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Izzo L, Pugliese F, Di Poce I, Valabrega S, Di Cello P, Gabriele R, Messineo D, Izzo S, Izzo P. Unusual presentation of metastatic thyroid cancer without a primary: role of diagnostic imaging in a daily clinical setting. G Chir 2019; 40:234-237. [PMID: 31484015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Papillary thyroid carcinoma (PTC) is the most common mali gnancy of the thyroid gland. In 21-90% of the patients occult lymph node metastases may occur. The case reported here describes a woman who underwent a total thyroidectomy for multinodular goiter and who presented an enlarged lymph node on the left side of the neck, which showed a metastasis from PTC. The patient underwent imaging investigation with CT and FNAB. The pathological examination diagnosed a papillary thyroid cancer metastases. The pT underwent a I131 total body scan, negative for secondary localization.
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2
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Crocetti D, Fiori E, Costi U, De Gori A, Miccini M, Valabrega S, Cavallaro G, De Toma G. Right pneumothorax secondary to colonoscopic perforation: a case. G Chir 2018; 39:375-377. [PMID: 30563601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
AIM The purpose of this study is to determine the anatomical aspects, mechanisms, risk factors and appropriate management of development of pneumothorax during a routine colonoscopy. CLINICAL CASE We report a case of an accidental bowel wall injury during diagnostic colonoscopic with consequent pneumoperitoneum; this was followed by expansion of gas through diaphragmatic fenestration perhaps congenital, in right pleural cavity causing pneumothorax. DISCUSSION Rarely, colonic perforation during colonoscopy can occur into the extraperitoneal space, thus leading to the passage and diffusion of air along the fascial planes and large vessels, possibly causing pneumoretroperitoneum, pneumomediastinum, pneumopericardium, pneumothorax, and subcutaneous emphysema. The combination of intraperitoneal and extraperitoneal perforation has also been reported. Pneumothorax following a colonoscopy sigmoid perforation is an extremely rare but severe and often lifethreatening complication. CONCLUSION If the patient develops dyspnea and pneumoderma during or after this procedure, a chest radiogram or thoracoabdominal CT should be taken for diagnostic purposes. Urgent treatment, starting with chest tube insertion(s) and laparotomy or laparoscopy could be lifesaving.
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Izzo S, Izzo L, Di Cello P, Sinaimeri G, De Santis A, Razionale F, Costi U, Gabriele R, Valabrega S, Pugliese F, Izzo P. Densitometric changes of the patella in patients undergoing unilateral knee arthroplasty. G Chir 2018; 39:239-244. [PMID: 30039792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Although the intervention of knee arthroplasty became routine, there is no standard reference on the densitometric characteristics of the patella before and after surgery. Scope of this work is the evaluation of patellar bone density before and after unilateral knee arthroplasty. PATIENTS AND METHODS BMD was assessed by DEXA examination in 146 individuals, who have been divided into three distinct groups. Group I: 68 subjects with a mean age of 70.6 years, with an unilateral femoral-tibial knee prothesis. Group II: healthy subjects of similar age (average: 64) and without implants. Group III: healthy adults with a mean age of 26.6 years. The follow-up was performed at 6 months to a maximum of 2 years post surgery. RESULTS The results were obtained from 68 subjects examined with the DEXA software dedicated to the forearm, which turned out to be the most appropriate for our purpose. The follow-up performed every 6 months after surgery showed a reduction of the density values in the operated knee in the 1st control with a return to the pre-surgiucal situation in the control performed after 1 year. In subsequent checks there was a further increase of the patellar density of the operated knee. CONCLUSION Patellar DEXA examination is recommended as an addition to the clinical and radiological standard examination.
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Izzo P, Di Cello P, Pugliese F, Izzo S, Grande R, Biancucci F, Sinaimeri G, Razionale F, Costi U, Al Mansour M, Muneer A, Valabrega S, Izzo L. Pancreas divisum: correlation between anatomical abnormalities and bile precipitation in the gallbladder in seven patients. G Chir 2016; 37:155-157. [PMID: 27938531 DOI: 10.11138/gchir/2016.37.4.155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pancreas divisum is a genetic defect associated with recurrent acute pancreatitis due to insufficient drainage of the accessory pancreatic duct. Seven young patients diagnosed with pancreatic divisum and thickening of the gallbladder bile as shown on magnetic resonance cholangio-pancreatography without pancreatic ductal changes underwent laparoscopic cholecystectomy. During the mean follow-up of 32 months no episode of pancreatitis was reported. There is an association between PD and higher concentration of bile in the gallbladder. Cholecystectomy can be considered curative in patients with PD in the absence of indications for major surgery.
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Di Cello P, Izzo S, Pugliese F, Di Poce I, Orsini A, Izzo L, Mazzone G, Biancucci F, Sinaimeri G, Valabrega S, Almansour M, Izzo P. Deep vein thrombosis of the lower limb secondary to lumbar discal hernia compression: a rarity? Review of the literature. G Chir 2016; 37:130-132. [PMID: 27734797 DOI: 10.11138/gchir/2016.37.3.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This case report is about a 70-years-old female patient, suffering from discal hernia, with compression of the iliac vein, that led to the formation of deep vein thrombosis of the lower limbs. The angio-CT scan revealed the starting point of the L4- L5 compression where a voluminous discal hernia caused deep vein thrombosis, with the involvement the femoro-popliteal venous axis. Blood samples and PET-CT scans excluded other possible etiologic factors. This case demonstrates how a voluminous discal hernia can cause venous thrombosis.
