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Hepatobiliary & Pancreatic Diseases International 2016年第3期15卷 324-328页

作者： francesco giudici benedetta pesi daniela zambonin stefano scaringi paolo bechi giacomo batignani Author Affiliations:Unit of Surgery Department of Surgery and Translational MedicineUniversity of Florence Medical SchoolCareggi University HospitalFlorenceItaly

Pancreatico-jejunal anastomosis after pancreato- duodenectomy still represents the Achilles＇ heel of the proce- dure： the failure of this anastomosis is relatively common and it is the main cause of post-operative morbidity and mortality. Studies have described different reconstruction strategies for the control of the development of post-operative pancreatic fistula, but the strategy to obtain a safer pancreatico-jejunal anastomosis is still far from satisfaction. We report a novel variation of the invagination technique based on preliminary clinical experience in 8 patients who underwent pancreatico- jejunal anastomosis after pancreatoduodenectomy in our hepatobiliopancreatic center from 2008 to 2014. The varia- tion could obtain a safer intestinal invagination for a solid pancreatico-jejunal anastomosis even in the presence of soft pancreatic remnant.

关键词： pancreatico-jejunal anastomosis anastomosis pancreatoduodenectomy invagination novel variation

Immunomodulation by probiotics and prebiotics in hepatocellular carcinoma

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World Journal of Hepatology 2022年第2期14卷 372-385页

作者： Edda Russo Camila Fiorindi francesco giudici Amedeo Amedei Department of Experimental and Clinical Medicine University of FlorenceFlorence 50134TuscanyItaly Department of Health Professions Dietary Production Line and NutritionUniversity Hospital of CareggiFlorence 50134Italy

Hepatocellular carcinoma(HCC)is the most prevalent primary malignancy in patients suffering from chronic liver diseases and *** attention has been paid to the involvement of the gut-liver axis(GLA)in HCC *** axis results from a bidirectional,anatomical and functional relationship between the gastrointestinal system and the ***,the complex network of interactions between the intestinal microbiome and the liver plays a crucial role in modulation of the HCC-tumor microenvironment,contributing to the pathogenesis of HCC by exposing the liver to pathogen-associated molecular patterns,such as bacterial lipopolysaccharides,DNA,peptidoglycans and ***,the alteration of gut microflora may disturb the intestinal barrier,bringing several toll-like receptor ligands to the liver thus activating the inflammatory *** review explores the new therapeutic opportunities that may arise from novel insights into the mechanisms by which microbiota immunomodulation,represented by probiotics,and prebiotics,affects HCC through the GLA.

关键词： Hepatocellular carcinoma Gut microbiota Probiotics Prebiotics Gut-liver axis Immunomodulation

Biliary tree gastrinomas in multiple endocrine neoplasia type 1 syndrome

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World Journal of Gastroenterology 2013年第45期19卷 8312-8320页

作者： francesco Tonelli francesco giudici Gabriella Nesi Giacomo Batignani Maria Luisa Brandi Department of Surgery and Translational Medicine University of Florence50014 Florence Italy

AIM:To describe our patients affected with ectopic biliary tree gastrinoma and review the literature on this ***:Between January 1992 and June 2012,28 patients affected by duodenopancreatic endocrine tumors in multiple endocrine neoplasia type 1(MEN1)syndrome underwent surgery at our *** retrospective review article analyzes our experience regarding seventeen of these patients subjected to duodenopancreatic surgery for Zollinger-Ellison syndrome(ZES).Surgical treatment consisted of duodenopancreatectomy(DP)or total pancreatectomy(TP).Regional lymphadenectomy was always *** hepatic tumoral lesions found were removed during *** MEN1 patients,removal of duodenal lesions can sometimes lead to persistence or recurrence of *** possible explanation for this unfavorable outcome could be unrecognized ectopic localization of gastrin-secreting *** study described three cases among the seventeen patients who were found to have an ectopic gastrinoma located in the biliary ***:Seventeen MEN1 patients affected with ZES were *** mean age was 40 *** patients underwent DP and two *** histopathological examination,duodeno pancreatic endocrine tumors were found in all 17 ***-one gastrinomas were detected in the first three portions of the *** one gastrinoma was found in the *** mean number of gastrinomas per patient was 5(range 1-16).Malignancy was established in 12 patients(70.5%)after lymph node,liver and omental metastases were *** patients exhibited biliary tree gastrinomas as well as duodenal gastrinoma(s).In two cases,the ectopic gastrinoma was removed at the same time as pancreatic surgery,while in the third case,the biliary tree gastrinoma was resected one year after DP because of recurrence of ***:These findings suggest the importance of checking for the presence of ectopic gastrinomas in the biliary tree in MEN1 patients undergoing Z

