338 results on '"Casaccia M"'
Search Results
102. [Hepatic resection and transplantation for hepatocellular carcinoma in patients with cirrhosis]
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Gugenheim J, Edoardo Baldini, Casaccia M, Ouzan D, Mc, Saint-Paul, and Mouiel J
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Liver Cirrhosis ,Male ,Carcinoma, Hepatocellular ,Liver Neoplasms ,Hepatectomy ,Humans ,Female ,Neoplasm Invasiveness ,Middle Aged ,Neoplasm Recurrence, Local ,Embolization, Therapeutic ,Liver Transplantation ,Retrospective Studies - Abstract
Liver resection and liver transplantation are the only curative treatments for hepatocellular carcinoma in patients with cirrhosis. The aim of this retrospective study was to compare survival and tumor recurrence in patients with cirrhosis after hepatic resection or liver transplantation for hepatocellular carcinoma in patients with cirrhosis.Between March 1988 and March 1995, 34 patients underwent liver resection and 30 patients with cirrhosis had liver transplantation for hepatocellular carcinoma. The probability of survival and recurrence were studied according to clinical, biological and pathological factors, defined in liver specimens. Comparisons were performed by the actuarial method and log rank test.Five-year survival after resection and transplantation was 13% and 32.6%, respectively, and 5-year recurrence was 92.6% and 40.9%, respectively (P0.01). The diameter of nodules was a significant predictive factor of recurrence in resected patients; the number of nodules was a significant predictive factor in transplanted patients. The combination of these two factors could be used to identify two groups: patients with large carcinoma (diameter5 cm and/or number of nodules3), and patients with small carcinoma (diameteror = 5 cm and number of nodulesor = 3). The five-year survival rate of large hepatocellular carcinoma was 17.3% after resection and 0% after transplantation. The five-year survival rate of small hepatocellular carcinoma was 0% after resection and 69.3% after transplantation (P0.01). The five-year recurrence of large hepatocellular carcinoma was 72.3% after resection and 100% after transplantation. The five-year recurrence of small hepatocellular carcinoma was 82.6% after resection and 11.1% after transplantation (P0.01).Liver transplantation seems to be the best treatment for small hepatocellular carcinoma, mainly because of a lower recurrence rate. On the other hand, both treatments had a high recurrence rate in large hepatocellular carcinoma.
103. [Volvulus of the gallbladder: a difficult diagnosis requiring urgent operation]
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Gugenheim J, Edoardo Baldini, Casaccia M, and Mouiel J
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Aged, 80 and over ,Torsion Abnormality ,Time Factors ,Humans ,Female ,Gallbladder Diseases ,laparoscopic surgery ,gallbladder ,Aged
104. Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study)
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Fox, K. M., Bertrand, M., Ferrari, Roberto, Remme, W. J., Simoons, M. L., Simoons, M., Bassand, J. P., Aldershvile, J., Hildebrandt, P., Cokkinos, D., Toutouzas, P., Eha, J., Erhardt, L., Erikssen, J., Grybauskas, P., Kalnins, U., Karsch, K., Sechtem, U., Keltai, M., Klein, W., Luscher, T., Mulcahy, D., Nieminen, M., Oto, A., Ozsaruhan, O., Paulus, W., Providencia, L., Riecansky, I., Ruzyllo, W., Ferrari, R., Santini, U., Tavazzi, L., Soler Soler, J., Widimsky, P., Julian, D., Dargie, H., Murray, G., Kubler, W., Thygesen, K., Duprez, D., Steg, G., Drexel, H., Gombotz, G., Heyndrickx, G. H., Legrand, V., Materne, P., Van Mieghem, W., Bocek, P., Branny, M., Cech, M., Charouzek, J., Drazka, J., Fabik, L., Florian, J., Francek, L., Groch, L., Havranek, P., Hradec, J., Jansky, P., Jirmar, R., Jokl, I., Krejcova, H., Kvasnak, M., Maratka, T., Marcinek, G., Moravcova, J., Nedbal, P., Peterka, K., Povolny, J., Rosolova, H., Semrad, B., Sochor, K., Spacek, R., Spinar, J., Stipal, R., Stuchlik, K., Sulda, M., Ulman, J., Vaclavicek, A., Vojtisek, P., Bjerregaard Andersen, H., Kristensen, K., Madsen, J. K., Markenvard, J., Meibom, J., Norgaard, A., Scheibel, M., Leht, A., Teesalu, R., Vahula, V., Itkonen, A., Juvonen, J., Karmakoski, J., Kilkki, E., Koskela, E., Melin, J., Nieminen, M. S., Savola, R., Terho, T., Voipio Pulkki, L. M., Apffel, F., Attali, P., Barjhoux, C., Baron, B., Berthier, Y., Dambrine, P., Decoulx, E., Deshayes, P., Fouche, R., Genest, M., Godard, S., Guillot, J. P., Hanania, G., Khattar, P., Leroy, F., Mansourati, J., Piquemal, R., Quiret, J. C., Raynaud, P., Rondepierre, D., Roynard, J. L., Sudhibhasilp, S., Van Belle, E., Bilbal, A., Lauer, B., Rettig Sturmer, G., Riessen, R., Rutsch, W., Sigel, H. A., Simon, R., Von Schacky, C., Winkelmann, B. R., Avgeropoulou, C., Christakos, S., Feggos, S., Floros, S., Fotiadis, I., Goudevenos, I., Kardara, D., Karidis, C., Koliopoulos, N., Kremastinos, D., Lekakis, I., Manolis, A., Pyrgakis, V., Papanikolaou, C., Papasteriadis, E., Skoufas, P., Stravrati, A., Stavridis, A., Syribeis, S., Vardas, P., Vassiliadis, I., Voudris, V., Zobolos, S., Berenyi, I., Edes, I., Janosi, A., Kalo, E., Karpati, P., Kornel, S., Pap, I., Polak, G., Reiber, I., Rusznak, M., Tarjan, J., Timar, S., Toth, K., Barton, J., Crean, P., Daly, K., Kearney, P., Meany, T. B., Quigley, P., Antolini, R., Azzolini, P., Bellone, E., Branzi, A., Brunelli, C., Capponi, E., Capucci, A., Casaccia, M., Cecchetti, E., Ceci, V., Celegon, L., Colombo, A., Corsini, G., Cucchini, F., Dalla Volta, S., De Caterina, R., De Luca, I., De Servi, S., Di Donato, M., Di Giacomo, U., Di Pasquale, G., Fiorentini, C., Gaddi, O., Giannetto, M., Giannuzzi, P., Giordano, A., Giovannini, E., Guarnierio, M., Iacono, A., Inama, G., Leghissa, R., Lorusso, R., Marinoni, G., Marzilli, M., Mauri, F., Mosele, G. M., Papi, S., Pela, G., Pettinati, G., Polimeni, M. R., Portaluppi, Francesco, Proto, C., Renaldini, E., Riva, S., Sanguinetti, M., Santini, M., Severi, S., Sinagra, G., Tantalo, L., Vajola, S. F., Volterrani, M., Ansmite, B., Gailiss, E., Gersamija, A., Ozolina, M. A., Baubiniene, A., Berukstis, E., Grigoniene, L., Kibarskis, A., Kirkutis, A., Marcinkus, R., Milvidaite, I., Vasiliauskas, D., Aalders, J. C. A., Bruggeling, W. A. J., De Feyter, P. J., De Leeuw, M. J., De Waard, D. E. P., De Weerd, G. J., De Zwaan, C., Dijkgraaf, R., Droste, H. T., Freericks, M. P., Hagoort Kok, A. W., Hillebrand, F., Jap, W. T. J., Jochemsen, G. M., Kiemeney, F., Kuijer, P. J. P., Mannaerts, H. F. J., Piek, J. J., Saelman, J. P. M., Slob, F. D., Smits, W. C. G., Suttorp, M. J., Tan, T. B., Van Beek, G. J., Van den Merkhof, L. F. M., Van der Heyden, R., Van Hessen, M. W. J., Van Langeveld, R. A. M., Van Nierop, P. R., Van Rey, F. J. W., Van Straalen, M. J., Vos, J., Werner, H. A., Westendorp, J. J. C., Achremczyk, P., Adamus, J., Baska, J., Bolinska Soltysiak, H., Bubinski, R., Ceremuzynski, L., Cieslinski, A., Dariusz, D., Drozdowski, P., Dubiel, J. S., Galewicz, M., Halawa, B., Janion, M., Jaworska, K., Kaszewska, I., Kleinrok, A., Kornacewicz Jach, Z., Krawczyk, W., Krynicki, R., Krzciuk, M., Krzeminska Pakula, M., Kuch, J., Kuzniar, J., Liszewska Pfejfer, D., Loboz Grudzien, K., Musial, W., Opolski, G., Pasyk, S., Piwowarska, W., Pulkowski, G., Rynkiewicz, A., Sinkiewicz, W., Skura, M., Slowinski, S., Smielak Korombel, W., Targonski, R., Templin, W., Tendera, M., Tracz, W., Trusz Gluza, M., Wodniecki, J., Zalewski, M., Zinka, E., Carrageta, M., Gil, J. C., Ferreira, R., Marques, A. L., Andrade, C. M. S., Seabra Gomes, R., Bada, V., Belicova, M., Dukat, A., Kaliska, G., Kamensky, G., Micko, K., Mikes, Z., Palinsky, M., Pella, D., Renker, B., Sefara, P., Sojka, G., Sulej, P., Szakacs, M., Salcedo, J. M. A., Orcajo, N. A., Garcia, P. A., Sanpera, J. M. A., Azcarate, J. A., Mayor, J. L. B., Martinez, V. B., Coronado, J. L. B., Ojeda, F. B., Caimari, R. B., Cortada, J. B., Valderrama, J. C., Ligorit, A. D., Caliani, J. S. E., Aviles, F. F., Guerrero, J. J. G., Lopez, D. G., Cocina, E. G., Urena, C. G., Lorente, L. J., Garcia Aranda, V. L., De Miguel, C. M., Montero, J. M., Romero, P. M., Benito, I. M., Lopez, F. N., Peiro, F. N., De Ros, J. O., Mas, J. O., Bermejo, M. A. P., Peralta, L. J. P., Padial, L. R., Sanz, A. S., Bonnin, J. S., Martin, E. S., Belsue, F. V., Ekdahl, S., Forslund, L., Ohlin, H., Pieper, M., Moccetti, T., Acarturk, E., Guzelsoy, D., Turkoglu, C., Adgey, A. A. J., Ahsan, A., Al Khafaji, M., Ball, S. G., Birkhead, J., Boon, N., Brack, M., Bridges, A., Buchalter, M., Calder, B., Cooke, R. A., Corr, L., Cowell, R., Curzen, N. P., Davidson, C., Davies, J., De Belder, M. A., Dhiya, L., Doig, J. C., Findlay, I. N., Francis, C. M., Glancy, J. M., Greenwood, T. W., Groves, P., Hall, A. S., Hamilton, G., Haq, I., Hillman, R., Hubbard, W., Hudson, I., Hutton, I., Ilsley, C., Innes, M., James, M., Jennings, K., Johnston, G., Jones, C. J. H., Joy, M., Keeling, P., Kooner, J., Lawson, C., Levy, R. D., Lip, G., Mclachlan, B., Montgomery, H. E., Morley, C. A., Murdoch, D. L., Muthusamy, R., Oakley, G. D. G., Penny, W., Percival, R., Purvis, J., Pye, M. P., Ramsdale, D., Roberts, D. H., Rozkovec, A., Salmassi, A. M., Saltissi, S., Sardar, S., Shapiro, L. M., Schofield, P. M., Stephens, J., Shakespeare, C., Srivastava, S., Swan, J. W., Tildesley, G., Travill, C., Wilkinson, P. R., Fratacci, M. D., Lerebours, G., and Deckers, J.