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Crescenzi A, Guidobaldi L, Nasrollah N, Taccogna S, Cicciarella Modica DD, Turrini L, Nigri G, Romanelli F, Valabrega S, Giovanella L, Onetti Muda A, Trimboli P. Immunohistochemistry for BRAF(V600E) antibody VE1 performed in core needle biopsy samples identifies mutated papillary thyroid cancers. Horm Metab Res 2014; 46:370-4. [PMID: 24570209 DOI: 10.1055/s-0034-1368700] [Citation(s) in RCA: 30] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BRAF(V600E) is the most frequent genetic mutation in papillary thyroid cancer (PTC) and has been reported as an independent predictor of poor prognosis of these patients. Current guidelines do not recommend the use of BRAF(V600E) mutational analysis on cytologic specimens from fine needle aspiration due to several reasons. Recently, immunohistochemistry using VE1, a mouse anti-human BRAF(V600E) antibody, has been reported as a highly reliable technique in detecting BRAF-mutated thyroid and nonthyroid cancers. The aim of this study was to test the reliability of VE1 immunohistochemistry on microhistologic samples from core needle biopsy (CNB) in identifying BRAF-mutated PTC. A series of 30 nodules (size ranging from 7 to 22 mm) from 30 patients who underwent surgery following CNB were included in the study. All these lesions had had inconclusive cytology. In all cases, both VE1 and BRAF(V600E) genotypes were evaluated. After surgery, final histology demonstrated 21 cancers and 9 benign lesions. CNB correctly diagnosed 20/20 PTC and 5/5 adenomatous nodules. One follicular thyroid cancer and 4 benign lesions were assessed at CNB as uncertain follicular neoplasm. VE1 immunohistochemistry revealed 8 mutated PTC and 22 negative cases. A 100% agreement was found when positive and negative VE1 results were compared with BRAF mutational status. These data are the first demonstration that VE1 immunohistochemistry performed on thyroid CNB samples perfectly matches with genetic analysis of BRAF status. Thus, VE1 antibody can be used on thyroid microhistologic specimens to detect BRAF(V600E)-mutated PTC before surgery.
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Affiliation(s)
- A Crescenzi
- Section of Pathology, Ospedale Israelitico, Rome, Italy
| | - L Guidobaldi
- Section of Pathology, Ospedale Israelitico, Rome, Italy
| | - N Nasrollah
- Section of Surgery, Ospedale Israelitico, Rome, Italy
| | - S Taccogna
- Section of Pathology, Ospedale Regina Apostolorum/IHG2, Albano Laziale (Rome), Italy
| | | | - L Turrini
- Section of Pathology, Ospedale Regina Apostolorum/IHG2, Albano Laziale (Rome), Italy
| | - G Nigri
- Department of Surgical and Medical Sciences, Sapienza University, Ospedale S. Andrea, Rome, Italy
| | - F Romanelli
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - S Valabrega
- Department of Surgical and Medical Sciences, Sapienza University, Ospedale S. Andrea, Rome, Italy
| | - L Giovanella
- Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - A Onetti Muda
- Integrated Research Center (CIR), Campus Bio-Medico University, Rome, Italy
| | - P Trimboli
- Section of Endocrinology and Diabetology, Ospedale Israelitico, Rome, Italy
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Trimboli P, La Torre D, Ceriani L, Condorelli E, Laurenti O, Romanelli F, Ventura C, Signore A, Valabrega S, Giovanella L. High sensitive thyroglobulin assay on thyroxine therapy: can it avoid stimulation test in low and high risk differentiated thyroid carcinoma patients? Horm Metab Res 2013; 45:664-8. [PMID: 23720229 DOI: 10.1055/s-0033-1345185] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [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: 10/26/2022]
Abstract
Thyroglobulin (Tg) is a key marker in the follow-up of differentiated thyroid cancer (DTC). Diagnostic accuracy of serum Tg is higher after TSH stimulation than during thyroxine treatment. However, some studies suggest that TSH stimulation could be not necessary in a large part of patients, if Tg is measured by high sensitive assay under replacement therapy. The aim of this study was to evaluate the need of Tg stimulation test in DTC followed-up by sensitive Tg assay. In a prospective multicenter explorative study, 68 low or high risk patients underwent Tg measurement on thyroxine (ON-LT4-Tg) and after LT4 withdrawal (OFF-LT4-Tg). Undetectable ON-LT4-Tg and OFF-LT4-Tg values (i. e.,<0.15 ng/ml) were found in 56/68 patients, all with negative imaging workup. Twelve subjects had skewed OFF-LT4-Tg: 8 cases had increased ON-LT4-Tg and local recurrence (n=6), distant metastasis (n=1), or benign thyroglossal duct (n=1); the remaining 4 patients had undetectable ON-T4-Tg but detectable OFF-LT4-Tg and neck metastasis was recorded in one of these. By ROC analysis, the most accurate cutoff for ON-LT4-Tg and OFF-LT4-Tg were set at 0.23 ng/ml and 0.70 ng/ml, respectively. A positive ON-LT4-Tg value accurately predicts a positive stimulation test and confers an Odds Ratio of 464 (95% CI from 26.3 to 8 173.2, p<0.0001) to have persistent/recurrent disease. This study shows that DTC patients with ON-LT4-Tg below 0.23 ng/ml by our high sensitive assay should be considered disease free and they can avoid Tg stimulation test. High sensitive Tg assays should be used to better manage DTC patients.
