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Colonoscopic evaluation of hematochezia in low and average risk patients for colorectal cancer:A prospective study

World Journal of Gastroenterology 2006年第45期12卷 7304-7308页

作者： Puglisi Carlo Russo Francesco Paolo Barbera Carmelo Incarbone Salvatore aprile giuseppe Bonanno Giacomo Russo Antonio Cattedra di Gastroenterologia Università di Catania Azienda Ospedaliero Universitaria Policlinico-Catania Italy

AIM: To relate the endoscopic findings in patients with hematochezia with regard to age in “low and average risk” for colorectal cancer (CRC) and to localize signifi cant lesions in order to identify patients who need sigmoidoscopy or total colonoscopy. METHODS: This prospective study was performed in an open access GI endoscopy unit. Out of 4322 consecutive patients undergoing colonoscopy, 918 reported hema- tochezia. The fi nal study group comprized 180 patients aged below 45 and 237 over 45. Main exclusion criteria were a 1st-degree family history of colorectal carcinoma, patients reporting blood mixed with stools and/or pro- gressive colonic symptoms, or patients who had under- gone colon surgery for neoplastic lesions. RESULTS: Total colonoscopy could be performed in 96% of patients. Abnormal findings were observed in 34.3% of the younger and in 65.7% of the older ones. Findings were the presence of polyps in the distal colon (n = 2) and IBD in the proximal colon (n = 29) in the group of the younger patients, and polyps (n = 15), IBD (n = 13), and carcinoma (n = 6, 4 of the lesions were located proximal to the splenic flexure) in the elderly. Our f indings suggest that the diagnostic potential of total colonoscopy in patients younger than 45 referring scant hematochezia, is not mandatory. By exploring only the distal tract of the colon we have misdiagnosed two cases of IBD located in the ascending colon. In this group of patients additional risk factors must be identifi ed before performing a total colonoscopy. Regarding the patients older than 45 yr, the exploration of the distal colon would have led to our overlooking a carcinoma, two neoplastic polyps and one IBD located in the proximal colon. CONCLUSION: Young patients with scant hematochezia but without risk factors for neoplasia do not need a totalcolonoscopy, whereas is mandatory performing a total colonoscopy in older patients even in the presence of anal pathology.

关键词：直肠癌结肠过敏结肠镜检查便血

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World Journal of Gastroenterology 2015年第41期21卷 11793-11803页

作者： giuseppe aprile Karim Rihawi Elisa De Carlo Stephen T Sonis Department of Medical Oncology University and General Hospital of Udine Divisions of Oral Medicine Brigham and Women’s Hospital Boston the Dana-Farber Cancer Institute BiomodelsLLCWatertown

Gastrointestinal toxicities(GIT), including oral mucositis,nausea and vomiting, and diarrhea, are common side effects of chemotherapy and targeted agents in patients with advanced colorectal cancer and pancreatic cancer. Being often underreported, it is still difficult to precisely establish their burden in terms of both patient's quality of life and cancer care costs. Moreover, with the use of more intensive upfront combination regimens, the frequency of these toxicities is rapidly growing with a potential negative effect also on patient's outcome, as a result of dose reductions, delays or even discontinuation of active treatments. Thus, identifying patients at higher risk of developing GIT as well as an optimal management are paramount in order to improve patient's compliance and outcome. After the description of the main treatment-induced GIT, we discuss the current knowledge on the pathophysiology of these side effects and comment the scales commonly used to assess and grade them. We then provide a critical update on GIT incidence based on the results of key randomized trials conducted in patients with metastatic colorectal cancer and advanced pancreatic cancer.

关键词： Gastrointestinal toxicities Oral mucositis Diarrhe

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Rare cause of odynophagia: Giant esophageal ulcer

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World Journal of Gastroenterology 2016年第14期22卷 3875-3878页

作者： Massimiliano Veroux giuseppe aprile Francesca F Amore Daniela Corona Alessia Giaquinta Pierfrancesco Veroux the Vascular Surgery and Organ Transplant Unit Department of Medical and Surgical Sciences and Advanced Technologies University Hospital of Catania 95123 Catania Italy Endoscopy Unit Department of Surgical Specialties University Hospital of Catania 95123 Catania Italy Pathology Unit Department of Medical and Surgical Sciences and Advanced Technologies University Hospital of Catania 95123 Catania Italy

Gastrointestinal complications are a frequent cause of morbidity after transplantation and may affect up to 40% of kidney transplant recipients. Here we report a rare case of idiopathic giant esophageal ulcer in a kidney transplant recipient. A 37-year-old female presented with a one-week history of odynophagia and weight loss. Upon admission, the patient presented cold sores, and a quantitative cytomegalovirus polymerase chain reaction was positive(105 copies/ml). An upper endoscopy demonstrated the presence of a giant ulcer. Serological test and tissue biopsies were unable to demonstrate an infectious origin of the ulcer. Immunosuppression was reduced and everolimus was introduced. An empirical i.v. therapy with acyclovir was started, resulting in a dramatic improvement in symptoms and complete healing of the ulcer. Only two cases of idiopathic giant esophageal ulcer in kidney transplant recipients have been reported in the literature; in both cases, steroid therapy was successful without recurrence of symptoms or endoscopic findings. However, this report suggests that correction of immune imbalance is mandatory to treat such a rare complication.