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Relative risk reduction ,Male ,medicine.medical_specialty ,Myocardial Infarction ,Angiotensin-Converting Enzyme Inhibitors ,Coronary Disease ,Coronary artery disease ,Double-Blind Method ,Internal medicine ,Cause of Death ,Clinical endpoint ,Perindopril ,Medicine ,Humans ,Myocardial infarction ,Heart Failure ,Ejection fraction ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,Heart Arrest ,Treatment Outcome ,Cardiovascular Diseases ,Heart failure ,ACE inhibitor ,Cardiology ,Female ,business ,circulatory and respiratory physiology ,medicine.drug ,Follow-Up Studies - Abstract
Background Treatment with angiotensin-converting-enzyme (ACE) inhibitors reduces the rate of cardiovascular events among patients with left-ventricular dysfunction and those at high risk of such events. We assessed whether the ACE inhibitor perindopril reduced cardiovascular risk in a low-risk population with stable coronary heart disease and no apparent heart failure. Methods We recruited patients from October, 1997, to June, 2000. 13655 patients were registered with previous myocardial infarction (64%), angiographic evidence of coronary artery disease (61%), coronary revascularisation (55%), or a positive stress test only (5%). After a run-in period of 4 weeks, in which all patients received perindopril, 12218 patients were randomly assigned perindopril 8 mg once daily (n=6110), or matching placebo (n=6108). The mean follow-up was 4.2 years, and the primary endpoint was cardiovascular death, myocardial infarction, or cardiac arrest. Analysis was by intention to treat. Findings Mean age of patients was 60 years (SD 9), 85% were male, 92% were taking platelet inhibitors, 62% beta blockers, and 58% lipid-lowering therapy. 603 (10%) placebo and 488 (8%) perindopril patients experienced the primary endpoint, which yields a 20% relative risk reduction (95% CI 9-29, p=0.0003) with perindopril. These benefits were consistent in all predefined subgroups and secondary endpoints. Perindopril was well tolerated. Interpretation Among patients with stable coronary heart disease without apparent heart failure, perindopril can significantly improve outcome. About 50 patients need to be treated for a period of 4 years to prevent one major cardiovascular event. Treatment with perindopril, on top of other preventive medications, should be considered in all patients with coronary heart disease.
105. Modern views on treatment of spontaneous pneumothorax,ATTUALI ORIENTAMENTI NEL TRATTAMENTO DEL PNEUMOTORACE SPONTANEO
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Cariati, E., Casaccia, M., Campisi, C., and GIORGIO WALTER CANONICA
106. Laparoscopic resection of hepatocellular carcinoma: Considerations on lesions in the posterosuperior segments of the liver
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Casaccia, M., Andorno, E., Di Domenico, S., Maximiliano Gelli, Bottino, G., and Valente, U.
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Hepatocellular Carcinoma ,Laparoscopic surgery ,Hepatic Resection
107. Patients with acute myocardial infarction in Northern Italy are often infected by Helicobacter pylori
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Pellicano, R., Parravicini, P. P., Bigi, R., Maria Teresa La Rovere, Baduini, G., Gandolfo, N., Casaccia, M., Reforzo, F., Santoriello, L., Aruta, E., Marenco, G., Arena, V., Bazzoli, F., Rizzetto, M., and Ponzetto, A.
108. Pathologic changes in a long-term heterotopic heart transplant survivor
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Angela Pucci, Passarino G, Marra S, Papandrea C, Casaccia M, di Summa M, and Mollo F
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Heart Failure ,Male ,Fatal Outcome ,Transplantation, Heterotopic ,Proliferating Cell Nuclear Antigen ,Cyclosporine ,Graft Occlusion, Vascular ,Heart Transplantation ,Humans ,Coronary Disease ,Middle Aged - Abstract
This report concerns the pathologic findings observed at autopsy in a 10-year-old heterotopic heart transplant under cyclosporine treatment. The allograft showed a diffuse multivessel atherosclerotic disease whereas in the recipient heart coronary arteries and aorta were focally affected by atherosclerosis. The proliferating cell nuclear antigen had significantly increased expression in the allograft vessels in comparison with the recipient.
109. Lasers and mechanical staplers in surgery of the digestive system,Laser e suturatrici meccaniche nella chirurgia dell'apparato digerente
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Campisi, C., Casaccia Jr, M., FRANCESCO MARIA BOCCARDO, Berardi, L., Pasero, E., Padula, P., Stanizzi, T., and Casaccia, M.
110. Artificial preservation of lymphatic and venous vessels for lymphatic microsurgery: first experimental applications
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Campisi, C., primary, Tosatti, E., additional, and Casaccia, M., additional
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- 1985
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111. Lymphatic or venous grafts in the microsurgical treatment of lymphoedema: first clinical applications
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Campisi, C., primary, Tosatti, E., additional, and Casaccia, M., additional
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- 1985
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112. PLATELET BEHAVIOR IN ESSENTIAL THROMBOCYTHEMIA: A STUDY OF 31 CASES.
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Bazzan, M., Tamponi, G., Schinco, P., Marranca, D., Pileri, A., Bertello, F., Pennone, M., Bassignana, A., and Casaccia, M.
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- 1989
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113. Sister Joseph's nodule in a liver transplant recipient: Case report and mini-review of literature
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Jarzembowski Tomasz M, Miggino Marco, Mondello Rosalia, Bottino Giuliano, Morelli Nicola, Di Domenico Stefano, Andorno Enzo, Panaro Fabrizio, Ravazzoni Ferruccio, Casaccia Marco, and Valente Umberto
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Surgery ,RD1-811 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Background Umbilical metastasis is one of the main characteristic signs of extensive neoplastic disease and is universally referred to as Sister Mary Joseph's nodule. Case presentation A 59-years-old Caucasian female underwent liver transplant for end stage liver disease due to hepatitis C with whole graft from cadaveric donor in 2003. After transplantation the patient developed multiple subcutaneous nodules in the umbilical region and bilateral inguinal lymphadenopathy. The excision biopsy of the umbilical mass showed the features of a poorly differentiated papillary serous cystadenocarcinoma. Computed tomographic scan and transvaginal ultrasonography were unable to demonstrate any primary lesion. Chemotherapy was start and the dosage of the immunosuppressive drugs was reduced. To date the patient is doing well and liver function is normal. Conclusions The umbilical metastasis can arise from many sites. In some cases, primary tumor may be not identified; nonetheless chemotherapy must be administrated based on patient's history, anatomical and histological findings.
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- 2005
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114. Prognostic value of high dose dipyridamole 99M Tc sestamibi SPET in uremic patients without cardiac signs, symptoms and diabetes on the waiting list for renal transplant
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De Berardinis, A., Baccega, M., Martiny, W., Ropolo, R., Tortore, A., Segoloni, G., Squiccimarro, G., Campana, M., De Filippi, P.G., and Casaccia, M.
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- 1995
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115. Laparoscopic bridging vs. anatomic open reconstruction for midline abdominal hernia mesh repair [LABOR]: single-blinded, multicenter, randomized, controlled trial on long-term functional results
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Fabrizio Lazzara, Denise Palombo, Umberto Bracale, Maria Santina Bruno, Stefano Pezzato, Tommaso Testa, Mikaela Imperatore, Cesare Stabilini, Gian Marco Rosa, Nicola Morelli, Serena Perotti, Marco Casaccia, Carolina Righetti, Marco Frascio, Rosario Fornaro, Giusto Pignata, Alessio Signori, Paolo Pelosi, Ezio Gianetta, Stabilini, C, Bracale, Umberto, Pignata, G, Frascio, M, Casaccia, M, Pelosi, P, Signori, A, Testa, T, Rosa, Gm, Morelli, N, Fornaro, R, Palombo, D, Perotti, S, Bruno, M, Imperatore, M, Righetti, C, Pezzato, S, Lazzara, F, and Gianetta, E.
