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Diagnosis and management of choledocholithiasis in the golden age of imaging, endoscopy and laparoscopy

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World Journal of Gastroenterology 2014年第37期20卷 13382-13401页

作者： Renato Costi Alessandro Gnocchi Francesco Di Mario Leopoldo Sarli dipartimento di Scienze Chirurgiche Università di ParmaAzienda Ospedaliero-Universitaria di Parma dipartimento materno infantile Unità Operativa di Gastroenterologia ed Endoscopia DigestivaAzienda Ospedaliero-Universitaria di Parma dipartimento di Medicina Clinica e Sperimentale Università di ParmaAzienda Ospedaliero-Universitaria di Parma

Biliary lithiasis is an endemic condition in both Western and Eastern countries, in some studies affecting 20% of the general population. In up to 20% of cases, gallbladder stones are associated with common bile duct stones (CBDS), which are asymptomatic in up to one half of cases. Despite the wide variety of examinations and techniques available nowadays, two main open issues remain without a clear answer: how to cost-effectively diagnose CBDS and, when they are finally found, how to deal with them. CBDS diagnosis and management has radically changed over the last 30 years, following the dramatic diffusion of imaging, including endoscopic ultrasound (EUS) and magnetic resonance cholangiography (MRC), endoscopy and laparoscopy. Since accuracy, invasiveness, potential therapeutic use and cost-effectiveness of imaging techniques used to identify CBDS increase together in a parallel way, the concept of “risk of carrying CBDS” has become pivotal to identifying the most appropriate management of a specific patient in order to avoid the risk of “under-studying” by poor diagnostic work up or “over-studying” by excessively invasive examinations. The risk of carrying CBDS is deduced by symptoms, liver/pancreas serology and ultrasound. “Low risk” patients do not require further examination before laparoscopic cholecystectomy. Two main “philosophical approaches” face each other for patients with an “intermediate to high risk” of carrying CBDS: on one hand, the “laparoscopy-first” approach, which mainly relies on intraoperative cholangiography for diagnosis and laparoscopic common bile duct exploration for treatment, and, on the other hand, the “endoscopy-first” attitude, variously referring to MRC, EUS and/or endoscopic retrograde cholangiography for diagnosis and endoscopic sphincterotomy for management. Concerning CBDS diagnosis, intraoperative chol

关键词： Biliary lithiasis Choledocholithiasis Laparoscopy Endoscopy Diagnosis Management

Complete pancreatic heterotopia of gallbladder with hypertrophic duct simulating an adenomyoma

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World Journal of Gastroenterology 2006年第11期12卷 1786-1787页

作者： Luca Pilloni Alessandro Cois Alessandro Uccheddu Rossano Ambu Pierpaolo Coni Gavino Faa Istituto di Anatomia Patologica dipartimento di Citomorfologia Universita degli Studi di CagliariItaly Semeiotica Chirurgica dipartimento Chirurgico materno infantile e di Scienze delle Immagini Università degli Studi di CagliariItaly Istituto di Anatomia Patologica dipartimento di Citomorfologia Università degli Studi di CagliariItaly

The gallbladder is an unusual location of pancreatic heterotopia, defined as the presence of pancreatic tissue lacking anatomical and vascular continuity with the main body of the gland. A 28-year-old man presented with anorexia, nausea and pain in the right upper abdomen. On physical examination, the abdomen was tender to palpation and Murphy sign was positive. The patient underwent a cholecystecomy. This case, in our opinion, is very interesting since it permits to consider a controversial issue in the pathology of the gallbladder. The histological appearance of ductal structure in pancreatic heterotopia resembles the histological picture of both Aschoff-Rokitansky （AR） sinuses and adenomyomas. This finding suggests that these lesions are linked by a common histogenetic origin. We suggest that the finding of an adenomyoma in the gallbladder should prompt an extensive sampling of the organ in order to verify the coexistence of pancreatic rests.