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Affiliation(s)
- P Trimboli
- Section of Endocrinology and Diabetology, Ospedale Israelitico, Rome, Italy.
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8
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Maglio R, Valabrega S, Ramacciato G. Duodenal carcinoma at ligament of Treitz. Case report and review of the literature. G Chir 2012; 33:179-181. [PMID: 22709455] [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: 06/01/2023]
Abstract
We report a case of adenocarcinoma of the duodenojejunal angle and remark the rarity of this pathology, the difficulty of diagnosis and treatment peculiar to tumours of the duodenum. This rare tumour is characterized by polymorphic and non specific symptomatology. The possible therapy is surgery. Radio and chemotherapy don't significantly improve survival.
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Trimboli P, Nigri G, Romanelli F, Cicciarella Modica DD, Crescenzi A, Valabrega S, Giovanella L. Medullary thyroid nodules by measurement of calcitonin (Ct) in aspiration needle washout in patients with multinodular goiter and moderately elevated serum Ct. Exp Clin Endocrinol Diabetes 2012; 120:234-7. [PMID: 22328107 DOI: 10.1055/s-0031-1291344] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The accuracy of fine needle aspiration cytology (FNAC) is low in medullary thyroid carcinomas (MTC). Recently, a few papers analyzed the measurement of calcitonin (Ct) in washout of the needle after aspiration (WO-Ct) suggesting that this approach may be useful in patients with high serum Ct. Here we reported, for the first time in our best knowledge, 3 patients with multinodular goiter, moderately elevated serum Ct, high value of WO-Ct, and medullary outcome. These findings suggest that in presence of high serum Ct, FNAC should be performed in all nodules, and it should be combined with WO-Ct in all cases.
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Affiliation(s)
- P Trimboli
- Section of Endocrinology and Diabetology, Ospedale Israelitico, Rome, Italy.
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Trimboli P, Rossi F, Baldelli R, Laurenti O, Nigri G, Ventura C, Appetecchia M, Attanasio D, Romanelli F, Guidobaldi L, Guarino M, Crescenzi A, Valabrega S. Measuring calcitonin in washout of the needle in patients undergoing fine needle aspiration with suspicious medullary thyroid cancer. Diagn Cytopathol 2011; 40:394-8. [DOI: 10.1002/dc.21731] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Accepted: 04/06/2011] [Indexed: 11/07/2022]
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11
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Trimboli P, Rossi F, Condorelli E, Laurenti O, Ventura C, Nigri G, Romanelli F, Guarino M, Valabrega S. Does normal thyroid gland by ultrasonography match with normal serum thyroid hormones and negative thyroid antibodies? Exp Clin Endocrinol Diabetes 2009; 118:630-2. [PMID: 19998241 DOI: 10.1055/s-0029-1237700] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [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] [Indexed: 10/20/2022]
Abstract
Few papers have shown that a hypoechoic appearance of the thyroid gland at ultrasonography (US) is related to a hypofunction and serum positivity of thyroid antibodies (T-Ab). However, it is not ascertained if normal thyroid appearance at US correspond to normal thyroid laboratory tests. The aim of this study was to assess the value of normal thyroid at US in predicting normal thyroid hormones and negative T-Ab in a cohort of 48 adult patients. All patients (37 females and 11 males) were referred to our hospital to undergo their first thyroid US examination, followed by a thyroid function evaluation. All subjects had normal thyroid gland at US. As a control group 65 patients with hypoechoic and inhomogeneous thyroid gland were enrolled. All 48 patients had normal free-T (3) and free-T (4) levels. While 41 patients (85.4%) showed normal TSH, in 7 subjects (14.6%) TSH was elevated and a significant (p < 0.001) difference was recorded between the two groups in mean TSH value. Positive T-Ab value was found in 5 patients (10.4%) and the remaining 43 patients (89.6%) had negative T-Ab. TSH was not significantly correlated with age, thyroid volume or BMI. The multivariate model showed that only BMI was significantly correlated to thyroid volume (p < 0.01, r(2)=0.31). These results showed that normal thyroid recorded by US matches with normal thyroid laboratory assessment to a large degree. These preliminary data need to be confirmed in a prospective study and in a larger series and should suggest the evaluation of thyrotropin and thyroid antibodies in subjects with normal thyroid gland as assessed by US.
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Affiliation(s)
- P Trimboli
- Section of Endocrinology and Diabetology, Ospedale Israelitico, Rome, Italy.
