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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： Gastric cancer Prognosis 18F-fluorodeoxyglucose Positron emission tomography-computed tomography Bone marrow

Update on Alcohol and Viral Hepatitis

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Journal of Clinical and Translational Hepatology 2014年第4期2卷 228-233页

作者： Stefano Gitto Giovanni Vitale Erica Villa Pietro Andreone dipartimento di Gastroenterologia Azienda Ospedaliero-Universitaria&University of Modena and Reggio Emilia Modena Italy dipartimento di Scienze Mediche e Chirurgiche University of Bologna and Dipartimento dell'Apparato Digerente Azienda Ospedaliero-Universitaria di Bologna Policlinico Sant'Orsola Malpighi Bologna Italy

Alcohol consumption is often associated with viral hepatitis. Although alcohol is known to worsen viral liver disease, the interactions between alcohol and viral hepatitis are not fully understood. Molecular alterations in the liver due to alcohol and viral hepatitis include effects on viral replication, increased oxidative stress, cytotoxicity, and a weakened immune response. Clinically, alcohol enhances disease pro-gression and favors induction of primitive liver neoplasm. The use of new antivirals for hepatitis C and well-established drugs for hepatitis B will determine how viral hepatitis can be controlled in a large percentage of these patients. However, alcohol-related liver disease continues to represent a barrier for access to antivirals, and it remains an unresolved health issue.

关键词： Alcohol HBV HCV

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 disea

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

Role and mechanisms of action of escherichia coli nissle 1917 in the maintenance of remission in ulcerative colitis patients: an update

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World Journal of Gastroenterology 2016年第24期22卷 5505-5511页

作者： Franco Scaldaferri Viviana Gerardi Francesca Mangiola Loris Riccardo Lopetuso Marco Pizzoferrato Valentina Petito Alfredo Papa Jovana Stojanovic Andrea Poscia Giovanni Cammarota Antonio Gasbarrini Polo apparato digerente e sistema Endocrino Metabolico Gastroenterology Division Catholic University of Sacred Hearth Institute of Hygiene Catholic University of Sacred Hearth

Ulcerative colitis (UC) is a chronic inflammatory disease, whose etiology is still unclear. Its pathogenesis involves an interaction between genetic factors, immune response and the “forgotten organ”, Gut Microbiota. Several studies have been conducted to assess the role of antibiotics and probiotics as additional or alternative therapies for Ulcerative Colitis. Escherichia coli Nissle (EcN) is a nonpathogenic Gram-negative strain isolated in 1917 by Alfred Nissle and it is the active component of microbial drug Mutaflor® (Ardeypharm GmbH, Herdecke, Germany and EcN, Cadigroup, In Italy) used in many gastrointestinal disorder including diarrhea, uncomplicated diverticular disease and UC. It is the only probiotic recommended in ECCO guidelines as effective alternative to mesalazine in maintenance of remission in UC patients. In this review we propose an update on the role of EcN 1917 in maintenance of remission in UC patients, including data about efficacy and safety. Further studies may be helpful for this subject to further the full use of potential of EcN.

关键词： Ulcerative colitis Escherichia coli Nissle Metanalysis Probiotic Randomized trial Inflammatory bowel disease

Twenty-year survival after iterative surgery for metastatic renal cell carcinoma: A case report and review of literature

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World Journal of Clinical Cases 2020年第19期8卷 4450-4465页

作者： Emilio De Raffele Mariateresa Mirarchi Riccardo Casadei Claudio Ricci Eugenio Brunocilla Francesco Minni dipartimento dell'apparato digerente Policlinico S.Orsola-MalpighiUniversity of BolognaBologna 40138Italy dipartimento Strutturale Chirurgico Ospedale SS Antonio e MargheritaTortona(AL)15057Italy dipartimento di Scienze Mediche e Chirurgiche(DIMEC) Alma Mater StudiorumPoliclinico S.Orsola-MalpighiUniversity of BolognaBologna 40138Italy dipartimento di Medicina Specialistica Diagnostica e Sperimentale(DIMES)Alma Mater StudiorumPoliclinico S.Orsola-MalpighiUniversity of BolognaBologna 40138Italy