关键词： Pancreatic heterotopia Gallbladder Hypertrophic duct Adenomyoma Aschoff-Rokitansky sinuses

Biliary complications after liver transplantation:current perspectives and future strategies

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Hepatobiliary Surgery and Nutrition 2021年第1期10卷 76-92页

作者： Bianca Magro Matteo Tacelli Alessandra Mazzola Filomena Conti Ciro Celsa Section of Gastroenterology and Hepatology Dipartimento di Promozione della SaluteMaterno-InfantileMedicina Interna e Specialistica di Eccellenza(PROMISE)University of PalermoPalermoItaly Service d'Hépatologie et Transplantation Hépatique Hôpital de la PitiéSalpétrièreAP-HPParisFrance

Importance:Liver transplantation(LT)is a life-saving therapy for patients with end-stage liver disease and with acute liver failure,and it is associated with excellent outcomes and survival rates at 1 and 5 *** incidence of biliary complications(BCs)after LT is reported to range from 5%to 20%,most of them occurring in the first three months,although they can occur also several years after ***:The aim of this review is to summarize the available evidences on pathophysiology,risk factors,diagnosis and therapeutic management of BCs after *** Review:a literature review was performed of papers on this topic focusing on risk factors,classifications,diagnosis and treatment Findings:Principal risk factors include surgical techniques and donor’s characteristics for biliary leakage and anastomotic biliary strictures and vascular alterations for non-anastomotic biliary *** is the gold standard both for intra-and extrahepatic BCs,while invasive cholangiography should be restricted for therapeutic uses or when MRCP is *** treatment,endoscopic techniques are the first line of treatment with success rates of 70-100%.The combined success rate of ERCP and PTBD overcome 90%of *** leaks often resolve spontaneously,or with the positioning of a stent in ERCP for major bile leaks Conclusions and Relevance:BCs influence morbidity and mortality after LT,therefore further evidences are needed to identify novel possible risk factors,to understand if an immunological status that could lead to their development exists and to compare the effectiveness of innovative surgical and machine perfusion techniques.

关键词： Liver transplantation(LT) biliary tract diseases cholangiography cholangiopancreatography endoscopic retrograde review

HIV Infection in Pregnancy and the Risk of Gestational Hypertension and Preeclampsia

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World Journal of Cardiovascular Diseases 2014年第5期4卷 257-267页

作者： Beatrice Landi Valeria Bezzeccheri Brunella Guerra Mariangela Piemontese Francesca Cervi Lucia Cecchi Eleonora Margarito Stefano R. Giannubilo Andrea Ciavattini Andrea L. Tranquilli dipartimento di Scienze Cliniche Specialistiche Università Politecnica delle Marche Ancona Italy dipartimento di Scienze Mediche e Chirurgiche Università di Bologna Bologna Italy dipartimento materno infantile AOU OORR Ancona Salesi Hospital Ancona Italy

The objective of this study was to evaluate the association between HIV infection and hypertensive disorders of pregnancy, comparing the rates of preeclampsia and gestational hypertension in a HIV-infected pregnant group and in a HIV-negative control pregnant group matched for age and parity. Furthermore, we aimed to compare the rates of hypertensive disorders in a subgroup of HIV-positive and HIV-negative African-American Black women. Patients and Methods: This was a prospective observational cohort study conducted at two University Departments of Obstetrics and Gynecology, Salesi Hospital, Ancona, and Sant’Orsola Hospital, Bologna. The HIV-infected patients’ group consisted of 126 pregnant women;140 HIV-negative pregnant women matched for age and parity served as controls. Gestational hypertension and preeclampsia were diagnosed according to NHBPEP-ISSHP criteria. Categorical data were analyzed using the Fisher exact test. Statistical significance was set at a p value < 0.05. Results: Gestational hypertension and preeclampsia were diagnosed in 3 of 126 HIV-positive patients (2.38%) and in 14 of 140 HIV-negative patients (10%), with a relative risk of 0.24 (p = 0.0112). In the subgroup of African-American Black women, gestational hypertension and preeclampsia were diagnosed in 2 out of 43 HIV-positive (4.7%) and in 3 out of 18 HIV-negative patients (16.7%) with a relative risk of 0.28, not statistically significant (p = 0.1887). Conclusion: Pregnant women with HIV infection seem to be protected against gestational hypertension and preeclampsia and this protective effect remains also in a high risk population, such as African-American Black ethnic group. The effect is present independently from treatment received and virus copies. The lack of immune response present since the conception period should account for unopposed trophoblast invasion resulting in a better placentation.

