RGS breast tumour resection and left axillary lymphadenectomy. In conclusion, we would like to emphasise: (1) the role of radionuclide imaging for the detection of breast NETs in relation to conventional diagnostic procedures; (2) the role of RGS in localising and removing a non-palpable breast NET that was undetectable with the use of conventional imaging techniques.
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Affiliation(s)
- S Panareo
- Nuclear Medicine Unit, Imaging Diagnostic and Laboratory Medicine Department, University Hospital S. Anna, Corso Giovecca 203, 44100 Ferrara, Italy.
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Carcoforo P, Feggi L, Trasforini G, Lanzara S, Sortini D, Zulian V, Pansini GC, Degli Uberti E, Liboni A. Use of preoperative lymphoscintigraphy and intraoperative gamma-probe detection for identification of the sentinel lymph node in patients with papillary thyroid carcinoma. Eur J Surg Oncol 2007; 33:1075-80. [PMID: 17344018 DOI: 10.1016/j.ejso.2007.01.025] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [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: 11/12/2006] [Accepted: 01/18/2007] [Indexed: 11/22/2022] Open
Abstract
AIMS Lymph node metastases for papillary thyroid carcinoma are associated with an increased incidence of locoregional recurrence. The use of preoperative lymphoscintigraphy and intraoperative gamma probe detection to localize the sentinel lymph node in papillary thyroid carcinoma was investigated. METHODS From February 2004 to December 2005 the sentinel lymph node technique was studied in 64 consecutive patients with cytological evidence of papillary thyroid carcinoma. The day before surgery, patients were submitted to US-guided peri-tumoural injection of the radiotracer and a lymphoscintigraphy was performed. In the operating room a total thyroidectomy was done, and thanks to a hand-held gamma probe the sentinel lymph node and all lymph nodes, belonging to the sentinel node compartment, were removed. RESULTS The gamma probe identified the sentinel lymph node in 62 patients (96.8%). We found 48 (77.5%) sentinel lymph node without metastases; 12 (19.3%) with metastases and 2 (3.2%) with micrometastases. In 7 cases (11.3%), with a negative sentinel lymph node, metastases in other nodes of the same region were recorded. In 22 cases (34.3%) the ultrasound give an erroneous indication (P=0.004). Five patients (8.0%), 4 with multifocal cancer, had a positive postoperative lymphoscintigraphy. CONCLUSION This study shows that the sentinel lymph node technique for papillary thyroid carcinoma is feasible, repeatable, and more accurate than preoperative ultrasound. In cases of multifocal thyroid lesions more patients should be enrolled to establish the utility of the radio-guided technique.
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Affiliation(s)
- P Carcoforo
- Section of General Surgery, Department of Surgical, Anaesthesiological and Radiological Sciences, University of Ferrara, Ferrara, Italy
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Carcoforo P, Maestroni U, Querzoli P, Lanzara S, Maravegias K, Feggi L, Soliani G, Basaglia E. Primary Breast Cancer Features Can Predict Additional Lymph Node Involvement in Patients with Sentinel Node Micrometastases. World J Surg 2006; 30:1653-7. [PMID: 16927059 DOI: 10.1007/s00268-005-0083-0] [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] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this retrospective study was to identify biological features of primary breast cancer from which to predict the presence of further axillary involvement in patients bearing micrometastases in the sentinel lymph node (SLN). METHODS From a starting group of 690 patients, we isolated patients with micrometastases in the SLN. Those patients were classified according to the presence/absence of further metastases in nonsentinel lymph nodes (NSLNs). We examined primary tumor features to identify any relevant difference. Analysis of primary tumors evaluated histology, tumor size, lymphovascular invasion, mitotic index (Mib-1), estrogen and progesterone receptor status (ER/PR status), C-erb B-2 (HER-2/neu) expression and amplification, and p53 expression. Chi square analysis for statistical significance was applied. RESULTS Of the original 690 patients, 296 showed some kind of metastases in the SLN; 238 patients had gross metastases in the SLN. After axillary lymph node dissection (ALND), 102 patients (43%) had NSLNs with metastases, and 136 (57%) had negative axillary non-sentinel nodes. Another 58 patients harbored solitary micrometastases in the SLN. After ALND, 8 (14%) patients had further NSLN involvement, and 50 (86%) had negative axillary nodes. CONCLUSIONS Analysis of the primary breast lesion in patients with micrometastatic SLN and metastatic NSLNs revealed the presence of lymphovascular invasion, Mib-1 index > 10%, and tumor size > 2 cm. Patients without lymphovascular invasion, Mib-1 < 10% and T size < 2 cm could avoid further ALND.
