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

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 surgeon.Multiple factors must be considered to allow development of an appropriate treatment plan.Medical therapy often precedes or complements the surgical management.The indications for operative management of CD include acute and chronic disease complications and failed medical therapy.Elective surgery comes into play when patients are refractory to medical treatment if they have an obstructive phenotype.Toxic colitis,acute obstruction,perforation,acute abscess,or massive hemorrhage represent indications for emergency surgery.These 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 making.Management of each emergency should be individualized based on patient age,disease type and duration,and patient goals of care.Moreover,the recurrent nature of disease mandates that we continue searching for innovative medical therapies and operative techniques that reduce the need to repeat surgical operations.in 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

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Diagnosis of ruptured superior mesenteric artery aneurysm mimicking a pancreatic mass

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World Journal of Gastroenterology 2010年第18期16卷 2298-2301页

作者： Stefano Palmucci Letizia Antonella Mauro Pietro Milone Francesco Di Stefano Antonino Scolaro Antonio Di Cataldo Giovanni Carlo Ettorre Department DOGiRA Section of Radiological Sciences"Policlinico-Vittorio Emanuele" University Hospital Division of Phlebologic Vascular Surgery Hospital "Garibaldi Nesima" Department of General and Colorectal Surgery "Policlinico-Vittorio Emanuele" University Hospital

Aneurysms and pseudoaneurysms of the superior mesenteric artery are potentially lethal and should be treated as urgently as possible.in a 52-year-old man with occasional epigastric pain,we accidentally discovered a superior mesenteric artery aneurysm that was ruptured with spontaneous tamponade in the uncinate process and in the head of the pancreas.The ruptured aneurysm had a heterogeneous appearance due to its thrombotic and hemorrhagic content,and it simulated a voluminous mass in the head and uncinate process of the pancreas,associated with mild dilatation of the main pancreatic duct.Recent advances in multidetector computed tomography and magnetic resonance imaging have enabled radiologists to develop a correct diagnosis of mesenteric aneurysms and pseudoaneurysms of the visceral branches of the abdominal aorta,and to differentiate this diagnosis from that of pancreatic or peripancreatic masses;angiography is currently used to confirm a diagnosis and to develop therapeutic treatments.

关键词： Superior mesenteric artery Magnetic resonance imaging Computed tomography Ruptured aneurysm

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Cardiometabolic risk factors in children with celiac disease on a gluten-free diet

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World Journal of Clinical Pediatrics 2017年第3期6卷 143-148页

作者： Caterina Anania Lucia Pacifico Francesca Olivero Francesco Massimo Perla Claudio Chiesa policlinico umberto Ⅰ hospital Sapienza University of Rome institute of Translational Pharmacology National Research Council

Celiac disease(CD) is an immune-mediated systemic condition evoked by gluten and related prolamines in genetically predisposed subjects. it is characterised by a variable combination of gluten-dependent clinical symptoms, CDspecific antibodies, HLA-DQ2 and HLA-DQ8 haplotypes, and enteropathy. The only therapy of CD consists of a life-long gluten free diet(GFD). Strict GFD adherence results in full clinical, serological and histological remission, avoiding long-term complications in CD patients. However, this diet is not without problems. Gluten free products have high levels of lipids, sugar and salt to improve food palatability and consistency, and subjects with CD show an excessive consumption of hypercaloric and hyperlipidic foods to compensate dietetic restriction. GFD may therefore have a negative impact on cardiometabolic risk factors such as obesity, serum lipid levels, insulin resistance, metabolic syndrome, and atherosclerosis. in adults, some studies have suggested that GFD have a beneficial effect on cardiovascular profile, whereas others have shown an atherogenic effect of GFD. in children, very few studies are available on the issue. Thus, the aim of the present narrative review was to analyze the current clinical evidence on the impact of GFD on cardiometabolic risk factors in children with CD.

