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Transanal eco-Doppler evaluation after hemorrhoidal artery embolization

World Journal of Gastroenterology 2024年第17期30卷 2332-2342页

作者： Roberta Tutino Tommaso Stecca Fabrizio Farneti Marco Massani Giulio Aniello Santoro Dipartimento chirurgia generale e Specialistica AOU Cittàdella Salute e della Scienza di TorinoTorino 10126Italy Division of General Surgery 1 Treviso Regional HospitalAULSS 2 Marca TrevigianaTreviso 31100Italy Division of Radiology Treviso Regional HospitalAULSS 2 Marca TrevigianaTreviso 31100Italy Tertiary Referral Pelvic Floor Center Division of General Surgery 2AULSS 2 Marca TrevigianaTreviso 31100Italy

BACKGROUND Hemorrhoidal artery embolization(emborrhoid)is a novel method for the treatment of severe hemorrhoidal bleeding.Despite having a technical success rate of 93%-100%,the clinical success ranges between 63%and 94%,with a rebleeding rate of 13.6%.AIM To evaluate the effectiveness of this procedure in reducing hemorrhoidal flow and hemorrhoidal bleeding.MeTHODS This prospective observational pilot study was conducted at Division of General Surgery 1 and Tertiary Referral Pelvic Floor Center,Treviso Regional Hospital,Italy.In a 2 months period(February-March 2022),consecutive patients with hemorrhoidal bleeding scores(HBSs)≥4,Goligher scores of II or III,failure of non-operative management,and a candidate for emborrhoid were included.endoanal ultrasound with eco-Doppler was performed preoperatively and 1 month after the procedure.The primary endpoint was to quantify the changes in arterial hemorrhoidal flow after treatment.The secondary endpoint was to evaluate the correlation between the flow changes and the HBS.ReSULTS eleven patients underwent emborrhoid.The overall pretreatment mean systolic peak(MSP)was 14.66 cm/s.The highest MSP values were found in the anterior left lateral(17.82 cm/s at 1 o’clock and 15.88 cm/s at 3 o’clock)and in the posterior right lateral(14.62 cm/s at 7 o’clock and 16.71 cm/s at 9 o’clock)quadrants of the anal canal.After treatment,the overall MSP values were significantly reduced(P=0.008)although the correlation between MSP and HBS changes was weak(P=0.570).A statistical difference was found between distal embolization compared with proximal embolization(P=0.047).However,the coil landing zone was not related to symptoms improvement(P=1.000).A significant difference in MSP changes was also reported between patients with type 1 and type 2 superior rectal artery(SRA)anatomy(P=0.040).No relationship between hemorrhoidal grades(P=1.000),SRA anatomy(P=1.000)and treatment outcomes was found.CONCLUSION The preliminary findings of this pilot study confirm that emborrhoid was effective in

关键词： Hemorrhoidal artery embolization Hemorrhoidal embolization Hemorrhoidal vascularization Transanal eco-Doppler Transanal ultrasound

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Major liver resections,perioperative issues and posthepatectomy liver failure:A comprehensive update for the anesthesiologist

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World Journal of Critical Care Medicine 2024年第2期13卷 49-71页

作者： Andrea De Gasperi Laura Petrò Ombretta Amici Ilenia Scaffidi Pietro Molinari Caterina Barbaglio eva Cibelli Beatrice Penzo elena Roselli Andrea Brunetti Maxim Neganov Alessandro Giacomoni Paolo Aseni elena Guffanti Former Head Anesthesia and Critical Care Service 2Grande Ospedale Metropolitano Niguarda ASST GOM NiguardaMilan 20163Italy AR1 Ospedale Papa Giovanni 23Bergamo 24100Italy Anesthesia and Critical Care Service 2 Grande Ospedale Metropolitano Niguarda AR2ASST GOM NiguardaMilan 20163Italy Anestesia e Terapia Intensiva generale Istituto Clinico HumanitasRozzano 20089Italy chirurgia Oncologica Miniinvasiva Grande Ospedale Metropolitano Niguarda ASST GOM NiguardaMilan 20163Italy Dipartimento di Medicina d’Urgenza ed emergenza Grande Ospedale Metropolitano Niguarda ASST GOM NiguardaMilano 20163MIItaly