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Bellagamba R, Nigri G, Aurello P, D'Angelo F, Valabrega S, Ramacciato G. Comparison between transperitoneal and retroperitoneal minimal invasive adrenalectomy in 189 cases. BMC Geriatr 2009. [PMCID: PMC4291059 DOI: 10.1186/1471-2318-9-s1-a88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Nigri G, Costa G, Valabrega S, Aurello P, D'Angelo F, Bellagamba R, Lauro A, Ramacciato G. [A rare presentation of Amyand's hernia. Case report and review of the literature]. MINERVA CHIR 2008; 63:169-174. [PMID: 18427448] [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: 05/26/2023]
Abstract
Amyand's hernia is defined as an inguinal hernia within the hernial sac containing the appendix. It is a rare disease, reported in 1% of cases of inguinal hernia repair. The appendix can be complicated by acute appendicitis in 0.13% of cases. This disease is often very difficult to diagnose, and most of the time it can be confused with an incarcerated or strangulated inguinal hernia. Often, it requires an emergent surgical treatment. This article describes the case of a 82-year-old female who was admitted for an intestinal obstruction and a bulge in the right inguinal region. An abdominal computed tomography scan showed dilated small bowel loops with multiple air/liquid levels and one loop herniating into the right inguinal canal. The patient underwent a laparotomy that showed the presence of an acute appendicitis and a necrotized ileal loop protruding into the right inguinal canal. The patient underwent an appendectomy and small bowel resection and she was discharged on postoperative day 10. Amyand's hernia can be a challenge for the surgeon. Its treatment depends on the grade of inflammation of the appendix. In fact, it can range from the simple repair of the abdominal defect with a prosthetic mesh, to appendectomy, small bowel resection and repair of the abdominal wall defect without a mesh.
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Affiliation(s)
- G Nigri
- Divisione di Chirurgia Generale, II Facoltà di Medicina e Chirurgia, Policlinico Sant'Andrea , Università di Roma La Sapienza II, Roma.
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15
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Aurello P, Cicchini C, De Angelis R, D'Angelo F, Ramacciatos G, Valabrega S, Indinnimeo M. Synchronous and metachronous retroperitoneal sarcomas: two case reports. Anticancer Res 2002; 22:2409-12. [PMID: 12174935] [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 Retroperitoneal sarcomas represent less than 1% of all diagnosed human neoplasias. They are generally malignant and can infiltrate retroperitoneal structures. The value of chemotherapy and radiotherapy are difficult to evaluate and the dominating factor in the outcome is the ability to resect the tumor. A few patients develop distant metastases. Recurrence of sarcoma at the operative site and on peritoneal surfaces is a prominent cause of morbidity and mortality. CASE REPORTS Here we report two patients who underwent surgery for retroperitoneal sarcoma. In each of them at least two primary retroperitoneal tumors were diagnosed. The neoplasms were histologically different, thus they cannot be considered local recurrence but rather primary tumors. CONCLUSION This is the first report underlying the synchronous or metachronous presence of different histological subtypes in this neoplastic pathology. In explanation of the occurrence of satellite tumors and multiple primary tumors, a virus-associated etiology or polyclonality of the tumor or pluripotentiality of tumor stem cells should be considered.
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Affiliation(s)
- P Aurello
- Department of Surgery Pietro Valdoni, School of Medicine, University of Rome La Sapienza, Italy.
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Bolognese A, Barbarosos A, Muttillo IA, Valabrega S, Bocchetti T. [Echinococcus cyst of the pancreas: description of a case and review of the literature]. G Chir 2000; 21:389-93. [PMID: 11126737] [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: 02/18/2023]
Abstract
The echinococcosis represents a common condition in many parts of the world with maximum incidence in Uruguay (32 cases/100,000/year), in Argentina (21 cases/100,000/year), and in Morocco (7.2 cases/100,000/year). Italy is among the middle-high risk countries with beyond 1000 annual surgeries for hydatid cyst. Liver (45-75%) and lung (10-50%) are the most frequent localizations of echinococcosis. The other localizations represents the 13% of total. The hydatid cyst of pancreas constitutes the 1%. The Authors report the clinical case of a 28 years old woman, admitted for abdominal pain. Abdominal ultrasound, angio-CT and angiography of celiac trunk and superior mesenteric artery have been undertaken and the presence of a 10 x 10 cm lesion in the body-tail of pancreas has been showed, and the diagnosis of pseudocyst or cystadeno-carcinoma of pancreas has been formulated. The patient underwent surgery with body-tail pancreatectomy plus splenectomy. The histopathological examination showed the presence of hydatid cyst contained clear fluid and daughter cysts. The treatment of this infrequent localization of hydatid cyst is exclusively surgical. The tactic and surgical technique must aim to radical cyst's removal, with the maximum saving of the stricken organ, maintaining a good pancreatic function, either exocrine and endocrine.