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medicine.medical_specialty ,Midline ,Bridging (networking) ,Hernia ,Time Factors ,Incisional ,Abdominal Hernia ,Randomized ,Medicine (miscellaneous) ,law.invention ,Abdominal wall ,Study Protocol ,Postoperative Complications ,Randomized controlled trial ,Clinical Protocols ,law ,Recurrence ,Functional results ,Medicine ,Humans ,Single-Blind Method ,Pharmacology (medical) ,Prospective Studies ,Laparoscopy ,Incisional, Midline, Hernia, Laparoscopy, Mesh, Functional results, Rives, Randomized ,Herniorrhaphy ,Mesh ,Mesh repair ,medicine.diagnostic_test ,business.industry ,Rives ,Equipment Design ,Middle Aged ,Surgical Mesh ,medicine.disease ,Surgery ,Hernia, Abdominal ,Surgical mesh ,medicine.anatomical_structure ,Treatment Outcome ,Italy ,Research Design ,Quality of Life ,business - Abstract
BACKGROUND: Re-approximation of the rectal muscles along the midline is recommended by some groups as a rule for incisional and ventral hernia repairs. The introduction of laparoscopic repair has generated a debate because it is not aimed at restoring abdominal wall integrity but instead aims just to bridge the defect. Whether restoration of the abdominal integrity has a real impact on patient mobility is questionable, and the available literature provides no definitive answer. The present study aims to compare the functional results of laparoscopic bridging with those of re-approximation of the rectal muscle in the midline as a mesh repair for ventral and incisional abdominal defect through an "open" access. We hypothesized that, for the type of defect suitable for a laparoscopic bridging, the effect of an anatomical reconstruction is near negligible, thus not a fixed rule. METHODS AND DESIGN: The LABOR trial is a multicenter, prospective, two-arm, single-blinded, randomized trial. Patients of more than 60 years of age with a defect of less than 10 cm at its greatest diameter will be randomly submitted to open Rives or laparoscopic defect repair. All the participating patients will have a preoperative evaluation of their abdominal wall strength and mobility along with volumetry, respiratory function test, intraabdominal pressure and quality of life assessment.The primary outcome will be the difference in abdominal wall strength as measured by a double leg-lowering test performed at 12 months postoperatively. The secondary outcomes will be the rate of recurrence and changes in baseline abdominal mobility, respiratory function tests, intraabdominal pressure, CT volumetry and quality of life at 6 and 12 months postoperatively. DISCUSSION: The study will help to define the most suitable treatment for small-medium incisional and primary hernias in patients older than 60 years. Given a similar mid-term recurrence rate in both groups, if the trial shows no differences among treatments (acceptance of the null-hypothesis), then the choice of whether to submit a patient to one intervention will be made on the basis of cost and the surgeon's experience. TRIAL REGISTRATION: Current Controlled Trials ISRCTN93729016.
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116. Fluorescence-guided laparoscopic lymph node biopsy for lymphoma: a new technique for an old procedure.
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Casaccia M
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- 2024
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117. Treatment of chronic and complex meniscal tears with arthroscopic meniscus repair augmented with collagen matrix wrapping: failure rate and functional outcomes.
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Vicens MH, Pujol O, Portas-Torres I, Aguilar M, Joshi N, Minguell J, Castellet E, and Casaccia M
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- Humans, Male, Female, Retrospective Studies, Adult, Middle Aged, Menisci, Tibial surgery, Treatment Outcome, Patient Satisfaction, Young Adult, Reoperation methods, Reoperation statistics & numerical data, Treatment Failure, Knee Injuries surgery, Chronic Disease, Tissue Engineering methods, Arthroscopy methods, Tibial Meniscus Injuries surgery, Collagen therapeutic use
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Purpose: Meniscal wrapping is a fully arthroscopic technique that involves enhanced meniscal repair with a tissue-engineered collagen matrix wrapping. This study aims to investigate the feasibility of using the meniscal wrapping technique for the treatment of chronic or complex meniscal tears. The primary objective is to assess its failure rate. The secondary objectives are to analyse complication rate, functional outcomes and overall patient satisfaction., Methods: This retrospective case series study included patients who sustained chronic and complex tears undergoing meniscal wrapping with autologous liquid bone marrow injection. Failure rate was considered if the patient underwent partial or complete meniscectomy or knee replacement during the follow-up, while other unexpected knee reoperations were considered as complications. Clinical outcomes were evaluated through the IKDC score, Tegner Activity Score and Short Assessment of Patient Satisfaction., Results: Twenty-one patients were included (15 non-acute bucket-handle tears, three non-acute horizontal tears and three non-acute complex injuries). The failure rate was 9.5% at 33 months. The rate of other unplanned reoperations was 14.3%, but none of these complications were apparently directly related to the wrapping technique. The average postoperative IKDC was 73.3/100. No statistically significant difference was encountered between preinjury and postoperative Tegner Activity Score. The mean overall patient satisfaction was 88.3/100., Conclusions: Meniscal wrapping can be safely used as an adjunctive technique to meniscal repair in such difficult-to-treat cases to preserve the meniscus. The technique achieves a low failure rate and promising results of knee function, and patient satisfaction., (© 2024. The Author(s).)
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- 2024
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118. Anti-biofilm mechanisms of action of essential oils by targeting genes involved in quorum sensing, motility, adhesion, and virulence: A review.
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Maggio F, Rossi C, Serio A, Chaves-Lopez C, Casaccia M, and Paparella A
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Biofilms are a critical factor for food safety, causing important economic losses. Among the novel strategies for controlling biofilms, essential oils (EOs) can represent an environmentally friendly approach, able to act both on early and mature stages of biofilm formation. This review reports the anti-biofilm mechanisms of action of EOs against five pathogenic bacterial species known for their biofilm-forming ability. These mechanisms include disturbing the expression of genes related to quorum sensing (QS), motility, adhesion, and virulence. Biofilms and QS are interconnected processes, and EOs interfere with the communication system (e.g. regulating the expression of agrBDCA, luxR, luxS, and pqsA genes), thus influencing biofilm formation. In addition, QS is an important mechanism that regulates gene expression related to bacterial survival, virulence, and pathogenicity. Similarly, EOs also influence the expression of many virulence genes. Moreover, EOs exert their effects modulating the genes associated with bacterial adhesion and motility, for example those involved in curli (csg), fimbriae (fim, lpf), and flagella (fla, fli, flh, and mot) production, as well as the ica genes responsible for synthetizing polysaccharide intercellular adhesin. This review provides a comprehensive framework on the topic for a better understanding of EOs biofilm mechanisms of action., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)
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- 2024
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119. Fluorescence-guided laparoscopic lymph node biopsy for lymphoma: the FLABILY study.
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Casaccia M, Alemanno G, Prosperi P, Ceccarelli G, Olmi S, Oldani A, Santarelli M, Tutino R, and De Cian F
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To date, no reports have indicated laparoscopic lymph node biopsies using Indocyanine green (ICG) in cases of lymphoproliferative disease. Preliminary data of patients undergoing fluorescence-guided laparoscopic lymph node biopsy (FGLLB) using ICG was retrospectively analysed from the multicentre registry FLABILY study. Between June 2022 and February 2024, 50 patients underwent FGLLB. The surgical biopsy aimed to re-stage lymphoproliferative disease for 25 patients and to establish a diagnosis in 25 patients. The median duration of the procedure was 65 ± 26.5 min. All the procedures were performed laparoscopically. One surgical conversion occurred due to bleeding. Median length of hospitalization was 1 ± 1.7 days. Two unrelated complications occurred in the immediate postoperative course. ICG was administrated preoperatively by means of an inguinal, perilesional, or intravenous injection according to the anatomical sites of the biopsy. Fluorescence was obtained in 43/50 (86%) of patients. A significant difference was highlighted in the appearance of fluorescence in sub-mesocolic lymph nodes compared to supra-mesocolic and mesenteric lymph nodes (41/49 (83.6%) vs. 13/22 (59%), p = 0,012). In 98% of cases, FGLLB provided the information necessary for the correct diagnosis. Fluorescence with ICG offers a simple and safe method for detecting pathological lymph nodes. FGLLB in suspected intra-abdominal lymphoma can largely benefit from this new opportunity which, to date, has not yet been tested. Further studies with a larger case series are needed to confirm its efficacy., (© 2024. The Author(s).)
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- 2024
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120. New clinical application of indocyanine green in fluorescence-guided laparoscopic lymph-node biopsy in case of lymphoma. Preliminary results on a case series.
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Casaccia M, Ibatici A, Ballerini F, Barabino NM, Santoliquido M, and De Cian F
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- Humans, Indocyanine Green, Retrospective Studies, Biopsy, Lymphoma diagnosis, Lymphoma surgery, Laparoscopy
- Abstract
Background: Indocyanine Green (ICG) fluorescence-guided surgery is widely used for intraoperative visualization of lymphatic structures. To date, there are no reports indicating this dye being used in lymph node biopsies for suspected or relapsed lymphoma., Methods: Between October 2021 and June 2022, 12 patients underwent a fluorescence-guided laparoscopic lymph node biopsy (FGLLB) using ICG. The following was retrospectively evaluated: the dosage of ICG, the injection site, the number of patients where fluorescence was obtained after ICG administration, and additionally, the parameters indicating the outcome of the surgical procedure., Results: The median duration of the surgery was 90 min. A laparotomy conversion was required in one case due to bleeding. Fluorescence was obtained in 10/12 (83.3%) patients by means of subcutaneous/perilesional injection in six of the patients, and intravenously in the other four. Hospitalization had a mean duration of three days. There were no major postoperative complications. FGLLB was used in seven patients to follow lymphoproliferative disease progression, and in five patients to establish a diagnosis. In all cases, FGLLB provided the information necessary for the correct diagnosis., Conclusions: Fluorescence with ICG offers a simple and safe method for detecting pathological lymph nodes. FGLLB in suspected intra-abdominal lymphoma can largely benefit from this new opportunity which has not yet been tested to date. Further studies with large case series are needed to confirm its efficacy., (© 2023. BioMed Central Ltd., part of Springer Nature.)
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- 2023
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121. Pediatric primary spontaneous pneumothorax: a comparison of treatment at pediatric surgery vs. thoracic surgery departments.
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Miscia ME, Castellano M, Chiarini S, Lauriti G, Casaccia M, Lelli Chiesa P, and Lisi G
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- Adult, Child, Humans, Recurrence, Retrospective Studies, Thoracic Surgery, Video-Assisted, Tomography, X-Ray Computed, Treatment Outcome, Pneumothorax surgery, Thoracic Surgery
- Abstract
Management of pediatric Primary Spontaneous Pneumothorax (PSP) is controversial and based on guidelines on adults. Therapeutic strategies include: observation, needle aspiration, chest drain, or surgery. We aimed to assess: i) differences in the management of PSP in pediatric vs. adult departments; ii) risk of recurrence associated to each therapeutic choice; iii) management of "large" pneumothorax (i.e. >3cm at the apex on chest X-Ray); iv) role of CT scan in addressing the treatment. We reviewed all PSP treated at Pediatric Surgery Unit (PSU) and Thoracic Surgery Unit for adults (TSU) in a 10-year period (2011 to 2020). We included a total of 42 PSP: 30/42 1st episodes and 12/42 recurrences. Among the 30/42 1st episodes, 15/30 were managed in the PSU and 15/30 in the TSU. Observation was significantly most common among PSU patients (9/15, 60%) vs. TSU cases (1/15, 6.7%; p=0.005]. Chest drain placement was reduced in PSU (3/15, 20%) vs. TSU (12/15, 80%; p=0.002). Observational was associated with a reduced risk of recurrence (0/10, 0%) compared to chest drain (7/15, 46.7%; p=0.01). Management of 20/42 "large" pneumothorax was: 4/20 (20%) observation, 10/20 (50%) chest drain, 2/20 (10%) needle aspiration, 4/20 (20%) surgery. Twentythree/ 29 PSP (79.3%) underwent CT-scan after the first episode. Bullae were detected in 17/23 patients and 5/17 (29.4%) had seven episodes of recurrence. PSP patients treated by PSU were more likely to receive clinical observation. Those managed by TSU were mostly treated by chest drain. Observation seems an effective choice for clinically stable PSP, with low risk of recurrence at a mid-term follow-up. CT-scan seems not to detect those patients at higher risk of recurrence.