关键词： Celiac disease Children Gluten free diet Cardiometabolic risk Atherosclerosis

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injectable versus oral first-line multiple sclerosis therapies:knows and unknowns from observational studies

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Neural Regeneration Research 2022年第3期17卷 567-568页

作者： Emanuele D’Amico Aurora Zanghì Carlo Avolio Department“G.F.ingrassia” MS CenterUniversity of CataniaCataniaItaly Department of Medical and Surgical Sciences University of Foggia Multiple Sclerosis Center Department of NeurosciencesPoliclinico Riuniti HospitalFoggiaItaly

The approval of oral disease modifying therapies(DMTs) for relapsing-remitting multiple sclerosis(RRMS) has changed considerably the therapeutic scenario and they often represent the first therapeutic choice for patie... 详细信息

关键词： al. therapies sclerosis

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Albumin-bilirubin score in non-malignant liver diseases should be properly validated

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World Journal of Gastroenterology 2023年第46期29卷 6089-6091页

作者： Andrea Pasta Francesco Calabrese Maria Corina Plaz Torres Giorgia Bodini Manuele Furnari EdoardoVincenzo Savarino Vincenzo Savarino Edoardo Giovanni Giannini Elisa Marabotto Gastroenterology Unit Department of Internal MedicineUniversity of GenoaIRCCS‐Ospedale Policlinico San MartinoGenoa 16132Italy Department of Surgery Oncology and GastroenterologyUniversity Hospital of PaduaPadua 35128Italy

The albumin-bilirubin(ALBi)score to assess the risk of decompensation in patients with initially compensated cirrhosis may improve their prognostic evaluation.This letter critically evaluates the research,which utilizes the ALBi score to forecast decompensation in cirrhosis patients over a three-year period.This score was initially developed to assess liver function in hepatocellular carcinoma,its prognostic utility for non-malignant liver diseases has now been explored,recognizing decompensation as a pivotal event that significantly affects patient’s survival.Some concerns regarding the methodology of this research may be raised,particularly the exclusive use of radiological diagnosis,potentially including patients without definite cirrhosis and thus skewing the decompensation risk assessment.The reported predominance of variceal bleeding as a decompensating event conflicts with established literature,that often reports ascites as the initial decompensation manifestation.The letter highlights the absence of details on esophageal varices and their management,which could introduce bias in evaluating the ALBi score's predictive power.Furthermore,the letter points out the small sample size of patients with high-risk ALBi grades,potentially compromising the score's validity in this context.We suggest prospective future research to investigate the dynamic changes in the ALBi score over time to reinforce the validity of the ALBi score as a predictor of decompensation in non-malignant liver disease.

关键词： Albumin-bilirubin score Decompensated cirrhosis Liver disease Nonmalignant liver disease Portal hypertension

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A systematic review of robot-assisted partial nephrectomy outcomes for advanced indications:Large tumors(cT2-T3),solitary kidney,completely endophytic,hilar,recurrent,and multiple renal tumors

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Asian Journal of Urology 2023年第4期10卷 390-406页

作者： Savio Domenico Pandolfo Clara Cerrato Zhenjie Wu Antonio Franco Francesco Del Giudice Alessandro Sciarra Paolo Verze Giuseppe Lucarelli Ciro imbimbo Sisto Perdonà Edward E.Cherullo Francesco Porpiglia ithaar H.Derweesh Riccardo Autorino Department of Urology Rush University Medical CenterChicagoILUSA Department of Neurosciences Reproductive Sciences and Odontostomatology“Federico II”UniversityNaplesItaly Department of Urology University of VeronaVeronaItaly Department of Urology Changhai HospitalNaval Medical UniversityShanghaiChina European Association of Urology(EAU)Young Academic Urologists(YAU)Renal Cancer Working Group Arnhemthe Netherlands Department of Urology Sant’Andrea HospitalLa Sapienza UniversityRomeItaly Department of Maternal-infant and Urologic Sciences La Sapienza UniversityPoliclinico Umberto I HospitalRomeItaly Department of Medicine and Surgery Scuola Medica SalernitanaUniversity of SalernoFiscianoItaly Department of Emergency and Organ Transplantation-Urology Andrology and Kidney Transplantation UnitUniversity of BariBariItaly Department Uro-Gynecology IRCCS G.Pascale FoundationNaplesItaly Department of Urology San Luigi Gonzaga HospitalUniversity of TurinOrbassanoItaly Department of Urology University of California San DiegoLa JollaCAUSA