关键词： Gastrinoma Multiple endocrine neoplasia type 1 Zollinger-Ellison Syndrome Ectopic gastrinoma Biliary tree Duodenopancreatectomy

Multiplex gene expression profile in inflamed mucosa of patients with Crohn’s disease ileal localization: A pilot study

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World Journal of Clinical Cases 2019年第17期7卷 2463-2476页

作者： francesco giudici Letizia Lombardelli Edda Russo Tiziana Cavalli Daniela Zambonin Federica Logiodice Ornela Kullolli Lamberto Giusti Tatiana Bargellini Marilena Fazi Livia Biancone Stefano Scaringi Ann Maria Clemente Eloisa Perissi Giovanni Delfino Maria G Torcia Ferdinando Ficari francesco Tonelli Marie-Pierre Piccinni Cecilia Malentacchi Department of Experimental and Clinical Medicine University of FirenzeFirenze 50134Italy Dipartimento Chirurgico Ortopedico Ospedale Carlo Poma di MantovaFirenze 50134Italy Department of Experimental and Clinical Biomedical Sciences “Mario Serio” University of FirenzeFirenze 50134Italy Surgical Unit Department of Surgery and Translational MedicineUniversity of FirenzeFirenze 50134Italy Department of Internal Medicine University of Roma Tor VergataRoma 00133Italy

BACKGROUND Crohn’s disease (CD) is a complex disorder resulting from the interaction of genetic,environmental,and microbial *** pathogenic process may potentially affect any segment of the gastrointestinal tract,but a selective location in the terminal ileum was reported in 50% of *** To characterize clinical sub-phenotypes (colonic and/or ileal) within the same disease,in order to identify new therapeutic *** 14 consecutive patients undergoing surgery for ileal CD were recruited for this *** blood samples from each patient were collected and the main polymorphisms of the gene Card15/Nod2 (R702W,G908R,and 1007fs) were analyzed in each *** addition,tissue samples were taken from both the tract affected by CD and from the apparently healthy and disease-free margins (internal controls).We used a multiplex gene assay in specimens obtained from patients with ileal localization of CD to evaluate the simultaneous expression of 24 genes involved in the pathogenesis of the *** also processed surgery gut samples with routine light microscopy (LM) and transmission electron microscopy (TEM) techniques to evaluate their structural and ultrastructural *** We found a significant increase of Th17 (IL17A and IL17F,IL 23R and CCR6) and Th1 (IFN-γ) gene expression in inflamed mucosa compared to non-inflamed sites of 14 CD ***4 and HAMP,two genes coding for antimicrobial peptides,were also strongly activated in inflamed ileal mucosa,suggesting the overwhelming stimulation of epithelial cells by commensal ***-γ and CCR6 were more expressed in inflamed mucosa of CD patients with ileal localization compared with patients with colonic localization suggesting a more aggressive inflammation process in this *** analysis of the epithelial lining of Lieberkün crypts disclosed enhanced release activity from goblet mucocytes,whereas the lamina propria contained numerous cells pertaining to vari

关键词： Crohn's disease Ileum Colon Messenger ribonucleic acid Th1/Th17 Microbiota Inflammation

Vascular Invasion, Satellite Nodules and Absence of Tumor Capsule Strongly Correlate with Disease-Free Survival and Long-Term Outcome in Patients Resected for Hepatocellular Carcinoma

