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Therapeutic strategies in Crohn’s disease in an emergency surgical setting

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World Journal of Gastroenterology 2022年第18期28卷 1902-1921页

作者： Maria Michela Chiarello Gilda Pepe Valeria Fico valentina bianchi Giuseppe Tropeano Gaia Altieri Giuseppe Brisinda Department of Surgery San Giovanni in Fiore HospitalAzienda Sanitaria Provinciale di CosenzaCosenza 87100Italy Emergency Surgery and Trauma Center Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy Department of Surgery Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy Medical and Surgical Science UniversitàCattolica del Sacro CuoreRome 00168Italy

Crohn’s disease(CD)remains a chronic,incurable disorder that presents unique challenges to the *** factors must be considered to allow development of an appropriate treatment *** therapy often precedes or complements the surgical *** indications for operative management of CD include acute and chronic disease complications and failed medical *** surgery comes into play when patients are refractory to medical treatment if they have an obstructive *** colitis,acute obstruction,perforation,acute abscess,or massive hemorrhage represent indications for emergency *** patients are generally in critical conditions and present with intra-abdominal sepsis and a preoperative status of immunosuppression and malnutrition that exposes them to a higher risk of complications and mortality.A multidisciplinary team including surgeons,gastroenterologists,radiologists,nutritional support services,and enterostomal therapists are required for optimal patient care and decision *** of each emergency should be individualized based on patient age,disease type and duration,and patient goals of ***,the recurrent nature of disease mandates that we continue searching for innovative medical therapies and operative techniques that reduce the need to repeat surgical *** this review,we aimed to discuss the acute complications of CD and their treatment.

关键词： Crohn’s disease Intestinal obstruction Free perforation Intra-abdominal sepsis Perineal sepsis Acute bleeding

SARS-CoV-2 and the pancreas: What do we know about acute pancreatitis in COVID-19 positive patients?

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World Journal of Gastroenterology 2022年第36期28卷 5240-5249页

作者： Giuseppe Brisinda Maria Michela Chiarello Giuseppe Tropeano Gaia Altieri Caterina Puccioni Pietro Fransvea valentina bianchi Department of Medical and Surgical Sciences Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy Department of Medicine and Surgery UniversitàCattolica del Sacro CuoreRome 00168Italy Department of Surgery Azienda Sanitaria Provinciale di CosenzaCosenza 87100Italy Emergency Surgery and Trauma Center Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy

Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)can cause pancreatic damage,both directly to the pancreas via angiotensin-converting enzyme 2 receptors(the transmembrane proteins required for SARS-CoV-2 entry,which are highly expressed by pancreatic cells)and indirectly through locoregional vasculitis and *** that,there is no clear evidence that SARS-CoV-2 is an etiological agent of acute *** pancreatitis in coronavirus disease 2019(COVID-19)positive patients often recognizes biliary or alcoholic *** prevalence of acute pancreatitis in COVID-19 positive patients is not exactly ***,COVID-19 positive patients with acute pancreatitis have a higher mortality and an increased risk of intensive care unit admission and necrosis compared to COVID-19 negative *** respiratory distress syndrome is the most frequent cause of death in COVID-19 positive patients and concomitant acute *** this article,we reported recent evidence on the correlation between COVID-19 infection and acute pancreatitis.

关键词： Acute pancreatitis SARS-CoV-2 Severe acute pancreatitis Multiparametric scores Infected necrosis Step-up approach

Anastomotic leakage in rectal cancer surgery:Retrospective analysis of risk factors

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World Journal of Clinical Cases 2022年第36期10卷 13321-13336页

作者： Giuseppe Brisinda Maria Michela Chiarello Gilda Pepe Maria Cariati Valeria Fico Paolo Mirco valentina bianchi Department of Medical and Surgical Sciences Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy Department of Surgery UniversitàCattolica S CuoreRome 00168Italy Department of Surgery Azienda Sanitaria Provinciale di CosenzaCosenza 87100Italy Emergency Surgery and Trauma Center Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy Department of Surgery Azienda Sanitaria Provinciale di CrotoneCrotone 88900Italy

BACKGROUND Anastomotic leakage(AL)after restorative surgery for rectal cancer(RC)is associated with significant morbidity and *** To ascertain the risk factors by examining cases of AL in rectal surgery in this retrospective cohort *** To identify risk factors for AL,a review of 583 patients who underwent rectal resection with a double-stapling colorectal anastomosis between January 2007 and January 2022 was ***,demographic and operative features,intraoperative outcomes and oncological characteristics were *** The incidence of AL was 10.4%,with a mean time interval of 6.2±2.1 *** mortality was 0.8%.Mortality was higher in patients with AL(4.9%)than in patients without leak(0.4%,P=0.009).Poor bowel preparation,blood transfusion,median age,prognostic nutritional index<40 points,tumor diameter and intraoperative blood loss were identified as risk factors for *** of anastomosis,number of stapler cartridges used to divide the rectum,diameter of circular stapler,level of vascular section,T and N status and stage of disease were also correlated to AL in our *** diverting ileostomy did not reduce the leak rate,while the use of the transanastomic tube significantly *** Clinical,surgical and pathological factors are associated with an increased risk of *** adversely affects the morbidity and mortality of RC patients.