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- 2023
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122. Single-Port Cholecystectomy for Cholecystitis Versus Non-Cholecystitis.
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Casaccia M, Ponzano M, Testa T, Martigli SP, Contratto C, and De Cian F
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- Cholecystectomy, Humans, Postoperative Complications epidemiology, Postoperative Complications surgery, Reproducibility of Results, Retrospective Studies, Cholecystitis surgery, Cholecystitis, Acute surgery
- Abstract
Background and Objectives: To assess the safety and efficacy of single-port laparoscopic cholecystectomy (SPLC) for the treatment of symptomatic cholelithiasis in different gallbladder pathologic conditions., Methods: All patients who underwent SPLC in our department between October 1, 2017 and March 31, 2020 were registered consecutively in a prospective database. Patients' charts were retrospectively divided according to histological diagnosis: normal gallbladder (NG) (n = 13), chronic cholecystitis (CC) (n =47), and acute cholecystitis (AC) (n = 10). The parameters for assessing the procedure outcome included operative time, blood loss, use of additional trocars, conversion to laparotomy, intraoperative and postoperative complications, and length of hospital stay. Patient groups were statistically compared., Results: Seventy patients underwent SPLC. Duration of surgery increased from NG (55 ± 22.7 min) to CC (70 ± 33.5 min), and to AC patients (110.5 ± 50.5 min), which is statistically significant ( P = .001). Postoperative complication rates were 7.6% in NG patients, 17% in CC, and 30% in AC ( P = .442). Length of hospitalization was shorter for NG patients (1.0 ± 0.6 days) versus CC (2.0 ± 1.1 days) and AC patients (2.0 ± 4.7 days), with statistical significance ( P = .020). Multivariate analysis found that pathology type and the occurrence of postoperative complications were independent predictors for prolonged operative times and prolonged hospital stay, respectively., Conclusion: SPLC is feasible for acute and chronic cholecystitis with good procedural outcomes. Since SPLC technique itself can be sometimes challenging with the existing technology, its application, especially in cases of acute cholecystitis, should be done with caution. Only prospective randomized studies on this approach for acute and chronic gallbladder diseases will assess the complete reliability of this technique., (© 2022 by SLS, Society of Laparoscopic & Robotic Surgeons.)
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- 2022
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123. Fluorescence-guided laparoscopic lymph node biopsy in a lymphoma patient: a possible new clinical application of indocyanine green.
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Casaccia M, Testa T, Martigli SP, Santoliquido M, and Lemoli RM
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To date, there are no reports indicating the use of indocyanine green (ICG) fluorescence to detect pathologic lymphatic tissue when a laparoscopic lymph node biopsy (LLB) for suspected new or recurrent lymphoma is performed. We present the case of a 72-year-old female patient admitted for suspicion of recurrent lymphoma. A preoperative imaging work-up showed solid tissue enveloping the terminal portion of the abdominal aorta with a standardized uptake value (SUV) of 10. Therefore, an LLB was planned. After induction of anesthesia, a ICG solution was injected intravenously and subcutaneously at both inguinal regions. At laparoscopy, a complete visualization of the pathologic lymph nodes was achieved, enabling an incisional biopsy of the lymphomatous mass. LLB with ICG-fluorescence offers a simple and safe method for pathologic lymph node detection in the suspicion of intra-abdominal lymphoma. More studies with large case series are needed to confirm the efficacy of this application., (Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2022.)
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- 2022
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124. Is routine blood typing and screening necessary before primary total hip or knee arthroplasty in the 21st century?
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Nuñez JH, Mora L, Carbonell C, Barro V, Casaccia M, Pérez M, and Minguell J
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- Blood Grouping and Crossmatching, Hemoglobins analysis, Humans, Retrospective Studies, Arthroplasty, Replacement, Hip adverse effects, Arthroplasty, Replacement, Knee adverse effects
- Abstract
Background: Blood loss warranting transfusion is a relatively rare complication of major-joint arthroplasty procedures like total knee arthroplasty (TKA) and total hip arthroplasty (THA). Despite this rarity, pre-transfusion testing (blood typing, screening, and cross-matching) has become routine. We sought to determine if such routine testing is necessary for patients who undergo a primary TKA or THA by (1) measuring the current rate of intraoperative transfusions in primary TKA and THA patients, (2) identifying risk factors for transfusions, and (3) calculating the costs of such blood typing and screening., Study Methods: We retrospectively examined the records of 992 patients who underwent primary TKA, THA, or unicompartmental knee arthroplasty (UKA) to identify patients requiring intra-operative or in-hospital postoperative transfusions. Demographic and baseline clinical and laboratory data also were collected and analyzed to identify predictors of transfusion. Cost analysis was performed., Results: The rate of intraoperative transfusion was 1.7% (17/992 patients), with rates of 2.1%, 1.6%, and 0% for TKA, THA, and UKA respectively. The in-hospital transfusion rate was 10.3%, with corresponding postoperative transfusion rates of 9.1%, 12.9%, and 2%. The only baseline variable significantly linked to transfusions on multivariable analysis was preoperative hemoglobin level, with preoperative Hgb <12 g/dl predictive of transfusions in both TKA (p = .02) and THA (p = .024) patients., Discussion: Our study suggests that pre-transfusion testing for all patients undergoing primary UKA, TKA or THA is unnecessary. We recommend reserving routine pre-transfusion testing for patients with preoperative hemoglobin levels below 12 g/dl., (© 2022 AABB.)
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- 2022
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125. Effectiveness and mechanisms of essential oils for biofilm control on food-contact surfaces: An updated review.
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Rossi C, Chaves-López C, Serio A, Casaccia M, Maggio F, and Paparella A
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- Anti-Bacterial Agents pharmacology, Bacteria, Biofilms, Humans, Quorum Sensing, Oils, Volatile pharmacology
- Abstract
Microbial biofilms represent a constant source of contamination in the food industry, being also a real threat for human health. In fact, most of biofilm-producing bacteria are becoming resistant to sanitizers, thus arousing the interest in natural alternatives to prevent biofilm formation on foods and food-contact surfaces. In particular, studies on biofilm control by essential oils (EOs) application are increasing, being EOs characterized by unique mixtures of compounds able to impair the mechanisms of biofilm development. This review reports the anti-biofilm properties of EOs in bacterial biofilm control (inhibition, removal and prevention of biofilm dispersion) on food-contact surfaces. The relationship between EOs effect and composition, concentration, involved bacteria, and surfaces is discussed, and the possible sites of action are also elucidated. The findings prove the high biofilm controlling capability of EOs through the regulation of genes and proteins implicated in motility, Quorum Sensing and exopolysaccharides (EPS) matrix. Moreover, incorporation in nanosized delivery systems, formulation of blends and combination of EOs with other strategies can increase their anti-biofilm activity. This review provides an overview of the current knowledge of the EOs effectiveness in controlling bacterial biofilm on food-contact surfaces, providing valuable information for improving EOs use as sanitizers in food industries.
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- 2022
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126. Laparoscopic lymph node biopsy for lymphoma with a novel use of indocyanine green fluorescence in a 66-year-old male patient.
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Casaccia M, Mora M, Santori G, Ghiggi C, and Angelucci E
- Abstract
Introduction: Indocyanine green (ICG) near-infrared fluorescence is primarily employed in detecting Intraoperative sentinel lymph node (SLN) mapping or to evaluate the extent of radical lymphadenectomy mainly in colo-rectal and gastric cancer. To date there are no reports indicating the use of this dye to detect pathologic lymphatic tissue when a lymph node biopsy for suspected lymphoproliferative disease is performed., Presentation of Case: A 66-year-old male patient was admitted to the hospital for severe pain of left renal colic type. A computed tomography (CT) scan and a positron emission tomography (PET) showed a left hydroureteronephrosis due to ureter compression by paraortic solid tissue of lymphomatous aspect with a standardized uptake value (SUV) of 15. Multiple lymphadenopathies on paracaval, para-aortic and common iliac sites were present as well., Discussion: A laparoscopic lymph node biopsy (LLB) was planned for diagnostic purposes. After induction of anesthesia a ICG solution was injected Intradermally at both inguinal regions. At laparoscopy a complete visualization of the pathologic lymphnodes was achieved, enabling incisional biopsies of the lymphomatous mass. Histopathological examination showed an extranodal localization of an aggressive B-cell non-Hodgkin lymphoma., Conclusion: ICG-fluorescence seems to offer a simple and safe method for pathologic lymph node detection. LLB in the suspicion of intra abdominal lymphoma can largely take advantage by this novel opportunity not yet tested to date. More studies with large case series are needed to confirm the efficacy of ICG-fluorescence for detecting pathologic lymph nodes., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)
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- 2022
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127. Feasibility of Single-Port Laparoscopic Lymph Node Biopsy for Intra-Abdominal Lymphoma: A Case Series.
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Casaccia M, Lemoli RM, Angelucci E, Bregante S, Ballerini F, Ibatici A, Ghiggi C, and De Cian F
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- Abdominal Cavity, Abdominal Neoplasms pathology, Adult, Aged, Biopsy methods, Comorbidity, Feasibility Studies, Female, Humans, Lymph Nodes pathology, Lymphoma pathology, Male, Middle Aged, Postoperative Complications pathology, Reproducibility of Results, Retrospective Studies, Abdominal Neoplasms diagnosis, Disease Progression, Laparoscopy methods, Lymphoma diagnosis
- Abstract
Background: Laparoscopic lymph node biopsy through a multi-port access (MPLB) is a well-established technique for intra-abdominal lymphoma diagnosis. The aim of the current study is to assess the feasibility and the diagnostic accuracy of the single-port laparoscopic lymph node biopsy (SPLB) in intra-abdominal lymphoma. Materials and Methods: Between October 2016 and February 2019, 15 patients underwent SPLB to rule out or to follow the progression of a lymphoma. The clinical outcome and the pathology reports were analyzed retrospectively. Results: SPLB was completed laparoscopically in all cases. The total number of biopsies performed for each procedure was sometimes multiple (median: 2; range: 1-3). Duration of surgery was 85 ± 32 minutes (range: 75-105 minutes). Length of hospitalization was 1.8 ± 0.7 days (range: 1-3 days). No major postoperative complications occurred. A cutaneous infection managed conservatively was observed in a patient. In 10 patients, SPLB was used to establish a diagnosis whereas in 5 patients it was performed to follow a progression of a lymphoproliferative disease. In 93.3% of the cases, SPLB achieved the correct diagnosis and subsequent therapeutic decisions. Conclusion: SPLB has shown good procedure and postoperative outcomes as well as a high diagnostic yield, comparable to literature data on traditional MPLB. Therefore, our results show that this approach is safe and effective and can be an equally valid option to MPLB to obtain a diagnosis or to follow the progression of a lymphoproliferative disease. Further studies are necessary to support these results before its widespread adoption.