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Journal of Cancer Therapy 2014年第14期5卷 1344-1353页

作者： Benedetta Pesi Luca Moraldi Daniela Zambonin francesco giudici Tiziana Cavalli Rami Addasi Francesca Leo Stefano Scaringi Giacomo Batignani Gastro-Intestinal Surgery Unit Department of Surgery and Translational Medicine Careggi University Hospital Florence Italy

Background: Hepatocellular carcinoma (HCC) is one of the most common cancer in the world. Liver resection (LR) is the most used therapy in well compensated liver cirrhosis and maybe used as a first-line treatment. Aim of the study is to evaluate survival rates in patients who underwent LR for HCC and to identify risk factors able to influence the prognosis. Material/Method: A retrospective study was carried out in 115 patients whounderwent LR for HCC. We evaluated overall and disease-free survival rates at 1, 3 and 5years (y) and a series of variables included: type of resection, clamping, blood loss, transfusions, tumor size, presence of capsule, satellite nodules and vascular invasion. Results: The 1-, 3-, 5-y survival rates were 90.2%, 67% and 52.7%, and disease-free survival rates were 75.3%, 44.7% and 28.4%, respectively. We have found presence/ absence of capsulated tumor (p = 0.05), satellite nodules (p = 0.004) and vascular invasion (p = 0.001) as factors able to influence the overall survival and the disease-free survival (p = 0.04 for capsulated tumor, p = 0.01 for satellite nodules and p = 0.006 for vascular invasion). Conclusion: LR is the best therapeutic option for HCC when liver transplantation is contraindicated, with good survival rates. Presence of capsule, satellite nodules and vascular invasion are the most important factors able to influence the prognosis.

关键词： Liver Resection Hepatocellular Carcinoma Prognostic Factors Vascular Invasion Satellite Nodules

Is lymphatic status related to regression of inflammation in Crohn's disease?

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World Journal of Gastrointestinal Surgery 2012年第10期4卷 228-233页

作者： francesco Tonelli francesco giudici Gadiel Liscia Department of Clinical Physiopathology University of FlorenceSurgical Unit50134 FlorenceItaly

AIM:To investigate the status of the lymphatic vessels in the small bowel affected by Crohn's disease(CD) at the moment of ***:During the period January 2011-June 2011,25 consecutive patients affected by CD were operated on in our *** surgery,Patent Blue Ⅴ was injected subserosally and the way it spread along the subserosa of the intestinal wall,through the mesenterial layers towards the main lymphatic collectors and eventually to the lymph nodes was observed and *** some patients had been undergone strictureplasty at previous surgery,we also examined the status of intestinal lymph vessels after previous *** same procedure was performed in a control group of 5 patients affected by colorectal *** of lesions,caliber,maximal thickness of the diseased intestinal wall,thickness of the wall at injection site and thickness of the mesentery were evaluated at ***:We observed three features after the injection of Patent Blue Ⅴ in the intestinal loops:(1) Macroscopically healthy terminal ileum of patients with CD or colon cancer showed thin lymphatic vessels linearly directed toward the mesentery;(2) In mild lesions in which the intestinal wall did not reach 8 mm of thickness,we observed short,wide and tortuous lymphatic vessels directed longitudinally along the intestinal axis toward disease-free areas and then transversally toward the mesentery;and(3) Injection in the severely affected lesions,that had a thickness of the intestinal wall over 10 mm,did not show any feature of lymphatic vessels at least on the subserosal *** was a correlation between the thickness of the parietal wall and the severity of the lymphatic *** lymphatic vessels were observed at previous strictureplasties in the presence of complete regression of the ***:Injection of Patent Blue Ⅴ in the intestinal wall could help distinguish healthy tracts of the small bowel from those macrosco

关键词： Lymphatic vessels Surgery Patent blue Ⅴ Strictureplasty Crohn’s disease Mesentery Thickness Intestinal wall Inlflammation