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Affiliation(s)
- P Carcoforo
- Department of Surgical, Anaesthesiological and Radiological Sciences, University of Ferrara, C.so Giovecca, 203-44100 Ferrara, Italy
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Sortini D, Feo C, Maravegias K, Carcoforo P, Pozza E, Liboni A, Sortini A. Intrathoracoscopic localization techniques. Surg Endosc 2006; 20:1341-7. [PMID: 16703435 DOI: 10.1007/s00464-005-0407-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [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: 06/06/2005] [Accepted: 12/18/2005] [Indexed: 12/19/2022]
Abstract
BACKGROUND Several techniques for localizing pulmonary nodules have been described, but the advantages and disadvantages of each method remain unclear. We reviewed ultrasound, endofinger, finger palpation and wait and watch, radioguided, vital dye, fluoroscopic, agar marking, and needle wire methods for localizing pulmonary nodules. METHODS Original, peer-reviewed, and full-length articles in English were searched with PubMed and ISI Web of Sciences. Case reports and case series with less than 10 patients were excluded. RESULTS All localization techniques showed good reliability, but some carry a high rate of major or minor complications and drawbacks. CONCLUSION No ideal localization technique is available; thus, the choice still depends on surgeon's preference and local availability of both specialists and instruments.
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Affiliation(s)
- D Sortini
- Department of Surgical, Anaesthesiological, and Radiological Sciences, University of Ferrara, C.so Giovecca 203, 44100, Ferrara, Italy
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17
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Carcoforo P, Sortini D, Soliani G, Basaglia E, Feggi L, Liboni A. Accuracy and reliability of sentinel node biopsy in patients with breast cancer. Single centre study with long term follow-up. Breast Cancer Res Treat 2005; 95:111-6. [PMID: 16244784 DOI: 10.1007/s10549-005-9052-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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: 08/10/2005] [Accepted: 08/11/2005] [Indexed: 10/25/2022]
Abstract
The aim of our study is to evaluate the frequency of false-negative (FN) sentinel node procedures in patients with breast cancer. A total of 791 breast cancer patients underwent sentinel lymph node (SLN) biopsy at our institution between July 1997 and February 2005. A 2-day protocol was used to localise the sentinel node with the injection of 99mTc-nanocolloid. There were two phases in the study: the learning phase (50 patients) and the application phase (741 patients). In the learning phase, a complete lymphadenectomy was always performed. In the application phase, sentinel nodes were studied postoperatively with breast cancer and lymphadenectomy was performed when considered warranted by the pathological postoperative results. The median follow-up duration in the 741 patients studied during the application phase was 32.3 months (range 6-72 months). In this phase a total of 787 sentinel nodes (719 axillary and 68 intramammary chain) were obtained (range 0-5 per patient, mean 1.01), with 153 (41 with micrometastasis) positive sentinel nodes. We observed a total of three FN SLN results (0.5%). All three presented as an axillary recurrence into 24 months from operation. After a median follow-up of 32.3 months we observed only three clinical recurrences among 741 patients. Our results indicate that the sentinel node protocol can give an adequate local control.
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Affiliation(s)
- P Carcoforo
- Department of Surgical, Anaesthesiological and Radiological Sciences, Section of General Surgery, University of Ferrara, Ferrara, Italy
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18
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Zavagno G, Carcoforo P, Franchini Z, Renier M, Barutta L, De Salvo GL, Maravegias K, Capitanio G, Nitti D, Lise M. Axillary recurrence after negative sentinel lymph node biopsy without axillary dissection: a study on 479 breast cancer patients. Eur J Surg Oncol 2005; 31:715-20. [PMID: 16005176 DOI: 10.1016/j.ejso.2005.04.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [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: 10/29/2004] [Revised: 04/18/2005] [Accepted: 04/26/2005] [Indexed: 11/16/2022] Open
Abstract
AIMS To determine the axillary recurrence rate in breast cancer patients with negative sentinel lymph nodes (SLN) who did not undergo further axillary lymph node dissection (ALND), and to establish whether this conservative axillary approach leads to an increased recourse to diagnostic axillary biopsy during the follow-up period because of the clinical suspicion of nodal recurrence. METHODS In 479 patients, operated on for early breast cancer between 1998 and 2002 in five institutions, SLN biopsy was negative and no further axillary surgery was performed. SLN was localized using subdermal injection with 30-50 MBq of 99m-Tc-colloidal albumin. Follow-up controls were performed at 6-monthly intervals. RESULTS The mean number of SLNs removed was 1.4 per patient. Most patients (90.6%) were given adjuvant systemic therapy, based on the primary tumour characteristics. At a median follow-up of 35.8 months, no clinical axillary recurrence was found. No patient underwent surgical axillary biopsy for suspicious clinical or ultrasonographic findings. CONCLUSIONS Our results confirm that SLN biopsy without ALND in SLN-negative patients with early breast cancer is not followed by clinically evident axillary recurrence in the short-term.
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Affiliation(s)
- G Zavagno
- Istituto Clinica Chirurgica II, University of Padova, Via Giustiniani 2, 35128 Padova, Italy.