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- 2021
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128. Single-Port vs. Conventional Multi-Port Laparoscopic Lymph Node Biopsy.
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Casaccia M, Fornaro R, Papadia FS, Testa T, Mascherini M, Ibatici A, Ghiggi C, Bregante S, and De Cian F
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- Abdominal Neoplasms secondary, Equipment Design, Female, Humans, Lymphatic Metastasis, Male, Middle Aged, Reproducibility of Results, Treatment Outcome, Abdominal Neoplasms diagnosis, Biopsy methods, Laparoscopes, Laparoscopy methods, Lymph Nodes pathology
- Abstract
Background and Objectives: The purpose of the investigation was to compare clinical results and diagnostic accuracy for conventional multiport laparoscopic lymph node biopsy (MPLB) and single-port laparoscopic lymph node biopsy (SPLB) operations at a single institution., Methods: A set of 20 SPLB patients operated on from October 2016 to May 2019 were compared to an historical series of 35 MPLB patients. Primary endpoints were the time of surgery, estimated blood loss, surgical conversion, length of stay and morbidity. The secondary endpoint was the diagnostic accuracy of the technique., Results: SPLB was completed laparoscopically in all cases. Two MPLB patients (5.7%) experienced a surgical conversion due to intraoperative difficulties. Duration of surgery was similar in SPLB and MPLB groups respectively (84 ± 31.7 min vs. 81.1 ± 22.2; P = .455). A shorter duration of hospital stay was shown for patients operated on by SPLB compared to the MPLB group (1.7 ± 0.9 days vs. 2.1 ± 1.2 days; P = .133). The postoperative course was uneventful in both groups. In 95% of the SPLB and 97.1% of the MPLB cases respectively, LLB achieved the necessary information for the diagnosis., Conclusion: SPLB has shown good procedural and postoperative outcomes as well as a high diagnostic yield, comparable to traditional MPLB. Therefore, our results show that this approach is safe and effective and can be an equally valid option to MPLB to obtain a diagnosis or to follow the progression of a lymphoproliferative disease. Further studies are necessary to support these results before its widespread adoption., Competing Interests: Conflicts of Interest: The authors declare no conflicts of interest., (© 2020 by JSLS, Journal of the Society of Laparoscopic & Robotic Surgeons.)
- Published
- 2020
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129. Letter to: Olmi S, Uccelli M, Cesana GC, et al. Modified laparoscopic sleeve gastrectomy with Rossetti antireflux fundoplication: results after 220 procedures with 24-months follow-up.
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Papadia FS, Camerini G, Casaccia M, Mascherini M, Rubartelli A, and Scopinaro N
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- Follow-Up Studies, Fundoplication, Gastrectomy, Humans, Gastroesophageal Reflux surgery, Laparoscopy
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- 2020
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130. Single-Port Versus Conventional Laparoscopic Cholecystectomy: Better Cosmesis at the Price of an Increased Incisional Hernia Rate?
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Casaccia M, Papadia FS, Palombo D, Di Domenico S, Sormani MP, Batistotti P, Mascherini M, and De Cian F
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- Adult, Aged, Female, Humans, Incidence, Incisional Hernia epidemiology, Incisional Hernia etiology, Italy epidemiology, Male, Middle Aged, Postoperative Complications epidemiology, Postoperative Complications etiology, Retrospective Studies, Surveys and Questionnaires, Cholecystectomy, Laparoscopic adverse effects, Incisional Hernia prevention & control, Laparoscopes, Patient Satisfaction, Postoperative Complications prevention & control
- Abstract
Background: The incidence of trocar site hernia (TSH) in single-port laparoscopic cholecystectomy (SPC) is still a debated issue. Aim of this retrospective study was to compare the incidence of postoperative hernia and cosmetic results among patients undergoing SPC and multiport laparoscopic cholecystectomy (MPC) performed at a single institution. Methods: A series of 60 SPC and 60 MPC patients operated on between July 2016 and May 2018 were compared. Primary endpoint was to assess the incidence of TSH at long term. All the patients were admitted as outpatients for physical examination and scar measurement. Secondary endpoints were the cosmetic results assessed by a cosmesis score (CS) and the body image questionnaire (BIQ). Results: After a median 18-month follow-up (range: 6-29 months), a hernia in umbilical trocar site was detected in 4 (7.1%) SPC patients and 1 (2%) MPC patient, the difference not being statistically significant ( P = .216). BIQ was almost equivalent in SPC and MPC groups (5.15 versus 5.27; P = .518), respectively. Statistically significant differences in favor of SPC were found in CS (22.3 versus 19.72; P = .001) and in total length of scars (1.2 cm versus 4 cm; P < .001). Conclusions: SPC technique has proved to be safe and effective in experienced hands. Superior cosmesis of SPC over MPC is confirmed, but close attention to fascial closure is a vital component of SPC, and surgeons performing single-site surgery need to be aware of this increased potential for hernia formation.
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- 2019
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131. Laparoscopic Single-Port Versus Traditional Multi-Port Laparoscopic Cholecystectomy.
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Casaccia M, Palombo D, Razzore A, Firpo E, Gallo F, and Fornaro R
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- Female, Humans, Incidence, Italy epidemiology, Male, Middle Aged, Operative Time, Postoperative Complications epidemiology, Treatment Outcome, Cholecystectomy, Laparoscopic instrumentation, Cholecystitis, Acute surgery, Laparoscopes
- Abstract
Background and Objectives: Safety, efficacy, and costs are still debated issues in single-port laparoscopy. The aim of the study was to compare clinical outcomes and hospital costs for conventional 4-port laparoscopic cholecystectomy (4PLC) and single-port laparoscopic cholecystectomy (SPLC) performed at a single institution., Methods: A series of 40 SPLC patients operated on from October 2016 to May 2017 were compared to a hystorical series of 40 4PLC patients. Primary endpoints were the operative time, blood loss, postoperative pain, analgesia requirement, length of stay, and morbidity. Secondary endpoints were the operative costs and total hospital costs., Results: No patient required surgical conversion in both groups. Duration of surgery was significantly longer in the SPLC group. Length of hospitalization was shorter for patients operated on by SPLC (1.9 ± 0.9 vs 2.3 ± 1.2 days; P = .104). According to visual analogue scale evaluation, the pain profile was similar. Minor postoperative complications were present in 12.5% of the SPLC group and 2.5% in 4PLC group ( P = .200). The total hospitalization costs associated with SPLC procedure were lower compared to standard 4PLC procedure. As regards the disposable operating room equipment costs, a statistically significant difference in favor of SPLC technique was found., Conclusion: SPLC has shown relevant procedure and postoperative outcomes when compared to traditional 4PLC. The technique has proved to be promising even in cases of acute cholecystitis considered to date a relative contraindication. Further studies are needed to confirm its safety and feasibility in this setting. In contrast with the current evidence of increased costs for the single-port technique, a reduction of material and hospitalization costs was experienced in our study., Competing Interests: Conflicts of Interest: All authors declare no conflict of interest regarding the publication of this article.
- Published
- 2019
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132. Laparoscopic Splenectomy Versus Open Splenectomy In Massive and Giant Spleens: Should we Update the 2008 EAES Guidelines?
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Casaccia M, Sormani MP, Palombo D, Dellepiane C, and Ibatici A
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- Adolescent, Adult, Aged, Blood Loss, Surgical, Conversion to Open Surgery statistics & numerical data, Feasibility Studies, Female, Humans, Laparoscopy adverse effects, Length of Stay statistics & numerical data, Male, Middle Aged, Operative Time, Postoperative Complications etiology, Practice Guidelines as Topic, Splenectomy adverse effects, Young Adult, Laparoscopy methods, Splenectomy methods, Splenomegaly surgery
- Abstract
The objective of this study was to derive some useful parameters to define the feasibility of laparoscopic splenectomy (LS) in massive [spleen longitudinal diameter (SLD)>20 cm] and giant spleens (SLD>25 cm). Between December 1996 and May 2017, 175 patients underwent an elective splenectomy. A laparoscopic approach was used in 133 (76%) patients. Massive spleens were treated in 65 (37.1%) patients, of which 24 were treated laparoscopically. In this subset of massive spleens, the results of laparoscopic splenectomy in massive spleens (LSM) and open splenectomy in massive spleens (OSM) were compared. The clinical outcome of a subgroup of patients with giant spleens was also analyzed. The LSM group resulted in significant longer operative times (143±31 vs. 112±40 min; P=0.001), less blood loss (278±302 vs. 575±583 mL; P=0.007), and shorter hospital stay (6±3 vs. 9±4 d; P=0.004). No conversions were experienced in the LSM group, and the morbidity rate was similar in both the LSM and OSM groups (16.6% vs. 20%; P=0.75). When considering the subset of 9 LSM patients and 26 OSM patients with giant spleens, the same favorable tendency of the laparoscopic group as regards surgical conversion, blood loss, and hospital stay was maintained. The laparoscopic approach can be successfully proposed in the presence of massive splenomegaly also after a careful preoperative evaluation of the expected abdominal "working space." In experienced hands, LS is safe, feasible, and associated with better outcomes than open splenectomy for the treatment of massive and giant spleen, with a maximum SLD limit of 31 cm.
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- 2019
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133. Thrombotic complications in inflammatory bowel diseases.