BACKGROUND The therapeutic approach of metastatic renal cell carcinoma(RCC)represents a real challenge for clinicians,because of the variable clinical course;the recent availability of numerous targeted therapies that have significantly improved overall oncological results,but still with a low percentage of complete responses;and the increasing role of metastasectomy(MSX)as an effective strategy to achieve a durable cure,or at least defer initiation of systemic therapies,in selected patients and in the context of multimodality treatment ***^E SUMMARY We report here the case of a 40-year-old man who was referred to our unit in November 2004 with lung and mediastinal lymph nodes metastases identified during periodic surveillance 6 years after a radical nephrectomy for RCC;he underwent MSX of multiple lung nodules and mediastinal lymphadenectomy,with subsequent systemic therapy with Fluorouracil,Interferon-alpha and Interleukin *** subsequent clinical course was characterized by multiple sequential abdominal and thoracic recurrences,successfully treated with multiple systemic treatments,repeated local treatments,including two pancreatic resections,conservative resection and ablation of multiple bilobar liver metastases,resection and stereotactic body radiotherapy of multiple lung *** is alive without evidence of recurrence 20 years after initial nephrectomy and sequential treatment of recurrences in multiple sites,including resection of more than 38 metastases,and 5 years after his last *** This case highlights that effective multimodality therapeutic strategies,including multiple systemic treatments and iterative aggressive surgical resection,can be safely performed with long-term survival in selected patients with multiple metachronous sequential metastases from RCC.

关键词： Renal cell carcinoma Metastases Surgery Thermal ablation Radiation Case report Systemic therapy

对食管下括约肌行内镜下扩张对酸反流性疾病的食管内动力学特征的影响

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世界核心医学期刊文摘（胃肠病学分册） 2005年第7期1卷 26-26页

作者： Cicala M. Gabbrielli A. Emerenziani S. 陈云茹 Dipto. Malat. apparato digerente Università Compus Bio- Medico Vio Longoni 83 00155 Rome Italy Dr.

Background and aims: Improvements in symptoms following endoscopic procedures for gastrooesophageal reflux disease (GORD) are seldom supported by normalisati on of acid exposure time at the distal oesophagus. However, the distribution of gastric acid within the proximal oesophagus is a main determinant of symptom gen eration in GORD patients. In this study, our aim was to assess the effect of end oscopic insertion of hydrogel expandable prostheses into the oesophageal submuco sa on spatiotemporal characteristics of gastro- oesophageal reflux. Methods: Oe sophageal manometry and multichannel ambulatory 24 hour pH monitoring were carri ed out in nine patients before and six months after the endoscopic procedure. Dy namic characteristics of gastro- oesophageal reflux in patients were also compa red with those in 13 asymptomatic controls. Results: Acid exposure time (AET) at the distal oesophagus decreased from 11.7% (95% confidence interval 6.1- 2 1.8) at baseline to 7.7% (3.7- 11.6) at follow up (NS). Of the nine patients, distal AET normalised in three. AET at the middle (7.6% (2.9- 12.3)) and pro ximal (2.4% (0.1- 4.8)) oesophagus decreased significantly in all patients (2 .4% (0.3- 4.5), p < 0.01; 1.2% (0.2- 2.2), p< 0.05 respectively). Proximal extent of acid events significantly decreased in all patients at followup (37.3 % v 9.5% ), reaching values observed in asymptomatic controls. Median GORD he alth related quality of life scores significantly improved from 35.5 at baseline to 9.4. Conclusions: Despite the lack of a significant improvement in tradition al pH variables, endoscopic implant of hydrogel prostheses above the lower oesop hageal sphincter significantly decreases proximal spread of acid reflux into oes ophageal body. This effect would explain the improvement in symptoms in patients six months after therapy.

关键词：食管下括约肌反流性疾病力学特征内动胃食管反流近端远端的假体置入黏膜下层无症状