Objective:Robot-assisted partial nephrectomy(RAPN)has become widely used for treatment of renal cell carcinoma and it is expanding in the field of complex renal masses.The aim of this systematic review was to analyze outcomes of RAPN for completely endophytic renal masses,large tumors(cT2-T3),renal cell carcinoma in solitary kidney,recurrent tumors,completely endophytic and hilar masses,and simultaneous and multiple tumors.Methods:A comprehensive search in the PubMed,Scopus,Web of Science,and Cochrane Central Register of Controlled Trials databases was performed in December 2022 for English language papers.The primary endpoint was to evaluate the role of RAPN in the setting of each category of complex renal masses considered.The secondary endpoint was to evaluate the surgical and functional outcomes.Results:After screening 1250 records,43 full-text manuscripts were selected,comprising over 8500 patients.Twelve and thirteen studies reported data for endophytic and hilar renal masses,respectively.Five and three studies reported outcomes for cT2-T3 and solitary kidney patients,respectively.Four studies focused on redo-RAPN for recurrent tumors.Two studies investigated simultaneous bilateral renal masses and five reports focused on multiple tumor excision in ipsilateral kidney.Conclusion:Over the past decade,evidence supporting the use of RAPN for the most challenging nephron-sparing surgery indications has continuously grown.Although limitations remain including study design and lack of detailed long-term functional and oncological outcomes,the adoption of RAPN for the included advanced indications is associated with favorable surgical outcomes with good preservation of renal function without compromising the oncological result.Certainly,a higher likelihood of complication might be expected when facing extremely challenging cases.However,none of these indications should be considered per se an exclusion criterion for performing RAPN.Ultimately,a risk-adapted approach should be employed.

关键词： Robot-assisted partial nephrectomy Complex renal mass Solitary kidney Larger tumors(cT2-T3) Endophytic and hilar mass Recurrent tumor Simultaneous and multiple tumor

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Effects of functional foods, nutraceuticals, and herbal products on pancreas

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Chinese Medical Journal 2023年第5期136卷 619-620页

作者： Angela Saviano Christian Zanza Yaroslava Longhitano Enrico Celestino Nista Francesco Franceschi Veronica Ojetti Department of Emergency Medicine Fondazione Policlinico Universitario Agostino GemelliIRCCSRomeItaly Foundation“Ospedale Alba-Bra”and Department of Anesthesia Critical Care and Emergency MedicineMichele and Pietro Ferrero HospitalVerdunoItaly Department of Anesthesiology and Perioperative Medicine University of PittsburghPittsburghPAUSA Department of Gastroenterology Fondazione Policlinico Universitario Agostino GemelliIRCCSRomeItaly.

To the Editor:Today functional foods,nutraceuticals,and herbal products are becoming a part of human daily diet.The patient’s interest and demand for them are rising.Globally,healthcare systems and people have shown an increased desire to prevent some diseases and to improve their performances.Published data about the properties and side effects of these products on the pancreas are still lacking,and more studies are required to provide a definitive opinion on their clinical benefits and safeties.The industry of functional foods,nutraceuticals,and herbal products is gaining popularity.

关键词： herbal functional becoming

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Cardiovascular risk after orthotopic liver transplantation, a review of the literature and preliminary results of a prospective study

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World Journal of Gastroenterology 2016年第40期22卷 8869-8882页

作者： Giuseppina Pisano Anna L Fracanzani Lucio Caccamo Maria F Donato Silvia Fargion Unit of internal Medicine Department of Pathophysiology and Transplantation Ca’ Granda IRCCS Foundation Policlinico Hospital University of Milan Unit of Hepatic Surgery Department of Pathophysiology and Transplantation Ca’ Granda IRCCS Foundation Policlinico Hospital University of Milan Division of Gastroenterology Department of Pathophysiology and Transplantation Ca’ Granda IRCCS Foundation Policlinico Hospital University of Milan