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Carcoforo P, Jorizzo EF, Maestroni U, Soliani G, Bergossi L, Pozza E. A new approach to the cure of the Ogilvie's syndrome. Ann Ital Chir 2005; 76:65-70. [PMID: 16035674] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The Authors describe a their own observation of 25 cases of acute colonic pseudo obstruction, better known as "Ogilvie Syndrome" with the objective to demonstrate that an early recognition and prompt appropriate therapy, better if conservative, can reduce the morbidity and the mortality of the Syndrome. The surgical therapy is reserved only to that cases in which the risk of perforation of the cecum represent an absolute indication to intervention.
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Affiliation(s)
- P Carcoforo
- University of Ferrara, General Surgery Department
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Carrella G, Sortini D, Basaglia E, Marcello D, Carcoforo P, Sortini A, Pozza E. Impact of laparoscopy and ultrasonography in gastrointestinal malignancies. Hepatogastroenterology 2005; 52:139-42. [PMID: 15783014] [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: 05/02/2023]
Abstract
BACKGROUND/AIMS An adequate preoperative disease staging is highly required before surgical treatment, even in gastrointestinal malignancies. Our study wants to give a contribution in order to define echolaparoscopy weight in gastrointestinal tumors and its impact in surgical therapy. METHODOLOGY 33 patients were affected by pancreas, 22 by stomach, 16 by extrahepatic biliary tract and 18 by liver cancers; every patient was considered worthy of radical or palliative surgery according to preoperative staging (thorax-abdominal CT and percutaneous ultrasonography). Paired sample t-tests were used to analyze the results of each methodical and probability values of less than 0.05 were considered significant. RESULTS Preoperative instrumental examinations gave correct evaluations only in 44 of 89 cases (49%) while echolaparoscopic gave correct evaluations in 82 on 89 cases (92%) (P<0.05). So after echolaparoscopic in only 7 cases we performed an explorative laparotomy. CONCLUSIONS Laparoscopy and ultrasound impact on therapy is worthy of attention. It seems to be able to give advantages in staging gastrointestinal malignancies, except for pancreas cancers, in which some limits and negative aspects have been demonstrated, regarding the possibility of giving correct diagnosis of portal axis infiltration.
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Affiliation(s)
- G Carrella
- University of Ferrara, Department of Surgical, Anesthesiological and Radiological Sciences Section of General Surgery, Universita di Ferrara, Italy
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Sortini D, Carcoforo P, Feo CV, Carrella G, Pozza E, Sortini A. Radiological examination for peripheral lung cancers and benign nodules less than 10 mm. Lung Cancer 2004; 45:393-4; author reply 395-6. [PMID: 15301881 DOI: 10.1016/j.lungcan.2004.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2004] [Indexed: 11/16/2022]
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Carcoforo P, Sortini D, Pozza E, Sortini A. Necessity of needle wire localization during video assisted thoracic surgery for patients with solitary pulmonary nodule. Eur J Cardiothorac Surg 2004; 26:233-4; author reply 234-5. [PMID: 15201017 DOI: 10.1016/j.ejcts.2004.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2004] [Accepted: 04/13/2004] [Indexed: 11/28/2022] Open
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Sortini D, Carrella G, Carcoforo P, Pozza E, Sortini A. Sonographic evaluation for peripheral pulmonary nodules during video-assisted thoracoscopic surgery. Surg Endosc 2004; 18:563; autrhor reply 564. [PMID: 15115033 DOI: 10.1007/s00464-003-9100-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Soliani G, Dominici M, Bergossi L, Basaglia E, Pauli S, Carcoforo P. Acute colon diverticulitis in multiple myeloma patient: an unusual presentation of a colonic perforation. Case report. Ann Ital Chir 2002; 73:643-6. [PMID: 12820590] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
This case report describes an acute colonic diverticular perforation occurred to a multiple myeloma patient, taking corticosteroid and morphine therapy, revealed by a subcutaneous emphysema of upper chest and right abdomen as initial presentation. Sigmoid diverticulitis with perforation and generalized peritonitis is a severe complication of the diverticular disease and it is due to diverticular microperforation. This condition occurs more frequently in patients with widespread diverticolosis and usually after 50 years of age, and the frequency of related complications increases with age (and with the use of corticosteroids). Extraperitoneal air from the sigmoid-rectum perforation can escape diffusing superiorly though paravertebral retroperitoneal tissues and via the diaphragmatic iatus into the mediastinum, producing pneumomediastinum and it diffuses to yield superior thoracic emphysema. This report suggests that the diagnosis of retroperitoneal perforation is usually difficult because of the lack of signs of peritoneal irritation and the paucity of symptoms, particularly in patients treated with corticosteroids.