关键词： Anastomosis Leak Anterior resection Morbidity Mortality Rectal surgery

Artificial intelligence and its role in guiding liverdirected therapy for hepatocellular carcinoma:Is it ready for prime time?

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Hepatoma Research 2022年第1期8卷 466-481页

作者： Elena Panettieri Andrea Campisi valentina bianchi Felice Giuliante Agostino Maria De Rose Hepatobiliary Surgery Unit Fondazione Policlinico Universitario Agostino Gemelli IRCCSUniversitàCattolica del Sacro CuoreRome 00168Italy Emergency and Trauma Surgery Unit Fondazione Policlinico Universitario Agostino Gemelli IRCCSUniversitàCattolica del Sacro CuoreRome 00168Italy

Artificial intelligence(AI)is an innovative discipline in medicine,impacting both hepatology and hepato-pancreatobiliary surgery,ensuring reliable outcomes because of its repeatable and efficient algorithms.A considerable number of studies about the efficiency of AI in the management of hepatocellular carcinoma(HCC)have been *** its diagnostic role is well recognized,providing large amounts of quantitative radiological HCC features,its use in HCC treatment is still *** use of AI may help to select the best approach for each patient as it is able to predict the outcomes after resection and/or other *** this review,we assess the role of AI in selecting the best therapeutic option and predicting long-term risks after surgical or interventional treatments for HCC *** studies are needed to consolidate AI applications.

关键词： Artificial intelligence precision medicine HCC hepatocellular carcinoma

The spectrum of pneumatosis intestinalis in the adult.A surgical dilemma

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World Journal of Gastrointestinal Surgery 2023年第4期15卷 553-565页

作者： Giuseppe Tropeano Marta Di Grezia Caterina Puccioni valentina bianchi Gilda Pepe Valeria Fico Gaia Altieri Giuseppe Brisinda Emergency Surgery and Trauma Center Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy Department of Surgery UniversitàCattolica del Sacro CuoreRome 00168Italy

Pneumatosis intestinalis(PI) is a striking radiological diagnosis. Formerly a rare diagnostic finding, it is becoming more frequently diagnosed due to the wider availability and improvement of computed tomography scan imaging. Once associated only with poor outcome, its clinical and prognostic significance nowadays has to be cross-referenced to the nature of the underlying *** mechanisms of pathogenesis have been debated and multiple causes have been detected during the years. All this contributes to creating a broad range of clinical and radiological presentations. The management of patients presenting PI is related to the determining cause if it is identified. Otherwise, in particular if an association with portal venous gas and/or pneumoperitoneum is present, the eventual decision between surgery and non-operative management is challenging,even for stable patients, since this clinical condition is traditionally associated to intestinal ischemia and consequently to pending clinical collapse if not *** the wide variety of origin and outcomes, PI still remains for surgeons a demanding clinical entity. The manuscript is an updated narrative review and gives some suggestions that may help make the decisional process easier,identifying patients who can benefit from surgical intervention and those who can benefit from non-operative management avoiding unnecessary procedures.

关键词： Pneumatosis intestinalis Risk factors Treatment Portal venous gas Portomesenteric pneumatosis

Surgical complications of oncological treatments: A narrative review

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World Journal of Gastrointestinal Surgery 2023年第6期15卷 1056-1067页

作者： Valeria Fico Gaia Altieri Marta Di Grezia valentina bianchi Maria Michela Chiarello Gilda Pepe Giuseppe Tropeano Giuseppe Brisinda Emergency Surgery and Trauma Center Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy Department of Surgery Azienda Sanitaria Provinciale di CosenzaCosenza 87100Italy Department of Medicine and Surgery Catholic School of MedicineRome 00168Italy

Gastrointestinal complications are common in patients undergoing various forms of cancer treatments,including chemotherapy,radiation therapy,and moleculartargeted *** complications of oncologic therapies can occur in the upper gastrointestinal tract,small bowel,colon,and *** mechanisms of action of these therapies are *** includes cytotoxic drugs,which block the activity of cancer cells by targeting intracellular DNA,RNA,or *** symptoms are very common during chemotherapy,due to a direct effect on the intestinal mucosa resulting in edema,inflammation,ulceration,and *** adverse events have been described as complications of molecular targeted therapies,including bowel perforation,bleeding,and pneumatosis intestinalis,which may require surgical *** is a local anti-cancer therapy,which uses ionizing radiation to cause inhibition of cell division and ultimately lead to cell *** related to radiotherapy can be both acute and *** therapies,including radiofrequency,laser,microwave,cryoablation,and chemical ablation with acetic acid or ethanol,can cause thermal or chemical injuries to the nearby *** of the different gastrointestinal complications should be tailored to the individual patient and based on the underlying pathophysiology of the ***,it is important to know the stage and prognosis of the disease,and a multidisciplinary approach is necessary to personalize the surgical *** purpose of this narrative review is to describe complications related to different oncologic therapies that may require surgical interventions.