improved surgical techniques and greater efficacy of new anti-rejection drugs have significantly improved the survival of patients undergoing orthotopic liver transplantation(OLT). This has led to an increased incidence of metabolic disorders as well as cardiovascular and cerebrovascular diseases as causes of morbidity and mortality in OLT patients. in the last decade, several studies have examined which predisposing factors lead to increased cardiovascular risk(i.e., age, ethnicity, diabetes, NASH, atrial fibrillation, and some echocardiographic parameters) as well as which factors after OLT(i.e., weight gain, metabolic syndrome, immunosuppressive therapy, and renal failure) are linked to increased cardiovascular mortality. However, currently, there are no available data that evaluate the development of atherosclerotic damage after OLT. The awareness of high cardiovascular risk after OLT has not only lead to the definition of new but generally not accepted screening of high risk patients before transplantation, but also to the need for careful patient follow up and treatment to control metabolic and cardiovascular pathologies after transplant. Prospective studies are needed to better define the predisposing factors for recurrence and de novo occurrence of metabolic alterations responsible for cardiovascular damage after OLT. Moreover, such studies will help to identify the timing of disease progression and damage,which in turn may help to prevent morbidity and mortality for cardiovascular diseases. Our preliminary results show early occurrence of atherosclerotic damage, which is already present a few weeks following OLT, suggesting that specific, patient-tailored therapies should be started immediately post OLT.

关键词： Orthotopic 肝移植心血管的风险动脉粥样硬化非酒精的脂肪肝疾病 intima 媒介厚度 Epicardial 胖厚度心脏舒张的机能障碍

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Operative management of a shear fracture of the bilateral capitellum： A case report and review of the literature

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Chinese Journal of Traumatology 2016年第4期19卷 231-234页

作者： Alessandro Are ignazio Tornatore Emmanouil Theodorakis Department of Orthopedics Policlinico Casilino Hospital Rome Italy Department of Orthopedics Aurelia Hospital Rome Italy

Fracture of bilateral capitulum humeri is a very rare injury. We present a case of a 38-year-old woman, affected by a shear fracture of bilateral capitellum after a motorcycle accident. intervention was carried out through a lateral approach on both sides and direct fixation of the fragment with headless screws. Consolidation was achieved and no signs of avascular necrosis occurred at 24 months of follow-up. The patient returned to her previous activities with no functional limitations. To the best of our knowledge, only four cases are reported describing different types of treatment and postoperative period of cast immobilization. According to our review of the literature regarding capitellar fractures, we preferred an immediate postoperative rehabilitation of the elbow, following the stable osteosynthesis.

关键词： Elbow joint Fracture of capitulum humeri Fracture fixation internal Recovery of functional

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Cytoreductive surgery after recurrent epithelial ovarian cancer and at other timepoints

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World Journal of Obstetrics and Gynecology 2013年第4期2卷 101-107页

作者： Paolo Sammartino Tommaso Cornali Marialuisa Framarino dei Malatesta Pompiliu Piso Department of Surgery Pietro Valdoni Policlinico Umberto I 00161 Rome Italy Department of Gynecological Obstetrical and Urological Sciences Policlinico Umberto I 00161 Rome Italy Department of General Surgery Barmherzige Brüder Hospital 93049 Regensburg Germany

in this descriptive review we look at the role of surgery for advanced ovarian cancer at other timepoints apart from the initial cytoreduction for front-line therapy or interval cytoreductive surgery after neoadjuvant chemotherapy. The chief surgical problem to face after primary treatment is recurrent ovarian cancer. Of far more marginal concern are the second-look surgical procedures or the palliative efforts intended to resolve the patient's symptoms with no curative intent. The role of surgery in recurrent ovarian cancer remains poorly defi ned. Current data, albeit from non-randomized studies, nevertheless clearly support surgical cytoreduction in selected patients, a rarely curative expedient that invariably yields a marked survival advantage over chemotherapy alone. Despite these fi ndings, some consider it too early to adopt secondary cytoreduction as the standard care for patients with recurrent ovarian cancer and a randomized study is needed. Two ongoing randomized trials(Arbeitsgemeinschaft Gynkologische Onkologie-Desktop Ⅲ and Gynecologic Oncology Group 213) intend to verify the role of secondary cytoreduction for platinum-sensitive ovarian cancer compared with chemotherapy considered as standard care for these patients. We await the results of these two trials for a defi nitive answer to the matter.

关键词：晚期卵巢癌手术治疗治疗方法临床分析

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