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Fornaro R, Caristo G, Stratta E, Caratto M, Caratto E, Giovinazzo D, Di Maira L, Casaccia M, and Frascio M
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- Anticoagulants therapeutic use, Colitis, Ulcerative complications, Crohn Disease complications, Fibrinolytic Agents therapeutic use, Humans, Venous Thromboembolism prevention & control, Inflammatory Bowel Diseases complications, Thrombolytic Therapy methods, Venous Thromboembolism etiology
- Abstract
Inflammatory bowel disease (IBD), Crohn's Disease (CD) and Ulcerative Colitis (UC) are associated with an increased risk of arterial and venous thromboembolism. A 2 to 3 time fold increased risk of developing thromboembolic complications was reported for IBD patients compared to general population. A systematic literature search was conducted using PubMed, Medline, Scopus, Cochrane database. The key words were: "Inflammatory Bowell Disease", "Crohn's Disease and Thrombosis", "Ulcerative Colitis and Thrombosis", "Thrombosis" and "Inflammatory Bowel Diseases and Thrombosis". Full articles and abstracts were included. Studies such as case reports, letters and commentaries were excluded from the analysis if appropriate data could not be extracted. Although no randomized controlled trials (RCTs) have been established to evaluate the efficacy of thromboprophylaxis in patients with IBD due to the incidence of VTE and PE in such patients, it is highly recommended the adoption of thromboprophylactic measures. Available prophylaxis and treatment options include pharmacological anticoagulant therapy (LMWH-Low Molecular Weight Heparin, Fondaparinux and UH-Unfractionated Heparin) and mechanical prophylaxis. In case of acute VTE patient must be treated with fibrinolytic agents and in selected non-responsive cases vascular surgery. IBD patients have an increased risk of VTE complications. Prophylaxis for VTE should be recommended in all patients who do not show contraindications to treatment.
- Published
- 2019
134. Elective surgery for ulcerative colitis, ileo-rectal anastomosis or restorative proctocolectomy An Update.
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Fornaro R, Casaccia M, Caristo G, Batistotti P, Di Maira L, Atzori G, Oliva A, Stratta E, Razzore A, Caratto M, Caratto E, Giovinazzo D, and Frascio M
- Subjects
- Adenocarcinoma epidemiology, Adenocarcinoma etiology, Anal Canal surgery, Anastomosis, Surgical methods, Anastomotic Leak epidemiology, Anastomotic Leak etiology, Cell Transformation, Neoplastic, Fecal Incontinence etiology, Female, Humans, Infertility, Female etiology, Intestinal Mucosa injuries, Intestinal Mucosa pathology, Meta-Analysis as Topic, Patient Selection, Postoperative Complications epidemiology, Postoperative Complications etiology, Pulmonary Embolism epidemiology, Pulmonary Embolism etiology, Rectal Neoplasms epidemiology, Rectal Neoplasms etiology, Risk Factors, Urination Disorders etiology, Colitis, Ulcerative surgery, Elective Surgical Procedures adverse effects, Ileum surgery, Proctocolectomy, Restorative adverse effects, Rectum surgery
- Abstract
Background: Despite advances in the medical management of Ulcerative Colitis (UC), surgery is required in about a third of patients., Aims and Methods: A review of the literature of the last 20 years was conducted in order to analyze the results of Ileo-Rectal Anastomosis (IRA) and of Ileal Pouch-Anal Anastomosis (IPAA) in the treatment of mild-to-moderate UC. Postoperative complications, functional results and the risk of cancer were analyzed in each of the two groups of patients., Results: In IRA group postoperative morbidity is low, varying from 8 to 28%. The risk of urinary and sexual dysfunction are rare and fertility rates are higher, compared to IPAA. The cumulative probability of success (working IRA) is 84% at 5 years and 51-69% at 10 years. The postoperative morbidity of IPAA is higher; dehiscence and pelvic sepsis were observed respectively in 9.5% and in 5.5%. A sexual dysfunction is present in 3.4%. In 18.8% occurs pouchitis. The risk of failure of the pouch is 6.8% and increased to 8.5% after 5 years. The risk of cancer is higher after IRA than after IPAA, with a cumulative risk at 20 years of 6-14% and 4.2% respectively., Discussion: The choice between IPAA or IRA is based upon patient's preference and clinical criteria (malignancy or sphincter injury). IPAA, intervention of choice, is burdened by a higher rate of complications, such as anastomotic leak with pelvic sepsis and subsequent functional pouch failure, pouchitis, infertility in young women, lesions of the pelvic nerves and portal vein thrombosis. There have been reports of cancer not only in the anal transitional zone, but also in the same pouch, either after mucosectomy that after stapled anastomosis. IRA is less invasive than IPAA and postoperative complications are lower. Does not require dissection of the pelvic and presents no risk of injury of the nerves of the urogenital sphere. The long-term results of the IRA are generally satisfactory and most of the patients stated that after the intervention improve both the health status and quality of life., Conclusion: Today IPAA is the gold standard. The IRA is indicated in selected patients where they meet the following requirements: normal sphincter tone, absence of severe perineal disease, rectum does not actively involved by the disease, absence of dysplasia or cancer. It is also indicated in patients who refuse an ileostomy and it can be proposed as a possible interim procedure in young women, because it does not need a pelvic dissection and because the risk of infertility is minimal or absent when compared to IPAA. Because the risk of cancer is higher, patients undergoing IRA must be adequately informed about the risk, as well as recurrent proctitis, also of cancer, and must fully understand the need for surveillance and accept at least annual endoscopy with rectal biopsies; if these conditions are not met, patients should not be candidates for IRA., Key Words: IPAA, IRA, Surgical treatment, Ulcerative Colitis.
- Published
- 2019
135. Adenocarcinoma Arising from Perianal Fistulizing Crohn's Disease.
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Fornaro R, Frascio M, Caratto M, Caratto E, Bianchi R, Razzore A, Caristo G, Sticchi C, and Casaccia M
- Abstract
Perianal fistula is a very debilitating event and a cause of morbidity in patients with Crohn's disease (CD). Its malignant transformation is very rare with an incidence of around 0.004-0.7$. Presence of disease in the colon and rectum is the major risk factor for the development of a perianal fistula. In this report we show a case of adenocarcinoma arising from a perianal fistulizing CD. This type of tumor is highly aggressive, difficult to diagnose, and has a rather poor prognosis. The different neoplastic transformations and the different types of tumors that may appear in patients with CD, especially at the colorectal level or at the level of an eventual anastomosis, are to date well documented and described in the literature, while there is a lack of information and of treated cases concerning the occurrence of cancer at the level of a fistula. Due to the rarity of cases, we tried to identify the most frequent and important risk factors: sex, duration of disease, age at diagnosis, and the history of the fistula.
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- 2018
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136. SECCA procedure for anal incontinence and antibiotic treatment: a case report of anal abscess.
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Mandolfino F, Fornaro R, Stabilini C, Casaccia M, Testa T, and Frascio M
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- Aged, Anus Diseases therapy, Female, Humans, Quality of Life, Treatment Outcome, Abscess etiology, Anal Canal pathology, Anti-Bacterial Agents administration & dosage, Fecal Incontinence therapy
- Abstract
Background: Fecal Incontinence (FI) can seriously affect quality of life. The treatment of fecal incontinence starts conservatively but in case of failure, different surgical approaches may be proposed to the patient. Recently several not invasive approaches have been developed. One of these is the radiofrequency (RF) energy application to the internal anal sphincter., Case Presentation: We report a rare case of an anal abscess related to a SECCA procedure in a 66-year-old woman affected by gas and FI for twenty years., Conclusions: The complications post-SECCA procedure reported in literature are generally not serious and often self-limited, such as bleeding or anal pain. This is a case of an anal abscess. We suggest that this finding could consolidate the importance of administering antibiotic therapy to patients and to run a full course of at least 6 days rather than a short-term (24 h) therapy, with the aim to minimize the incidence of this complication.
- Published
- 2018
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137. Laparoscopic "double-port" splenectomy. A new minimally-invasive option in a giant spleen.
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Casaccia M, Palombo D, Fornaro R, Razzore A, Soriero D, and Frascio M
- Abstract
Introduction: In case of massive splenomegaly, laparoscopic splenectomy (LS) becomes challenging, uncomfortable and risky both for the surgeon and for the patient. As a consequence of ongoing research to obtain efficient and cheaper "scarless surgery", single-port technique and hand-assisted devices were developed and improved in this field., Presentation of Case: We present the clinical case of a patient affected by idiopathic myelofibrosis (MF) and splenomegaly who was admitted to our Department to perform a splenectomy for a suspected 5-cm splenic lesion., Discussion: The splenic longitudinal diameter measured 26 cm. The patient underwent splenectomy by laparoscopy, combining a single-port access and a gel-port device. The operation was completed laparoscopically. The operating time was 220 min and the estimate blood loss was 100 ml. The patient was discharged at 11 post-operative day in overall good conditions. Upon pathological analysis the splenic lesion was a localization of diffuse large B-cell Lymphoma in the context of MF., Conclusion: this novel "hybrid technique" of splenectomy, combining the advantages of reduced number of abdominal incisions of the single-port technique to those of the hand assistance, is feasible in massive splenomegaly with good results. Furthermore, the use of the sovrapubic retrieval incision as the introduction site for the hand assisted device is convincing, since it's useful for both tasks. Further studies with large casuistries are necessary to confirm the effectiveness of the technique., (Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.)
- Published
- 2018
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138. Primary lymphoma of appendix presenting as acute appendicitis: A case report.
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Caristo G, Griseri G, Fornaro R, Langone A, Franceschi A, Errigo V, Ferrari C, Casaccia M, Frascio M, and Schirru A
- Abstract
Introduction: Primary lymphomas of appendix are extremely rare tumors. The incidence is 0.015% of all gastrointestinal lymphomas., Presentation of Case: We present a case of a 75 year-old male patient who presented with acute abdominal pain in the lower right quadrant and fever., Discussion: The patient received laparotomic appendectomy. The definitive histopathological examination revealed the presence of diffuse large cell B-lymphoma of the appendix. The neoplasms of appendix usually manifest clinically with sign and symptoms of acute appendicitis from luminal obstruction (30-50%). Preoperative diagnosis is difficult and often occurs through histopathological examination., Conclusion: Primary appendiceal lymphoma is rare and there are no clear guidelines for therapy. Primary surgical resection followed by post-operative chemotherapy showed high efficacy. The histopathological examination of all appendectomy is essential., (Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.)
- Published
- 2018
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139. Schwannoma of the hypoglossal nerve: Review of the literature based on an illustrative case.