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Affiliation(s)
- G Soliani
- Department of General Surgery, University of Ferrara, Italy
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25
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Navarra G, Ascanelli S, Turini A, Carcoforo P, Tonini G, Pozza E. [Laparoscopic appendectomy versus open appendectomy in suspected acute appendicitis in female patients]. Ann Ital Chir 2002; 73:59-63. [PMID: 12148423] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
INTRODUCTION The aim of the study is to analyse the own data and try to discuss if laparoscopic appendectomy offers any advantages in treating young women suffering from pain in right lower abfdominal quadrant. MATERIALS AND METHODS The study was conducted on 148 patients admitted from October 1993 to December 1998 with diagnosis of of pain in right iliac fossa and operated on with a laparoscopic (LA group: 75 cases) or open approach (OA group: 73 cases). Patients were prospectively randomized on the surgical approach adopted, following a randomized list. RESULTS The operative time in LA group was significantly (p < 0.001) longer (87.2 minutes) than for OA group (65.2 minutes). In 2 patients (2.7%) the operation had to be converted. Diagnosis had remained unknown in 16 patients (21.9%) of OA group, in spite of only one case (1.4%) with laparoscopic technique. We didn't observed intraoperative complications. Pain in the first and second postoperative days, evaluated on the use of pain medication, was significantly less in patients in group LA (p < 0.01). There were no deaths. Postoperative complications occurred in 4 patients (5.5%) of group LA, and in 8 patients (10.9%) of group OA. Hospital stay was significantly shorter for those having laparoscopic appendectomy (p < 0.001). DISCUSSION The main advantages of laparoscopic appendectomy consist more in diagnostic accuracy, than in less postoperative pain, less hospital stay and less postoperative complications. CONCLUSION Laparoscopic appendectomy is a safe and accurate approach.
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Affiliation(s)
- G Navarra
- Department of Human Pathology, University of Messina, Hammersmith Hospital, London.
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Carcoforo P, Jorizzo EF, Maestroni U, Soliani G, Navarra G. A new device for sutureless skin closure "the zipper". Ann Ital Chir 2002; 73:75-9; discussion 79-80. [PMID: 12148426] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
BACKGROUND We have done a prospective, controlled, randomized study to investigate the role of the "zipper", a new device for skin closure. We have also analysed morbility and advantages with the use of the "zipper" compared with sutures. METHODS 610 consecutive patients underwent surgery for abdominal thoracic endocrinologic and post traumatic pathologies. In 203 cases we used the zipper a new device for skin closure. RESULTS 6/203 Morbility: in six cases it was necessary to substitute the zipper with sutures or leave the wound healing by second intention. The patients were operated for inguinal hernioplasty, axillary lymphadenectomy, appendicectomy and cholecystectomy. These patients developed complications after surgery as hematoma, lymphorrhea, wound infection and a reintervention. The correction has been done removing the zipper and positioning sutures or leaving the wound healing by second intention. CONCLUSIONS The use of the zipper permits to achieve an efficient seal, a simple application, an aesthetic comfort; it can be applied in local anaesthesia and for its painless, application it is indicated in pediatric surgery.
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Affiliation(s)
- P Carcoforo
- University of Ferrara, Department of General Surgery
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Abstract
OBJECTIVES To determine the diagnosis, treatment and follow-up in patients with a solitary lung nodule and a previous primary extrapulmonary neoplasm. METHODS The authors evaluated the charts of 45 patients with an extrapulmonary malignant neoplasm and a solitary pulmonary nodule. The histologic characteristics of the nodule were correlated with those of the extrapulmonary neoplasm. RESULTS The histology of the nodule was not known preoperatively in 43 cases (93.5%); in the remaining three cases cytologic examination had shown the presence of atypical cells. The majority of pulmonary lesions (73.9%) were found during the follow-up of the previous tumour, but a significant percentage of nodules (17.4%) were found incidentally. Pre- or intraoperative localisation of the nodule was done in 19 cases (41.3%), and was successful in nine cases (47.4%). Thoracoscopy was performed in 44 patients (95.6%). The coincidence between the pathology of the previous tumour and that of the nodule was 41.3% (19/46). The coincidence rate was 100% for the tumours of ovary, prostate, and sarcomas. CONCLUSIONS The advent of minimally invasive surgical techniques has made a definitive diagnosis likely, providing also therapy with a less painful engagement for the patient and a less cost for the community.
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Affiliation(s)
- A Sortini
- Department of Surgical, Anesthesiological and Radiological Sciences, University of Ferrara, Corso Giovecca 203, 44100 Ferrara, Italy.