关键词： Human Immunodeficiency Virus Preeclampsia Gestational Hypertension African Ethnic Group Immune Tolerance

Neonatal pyknocytosis in a preterm dizygotic twin

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World Journal of Clinical Pediatrics 2017年第4期6卷 176-179页

作者： Alberto Berardi Eleonora Balestri Goretta Bonacorsi Claudio Chiossi Giovanni Palazzi Eugenio Spaggiari Fabrizio Ferrari Unità Operativa di Terapia Intensiva Neonatale Dipartimento Integrato Materno-InfantileAzienda Ospedaliero-Universitaria Policlinico Unità Operativa di Terapia Intensiva Neonatale Azienda Ospedaliera Santa Maria Nuova Unità Operativa di Ematologia Dipartimento di Scienze Mediche e ChirurgicheAzienda Ospedaliero-Universitaria Policlinico Unità Operativa di Pediatria Nuovo Ospedale Civile Unità Operativa di Pediatria Dipartimento Integrato Materno-InfantileAzienda Ospedaliero-Universitaria Policlinico

infantile pyknocytosis(IP) is a rare, self-limited neonatal haemolytic anaemia that may require multiple blood transfusions. Only a little more than 50 cases have been reported in the medical literature, and the great majority of them concerns term infants. The etiology of IP is not well understood; most likely it results from a transient extra-corpuscular factor, whose nature is unknown, transmitted from mother to child or, alternatively, from a deficiency of an anti-oxidative agent. We report the case of two preterm twins, one of which suffered from IP and developed severe anaemia at age 2 wk, while the other was unaffected. Although no specific agent was identified as the cause of anaemia and IP, we speculate that the transmission of an agent from mother to child was unlikely, as only twin one suffered from IP. Smelly greenish diarrhoea occurred just before the presentation of IP, suggesting that the same agent led to both the diarrhoea and the oxidative injury. Because IP may remain underdiagnosed, it should be considered in cases of early unexplained severe hemolytic anemia.

关键词： infantile pyknocytosis Glucose-6-phosphate dehydrogenase deficiency Anemia Oxidative stress Hemolysis

先天性肝脏间充质细胞错构瘤伴有胎盘间充质干绒毛膜增生:病例报道

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世界核心医学期刊文摘（儿科学分册） 2005年第11期1卷 61-62页

作者： Carta M. Maresi E. GiuffrèM. 王经纬 dipartimento materno infantile Universitàdi Palermo 90100 Palermo Italy

A newborn with an unusual association of hepatic mesenchymal hamartoma and mesenchymal stem villous hyperplasia of the placenta is presented. At birth, the large hepatic mass caused severe respiratory distress necessitating early surgical intervention. This report on the association of hepatic mesenchymal hamartoma and mesenchymal stem villous hyperplasia of the placenta strongly suggests a common pathogenetic origin of the 2 lesions.

关键词：间充质细胞错构瘤绒毛膜呼吸窘迫外科手术发病机制生时

Duplication of the transverse colon in an adult:Case report and review

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World Journal of Gastroenterology 2013年第4期19卷 586-589页

作者： Filippo Banchini Rocco Delfanti Evelina Begnini Maria Candida Tripodi Patrizio Capelli Department of General Surgery Ospedale Guglielmo da Saliceto29100 PiacenzaItaly UO Fibrosi Cistica dipartimento materno infantile Azienda Ospedaliera Universitaria di Parma 43126 ParmaItaly

Tubular duplication of the colon is very rare especially in adulthood,because it is frequently symptomatic earlier in newborn life,so only few cases are reported in *** theories are proposed to explain the onset and the evolution of gut malformations as the aberrant lumen recanalization or the diverticular theory,the alteration of the lateral closure of the embryonal disk or finally the dorsal protrusion of the yolksac for herniation or adhesion to the ectoderm for an abnormality of the longitudinal line,but none clarifies the exact genesis of *** present a case of "Y-shaped" tubular duplication of the transverse colon in a 21-year-old adult,with a history of chronic pain and constipation,referred to our department for abdominal pain with retrosternal irradiation,treated with the resection of the aberrant bowel.