Significant advances in surgical techniques and relevant medium-and long-term outcomes over the past two decades have led to a substantial expansion in the indications for major liver resections.To support these outstanding results and to reduce perioperative complications,anesthesiologists must address and master key perioperative issues(preoperative assessment,proactive intraoperative anesthesia strategies,and implementation of the enhanced Recovery After Surgery approach).Intensive care unit monitoring immediately following liver surgery remains a subject of active and often unresolved debate.Among postoperative complications,posthepatectomy liver failure(PHLF)occurs in different grades of severity(A-C)and frequency(9%-30%),and it is the main cause of 90-d postoperative mortality.PHLF,recently redefined with pragmatic clinical criteria and perioperative scores,can be predicted,prevented,or anticipated.This review highlights:(1)The systemic consequences of surgical manipulations anesthesiologistsmust respond to or prevent,to positively impact PHLF(a proactive approach);and(2)the maximal intensivetreatment of PHLF,including artificial options,mainly based,so far,on Acute Liver Failure treatment(s),to buytime waiting for the recovery of the native liver or,when appropriate and in very selected cases,toward livertransplant.Such a clinical context requires a strong commitment to surgeons,anesthesiologists,and intensivists towork together,for a fruitful collaboration in a mandatory clinical continuum.

关键词： Liver resection Chronic liver disease Preoperative assessment Vascular clamping Intraoperative hemodynamic monitoring Postoperative intensive care unit Posthepatectomy liver failure Artificial liver support

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Preoperative and postoperative risk factors for periprosthetic joint infection in primary total hip arthroplasty:A 1-year experience

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World Journal of Orthopedics 2022年第10期13卷 903-910页

作者： Giuseppe Ferdinando Tella Cesare Donadono Francesco Castagnini Barbara Bordini Monica Cosentino Michele Di Liddo Francesco Traina Ortopedia-Traumatologia e chirurgia protesica e dei reimpianti d'anca e di ginocchio IRCCS Istituto Ortopedico RizzoliBologna 40125Italy Laboratorio di Tecnologia Medica IRCCS Istituto Ortopedico RizzoliBologna 40125Italy

BACKGROUND Periprosthetic joint infection(PJI)in primary total hip replacement(THR)is one of the most important threats in orthopedic surgery,so one important surgeon’s target is to avoid or early diagnose a PJI.Although the incidence of PJI is very low(0.69%)in our department,with an average follow-up of 595 d,this infection poses a serious threat due to the difficulties of treatment and the lower functional outcomes after healing.AIM To study the incidence of PJI in all operations occurring in the year 2016 in our department to look for predictive signs of potential infection.MeTHODS We counted 583 THR for 578 patients and observed only 4 cases of infection(0.69%)with a mean follow-up of 596 d(min 30,max 1451).We reviewed all medical records to collect the data:duration and time of the surgery,presence,type and duration of the antibiotic therapy,preoperative diagnosis,blood values before and after surgery,transfusions,presence of preoperative drugs(in particularly anticoagulants and antiaggregant,corticosteroids and immunosuppressants),presence of some comorbidities(high body mass index,blood hypertension,chronic obstructive pulmonary disease,cardiac ischemia,diabetes,rheumatological conditions,previous local infections).ReSULTS No preoperative,intraoperative,or postoperative analysis showed a higher incidence of PJI.We did not find any class with evident major odds of PJI.In our study,we did not find any border value to predict PJI and all patients had similar values in both groups(non-PJI and PJI).Only some categories,such as female patients,showed more frequency of PJI,but this difference related to sex was not statistically significant.CONCLUSION We did not find any category with a higher risk of PJI in THR,probably due to the lack of few cases of infection.