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Feggi L, Basaglia E, Corcione S, Querzoli P, Soliani G, Ascanelli S, Prandini N, Bergossi L, Carcoforo P. An original approach in the diagnosis of early breast cancer: use of the same radiopharmaceutical for both non-palpable lesions and sentinel node localisation. Eur J Nucl Med 2001; 28:1589-96. [PMID: 11702098 DOI: 10.1007/s002590100601] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2001] [Accepted: 06/18/2001] [Indexed: 10/27/2022]
Abstract
A modern approach to the surgical treatment of early breast carcinoma requires intraoperative localisation of non-palpable lesions and assessment of the lymph node status. Localisation of breast lesions can be achieved by intratumoural injection of a small amount of radiotracer and intraoperative use of a gamma probe (i.e. radioguided occult lesion localisation, or ROLL). Assessment of the lymph node status is possible by means of the sentinel node approach. To date, two different radiopharmaceuticals have been used for localisation of tumour and sentinel node. We now propose the use of a single nanocolloidal tracer (Nanocoll, with a particle size of less than 80 nm) which is labelled with technetium-99m for simultaneous performance of ROLL and sentinel node identification. The aim of this study was to evaluate the feasibility of this approach, which should be easier and more practical than the dual-tracer injection method. We have employed this new technique in 73 patients with non-palpable, cytologically diagnosed breast cancer and non-palpable axillary lymph nodes. In all patients the radiocolloid, in a total volume of 0.3-0.4 cc, was injected under sonographic or stereotactic guidance. Half of the dose was injected intratumourally and half superficially, but very close to the tumour. Because of the slow lymphatic flow in the breast, Nanocoll must be injected some time before surgery in order to enable adequate migration to the axilla. We injected colloid in the afternoon before surgery (16-23 h before the start of the operation, with an average interval of 18 h). An average dose of 130 MBq (range 110-150) was injected in order to have about 10 MBq of radioactivity when surgery commenced. Lymphoscintigraphy was performed after 15-19 h, with an average interval of 17 h. The procedure was always successful in permitting the localisation of occult breast lesions. Lesions were always localised at the first attempt, and were always contained within the surgical margins. Histological examination revealed all 73 resected lesions to be malignant: there were 64 cases of infiltrating carcinoma and nine of intraductal carcinoma. All breast lesions were therefore confirmed to be early breast cancer. We achieved sentinel node localisation in 71 out of 73, either at scintigraphy or with the intraoperative probe; in two patients, radiopharmaceutical migration was absent. Lymphoscintigraphy showed only axillary drainage in 52 cases, only internal mammary chain (IMC) drainage in nine cases, and combined axillary and IMC drainage in eight cases. In two cases, lymphoscintigraphy suggested the sentinel node was located inside the same breast (intramammary lymph node). All the visualised sentinel nodes were biopsied except for four that were localised in the IMC. Histological examination of the nodes showed metastases in 20 cases: in 15 cases there were micrometastases, and in five, macrometastases. In conclusion, this study has demonstrated the feasibility of the proposed procedure. Simultaneous performance of ROLL and sentinel node localisation using a single tracer represents a useful and practicable choice in the management of early breast cancer.
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Affiliation(s)
- L Feggi
- Department of Nuclear Medicine, S. Anna Hospital, Ferrara, Italy
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Navarra G, Feggi L, Ascanelli S, Turini A, Carcoforo P, De Paoli E, Pozza E. Role of radio-guided surgery in recurrent secondary hyperparathyroidism. Nephron Clin Pract 2001; 88:36-8. [PMID: 11340348 DOI: 10.1159/000045956] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The aim of this paper is to state the role of radio-guided surgery (RGS) in case of recurrent secondary hyperparathyroidism. METHODS Two cases of recurrent secondary hyperparathyroidism were treated using RGS. After a preoperative assessment, which included ultrasonography (US), MRI and (99m)Tc-radiolabelled sestamibi scan, a radio-guided neck re-exploration was planned. On the day of surgery the patients underwent a radionuclide injection. After 90 min, surgery began. RESULTS Dissection was guided by placing the probe in the wound to localize any increased concentration of radioactivity. In the first case the probe identified the gland located deeply in the right tracheo-esophageal groove; in the other case the probe detected a site of increased uptake in the upper mediastinum. Both lesions were dissected and excised; a frozen section confirmed they were parathyroid glands with diffuse hyperplasia. The operative time was less than 60 min in both cases. The patients were discharged on the first postoperative day. A decrease in serum calcium and PTH was observed subsequently. A minimum follow-up of 6 months did not show any recurrence. CONCLUSION RGS can help in detecting the parathyroid tissue in selected cases of renal hyperparathyroidism and makes operation much easier and more predictable.
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Affiliation(s)
- G Navarra
- Department of General Surgery, University of Ferrara, Ferrara, Italy.
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Pozza E, Ascanelli S, Bardella E, Carcoforo P, Turini A, Navarra G. Pancreatic surgery in Jehovah's Witnesses: the role of perioperative erythropoietin and intravenous iron. Surgery 2001; 129:120. [PMID: 11150046 DOI: 10.1067/msy.2001.111998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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31
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Navarra G, Carcoforo P, Turini A, Ascanelli S, Tonini G, Pozza E. [Colonic pouch versus direct colo-anal anastomosis in the reconstruction after total resection of the mesorectum: review of the literature]. G Chir 2001; 22:49-56. [PMID: 11272438] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Good results in terms of control of the disease and 5 years survival have encouraged the use of the sphincter-saving technique for the treatment of cancers of the lower rectum. However, after this operation a percentage of patients complains of functional abnormalities such as increased bowel frequency and modification of continence especially within 12-18 months after surgery. This review analyzes the results of coloanal anastomosis following rectal excision trying to evaluate if the construction of a colonic pouch allows to limit or to prevent the functional anorectal abnormalities that usually follow a straight colo-anal anastomosis.