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Affiliation(s)
- A Bolognese
- Dipartimento di Chirurgia Pietro Valdoni, Università degli Studi La Sapienza di Roma, Azienda Policlinico Umberto I
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Abstract
BACKGROUND AND OBJECTIVES The aim of our study was to retrospectively evaluate the results of 2 groups of patients admitted and treated for rectal cancer. METHODS One hundred and fifty-one patients were available for evaluation. Eighty (group A) were radically operated with the standard technique; 71 (group B) underwent total mesorectal excision (TME). Groups were similar according to demographics, staging, and pathological data. Mean follow-up was 73.5 months. RESULTS No operative mortality was observed. Complications were 15% in group A and 32% in group B. Local recurrence rates were 41.2% in group A and 12.6% in group B. Distant metastases occurred in 21.2% and 7.6%, respectively, in groups A and B. Cancer-related mortality was 62.5% in the non-TME group and 19.5% in the TME group. Overall 5-year survival rates were 32.4% in group A and 70.5% in group B. Disease-free survival rates were 25% in group A and 62.3% in group B. CONCLUSIONS TME appears to lower the incidence of cancer-related mortality, with a higher incidence of postoperative complications. Further studies need to be done to assess the real benefits of TME in the surgical treatment of rectal cancer.
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Affiliation(s)
- A Bolognese
- Department of Surgery "Pietro Valdoni" C.I.M.S., Policlinico Umberto I, University of Rome "La Sapienza," Rome, Italy.
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Bolognese A, Cardi M, Muttillo IA, Barbarosos A, Bocchetti T, Valabrega S. Total mesorectal excision for surgical treatment of rectal cancer. J Surg Oncol 2000. [PMID: 10861603 DOI: 10.1002/1096-9098(200005)74:] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES The aim of our study was to retrospectively evaluate the results of 2 groups of patients admitted and treated for rectal cancer. METHODS One hundred and fifty-one patients were available for evaluation. Eighty (group A) were radically operated with the standard technique; 71 (group B) underwent total mesorectal excision (TME). Groups were similar according to demographics, staging, and pathological data. Mean follow-up was 73.5 months. RESULTS No operative mortality was observed. Complications were 15% in group A and 32% in group B. Local recurrence rates were 41.2% in group A and 12.6% in group B. Distant metastases occurred in 21.2% and 7.6%, respectively, in groups A and B. Cancer-related mortality was 62.5% in the non-TME group and 19.5% in the TME group. Overall 5-year survival rates were 32.4% in group A and 70.5% in group B. Disease-free survival rates were 25% in group A and 62.3% in group B. CONCLUSIONS TME appears to lower the incidence of cancer-related mortality, with a higher incidence of postoperative complications. Further studies need to be done to assess the real benefits of TME in the surgical treatment of rectal cancer.
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Affiliation(s)
- A Bolognese
- Department of Surgery "Pietro Valdoni" C.I.M.S., Policlinico Umberto I, University of Rome "La Sapienza," Rome, Italy.
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Abstract
BACKGROUND AND OBJECTIVES The aim of our study was to retrospectively evaluate the results of 2 groups of patients admitted and treated for rectal cancer. METHODS One hundred and fifty-one patients were available for evaluation. Eighty (group A) were radically operated with the standard technique; 71 (group B) underwent total mesorectal excision (TME). Groups were similar according to demographics, staging, and pathological data. Mean follow-up was 73.5 months. RESULTS No operative mortality was observed. Complications were 15% in group A and 32% in group B. Local recurrence rates were 41.2% in group A and 12.6% in group B. Distant metastases occurred in 21.2% and 7.6%, respectively, in groups A and B. Cancer-related mortality was 62.5% in the non-TME group and 19.5% in the TME group. Overall 5-year survival rates were 32.4% in group A and 70.5% in group B. Disease-free survival rates were 25% in group A and 62.3% in group B. CONCLUSIONS TME appears to lower the incidence of cancer-related mortality, with a higher incidence of postoperative complications. Further studies need to be done to assess the real benefits of TME in the surgical treatment of rectal cancer.
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Affiliation(s)
- A Bolognese
- Department of Surgery "Pietro Valdoni" C.I.M.S., Policlinico Umberto I, University of Rome "La Sapienza," Rome, Italy.
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Ramacciato G, Aurello P, D'Angelo F, Broglia S, Valabrega S, Caramitti A, Fornasari V. [Use of vascular endostapler in surgery of the lower rectum]. MINERVA CHIR 1999; 54:899-903. [PMID: 10736996] [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: 02/15/2023]
Abstract
A practical and effective method for rapid and bloodless preparation of the rectum using endovascular stapler devices during low anterior resection, or abdominal-perineal excision, is described. This method is presented as an effective means for easily dividing the anterior and lateral attachment of the rectum. The application of this technique is the absence of intraoperative bleeding related to injury of middle hemorrhoidal vessels, with minimal risk of autonomic pelvic nerve damage. An additional factor relevant in the choice of this technique, is the easier possibility to perform rectal dissection of an oncologically adequate tumor clearance from the margin of rectal tumor and with complete radical transection of the lateral ligaments fastly proceeding with the downward mobilization of the rectum close to the pelvic side walls, between the parietal and visceral layer of the pelvic fascia.