关键词： Primary total hip replacement Periprosthetic joint infection Preoperative risk factors Postoperative risk factors Preoperative and postoperative blood value Total hip arthroplasty

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evolving role of FDG-PeT/CT in prognostic evaluation of resectable gastric cancer

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World Journal of Gastroenterology 2017年第38期23卷 6923-6926页

作者： emilio De Raffele Mariateresa Mirarchi Dajana Cuicchi Ferdinando Lecce Bruno Cola Unità Operativa di chirurgia generale Dipartimento dell’Apparato Digerente Azienda Ospedaliero-Universitaria di Bologna U.O. di chirurgia generale Dipartimento Strutturale Chirurgico Ospedale 'SS Antonio e Margherita'

Gastric cancer(GC) remains a leading cause of cancer death worldwide. Radical gastrectomy is the only potentially curative treatment, and perioperative adjuvant therapies may improve the prognosis after curative resection. Prognosis largely depends on the tumour stage and histology, but the host systemic inflammatory response(SIR) to GC may contribute as well, as has been determined for other malignancies. In GC patients, the potential utility of positron emission tomography/computed tomography(PeT/CT) with the imaging radiopharmaceutical 18F-fluorodeoxyglucose(FDG) is still debated, due to its lower sensitivity in diagnosing and staging GC compared to other imaging modalities. There is, however, growing evidence that FDG uptake in the primary tumour and regional lymph nodes may be efficient for predicting prognosis of resected patients and for monitoring tumour response to perioperative treatments, having prognostic value in that it can change therapeutic strategies. Moreover, FDG uptake in bone marrow seems to be significantly associated with SIR to GC and to represent an efficient prognostic factor after curative surgery. In conclusion, PeT/CT technology is efficient in GC patients, since it is useful to integrate other imaging modalities in staging tumours and may have prognostic value that can change therapeutic strategies. With ongoing improvements, PeT/CT imaging may gain further importance in the management of GC patients.

关键词：胃的癌症预后 18 F-fluorodeoxyglucose 正电子排放计算断层摄影术的断层摄影术骨头髓

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Simultaneous curative resection of double colorectal carcinoma with synchronous bilobar liver metastases

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World Journal of Gastrointestinal Oncology 2018年第10期10卷 293-316页

作者： emilio De Raffele Mariateresa Mirarchi Dajana Cuicchi Ferdinando Lecce Claudio Ricci Riccardo Casadei Bruno Cola Francesco Minni Unità Operativa di chirurgia generale Dipartimento dell’Apparato DigerenteAzienda Ospedaliero-Universitaria di BolognaPoliclinico S.Orsola-Malpighi U.O.di chirurgia generale Dipartimento Strutturale Chirurgico Ospedale "Antonio e Margherita" Dipartimento di Scienze Mediche e Chirurgiche (DIMeC) Alma Mater Studiorum Policlinico S.Orsola-Malpighi University of Bologna

Synchronous colorectal carcinoma(SCRC) indicates more than one primary colorectal carcinoma(CRC) discovered at the time of initial presentation, accounts for 3.1%-3.9% of CRC, and may occur either in the same or in different colorectal segments. The accurate preoperative diagnosis of SCRC is difficult and diagnostic failures may lead to inappropriate treatment and poorer prognosis. SCRC requires colorectal resections tailored to individual patients, based on the number, location, and stage of the tumours, from conventional or extended hemicolectomies to total colectomy or proctocolectomy, when established predisposing conditions exist. The overall perioperative risks of surgery for SCRC seem to be higher than for solitary CRC. Simultaneous colorectal and liver resection represents an appealing surgical strategy in selected patients with CRC and synchronous liver metastases(CRLM), even though the cumulative risks of the two procedures need to be adequately evaluated. Simultaneous resections have the noticeable advantage of avoiding a second laparotomy, give the opportunity of an earlier initiation of adjuvant therapy, and may significantly reduce the hospital costs. Because an increasing number of recent studies have shown goodresults, with morbidity, perioperative hospitalization, and mortality rates comparable to staged resections, simultaneous procedures can be selectively proposed even in case of complex colorectal resections, including those for SCRC and rectal cancer. However, in patients with multiple bilobar CRLM, major hepatectomies performed simultaneously with colorectal resection have been associated with significant perioperative risks. Conservative or parenchymal-sparing hepatectomies reduce the extent of hepatectomy while preserving oncological radicality, and may represent the best option for selected patients with multiple CRLM involving both liver lobes. Parenchymal-sparing liver resection, instead of major or two-stage hepatectomy for bilobar disease, seemingly reduces the overall operative risk

关键词： Colorectal surgery Synchronous colorectal liver metastases Major hepatectomy Parenchymalsparing hepatectomy Intraoperative ultrasonography Simultaneous colorectal and liver surgery Synchronous colorectal carcinoma Ablative therapies

