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Robotic choledochoduodenostomy for complicated common bile duct stones-a video vignette

Hepatobiliary & Pancreatic Diseases International 2021年第3期20卷 296-297页

作者： francesco guerra Filippo Petrelli Alberto Patriti Division of Surgery-Ospedali Riuniti Marche Nord Piazzale Cinelli 361121 PesaroItaly

Despite that endoscopic retrograde cholangiopancreatography(ERCP) has become the gold standard in the treatment of benign biliary obstruction, bilioenteric anastomosis still represents a valid option to treat the increasing number of patients with recalcitrant obstruction, and/or altered anatomy after digestive surgery [1,2]. Minimally invasive techniques have become the standard of care for the surgery of the biliary tract in specialized centers [2,3].

关键词： anatomy obstruction surgery

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Clinical outcomes of ERCP-related retroperitoneal perforations

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Hepatobiliary & Pancreatic Diseases International 2017年第2期16卷 160-163页

作者： francesco guerra Giuseppe Giuliani Diego Coletta Stefano Amore Bonapasta Giovanni Battista Levi Sandri Department of Surgery Umberto I University Hospital Rome Italy

Endoscopic retrograde cholangiopancreatography（ERCP）-related perforations represent rare but often severe conditions. While lesions with intraperitoneal perforation have an almost imperative indication to surgery, whether or not to manage retroperitoneal perforations surgically is still an area of debate. The aim of the present work was to review the available clinical evidence on the operatively and medi cally treated ERCP-related retroperitoneal perforations. From MEDLINE/Pub Med databases 137 patients with retroperito neal perforation were included from 12 studies that met the selection criteria for data investigation and analysis. Twenty four patients were treated by prompt surgery; 113 were primarily managed conservatively and about 20% of these patients required surgery subsequently. Overall, the morbid ity and mortality were 15.4% and 6.6%, respectively. Although most patients with retroperitoneal perforation may benefit from a non-operative management, a considerable number of patients fail to respond to medical treatment and require sur gery afterwards. Identifying those patients who are at highest risk of poor outcome after conservative treatment should be considered a research priority.

关键词： endoscopic retrograde cholangiopancreatography complications retroperitoneum

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Pancreaticoduodenectomy in elderly patients:a special place for minimally invasive surgery?

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Hepatobiliary & Pancreatic Diseases International 2016年第6期15卷 665-665页

作者： francesco guerra lapo bencini giovanni battista levi sandri division of oncological and robotic general surgery careggi university hospital FlorenceItaly division of general surgery and liver transplantation san camillo hospitalRomeItaly

To the Editor： We read with keen interest the recent paper by El Nakeeb et al, and the subsequent editorial published by Dudeja and Livingstone. Globally, the authors have correctly and timely portrayed the current r... 详细信息

关键词： Pancreaticoduodenectomy in elderly patients

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Immune response activation following hyperthermic intraperitoneal chemotherapy for peritoneal metastases:A pilot study

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World Journal of Clinical Oncology 2020年第6期11卷 397-404页

作者： Giammaria Fiorentini Donatella Sarti Alberto Patriti Emilio Eugeni francesco guerra francesco Masedu Andrew Reay Mackay Stefano Guadagni Department of Onco-Hematology Azienda Ospedaliera“Ospedali Riuniti Marche Nord”Pesaro 61122Italy Department of General Surgery Azienda Ospedaliera“Ospedali Riuniti Marche Nord”Pesaro 61122Italy Department of Applied Clinical Sciences and Biotechnology University of L’AquilaL’Aquila 67100Italy