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Affiliation(s)
- G Ramacciato
- Istituto di I Clinica Chirurgica, Università degli Studi di Roma La Sapienza
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21
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Barillari P, Aurello P, De Angelis R, Valabrega S, Ramacciato G, D'Angelo F, Fegiz G. Management and survival of patients affected with obstructive colorectal cancer. Int Surg 1992; 77:251-5. [PMID: 1335999] [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: 12/26/2022] Open
Abstract
Between 1978 and 1984 a consecutive series of 571 patients with colorectal cancer were admitted to the First Department of Surgery of the University of Rome. Patients were divided into a group of 82 patients affected with obstructive cancer and a control group of 489 patients with non-obstructive tumors. In the obstructed group there was a significantly higher incidence of lesions localized in the left colon. Depending on the advancement of lesions a significantly higher incidence of Dukes D tumor, nodal involvement, hepatic metastases and peritoneal dissemination and a significantly lower incidence of Dukes A tumors, were found in the obstructed patients. No significant differences were found in the two groups according to age distribution, duration of symptoms and degree of differentiation of neoplasms. The mortality and morbidity rate were 9.7% and 12.2% respectively in the obstructed patients, and 3.5% and 8.3% respectively in the non-obstructed patients. The rate of complications was greater in the two groups when serum albumin values were under 3 g/l, being 40% vs. 3.3 and 20% vs. 5.2% in obstructed and nonobstructed groups respectively. When Hb levels were under 10 g/l the incidence of complications was 16.7% and 14.4% for the two groups, while when it was higher than 10 mg% the morbidity rate was 8.7% and 6.3% in obstructed and non-obstructed patients respectively. The execution of surgical treatment within 24 hours was related to a morbidity and mortality rate of 50% and 22.2% in obstructed patients, and 40% and 20% in the non-obstructed group.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- P Barillari
- Department of Surgery, University of Rome La Sapienza, Italy
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22
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Aurello P, D'Angelo F, Pozzi G, Barillari P, Brozzetti S, Truglia S, Valabrega S, Fegiz G. [Therapy of massive anastomotic hemorrhage after anterior mechanical rectocolonic resection]. G Chir 1991; 12:164-5. [PMID: 1873157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- P Aurello
- Istituto di I Clinica Chirurgica, Università degli Studi La Sapienza, Roma
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23
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Fegiz G, Ramacciato G, D'Angelo F, Barillari P, Indinnimeo M, Gozzo P, Aurello P, Valabrega S, De Angelis R. Patient selection and factors affecting results following resection for hepatic metastases from colorectal carcinoma. Int Surg 1991; 76:58-63. [PMID: 2045254] [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: 12/30/2022] Open
Abstract
Personal experience is reported of 47 consecutive liver resections for metastatic colorectal carcinoma treated in the I Clinica Chirurgica of the University of Rome for the purpose of contributing to treatment and evaluating the clinical factors and possible determinants of prognosis that could be potentially predictive of outcome and length of survival after liver resection: Duke's stage of primary colorectal cancer, synchronous or metachronous disease, number of hepatic lesions. Patients were classified according to the proposed staging system of the "Istituto Nazionale Tumori" in Milan. For Stage I and II patients the median survival time was 15 months, while in Stage III patients survival time was reduced to only 4.5 months. The 3- and 5-year survival rate was 20% and 12% respectively for Stage I patients; no patients at stage II or III survived more than 3 years.
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Affiliation(s)
- G Fegiz
- Istituto di I Clinica Chirurgica Università degli Studi di Roma La Sapienza
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24
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Barillari P, Ramacciato G, De Angelis R, Gozzo P, Indinnimeo M, Valabrega S, Aurello P, Fegiz G. Effect of preoperative colonoscopy on the incidence of synchronous and metachronous neoplasms. Acta Chir Scand 1990; 156:163-6. [PMID: 2330795] [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: 12/31/2022]
Abstract
Colonoscopy and air-contrast barium enema performed preoperatively in 389 patients with colorectal cancer revealed synchronous cancer in 4% and polyp in 14%. Nine of the 16 synchronous cancers were located in other surgical segments than the index cancer, and six of the nine were in stage A or B1. Of the 54 synchronous polyps, 28 were located in such other segments. Half of the synchronous cancers and almost half of the synchronous polyps were missed at double-contrast barium enema. All synchronous cancers and three-fourths of the synchronous polyps were detected at colonoscopy. No patient with preoperative colonoscopy presented with metachronous cancer within 3 years from surgery, and only two were subsequently found to have adenocarcinoma arising from an adenomatous polyp. Endoscopic polypectomy was performed in 21 cases during follow-up. Extensive use of preoperative colonoscopy is recommended in the evaluation of colorectal cancer, in order to promote detection of synchronous tumors, reduce the incidence of 'early metachronous' cancer and avoid malignant degeneration of adenomatous polyp.