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Affiliation(s)
- G Navarra
- Dipartimento di Scienze Chirurgiche, Anestesiologiche e Radiologiche Sezione di Clinica Chirurgica, Università degli Studi di Ferrara
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32
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Sortini A, Santini M, Carcoforo P, Sortini D, Pozza E, Donini I. Primary lung epithelioid hemangio-endothelioma with multiple bilateral metachronous localizations: case report and review. Int Surg 2000; 85:336-8. [PMID: 11589603] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
Abstract
The authors report a case of primary epithelioid (EH) in a 73-year-old female.
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Affiliation(s)
- A Sortini
- DSBTA--Division of General Surgery, University of Ferrara, Italy.
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33
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Abstract
BACKGROUND It has been demonstrated that radio-guided surgery offers several advantages in treating primary hyperparathyroidism. Even if it is considered less helpful in renal hyperparathyroidism, it could be of tremendous advantage in the treatment of persistent or recurrent secondary hyperparathyroidism. METHODS We report a case of recurrent secondary hyperparathyroidism treated by the use of radio-guided surgery. The preoperative assessment consisting of ultrasonography, magnetic resonance imaging, and 99mTc-sestamibi scintigraphy identified a parathyroid in the upper mediastinum. The patient underwent a radio-guided neck re-exploration that allowed a rapid localization and excision of the ectopic gland, which was located in the anterosuperior mediastinum, in front of the trachea, between the innominant and the left common carotid artery. RESULTS The operative time was 45 minutes. The patient was discharged on the first postoperative day. A decrease in serum calcium and parathyroid hormone was observed subsequently. A follow-up of 6 months did not show any recurrence. CONCLUSIONS The case reported indicates that radio-guided surgery can help surgeons detect parathyroid tissue in selected cases of renal hyperparathyroidism.
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Affiliation(s)
- G Navarra
- Department of General Surgery, University of Ferrara, C.so Giovecca 203, 44100 Ferrara, Italy
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34
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Navarra G, Ascanelli S, Turini A, Carcoforo P, Pozza E. A stone within an anal fistula tract. Int J Colorectal Dis 1999; 14:263. [PMID: 10647638 DOI: 10.1007/s003840050222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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35
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Pelizzola D, Malagutti R, Giovannini G, Indelli M, Carcoforo P, Piffanelli A. Immunometric Assays of Ras and c-erbB-2/Neu Overexpression in Breast Cancer: A Pilot Study. Int J Biol Markers 1999; 14:178-85. [PMID: 10569141 DOI: 10.1177/172460089901400310] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The expression of the ras and c-erbB2 oncoproteins (p21 and p185, respectively), together with estrogen receptor (ER) and progesterone receptor (PgR) determination, has been retrospectively analyzed in 68 primary breast carcinomas and in 19 normal breast tissue samples. The aims of this study were: a) to explore the association between ras and c-erbB2 expression; b) to evaluate the relationship between ras and c-erbB2 expression and both steroid receptor status and the classical clinical and pathological parameters; and c) to compare two different methods for p185 determination. p185 and p21 were measured by enzyme immunoassay (EIA); p185 was also determined by Western blotting (WB); ER and PgR were assayed by radioligand binding assay. The highest value of p185 in benign breast lesions was used as the threshold to distinguish between positive and negative samples. With this threshold the c-erbB2 oncoprotein was overexpressed in 41.2% (with EIA) and in 50% (with WB) of cancer samples. The concordance rate between the two methods was 79.4. No significant association was found between p21 and p185 levels either in cancer or in normal breast tissue samples. Increasing levels of tumor p21 were associated with a shorter time to recurrence and overall survival. Increasing levels of p185 were associated with a significantly shorter time to recurrence (p185 EIA: p=0.04, p185 WB: p=0.029) and overall survival (p185 EIA: p=0.04, p185 WB: p=0.029).
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Affiliation(s)
- D Pelizzola
- Department of Clinical and Experimental Medicine, University of Ferrara, Italy
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36
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Carcoforo P, Feggi L, Sartori A, Navarra G, Pozza E, Donini I. Lymphatic mapping for the dissection of the sentinel node in the treatment of breast carcinoma. J Exp Clin Cancer Res 1999; 18:75-7. [PMID: 10374682] [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: 02/12/2023]
Abstract
The Authors present the preliminary results of a study aimed at verifying the effectiveness of lymphatic mapping for the dissection of the sentinel lymph node in the treatment of breast carcinoma. The lymphoscintigraphy method was used in the study performed on 24 patients to evidence the sentinel lymph node. The sentinel lymph node was identified in 23/24 patients (95,8%), with 100% accuracy, negative predictions were 100% (21/21). Consistently with the low number of cases treated, our results seem to guarantee the same prognostic accuracy obtained using radical lymphadenectomy extended to the third lymph node level.