BACKGROUND Hyperthermic intraperitoneal chemotherapy(HIPEC)for peritoneal metastases(PM)is considered to be feasible,safe and to improve survival.AIM To investigate whether an immune response is activated following HIPEC for PM.METHODS Six patients were enrolled in this study.Peripheral blood samples were obtained from each patient prior to(day 0)and post-procedure(day 30),and used to evaluate the number of CD3+total,CD3+/CD4+T-Helper,CD3+/CD8+cytotoxic T,CD3+/CD56+natural killer and CD19+B lymphocyte numbers,and CD4+:CD8+T lymphocyte ratios.RESULTS The total numbers of CD3+,CD3+/CD4+T-Helper,CD3+/CD8+cytotoxic T,CD3+/CD56+natural killer and CD19+B lymphocytes,and CD4+:CD8+lymphocyte ratios were increased in all but one patient 30 d following the cytoreductive surgery-HIPEC procedure,and these increases were significant(P≤0.05)for CD3+/CD4+T Helper and CD3+/CD8+cytotoxic T lymphocyte numbers.CONCLUSION This report provides the first evidence that HIPEC exhibits immunomodulating activity in PM patients,resulting in generalized activation of the adaptive immune response.Moreover,the majority of lymphocyte populations increased following HIPEC and continued to be elevated several weeks following the procedure,consistent with a potential authentic immunomodulating effect rather than a normal inflammatory response,to be fully characterised in future studies.

关键词： Immune response Hyperthermic intraperitoneal chemotherapy Peritoneal metastases Regulatory T lymphocytes Pseudomyxoma peritonei Colorectal cancer

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Minimally invasive surgical approach to pancreatic malignancies

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World Journal of Gastrointestinal Oncology 2015年第12期7卷 411-421页

作者： Lapo Bencini Mario Annecchiarico Marco Farsi Ilenia Bartolini Vita Mirasolo francesco guerra Andrea Coratti Department of Oncology Division of Surgical Oncology and Robotics Careggi University Hospital

Pancreatic surgery for malignancy is recognized as challenging for the surgeons and risky for the patientsdue to consistent perioperative morbidity and mortality. Furthermore, the oncological long-term results are largely disappointing, even for those patients who experience an uneventfully hospital stay. Nevertheless, surgery still remains the cornerstone of a multidisciplinary treatment for pancreatic cancer. In order to maximize the benefits of surgery, the advent of both laparoscopy and robotics has led many surgeons to treat pancreatic cancers with these new methodologies. The reduction of postoperative complications, length of hospital stay and pain, together with a shorter interval between surgery and the beginning of adjuvant chemotherapy, represent the potential advantages over conventional surgery. Lastly, a better cosmetic result, although not crucial in any cancerous patient, could also play a role by improving overall well-being and patient self-perception. The laparoscopic approach to pancreatic surgery is, however, difficult in inexperienced hands and requires a dedicated training in both advanced laparoscopy and pancreatic surgery. The recent large diffusion of the da Vinci® robotic platform seems to facilitate many of the technical maneuvers, such as anastomotic biliary and pancreatic reconstructions, accurate lymphadenectomy, and vascular sutures. The two main pancreatic operations, distal pancreatectomy and pancreaticoduodenectomy, are approachable by a minimally invasive path, but more limited interventions such as enucleation are also feasible. Nevertheless, a word of caution should be taken into account when considering the increasing costs of these newest technologies because the main concerns regarding these are the maintenance of all oncological standards and the lack of long-term follow-up. The purpose of this review is to examine the evidence for the use of minimally invasive surgery in pancreatic cancer(and less aggressive tumors), with particular attention to the oncological resu

关键词： Pancreatic cancer Pancreatic adenocarcinoma Neuroe

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Myocarditis in athlete and myocardial bridge:An innocent bystander?

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World Journal of Cardiology 2015年第5期7卷 293-298页

作者： Federico Quaranta Emanuele guerra Fabio Sperandii francesco De Santis Fabio Pigozzi Leonardo Calò Paolo Borrione Department of Movement Human and Health ScienceUniversity of Rome "Foro Italico" Department of Cardiology Policlinico CasilinoASL Rome B00169 RomeItaly

Myocarditis is a bacterial or viral inflammatory disease,often unnoticed or misdiagnosed.Athletes with myocarditis must stop practicing their activity since International medical Literature described some cases of sudden death.In the present report,we describe a case of an asymptomatic,apparently healthy,competitive athletes,who was diagnosed a myocarditis and as incidental finding a myocardial bridging.We focused the attention on the importance of anamnesis,electrocardiogram and athletes' entourage for the diagnosis of such insidious pathologies and we evaluated the follow up,focusing the attention on electrocardiogram changes as well as on restitution ad integrum and prognosis,especially for the athletes.

关键词： Myocarditis Sudden cardiac death Preparticipation screening

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