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Affiliation(s)
- P Barillari
- First Department of Surgery, University of Rome, Italy
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25
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Barillari P, Ramacciato G, de Angelis R, Gozzo P, Aurello P, Indinnimeo M, Valabrega S, D'Angelo F, Fegiz G. The role of CEA, TPA and CA 19-9 in the early detection of recurrent colorectal cancer. Int J Colorectal Dis 1989; 4:230-3. [PMID: 2693562 DOI: 10.1007/bf01644987] [Citation(s) in RCA: 10] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Eighty-eight consecutive patients who underwent curative resection for colorectal cancer between 1983 and 1985 were studied prospectively to evaluate the roles of sequential CEA, TPA and CA 19-9 determinations and independent clinical examination in the early diagnosis of resectable recurrences. Twenty nine recurrences were detected between 8 and 38 months after primary surgery. CEA, TPA and CA 19-9 showed a sensitivity of 72%, 62% and 38%, and a specificity of 78%, 86% and 97%, respectively. Of eight recurrences in which CEA was not raised, five induced a rise in TPA and two a rise in CA 19-9. The rise in the serum concentration of one of the three markers was the first sign of relapse in 23 (79%) patients. Two second-look laparotomies based solely on a rise in serum markers were performed. In one case diffuse recurrent disease was found, and in the other a resectable solitary hepatic metastasis was found.
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Affiliation(s)
- P Barillari
- 1st Surgical Clinic, University of Rome La Sapienza, Italy
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26
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Barillari P, de Angelis R, Valabrega S, Indinnimeo M, Gozzo P, Ramacciato G, Fegiz G. Relationship of symptom duration and survival in patients with colorectal carcinoma. Eur J Surg Oncol 1989; 15:441-5. [PMID: 2551743] [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: 01/01/2023]
Abstract
An early diagnosis in asymptomatic patients and a prompt treatment lead to an improved survival rate in patients with carcinoma of the colon. Patients with a short symptomatic history of colon cancer do not have a better prognosis than patients with a long history. Between 1978 and 1984 a consecutive series of 571 patients with colorectal cancer were admitted to the First Department of Surgery of the University of Rome. All patients were classified into five groups according to the duration of specific intestinal symptoms. In Group 1 (51 cases) asymptomatic patients were included, or patients with no specific symptoms such as asthenia, anemia, occult fecal blood. In Group 2 there were 129 patients with intestinal symptoms of less than 3 months' duration before treatment. In Group 3 there were 192 patients with symptoms of between 4 and 6 months' duration; 151 patients with symptoms of between 6 and 12 months were included in Group 4, and finally 48 patients who presented with symptoms of more than 1 year were included in Group 5. No relationship was noted between tumor site and duration of symptoms. Similarly, no relationship was noted between the duration of intestinal symptoms and stage and tumor differentiation. On the other hand, asymptomatic patients showed a higher incidence of T1N0M0 stage tumor and a lower percentage of undifferentiated neoplasms. The resectability rate was 79% and it was significantly related to the absence of intestinal symptoms. Follow-up data were available in 454 patients (80%). The overall survival rate was 52.4%. In Group 1 through Group 5 the 5-year survival rate was: 83.7%, 50%, 50%, 46.3%, 46.9%. The results of our study indicate that patients admitted in asymptomatic phase presented less-advanced stage tumors and, thus, best survival rate. On the other hand, from our data the duration of intestinal symptoms is not related to the stage and prognosis of tumors.
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Affiliation(s)
- P Barillari
- First Department of Surgery, University of Rome La Sapienza, Italy
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27
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Barillari P, Ramacciato G, Valabrega S, Gozzo P, Indinnimeo M, De Angelis R, Fegiz G. Colorectal cancer in young patients. Int Surg 1989; 74:240-3. [PMID: 2560472] [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: 01/01/2023] Open
Abstract
Colorectal cancer is rare in patients under 40 years of age. We reviewed all colorectal cancer patients treated at the First Department of Surgery of the University of Rome, to determine the true incidence of large bowel cancer in young patients. During the period 1978-1984 a total of 571 patients were indexed. Out of these 44 were 39 years of age or less. A group of 527 patients 40 years of age or over served as a control. Neoplasms were localized in the right colon in 19 cases and in the left colon in 25 patients, in the young group. In the control group 178 patients presented neoplasms localized in the right colon, while 349 presented tumors localized in the left colon. According to tumor advancement in the young group tumor classification from A stage tumor through D stage was: 4, 6, 14, 5, 9, 6. In the control group 22 patients presented A stage tumors, 106 B1, 139 B2, 50 C1, 118 C2, 92 D tumors. The operability rate was 93.2% in the young group, and 92% in the old one. The operative mortality rate was 0% in the young group, and 2.5% in the old one. Four complications occurred in the young patients, and 57 in the old patients. The five years survival rate was 56.7% and 52.1% in young and old patients respectively. The results of our study indicate that there are no significant differences in prognosis and five years survival in young patients with colorectal cancer.