关键词： Cancer Chemotherapy Radiotherapy Complications Bowel perforation Gastrointestinal bleeding

Family history of irritable bowel syndrome is the major determinant of persistent abdominal complaints in young adults with a history of pediatric recurrent abdominal pain

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World Journal of Gastroenterology 2006年第24期12卷 3874-3877页

作者： Fabio Pace Giovanna Zuin Stefania Di Giacomo Paola Molteni valentina Casini Massimo Fontana Gabriele bianchi Porro Gastroenterology Department University Hospital "L.Sacco"-Milan Italy Pediatric Department University Hospital "L.Sacco"-Milan Italy

瞄准：与周期性的腹的疼痛(敲击) 或急躁的肠症候群(IBS ) 的以前的历史估计少年的迟了的结果。方法：有敲击的一组 67 个孩子从 1986 年 1 月指了部门到 1995 年 12 月被跟随在上面在 5 和 13 之间，在借助于一个结构化的电话的起始的... 详细信息

瞄准：与周期性的腹的疼痛(敲击) 或急躁的肠症候群(IBS ) 的以前的历史估计少年的迟了的结果。方法：有敲击的一组 67 个孩子从 1986 年 1 月指了部门到 1995 年 12 月被跟随在上面在 5 和 13 之间，在借助于一个结构化的电话的起始的诊断以后的年会见。我们假设了有坚持的成年象 IBS 一样症状的那些病人将是显著地更可能没有坚持的腹的抱怨与成年人比较报导 IBS 的家庭历史。结果：从 52 轨道有能力的题目， 15 被发现在后续(29%) 介绍象 IBS 一样症状而多数(37 个题目) 不。有象 IBS 一样症状的题目更多半是几乎三次与不抱怨的题目(40.0% 对 16.0%) 相比与类似的症状介绍至少一个兄弟，分别地(P < 0.05 在学生 t ) 。有象 IBS 一样症状的题目也报导了额外肠的症状的更高的流行，例如背疼痛， fibromyalgia，头疼，疲劳和睡觉骚乱。结论：学习证实显示那小儿科的敲击的以前的观察能预言 IBS 的以后的开发。后者看起来被症状的 intrafamilial 聚集极大地影响，可能通过听说特定的病行为。

关键词：肠疾病遗传疾病腹部疾病儿科

Pancreatic metastasis from mycosis fungoides mimicking primary pancreatic tumor

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World Journal of Gastroenterology 2016年第12期22卷 3496-3501页

作者： Paola Ceriolo valentina Fausti Elisa Cinotti Silvia Bonadio Lizzia Raffaghello Giovanna bianchi Giulio Fraternali Orcioni Roberto Fiocca Franco Rongioletti Vito Pistoia Giacomo Borgonovo Course in Paediatric Science Fetal-Perinatal and Paediatric Pathology University of Genoa Pathology Unit Istituto Giannina Gaslini Section of Dermatology IRCCS AOU San Martino-IST Pathology Unit IRCCS AOU San Martino-IST Laboratory of Oncology Istituto Giannina Gaslini Pathology Unit IRCCS AOU San Martino-IST and University of Genoa Surgery Unit IRCCS AOU San Martino-IST and University of Genoa

Mycosis fungoides(MF) is a cutaneous T-cell lymphoma that can undergo local progression with possible systemic dissemination. We report a case of a patient affected by MF with a pancreatic mass that was a diagnostic challenge between primitive tumor and pancreatic metastasis from MF. Clinical setting findings and imaging studies raised the suspicion of a pancreatic primary neoplasm. A diagnostic clue was provided by the combined histomorphologic/immunohistochemical study of pancreatic and cutaneous biopsies, which revealed a pancreatic localization of MF. Considering the rarity of metastatic localization of MF to the pancreas, we next investigated whether chemokinechemokine receptor interactions could be involved in the phenomenon to provide new insight into the possible mechanisms underlying metastatic localization of MF to the pancreas. Histological analyses of archival pancreatic tissue demonstrated that glucagon-secreting cells of the pancreatic islets expressed the CCL27 chemokine, which may have attracted in our case metastatic MF cells expressing the complementary receptor CCR10.

关键词： Differential diagnosis Pancreatic mass Extracutaneous localization Mycosis fungoides CCL27 CCR10