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Fornaro R, Salerno A, Filip DC, Caratto E, Caratto M, and Casaccia M
- Abstract
Schwannomas are benign tumours that originate from the myelin sheath of peripheral nerves. They are characterised by a slow growth tendency. Benign schwannomas represent 35% of the head and neck district tumours. Hypoglossal schwannomas account for 5% of non-vestibular schwannomas, and malignant schwannomas occur very rarely. In the present case report, the case of a 49-year-old man who presented with paraesthesias in the left parotid and submandibular region, associated with sensation of foreign bodies and dysphagia for solids, is described. A clinical examination revealed the presence of an ovoid palpable mass in the lateral-cervical region of the neck. The patient subsequently underwent excisional surgery, and neuropathological evaluation of the specimen confirmed the diagnosis of benign schwannoma with Antoni areas A and B. Despite the rarity of schwannomas, this condition should be considered in differential diagnoses for masses localised in the neck, as in cases where they reach considerable sizes (>3 cm in diameter). Surgery therefore represents the first-choice treatment.
- Published
- 2017
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140. Radiofrequency Procedure (SECCA®) for Fecal Incontinence: One-Year Experience.
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Frascio M, Stabilini C, Casaccia M, Testa T, Fornaro R, Parodi MC, Marrone C, Gianetta E, and Mandolfino F
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- Aged, Female, Follow-Up Studies, Humans, Middle Aged, Patient Satisfaction statistics & numerical data, Prospective Studies, Quality of Life, Severity of Illness Index, Catheter Ablation adverse effects, Catheter Ablation methods, Catheter Ablation statistics & numerical data, Fecal Incontinence epidemiology, Fecal Incontinence physiopathology, Fecal Incontinence surgery
- Abstract
Introduction: Radiofrequency is a treatment option for patients suffering from fecal incontinence., Objective: To assess the one-year follow-up results following the radiofrequency procedure for fecal incontinence., Design: Prospective, single-center, observational study., Materials and Methods: Twenty-one patients underwent the SECCA® radiofrequency procedure, 19 of who completed the one-year of follow-up (Cleveland Clinic Florida Fecal Incontinence score, Fecal Incontinence Quality of Life Scale (FIQoL), anorectal manometry, and endoanal ultrasound)., Main Outcome Measures: Any change in the Fecal Incontinence Score or Fecal Incontinence Quality of Life scales post SECCA® radiofrequency procedure., Results: The mean Fecal Incontinence Score significantly improved at three months' follow-up from 14.5 prior to treatment to 11.9 post-treatment, and was maintained at six months (12). A slight decrease was observed at one year (12.9), which had no impact on the global satisfaction. During the same period, only 1/4 subsets of the Fecal Incontinence Quality of Life score improved. Manometry and endoanal ultrasound did not show significant changes post procedure., Limitations: Limited number of patients., Conclusions: Radiofrequency is a valid treatment option for patients with mild-to-moderate fecal incontinence. This treatment has demonstrated clinically significant improvements in symptoms, as demonstrated by statistically significant reductions in the Fecal Incontinence Score as well as significant improvements in Fecal Incontinence Quality of Life scores at six months, with a slight, though not clinically significant, decrease at one year follow-up.
- Published
- 2017
141. Single-stage laparoscopic adrenalectomy for pheochromocytoma and enucleation of a pancreatic neuroendocrine tumor in Von Hippel-Lindau disease: A case report.
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Casaccia M, Macina S, and Fornaro R
- Abstract
Von Hippel-Lindau (VHL) disease is an inherited syndrome with autosomal-dominant transmission, characterized by central nervous system and retinal hemangioblastomas, visceral cysts and tumors. Optimal surgical treatment, including its timing, remains a controversial topic. The present study reports the case of a 67-year-old female patient with adrenal and pancreatic manifestations of VHL. A laparoscopic cortex-sparing left adrenalectomy for a 4-cm pheochromocytoma and pancreatic enucleation for pancreatic polypeptidoma of the pancreas tail were performed during the same operative procedure. The total operative time was 240 min. There were no operative complications, and the surgery was completed laparoscopically with minimal blood loss. A prolonged hospital stay was necessary to treat a grade C postoperative pancreatic fistula. The histopathological result was an adrenal pheochromocytoma and a well-differentiated neuroendocrine tumor, secreting pancreatic polypeptides. In conclusion, organ-sparing laparoscopic surgery is an important option for treating simultaneous lesions in several abdominal solid viscera, such as VHL disease, and the present case study represents, to the best of the authors' knowledge, the first report of single-stage laparoscopic adrenalectomy and pancreatic tumor enucleation.
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- 2017
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142. Laparoscopic resection vs laparoscopic radiofrequency ablation for the treatment of small hepatocellular carcinomas: A single-center analysis.
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Casaccia M, Santori G, Bottino G, Diviacco P, and Andorno E
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- Aged, Carcinoma, Hepatocellular mortality, Disease-Free Survival, Female, Follow-Up Studies, Humans, Liver Neoplasms mortality, Male, Middle Aged, Neoplasm Recurrence, Local surgery, Probability, Proportional Hazards Models, Radio Waves, Retrospective Studies, Treatment Outcome, Carcinoma, Hepatocellular surgery, Catheter Ablation, Laparoscopy, Liver Neoplasms surgery
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Aim: To compare survival and recurrence after laparoscopic liver resection (LLR) and laparoscopic radiofrequency ablation (LRFA) for the treatment of small hepatocellular carcinoma (HCC)., Methods: Between June 1, 2005 and November 30, 2010, 46 patients (62.26 ± 8.55 years old; female/male: 12/34) treated for small HCC were enrolled following strict criteria. Patients with better liver function and larger tumors were referred for LLR ( n = 24), while those with poorer liver function and multiple tumors were referred for LRFA ( n = 22), and they were then followed for similar durations (44.74 ± 21.3 mo for LLR vs 40.27 ± 30.8 mo for LRFA)., Results: The LLR and LRFA groups were homogeneous with regard to age, sex, etiology of liver cirrhosis, and AFP levels. The overall survival (OS) and disease-free survival (DFS) probability was 0.354 and 0.260, respectively. A significantly higher OS was observed in the LLR group (LLR: 0.442; LRFA: 0.261; P = 0.048), whereas no statistical difference was found for DFS (LLR: 0.206; LRFA: 0.286; P = 0.205). In the LRFA group was treated a greater number of nodules (LLR: 1.41 ± 0.77; LRFA: 2.72 ± 1.54; P < 0.001). Cox regression analysis found the number of intraoperative HCC nodules as the unique variable statistically significant for OS (hazard ratio: 2.225; P < 0.001). The rank-hazard plot showed a steeper increase of relative hazard for intraoperative nodules > 2., Conclusion: Our preliminary results confirm the superiority of hepatic resection on thermoablation in the treatment of small HCC in selected patients, when both approaches are made laparoscopically. LLR showed better results compared to LRFA in terms of OS. These data need to be confirmed by further studies on a larger number of patients., Competing Interests: Conflict-of-interest statement: We have no financial relationships to disclose.
- Published
- 2017
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143. Peritoneal carcinomatosis-like implants of extramedullary hematopoiesis. An insolite occurrence during splenectomy for myelofibrosis.
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Casaccia M, Fornaro R, Frascio M, Palombo D, Stabilini C, Firpo E, and Gianetta E
- Abstract
Introduction: Primary myelofibrosis (MF) is a myeloproliferative neoplasm that results in debilitating constitutional symptoms, splenomegaly, and cytopenias. In patients with symptomatic splenomegaly, splenectomy remains a viable treatment option for MF patients with medically refractory symptomatic splenomegaly that precludes the use of ruxolitinib., Case Presentation: We present the clinical case of a patient who was admitted to our Department to perform a splenectomy in MF as a therapeutic step prior to an allogeneic stem cell transplantation (ASCT). A laparotomic splenectomy and excision of whitish wide-spread peritoneal and omental nodulations was performed. There were no operative complications and the surgery was completed with minimal blood loss. The histopathological exam revealed an extramedullary hematopoiesis in both spleen and peritoneal nodules., Conclusion: In primary myelofibrosis it must always be kept in mind the possible presence of peritoneal implants of extramedullary hematopoiesis and ascites of reactive genesis. We report a rare case of peritoneal carcinomatosis-like implants of extramedullary hematopoiesis found at splenectomy for MF., (Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.)
- Published
- 2017
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144. Colorectal Cancer in Patients With Inflammatory Bowel Disease: The Need for a Real Surveillance Program.
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Fornaro R, Caratto M, Caratto E, Caristo G, Fornaro F, Giovinazzo D, Sticchi C, Casaccia M, and Andorno E
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- Humans, Risk Factors, Colorectal Neoplasms etiology, Early Detection of Cancer methods, Epidemiological Monitoring, Inflammatory Bowel Diseases complications, Mass Screening methods
- Abstract
The association between inflammatory bowel disease (IBD) and colorectal cancer (CRC) has been widely shown. This association is responsible for 10% to 15% of deaths in patients with IBD, even if according to some studies, the risk of developing CRC seems to be decreased. An adequate surveillance of patients identified as at-risk patients, might improve the management of IBD-CRC risk. In this article we review the literature data related to IBD-CRC, analyze potential risk factors such as severity of inflammation, duration, and extent of IBD, age at diagnosis, sex, family history of sporadic CRC, and coexistent primary sclerosing cholangitis, and update epidemiology on the basis of new studies. Confirmed risk factors for IBD-CRC are severity, extent, and duration of colitis, the presence of coexistent primary sclerosing cholangitis, and a family history of CRC. Current evidence-based guidelines recommend surveillance colonoscopy for patients with colitis 8 to 10 years after diagnosis, further surveillance is decided on the basis of patient risk factors. The classic white light endoscopy, with random biopsies, is now considered unsatisfactory. The evolution of technology has led to the development of new techniques that promise to increase the effectiveness of the monitoring programs. Chromoendoscopy has already proved highly effective and several guidelines suggest its use with a target biopsy. Confocal endomicroscopy and autofluorescence imaging are currently being tested and for this reason they have not yet been considered as useful in surveillance programs., (Copyright © 2016 Elsevier Inc. All rights reserved.)
- Published
- 2016
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145. Stapled Mesh Reinforcement Technique (SMART) to Prevent Parastomal Hernias: Our Initial Experience and Review of the Literature.