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Urea cycle disorders:A case report of a successful treatment with liver transplant and a literature review

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World Journal of Gastroenterology 2015年第13期21卷 4063-4068页

作者： Francesco Giuseppe Foschi Maria Cristina Morelli Sara Savini Anna Chiara Dall’Aglio Arianna Lanzi Matteo Cescon Giorgio ercolani Alessandro Cucchetti Antonio Daniele Pinna Giuseppe Francesco Stefanini U.O.Medicina Interna Ospedale di Faenza48018 FaenzaItaly U.O.chirurgia generale e dei trapianti Policlinico-S.Orsola-MalpighiUniversità di Bologna40138 BolognaItaly

The urea cycle is the final pathway for nitrogen metabolism. Urea cycle disorders(UCDs) include a variety of genetic defects, which lead to inefficient urea synthesis. elevated blood ammonium level is usually dominant in the clinical pattern and the primary manifestations affect the central nervous system. Herein, we report the case of a 17-year-old girl who was diagnosed with UCD at the age of 3. Despite a controlled diet, she was hospitalized several times for acute attacks with recurrent life risk. She came to our attention for a hyperammonemic episode. We proposed an orthotopic liver transplant(OLT) as a treatment; the patient and her family were in complete agreement. On February 28, 2007, she successfully received a transplant. Following the surgery, she has remained well, and she is currently leading a normal life. Usually for UCDs diet plays the primary therapeutic role, while OLT is often considered as a last resort. Our case report and the recent literature data on the quality of life and prognosis of traditionally treated patients vs OLT patients, support OLT as a primary intervention to prevent life-threatening acute episodes and chronic mental impairment.

关键词： Urea cycle disorders Hyperammonemia Diet Liver tra

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Non-intrusive data-driven ROM framework for hemodynamics problems

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Acta Mechanica Sinica 2021年第7期37卷 1183-1191,I0003页

作者： M.Girfoglio L.Scandurra F.Ballarin G.Infantino F.Nicolo A.Montalto G.Rozza R.Scrofani M.Comisso F.Musumeci Area di Matematica mathLabSISSAScuola Internazionale Superiore di Studi AvanzatiTriesteItaly Modelli Matematici e Simulazioni Numeriche Collegio di Ingegneria MatematicaPolitecnico di TorinoTorinoItaly Unit Operativa Complessa di Cardiochirurgia e chirurgia dei trapianti Azienda Ospedaliera San CamilloRomeItaly Dipartimento di Cardiochirurgia Azienda Ospedaliera FBF Luigi SaccoMilanItaly

Reduced order modeling(ROM)techniques are numerical methods that approximate the solution of parametric partial differential equation(PeD)by properly combining the high-fidelity solutions of the problem obtained for several configurations,i.***.for several properly chosen values of the physical/geometrical parameters characterizing the problem.By starting from a database of high-fidelity solutions related to a certain values of the parameters,we apply the proper orthogonal decomposition with interpolation(PODI)and then reconstruct the variables of interest for new values of the parameters,i.***.different values from the ones included in the database.Furthermore,we present a preliminary web application through which one can run the ROM with a very user-friendly approach,without the need of having expertise in the numerical analysis and scientific computing field.The case study we have chosen to test the efficiency of our algorithm is represented by the aortic blood flow pattern in presence of a left ventricular(LVAD)assist device when varying the pump flow rate.

关键词： Non intrusive model reduction Data-driven techniques Hemodynamics LVAD Web computing

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Metastatic tumors to the stomach: Clinical and endoscopicfeatures

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World Journal of Gastroenterology 2006年第45期12卷 7326-7328页

作者： Giovanni D De Palma Stefania Masone Maria Rega Immacolata Simeoli Mario Donisi Pietro Addeo Loredana Iannone Vincenzo Pilone Giovanni Persico Centro per l'Innovazione Tecnologica in chirurgia Dipartimento di chirurgia generale Oncologica e Tecnologie Avanzate. Università degli Studi di Napoli Federico II Facoltà di Medicina e Chirurgia Napoli Italy Centro per l’Innovazione Tecnologica in chirurgia Dipartimento di chirurgia generale Oncologica e Tecnologie Avanzate. Università degli Studi di Napoli Federico II Facoltà di Medicina e Chirurgia Napoli Italy

