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Adjusting CA19-9 values to predict malignancy in obstructive jaundice:Influence of bilirubin and C-reactive protein

World Journal of Gastroenterology 2012年第31期18卷 4150-4155页

作者： Gaetano La Greca Maria Sofia Rosario Lombardo saverio latteri Agostino Ricotta Stefano Puleo Domenico Russello Department of Surgical Sciences Organ Transplantation and Advanced TechnologiesUniversity of Catania95125 CataniaItaly

AIM:To find a possible relationship between inflammation and CA19-9 tumor marker by analyzing data from patients with benign jaundice(BJ) and malignant jaundice(MJ).METHODS:All patients admitted for obstructive jaundice,in the period 2005-2009,were prospectively enrolled in the study,obtaining a total of 102 *** admission,all patients underwent complete standard blood test examinations including C-reactive protein(CRP),bilirubin,*** were considered eligible for the study when they presented obstructive jaundice confirmed by instrumental examinations and increased serum bilirubin levels(total bilirubin > 2.0 mg/dL).The standard cut-off level for CA19-9 was 32 U/mL,whereas for CRP this was 1.5 mg/*** CA19-9 level was adjusted by dividing it by the value of serum bilirubin or by the CRP *** patients were divided into 2 groups,MJ and BJ,and after the adjustment a comparison between the 2 groups of patients was ***,specificity and positive predictive values were calculated before and after the ***:Of the 102 patients,51 were affected by BJ and 51 by *** CA19-9 levels were found in 71.7% of the *** the group of 51 BJ patients there were 29(56.9%) males and 22(43.1%) females with a median age of 66 years(range 24-96 years),whereas in the MJ group there were 24(47%) males and 27(53%) females,with a mean age of 70 years(range 30-92 years).Pathologic CA19-9 serum level was found in 82.3% of *** levels were pathologic in 66.6% of the patients with BJ and in 49% with *** and CA19-9 average levels were significantly higher in MJ compared with BJ(P = 0.000 and P = 0.02),while the CRP level was significantly higher in BJ(P = 0.000).Considering a CA19-9 cut-off level of 32 U/mL,82.3% in the MJ group and 54.9% in the BJ group were positive for CA19-9(P = 0.002).A CA19-9 cut-off of 100 U/mL increases the difference between the two groups:35.3% in BJ and 68.6% in MJ(P = 0.0007).Adjusting the CA1

关键词： Tumor marker CA19-9 C-reactive protein Bilirubin Pancreato-biliary malignancy Biliary stones

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Successful endoscopic repair of an unusual colonic perforation following polypectomy using an endoclip device

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World Journal of Gastroenterology 2007年第20期13卷 2889-2891页

作者： Francesco Barbagallo Giorgio Castello saverio latteri Emanuele Grasso Salvatrice Gagliardo Gaetano La Greca Michele Di Blasi Department of Surgical Sciences Transplantation and Advanced TechnologiesUniversity of CataniaPadiglione 29Policlinico UniversitarioVia S. SofiaCatania 95100Italy Digestive Endoscopic Unit University of CataniaP.O. CannizzaroVia Messina 829Catania 95126Italy

Colonic perforation during endoscopic diagnostic or therapeutic procedures,represents an uncommon occurrence even if,together with haemorrhage,it is still the most common complication of colonoscopy,with an incidence ranging between 0.1% and 2% of all colonoscopic procedures. The ideal treatment in these cases remains elusive as the endoscopist and the surgeon have to make a choice case by case,depending on many factors such as how promptly the rupture is identified,the condition of the patient,the degree of contamination and the evidence of peritoneal irritation. Surgical interventions both laparotomic and laparoscopic,and other medical non-operative solutions are described in the literature. Only three cases have been reported in the literature in which the endoscopic apposition of endoclips was used to repair a colonic perforation during colonoscopy. Ours is the first case that the perforation itself was caused by the improper functioning of a therapeutic device.

关键词： Polypectomy Colonic perforation Endoscopic device Pneumoperitoneum

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Acute biliary pancreatitis and cholecystolithiasis in a child: one time treatment with laparoendoscopic "Rendez-vous" procedure

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World Journal of Gastroenterology 2006年第11期12卷 1782-1785页

作者： Gaetano La Greca Michele Di Blasi Francesco Barbagallo Manuela Di Stefano saverio latteri Domenico Russello Department of Surgical Sciences Transplantation and Advanced Technologies University of Catania Cannizzaro HospitalVia Messina 829-95100CataniaItaly

Acute biliary pancreatitis （ABP） is rare in childhood and endoscopic sphincterotomy should be avoided in the child due to the risk of both early and late complications but, when necessary, the optimal timing between endoscopic procedure and cholecystectomy is still uncertain, A nine years old child with acute biliary pancreatitis underwent successfull laparo-endoscopic ＂Rendez-Vous＂ procedure in which endoscopic drainage of the common bile duct and laparoscopic cholecystectomy were performed simultaneously. This is the first case reported of laparo-endoscopic RendezoVous in a child. The excellent outcome of this patient and the review of the literature concerning other available options for the treatment of such cases suggest that this procedure offers great advantages, especially in children, of reducing the required number of treatments, the risk of ineffectiveness, the number of anaesthesia, the length of hospital stay and the risk of iatrogenic morbidity.