关键词： Acyclovir Gastrointestinal complications Kidney transplantation Endoscopy Steroid Idiopathic

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Molecular classifications of gastric cancers: Novel insights and possible future applications

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World Journal of Gastrointestinal Oncology 2017年第5期9卷 194-208页

作者： Silvio Ken Garattini Debora Basile Monica Cattaneo Valentina Fanotto Elena Ongaro Marta Bonotto Francesca V Negri Rosa Berenato Paola Ermacora Giovanni Gerardo Cardellino Mariella Giovannoni Nicoletta Pella Mario Scartozzi Lorenzo Antonuzzo Nicola Silvestris Gianpiero Fasola giuseppe aprile Department of Oncology University and General Hospital Medical Oncology University Hospital Medical Oncology National Cancer InstituteIRCCS Department of Oncology University Hospital

Despite some notable advances in the systemic management of gastric cancer(GC), the prognosis of patients with advanced disease remains overall poor and their chance of cure is anecdotic. In a molecularly selected population, a median overall survival of 13.8 mo has been reached with the use of human epidermal growth factor 2(HER2) inhibitors in combination with chemotherapy, which has soon after become the standard of care for patients with HER2-overexpressing GC. Moreover, oncologists have recognized the clinical utility of conceiving cancers as a collection of different molecularlydriven entities rather than a single disease. Several molecular drivers have been identified as having crucial roles in other tumors and new molecular classifications have been recently proposed for gastric cancer as well. Not only these classifications allow the identification of different tumor subtypes with unique features, but also they serve as springboard for the development of different therapeutic strategies. Hopefully, the application of standard systemic chemotherapy, specifictargeted agents, immunotherapy or even surgery in specific cancer subgroups will help maximizing treatment outcomes and will avoid treating patients with minimal chance to respond, therefore diluting the average benefit. In this review, we aim at elucidating the aspects of GC molecular subtypes, and the possible future applications of such molecular analyses.

关键词：分子的生物学免疫疗法胃的癌症分类指向的治疗

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Evidence-based appraisal of the upfront treatment for unresectable metastatic colorectal cancer patients

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World Journal of Gastroenterology 2013年第46期19卷 8474-8488页

作者： giuseppe aprile Stefania Eufemia Lutrino Laura Ferrari Mariaelena Casagrande Marta Bonotto Elena Ongaro Fabio Puglisi Department of Oncology University and General Hospital Department of Medical and Biological Sciences University of Udine

Colorectal cancer(CRC)is a significant health problem,with around 1 million new cases and 500000 deaths every year worldwide.Over the last two decades,the use of novel therapies and more complex treatment strategies have contributed to progressively increase the median survival of patients with unresectable advanced CRC up to approximately 30 mo.The availability of additional therapeutic options,however,has created new challenges and generated more complicated treatment algorithms.Moreover,several clinically important points are still in debate in first-line,such as the optimal treatment intensity,the most appropriate maintenance strategy,the preferred biologic to be used upfront in patients with KRAS wild-type CRC,and the need for more detailed information on tumor biology.In this moving landscape,this review analyses why the firstline treatment decision is crucial and how the choicemay impact on further treatment lines.In addition,it focuses on results of major phaseⅢrandomized trials.

关键词： Colorectal cancer Chemotherapy Ang-iogenic inhibitors Epidermal growth factor receptor inhibitors Maintenance First-line

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Prevalence of celiac disease in adult patients with refractory functional dyspepsia:Value of routine duodenal biopsy

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World Journal of Gastroenterology 2008年第45期14卷 6948-6953页

作者： Emiliano Giangreco Cinzia D'agate Carmelo Barbera Lidia Puzzo giuseppe aprile Pietro Naso Giacomo Bonanno Alessandra Nicoletti Salvatore Incarbone giuseppe Trama Antonio Russo Francesco Paolo Russo Department of Surgery Gastroenterology and Endoscopy Unit University of Catania Department of Surgical and Gastro-enterological Sciences Gastroenterology Section University of Padova

AIM: To investigate the prevalence of celiac disease (CD) in adult patients referred to an open access gas-troenterology clinic in the south of Italy and submitted to esophago-gastro-duodenoscopy (EGD) for evaluation of refractory functional dyspepsia.METHODS: Seven hundred and twenty six consecutive dyspeptic patients (282 male, 444 female; mean age 39.6 years, range 18-75 years) with unexplained prolonged dyspepsia were prospectively enrolled. Duo-denal biopsies were taken and processed by standard staining. Histological evaluation was carried out according to the Marsh-Oberhuber criteria.RESULTS: The endoscopic findings were: normal in 61.2%, peptic lesions in 20.5%, malignancies in 0.5%, miscellaneous in 16.7%. CD was endoscopically diagnosed in 8 patients (1.1%), histologically in 15 patients (2%). The endoscopic features alone showed a sensitivity of 34.8% and specificity of 100%, with a positive predictive value (PPV) of 100% and a negative predictive value (NPP) of 97.9%.CONCLUSION: This prospective study showed that CD has a high prevalence (1:48) in adult dyspeptic patients and suggests the routine use of duodenal biopsy in this type of patient undergoing EGD.

关键词：内窥镜检查法胃病胃消化不良治疗诊断

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