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Affiliation(s)
- P Carcoforo
- Dept. of General Surgery, University of Ferrara, Italy
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37
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Di Marco L, Carcoforo P, Pozza E, Donini I. Seldom found acute abdomen: perforated diverticulum in the transverse colon. Int Surg 1999; 84:43-5. [PMID: 10421017] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023] Open
Abstract
The authors report a recently examined rare case of isolated perforated diverticulum of the transverse colon. At surgery, a perforated omentum-sealed diverticulum was found in the third distal wall of the transverse colon. A diverticulectomy was performed. The postoperative course was excellent.
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Affiliation(s)
- L Di Marco
- Department of General Surgery, University of Ferrara, Italy
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38
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Occhionorelli S, Mascoli F, Ascanelli S, Navarra G, Carcoforo P, Traina L, Pollinzi V. Intraoperative H/R echography for carotid surgery. J Cardiovasc Surg (Torino) 1998; 39:541-6. [PMID: 9833708] [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: 02/09/2023]
Abstract
BACKGROUND Intraoperative duplex examination can be used during carotid surgery to identify small technical defects (like anastomotic stenosis, intimal flaps or subintimal wall dissections) that cannot be easily found by palpatory manoeuvres. The objective of this clinical study is to correlate intraoperative duplex findings with early postoperative complications and with duplex data obtained during follow-up. METHODS From January 1993 to January 1996 we compared early and late postoperative complications that occurred after carotid surgery in two groups of patients: a group of 120 patients undergone intraoperative duplex compared with a group of 100 patients not undergone intraoperative ultrasound. RESULTS The percentages of early and late postoperative complications which occurred in the first group were respectively 7.5% and 4.2% contrary to 10% and 7% occurred in the control group. CONCLUSIONS Duplex constitutes a selective intraoperative method for carotid surgery, easy to use, enable to identify and immediately correct technical defects.
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Mazzetti J, Occhionorelli S, Navarra G, Schettino AM, Di Marco L, Sartori A, Carcoforo P. [The right laparoscopic adrenalectomy of an incidentaloma]. Ann Ital Chir 1998; 69:521-3; discussion 524. [PMID: 9835129] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The authors report a case of incidental lesion of right adrenal gland in a 56-years-old patient, followed for a liver disfunction. The lesion, with cystic and hemorrhagic histological characters, was treated with laparoscopic resection. The following case report covers the diagnostic procedures, laparoscopic technique, showing the advantages, and postoperative course in surrenal lesion without local infiltration.
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Affiliation(s)
- J Mazzetti
- Dipartimento di Scienze Biomediche e Terapie Avanzate, Università degli Studi di Ferrara
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40
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Fabbri N, Rocca T, Navarra G, Adani GL, Rinaldi R, Carcoforo P. "Carcinoid tumorlets". Case report and review of the literature. Ann Ital Chir 1998; 69:509-11. [PMID: 9835127] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
It is reported a case of "carcinoid tumorlets" of the lung, in a 63-year-old woman, who underwent surgery for a breast cancer. These lesions are histologically similar with carcinoid, but different for clinical evolution. They are benign lesions generally without metastasis. The authors point out the importance of histological, clinical and diagnostical aspects, and the follow-up of patients in order to have evidence of the eventual malignant evolution.
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Affiliation(s)
- N Fabbri
- Dipartimento di Scienze Biomediche e Terapie Avanzate, Università degli Studi di Ferrara
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41
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Carcoforo P, Navarra G, Sartori A, Rocca T, Pozza E, Donini I. [The indications for prophylactic colectomy in diverticular disease]. Ann Ital Chir 1998; 69:433-8. [PMID: 9835116] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Still controversial is the role of surgery in symptomatic colon diverticular disease, outside the major complications. In such circumstances the surgeon has to comfort himself with diagnostic and then with operative choices, and also the preventive colectomy has to be considered. To make a correct decision very important is the global evaluation of the patient, for age, sex life habits, other existing pathologies, general condition. Also unsolved doubt for a neoplastic evolution has its worth.
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Affiliation(s)
- P Carcoforo
- Istituto di Clinica Chirurgica Generale e Terapia Chirurgica, Università degli Studi di Ferrara
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42
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Occhionorelli S, Navarra G, Santini M, Carcoforo P, Sartori A, Pollinzi V, Mascoli F. Symptomatic abdominal aortic aneurysm and "situs viscerum inversus." Diagnostic and therapeutic approach. J Cardiovasc Surg (Torino) 1998; 39:31-3. [PMID: 9537532] [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: 02/07/2023]
Abstract
BACKGROUND We report one case of symptomatic aneurysm of infrarenal abdominal aorta in a patient symptomatic for acute abdomen. METHODS The patient was accepted at the Emergency Care Unit and the routine admission tests were taken. US of the abdomen revealed a <<Situs Viscerum Inversus Totalis>> (SVI) disposition of the organs and an aneurysm of the abdominal aorta below the renal arteries. Patient underwent an aorto-aortic straight graft CONCLUSIONS In this case-report we show SVI cannot be considered a problem in the surgical treatment of symptomatic abdominal aortic aneurysms.