关键词： Acute biiiary pancreatitis Gallstones ERCP Laparoscopic cholecystectomy Endoscopic sphyncterotomy

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Appendicular tuberculosis:The resurgence of an old disease with difficult diagnosis

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World Journal of Gastroenterology 2010年第4期16卷 518-521页

作者： Francesco Barbagallo saverio latteri Maria Sofia Agostino Ricotta Giorgio Castello Andrea Chisari Valentina Randazzo Gaetano La Greca Department of Surgical Sciences Transplantation and New TechnologiesUniversity of CataniaVia Messina 35495126 CataniaItaly

Gastrointestinal tuberculosis(TB) is quite rare,representing only 3% of all extra-pulmonary *** gut and ileum are the most common gastrointestinal localizations,while appendix involvement is *** involvement is usually related to symptoms of acute appendicitis since the caseous necrosis may lead to adhesions and surgical complications such as *** this reason patients with suspected appendicular TB usually undergo surgery even without a secure *** these cases,due to the absence of specific symptoms and signs,the diagnosis is delayed after surgery,thus resulting in a high percentage of important,and sometimes lethal,*** examination is often the only way to reach a diagnosis and to establish specific antibiotic therapy,while an early diagnosis could avoid surgical *** report a case of appendicular TB not only for its rarity but also todiscuss the difficulty in its diagnosis.

关键词： Appendicitis Peritoneal tuberculosis Peritonitis Tuberculosis

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Laparo-endoscopic “Rendezvous” to treat cholecysto-choledocolithiasis: Effective,safe and simplifies the endoscopist’s work

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World Journal of Gastroenterology 2008年第18期14卷 2844-2850页

作者： Gaetano La Greca Francesco Barbagallo Michele Di Blasi Andrea Chisari Rosario Lombardo Rosario Bonaccorso saverio latteri Andrea Di Stefano Domenico Russello Department of Surgical Sciences Transplantation and Advanced Technologies University of Catania Cannizzaro Hospital Via Messina 829 Catania 95126 Italy Endoscopic Unit Cannizzaro Hospital Via Messina 829 Catania 95126 Italy

AIM: To investigate our clinical experience with combined laparo-endoscopic Rendezvous (RV) for the treatment of patients affected by gallstones and common bile duct (CBD) stones and especially to study the never evaluated opinion of the endoscopist concerning the difficulty of the intraoperative endoscopic procedure during the RV in comparison with standard endoscopic retrograde cholangio-pancreatography (ERCP). METHODS: Eighty consecutive patients affected by cholecystolithiasis and diagnosed or suspected CBD stones were treated with a standardized "tailored" RV. The relevant technical features, the feasibility, the effectiveness in stone clearance, the safety but also the simple evaluation of difficulty and agreement of the endoscopist were analyzed with a questionnaire. RESULTS: The feasibility was 97.5% and the effectiveness 100% concerning CBD clearance and solution of coexisting problems at the papilla. Minor morbidity was 3.3%, the operating time was prolonged by a mean of 14 min, the mean hospital stay was 3.8 d and only one stone’s recurrence occurred. The endoscopist evaluated the procedure to be simpler than standard ERCP-ES in 81.2% of the ***: Simultaneous RV carries higheffectiveness and safety at least comparable to those reported for other options. The endoscopist is very often satisfied with this approach because of the minimization of some steps of the endoscopic procedure and avoidance of relevant iatrogenic risk factors. If the mandatory collaboration between surgeons and endoscopists is guaranteed, this approach can often be preferable for the patient, the surgeon, the endoscopist and the hospital.

关键词： Gallstones Common bile duct Endoscopic retrograde cholangio-pancreatography Endoscopic sphincterotomy Rendezvous Intra-operative cholangiography Laparoscopic cholecystectomy

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Awake laparoscopic cholecystectomy:A case report and review of literature

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World Journal of Clinical Cases 2023年第13期11卷 3002-3009页

作者： Chiara Mazzone Maria Sofia Iacopo Sarvà Giorgia Litrico Andrea Maria Luca Di Stefano Gaetano La Greca saverio latteri Dipartimento di Scienze Mediche Chirurgiche e Tecnologie Avanzate"G.F.Ingrassia"Universitàdegli Studi di CataniaCatania 95123Italy

BACKGROUND Laparoscopic cholecystectomy(LC)is one of the most widely practiced surgical procedures in abdominal *** undergo LC during general anaesthesia;however,in recent years,several studies have suggested the ability to perform LC in patients who are *** report a case of awake LC and a literature *** SUMMARY A 69-year-old patient with severe pulmonary disease affected by cholelithiasis was scheduled for LC under regional *** first performed peridural anaesthesia at the T8-T9 level and then spinal anaesthesia at the T12-L1 *** procedure was managed in total comfort for both the patient and the *** intra-abdominal pressure was 8 *** patient remained stable throughout the procedure,and the postoperative course was *** Evidence has warranted the safe use of spinal and epidural anaesthesia,with minimal side effects easily managed with *** anaesthesia in selected patients may provide some advantages over general anaesthesia,such as no airway manipulation,maintenance of spontaneous breathing,effective postoperative analgesia,less nausea and vomiting,and early ***,this technique for LC is not widely used in Europe;this is the first case reported in Italy in the *** anaesthesia is feasible and safe in performing some types of laparoscopic *** studies should be carried out to introduce this type of anaesthesia in routine clinical practice.

关键词： Laparoscopic cholecystectomy Awake surgery Awake laparoscopy Gallstone disease Regional anaesthesia Spinal anesthesia Case report

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