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Affiliation(s)
- P Barillari
- First Department of Surgery, University of Rome La Sapienza, Italy
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28
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Fegiz G, Barillari P, Ramacciato G, De Angelis R, Gozzo P, Indinnimeo M, Valabrega S. Right colon cancer: long-term results after curative surgery and prognostic significance of duration of symptoms. J Surg Oncol 1989; 41:250-5. [PMID: 2755143 DOI: 10.1002/jso.2930410412] [Citation(s) in RCA: 9] [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: 01/02/2023]
Abstract
Between 1976 and 1986, a consecutive series of 195 patients with right colon cancer were admitted at the First Department of Surgery of the University of Rome. Patients were divided into five groups according to the absence of intestinal symptoms (group 1) and the duration of the symptomatic phase (groups 2-5). Analysis of the preoperative investigation showed that colonoscopy was able to identify 33 (26.2%) of tumors misdiagnosed by double contrast X-ray barium enema. We did not notice any correlation among symptom duration and tumor stage, tumor differentiation, operability rate, and survival. Patients admitted in the asymptomatic phase presented tumors of less advanced stage and, thus, had the best survival rate (71.4%). In this group, patients promptly treated had a better survival rate (87.5%) than those treated after 2 months (50%). Our study suggests that only neoplasms diagnosed in asymptomatic patients and treated promptly are related to a good survival rate. We, therefore, emphasize the importance of education of patients and family physicians about right colon cancer and the necessity to investigate all patients with a suspected right colon cancer by means of colonoscopy.
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Affiliation(s)
- G Fegiz
- First Department of Surgery, University of Rome La Sapienza, Italy
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29
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Antonaci AR, Indinnimeo M, Valabrega S, Assenza M, Vedda G, Cicero AM, Maida M. [Physiopathology of gastric and biliary reconstruction: evaluation of several entero-hormones]. MINERVA CHIR 1989; 44:547-50. [PMID: 2654726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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30
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Barillari P, Aurello P, D'Angelo F, Gozzo P, Indinnimeo M, Valabrega S, Ramacciato G, De Angelis R, Pozzi G. Congenital choledochal cysts: our experience. G Chir 1988; 9:883-6. [PMID: 3152901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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31
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Fegiz G, Antonaci A, Assenza M, Indinnimeo M, Valabrega S, Consoli C, Menichelli F. [Cancer of the stomach: indications and limits of reductive and palliative surgery]. G Chir 1988; 9:565-72. [PMID: 2484647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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32
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De Angelis R, Barillari P, Indinnimeo M, Ramacciato G, Valabrega S, D'Angelo F, Di Lorenzo N, Gozzo P. [Role of preoperative biliary decompression in prolonged obstructive neoplastic jaundice]. G Chir 1988; 9:114-5. [PMID: 3153969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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33
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Fegiz G, Ramacciato G, Barillari P, De Angelis R, Gozzo P, Indinnimeo M, Valabrega S. Surgical treatment of metachronous colorectal cancers. Int Surg 1988; 73:16-8. [PMID: 3360571] [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: 01/05/2023] Open
Abstract
Thirty-four patients with metachronous colorectal cancer who underwent surgical procedures at the First and Fourth Department of Surgery of the University of Rome were reviewed. 55.9% of the patients developed a second carcinoma within five years after the first operation, and the time interval for the entire group ranged from 13 to 228 months. Adenomatous polyps occurred in 14 patients. Two patients developed a third metachronous cancer. We followed up eight patients using colonoscopy regularly. In this group we found two early cancers, five submucosal cancers and only one advanced tumor. In the other group we found 16 advanced cancers and ten submucosal cancer. The curability rate at second operation was 88.2%, and at the third 50%. The management of metachronous tumors should imply total colonoscopy, at a mean interval of 12-18 months.
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Affiliation(s)
- G Fegiz
- First Department of Surgery, University of Rome, Italy
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34
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Fegiz G, Bezzi M, Valabrega S, Ramacciato G, Urbano V, Marchionni M, Tucci G, Angelini L. [Very low mechanical ileo-rectal anastomosis with an ileal reservoir in the surgical treatment of ulcerative rectocolitis and diffuse polyposis of the large intestine]. MINERVA CHIR 1986; 41:453-8. [PMID: 3725074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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35
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Lirici MM, Indinnimeo M, D'Angelo F, Ragusa M, Valabrega S, Antonaci A. [Comparative evaluation of the results of the surgical therapy of cancer of the gastric stump and of primary carcinoma of the stomach]. MINERVA CHIR 1985; 40:1219-24. [PMID: 4080197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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36
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Antonaci AR, Maceratini R, Indinnimeo M, Valabrega S. [Current trends in the surgical therapy of carcinomas of the cardia]. MINERVA CHIR 1982; 37:347-51. [PMID: 7088329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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37
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Antonaci AR, Valabrega S, Ramacciato G, De Angelis R, Ciulli A. [Evaluation of the operative risk in transduodenal papillostomy]. MINERVA CHIR 1982; 37:441-3. [PMID: 7088343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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38
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Antonaci AR, Indinnimeo M, Maceratini R, Valabrega S. [Criteria of surgical treatment of malignant neoplasms of the gastric antrum]. MINERVA CHIR 1982; 37:391-2. [PMID: 7088334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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39
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Antonaci AR, Valabrega S, Ramacciato G, De Angelis R, Ciulli A. [Criteria for surgery of lithiasis of the common bile duct]. MINERVA CHIR 1982; 37:415-20. [PMID: 7088340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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40
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Bezzi M, Tucci G, De Angelis R, Ciulli A, Ramacciato G, Valabrega S, Angelini L. [Experience and results in low colo-rectal mechanical anastomosis in surgery of cancer of the rectum]. MINERVA CHIR 1982; 37:363-6. [PMID: 7045726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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