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Affiliation(s)
- S Occhionorelli
- Dipartimento di Scienze Biomediche e Terapie Avanzate, University of Ferrara, Italy
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43
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Carcoforo P, Di Marco L, Schettino AM, Rocca T, Occhionorelli S, Pollinzi V, Donini I. Intestinal occlusion secondary to Morgagni-Larrey's herniation in an adult. Case report and analysis of the literature. Ann Ital Chir 1998; 69:97-100. [PMID: 11995044] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Morgagni-Larrey's hernias are congenital diaphragmatic hernias, rarely observed and generally identified accidentally due to the lack of symptoms. The authors report a case of intestinal occlusion secondary to Morgagni-Larrey herniation in an adult recently observed and underline the aetiopathogenic aspects, the diagnostic tools and the clinical pattern. They suggest to consider surgical repair as a choice of treatment, also for asymptomatic patients.
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Affiliation(s)
- P Carcoforo
- Department of General Surgery, University of Ferrara
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44
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Di Marco L, Occhionorelli S, Schettino AM, Carcoforo P, Navarra G, Pollinzi V. [Laparoscopy in iatrogenic lesions of the colon during operative endoscopy]. Ann Ital Chir 1997; 68:859-61; discussion 861-2. [PMID: 9646549] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Colonscopy is a standard diagnostic and therapeutic procedure that has its own morbidity. Colonic perforation is the dangerous complication of this procedure. Successful management of perforation by conservative or surgical treatment remains controversial. We report two cases, recently observed, of patients with colonic perforation occurring during therapeutic colonscopy treated with minimally invasive technique.
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Affiliation(s)
- L Di Marco
- Dipartimento di Scienze Biomediche e Terapie avanzate, Università degli Studi di Ferrara
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45
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Affiliation(s)
- G Navarra
- Department of General Surgery, University of Ferrara, Italy
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46
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Affiliation(s)
- G Navarra
- Department of General Surgery, University of Ferrara, Italy
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47
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Affiliation(s)
- G Navarra
- Department of General Surgery, University of Ferrara, Italy
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48
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Carcoforo P, Navarra G, Di Marco L, Occhionorelli S, Rocca T, Pollinzi V. Reversal of Hartmann's procedure. Our experience. Ann Ital Chir 1997; 68:523-7; discussion 527-8. [PMID: 9494184] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Hartmann's procedure has progressively changed its indications in the last years; nowadays they are reduced by the increasing of anesthesiology and the introduction of stapler devices. The introduction of staplers makes reconstructive operation easier and it contributes to a sensible increasing of reversal percentage after Hartmann's procedure. Video-assisted techniques make Hartmann's procedure possible for older patients with high-risk of post-operative general complications. The authors describe the results obtained with traditional and video-assisted reversal Hartmann's procedure, comparing with data from Literature.
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Affiliation(s)
- P Carcoforo
- Dipartimento di Scienze Biomediche e Terapie Avanzate Università degli Studi di Ferrara
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49
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Carcoforo P, Navarra G, Gasbarro V, Occhionorelli S, Fabbri N, Sartori A, Pollinzi V, Sortini A. [Cutaneous mechanical staplers. Our experience]. MINERVA CHIR 1997; 52:1009-13. [PMID: 9411287] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This paper reports the results of a trial, comparing the use of disposable skin staplers with conventional nylon or silk sutures in skin closure. This study began in 1986; 7274 patients undergoing elective and emergency operations were controlled during the postoperative period, 3 and 6 months after surgery. It was shown that skin clips instead of sutures decrease the operative time, produce wound healing with a good cosmetic results, and above all a significant lowering of the wound infection rate.
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Affiliation(s)
- P Carcoforo
- Istituto di Clinica Chirurgica Generale e Terapia Chirurgica, Università degli Studi, Ferrara
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50
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Di Marco L, Occhionorelli S, Navarra G, Carcoforo P, Schettino AM, Pollinzi V. [Adenomyomatosis of the gallbladder. Our experience]. Ann Ital Chir 1997; 68:321-3; discussion 323-4. [PMID: 9454544] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Adenomyomatosis is a rare affection of the gallbladder and it's infrequently reported in the Literature. Having observed eighteen cases of adenomyomatosis of the gallbladder in the last five years and considering the difficulties in making an early diagnosis of gallbladder cancer, the authors suggest the importance of cholecystectomy in this pathology.
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Affiliation(s)
- L Di Marco
- Dipartimento di Scienze Biomediche e Terapie Avanzate, Università degli Studi di Ferrara
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