AIM: To evaluate the clinical and endoscopic patterns in a large series of patients with metastatic tumors in the stomach. MeTHODS: A total of 64 patients with gastric meta- stases from solid malignant tumors were retros- pectively examined between 1990 and 2005. The clinicopathological findings were reviewed along with tumor characteristics such as endoscopic pattern, location, size and origin of the primary sites. ReSULTS: Common indications for endoscopy were anemia, bleeding and epigastric pain. Metastases presented as solitary (62.5%) or multiple (37.5%) tumors were mainly located in the middle or upper third of stomach. The main primary metastatic tumors were from breast and lung cancer and malignant melanoma. CONCLUSION: As the prognosis of cancer patients has been improving gradually, gastrointestinal (GI) metastases will be encountered more often. endoscopic examinations should be conducted carefully in patients with malignancies, and endoscopic biopsies and information on the patient’s clinical history are useful for correct diagnosis of gastric metastases.

关键词：胃病临床表现病理学内窥镜检查法

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Actively bleeding Dieulafoy's lesion of the small bowel identified by capsule endoscopy and treated by push enteroscopy

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World Journal of Gastroenterology 2006年第24期12卷 3936-3937页

作者： Giovanni D De Palma Francesco Patrone Maria Rega Immacolata Simeoli Stefania Masone Giovanni Persico Centro per l'Innovazione Tecnologica in chirurgia-Dipartimento di chirurgia generale Oncologica e Tecnologie Avanzate Universita degli Studi di Napoli Federico Ⅱ Facoltà di Medicina e ChirurgiaNapoliItaly

Dieulafoy 的损害是周期性的官方补给的流血的一个不平常的原因。这份报告描述活跃地为 Dieulafoy 诊断被囊内视镜检查法在做的小肠的损害放血的一个案例，与推肠寄生物的使用由治疗列在后面。案例说明那囊内视镜检查法，肠寄生物在有... 详细信息

Dieulafoy 的损害是周期性的官方补给的流血的一个不平常的原因。这份报告描述活跃地为 Dieulafoy 诊断被囊内视镜检查法在做的小肠的损害放血的一个案例，与推肠寄生物的使用由治疗列在后面。案例说明那囊内视镜检查法，肠寄生物在有小肠疾病的病人是高度补足的。

关键词：小肠炎症内窥镜肠镜检查病理机制

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Conventional colonoscopy and magnified chromoendoscopy for the endoscopic histological prediction of diminutive colorectal polyps: A single operator study

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World Journal of Gastroenterology 2006年第15期12卷 2402-2405页

作者： Giovanni D De Palma Maria Rega Stefania Masone Marcello Persico Saverio Siciliano Pietro Addeo Giovanni Persico Centro di eccellenza per 1'Innovazione Tecnologica in chirurgia Dipartimento di chirurgia generale e Tecnologie Avanzate Università degli Studi di Napoli Federico ⅡFacoltà di Medicina e ChirurgiaNapoliItaly

瞄准：精确地由结肠镜检查把腺瘤区分开来与 non-adenomatous 息肉。方法：结肠镜检查检测的所有损害首先用多彩石印版内视镜检查法与放大跟随的常规看法被诊断。在每个步骤的诊断连续地被记录。所有息肉是为组织学的评估的完全移开的... 详细信息

瞄准：精确地由结肠镜检查把腺瘤区分开来与 non-adenomatous 息肉。方法：结肠镜检查检测的所有损害首先用多彩石印版内视镜检查法与放大跟随的常规看法被诊断。在每个步骤的诊断连续地被记录。所有息肉是为组织学的评估的完全移开的内视镜的联盟者。内视镜的诊断的每种类型的精确性率被评估，用象标准答案的组织检查所见。结果：240 损害的一个总数被识别，哪个(65.8%) 158 是非肿瘤的，(34.2%) 82 是腺瘤。常规看法的全面诊断精确性，和有放大的多彩石印版内视镜检查法是 76.3%(183/240 ) 并且 95.4%(229/240 ) ，分别地(P<0.001 ) 。结论：结肠镜检查和放大多彩石印版内视镜检查法的联合是为区分的最可靠的非活体检视方法从肿瘤的损害非肿瘤。

关键词：结肠镜检查内窥镜结肠息肉病理机制

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