关键词： Colonic diseases Colorectal duplication Neogenesis Colonic duplication Transverse duplication

Validation of the Italian Version of the Developmental Disability-Child Global Assessment Scale (DD-CGAS)

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Open Journal of Psychiatry 2014年第3期4卷 218-227页

作者： Diego F. M. Mugno Manuela Strano Mara Collini Andrea Gemma Lavinia De Peppo Laura Reale Veronica Micalizio Luigi Mazzone Manuela Maserada sul Piave Treviso Italy Neuropsichiatria infantile Dipartimento di Neuroscienze Ospedale Pediatrico Bambino Gesù Rome Italy Neuropsichiatria infantile ULSS 8 Veneto Region Italy Neuropsichiatria infantile University of Catania Catania Italy Stepping Stones Center Dubai UAE

Objective: The aim of this study is to validate the Italian version of the Developmental Disability-Child Global Assessment Scale (DD-CGAS), a scale developed to assess global functioning in children with Autism Spectrum Disorders (ASDs). Methods: Following the validation procedures used for the English version of the scale, inter-rater reliability, temporal stability and convergent validity were assessed in a group of 48 children with ASD and temporal stability in a subset of 42 subjects. Results: Inter-rater reliability and temporal stability (ICC) were respectively 0.78 and 0.79;effect size for convergent validity were moderate to large;the pre-post DD-CGAS change had an effect size of 0.59. Conclusions: The Italian version of the DD-CGAS is a reliable instrument for measuring global functioning of children with ASD.

关键词： Assessment Autism Children Functioning Pervasive Developmental Disorder Italian

Dose escalation of adalimumab as a strategy to overcome anti-drug antibodies:A case report of infantile-onset inflammatory bowel disease

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World Journal of Gastroenterology 2023年第38期29卷 5428-5434页

作者： Silvana Ancona Sara Signa Chiara Longo Giuliana Cangemi Roberta Carfora Enrico Drago Alessandro La Rosa Marco Crocco Andrea Chiaro Paolo Gandullia Serena Arrigo dipartimento di Neuroscienze RiabilitazioneOftalmologiaGenetica e Scienze Materno-Infantili(DINOGMI)Universitàdegli Studi di GenovaGenova 16126Italy Pediatric Gastroenterology and Endoscopy Unit IRCCS Istituto Giannina GasliniGenova 16147Italy Chromatography and Mass Spectrometry Section Central Laboratory of AnalysisIRCCS Istituto Giannina GasliniGenova 16147Italy

BACKGROUND Treatment of infantile-onset inflammatory bowel disease(IO-IBD)is often challenging due to its aggressive disease course and failure of standard therapies with a need for *** loss of response is frequently caused by the production of anti-drug antibodies,a well-known problem in IBD patients on biologic *** present a case of IO-IBD treated with therapeutic drug monitoring(TDM)-guided high-dose anti-tumor necrosis factor therapy,in which dose escalation monitoring was used as a strategy to overcome anti-drug *** SUMMARY A 5-mo-old boy presented with a history of persistent hematochezia from the 10th d of life,as well as relapsing perianal abscess and growth ***,anemia,and elevated inflammatory markers were also *** assessment revealed skip lesions with deep colic ulcerations,inflammatory anal sub-stenosis,and deep fissures with persistent abscess.A diagnosis of IO-IBD Crohn-like was *** patient was initially treated with oral steroids and *** the perianal abscess healed,adalimumab(ADA)was administered with concomitant gradual tapering of *** and biochemical steroid-free remission was achieved with good trough *** 3 mo,antibodies to ADA(ATA)were found with undetectable trough levels;therefore,we optimized the therapy schedule,first administering 10 mg weekly and subsequently up to 20 mg weekly(2.8 mg/kg/dose).After 2 mo of high-dose treatment,ATA disappeared,with concomitant high trough levels and stable clinical and biochemical remission of the *** TDM-guided high-dose ADA treatment as a monotherapy overcame ATA *** strategy could be a good alternative to combination therapy,especially in very young patients.

关键词： infantile-onset inflammatory bowel disease Adalimumab Loss of response Dose escalation Anti-drug antibodies Case report