- Author
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Macina S, Mandolfino F, Frascio M, Casaccia M, Stabilini C, Fornaro R, and Testa T
- Subjects
- Equipment Design, Equipment Failure Analysis, Hernia, Abdominal diagnosis, Hernia, Abdominal etiology, Humans, Pilot Projects, Surgical Staplers, Surgical Stapling instrumentation, Surgical Stapling methods, Treatment Outcome, Hernia, Abdominal surgery, Herniorrhaphy instrumentation, Herniorrhaphy methods, Surgical Mesh, Surgical Stomas adverse effects, Sutures
- Abstract
Parastomal hernia is one of the most common stoma related complication, with the correlated risk of incarceration, obstruction, and strangulation. The incidence is high (30-50%) and depends on the length of follow up. Different surgical options for repairing are defective with a 25-70% failure and recurrence rate. Prevention of parastomal hernia with mesh reinforcement seems to be effective. Three available trials are recruiting patients: Prism (with matrix porcine prothesis), Prevent (with preperitoneal polypropylene mesh), and the stapled polypropylene mesh stoma reinforcement technique (SMART). We performed the SMART procedure in six patients undergoing definitive colostomy. Our cases show that the procedure is rapid (duration range 15-20 minutes), cost effective (500 euro), and safe (in our experience, there are no post-surgical complications that are procedure-related). A long term follow-up and a higher number of patients will give us confirmation of the initial hopeful results.
- Published
- 2016
146. Splenectomy for E. coli abscess: A case report with a difficult preoperative diagnosis and unclear pathogenesis.
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Casaccia M, Macina S, Fornaro R, Frascio M, Testa T, Stabilini C, and Gianetta E
- Abstract
Introduction: Isolated splenic abscess is a rare clinical condition and remains a diagnostic dilemma. Clinical presentation is non-specific and the diagnosis is often delayed. Ultrasonography and CT scan are the gold standard. The treatment is still controversial: antibiotic therapy, percutaneous drainage (PCD) or splenectomy., Case Presentation: We present the clinical case of a patient, admitted to our Department because of abdominal pain, without fever. The preoperative radiological assesment showed three intrasplenic liquid collections, whose differential diagnosis was made between hematic collection and abscess. The treatment was splenectomy. The samples of collected liquid were positive for Escherichia Coli., Conclusion: In case of splenic abscess, splenectomy is the best therapeutic choice. The other therapeutical options like antibiotic therapy and PCD, can be used only in particular cases, but without the same efficacy., (Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.)
- Published
- 2016
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147. The procedure outcome of laparoscopic resection for 'small' hepatocellular carcinoma is comparable to vlaparoscopic radiofrequency ablation.
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Casaccia M, Santori G, Bottino G, Diviacco P, Negri AD, Moraglia E, and Adorno E
- Abstract
Background: The aim of this study was to compare the effectiveness of laparoscopic liver resection (LLR) and laparoscopic radiofrequency ablation (LRFA) in the treatment of small nodular hepatocellular carcinoma (HCC)., Patients and Methods: We enrolled 50 cirrhotic patients with similar baseline characteristics that underwent LLR (n = 26) or LRFA (n = 24), in both cases with intraoperative ultrasonography. Operative and peri-operative data were retrospectively evaluated., Results: LLR included anatomic resection in eight cases and non-anatomic resection in 18. In LRFA patients, a thermoablation of 62 nodules was achieved. Between LLR and LRFA groups, a significant difference was found both for median diameters of treated HCC nodules (30 vs. 17.1 mm; P < 0.001) and the number of treated nodules/patient (1.29 ± 0.62 vs. 2.65 ± 1.55; P < 0.001). A conversion to laparotomy occurred in two LLR patient (7.7%) for bleeding. No deaths occurred in both groups. Morbidity rates were 26.9% in the LLR group versus 16.6% in the LRFA group (P = 0.501). Hospital stay in the LLR and LRFA group was 8.30 ± 6.52 and 6.52 ± 2.69 days, respectively (P = 0.022). The surgical margin was free of tumour cells in all LLR patients, with a margin <5 mm in only one case. In the LRFA group, a complete response was achieved in 90.3% of thermoablated HCC nodules at the 1-month post-treatment computed tomography evaluation., Conclusions: LLR for small peripheral HCC in patients with chronic liver disease represents a valid alternative to LRFA in terms of patient toleration, surgical outcome of the procedure, and short-term morbidity.
- Published
- 2015
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148. Laparoscopic bridging vs. anatomic open reconstruction for midline abdominal hernia mesh repair [LABOR]: single-blinded, multicenter, randomized, controlled trial on long-term functional results.
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Stabilini C, Bracale U, Pignata G, Frascio M, Casaccia M, Pelosi P, Signori A, Testa T, Rosa GM, Morelli N, Fornaro R, Palombo D, Perotti S, Bruno MS, Imperatore M, Righetti C, Pezzato S, Lazzara F, and Gianetta E
- Subjects
- Clinical Protocols, Equipment Design, Hernia, Abdominal diagnosis, Herniorrhaphy adverse effects, Humans, Italy, Laparoscopy adverse effects, Middle Aged, Postoperative Complications diagnosis, Postoperative Complications therapy, Prospective Studies, Quality of Life, Recurrence, Single-Blind Method, Time Factors, Treatment Outcome, Hernia, Abdominal surgery, Herniorrhaphy instrumentation, Herniorrhaphy methods, Laparoscopy instrumentation, Research Design, Surgical Mesh
- Abstract
Background: Re-approximation of the rectal muscles along the midline is recommended by some groups as a rule for incisional and ventral hernia repairs. The introduction of laparoscopic repair has generated a debate because it is not aimed at restoring abdominal wall integrity but instead aims just to bridge the defect. Whether restoration of the abdominal integrity has a real impact on patient mobility is questionable, and the available literature provides no definitive answer. The present study aims to compare the functional results of laparoscopic bridging with those of re-approximation of the rectal muscle in the midline as a mesh repair for ventral and incisional abdominal defect through an "open" access. We hypothesized that, for the type of defect suitable for a laparoscopic bridging, the effect of an anatomical reconstruction is near negligible, thus not a fixed rule., Methods and Design: The LABOR trial is a multicenter, prospective, two-arm, single-blinded, randomized trial. Patients of more than 60 years of age with a defect of less than 10 cm at its greatest diameter will be randomly submitted to open Rives or laparoscopic defect repair. All the participating patients will have a preoperative evaluation of their abdominal wall strength and mobility along with volumetry, respiratory function test, intraabdominal pressure and quality of life assessment.The primary outcome will be the difference in abdominal wall strength as measured by a double leg-lowering test performed at 12 months postoperatively. The secondary outcomes will be the rate of recurrence and changes in baseline abdominal mobility, respiratory function tests, intraabdominal pressure, CT volumetry and quality of life at 6 and 12 months postoperatively., Discussion: The study will help to define the most suitable treatment for small-medium incisional and primary hernias in patients older than 60 years. Given a similar mid-term recurrence rate in both groups, if the trial shows no differences among treatments (acceptance of the null-hypothesis), then the choice of whether to submit a patient to one intervention will be made on the basis of cost and the surgeon's experience., Trial Registration: Current Controlled Trials ISRCTN93729016.
- Published
- 2013
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149. Reports of magnetic resonance images of the hip in patients with femoroacetabular impingement: is useful information provided to the orthopedic surgeon?
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Diaz-Ledezma C, Casaccia M, and Parvizi J
- Subjects
- Adult, Female, Femoracetabular Impingement epidemiology, Humans, Male, Pennsylvania epidemiology, Prevalence, Femoracetabular Impingement pathology, Femoracetabular Impingement surgery, Health Records, Personal, Hip pathology, Magnetic Resonance Imaging statistics & numerical data, Preoperative Care statistics & numerical data, Referral and Consultation statistics & numerical data
- Abstract
Objective: The aim of this study was twofold: (1) To evaluate the quality of radiology reports of MR imaging/arthrography (MRI/MRA) of the hip performed on symptomatic young adults with suspected femoroacetabular impingement (FAI); and (2) to assess if MRI/MRA reports provide relevant information for surgical decision-making., Materials and Methods: We evaluated 110 MRI/MRA reports provided by 73 radiologists from 42 institutions. The images were requested preoperatively in young adults who underwent hip-preserving surgery for treatment of FAI. The quality of reports was graded using Lee's method by two independent observers. The description of seven characteristics of the hip joint was scrutinized in order to assess if the reports contained relevant information for surgical decision-making., Results: The quality of reports was Grade IIA in two cases (1.8 %), IIB in six (5.5 %), III in 60 (54.5 %), and IV in 42 (38.2 %). Relevant hip characteristics for the study of FAI were reported as follows: acetabular labrum (88.1 %), cartilage characteristics (69 %), morphology of the femoral head-neck junction (34.5 %), acetabular version (6.3 %), acetabular coverage (20.9 %), soft tissues description (82.7 %), and presence of bone marrow edema (80.9 %). The vast majority (91.8 %) of the reports described five or less relevant FAI characteristics., Conclusions: Most of the radiology reports of MRI/MRA of the hip performed on symptomatic young adults with FAI were of the highest quality. However, some characteristics believed to be important for surgical decision-making in this particular group of patients were frequently not described. The inclusion of these hip joint characteristics in the radiology reports may improve the usefulness of the information provided to the orthopedic surgeon.
- Published
- 2013
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150. Laparoscopic resection of hepatocellular carcinoma. Considerations on lesions in the posterosuperior segments of the liver.
- Author
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Casaccia M, Andorno E, Di Domenico S, Gelli M, Bottino G, and Valente U
- Subjects
- Aged, Carcinoma, Hepatocellular pathology, Feasibility Studies, Female, Follow-Up Studies, Hepatectomy adverse effects, Humans, Liver Neoplasms pathology, Male, Middle Aged, Retrospective Studies, Carcinoma, Hepatocellular surgery, Hepatectomy methods, Laparoscopy, Liver Neoplasms surgery
- Abstract
Aim: The aim of this study was to evaluate retrospectively our results for laparoscopic liver resection (LLR) of hepatocellular carcinoma (HCC) including lesions in the posterosuperior segments of the liver in terms of feasibility, outcome, recurrence and survival., Material of Study: Between June 2005 and May 2009, we performed 22 LLR for HCC. The underlying cirrhosis was staged as Child A in 19 cases and Child B in 3., Results: LLR included a non anatomic resection in 15 cases and an anatomic resection in 7. A conversion to laparotomy occurred in one (4.5%) patient for hemorrhage. Mortality and morbidity rates were 0% and 18.1% (4/20). Over a mean follow-up period of 29 months (range: 19-65 months), 11 (50%) patients presented recurrence, mainly at distance from the surgical site., Discussion: A laparoscopic approach is more suitable when the lesion is located in the peripheral "laparoscopic" segments 2 to 6. Nevertheless, six resections were made in the posterosuperior segments. Although parenchymal-sparing resection is required by the presence of underlying liver disease, anatomic resection has always to be considered and pursued to reduce local recurrence. In our series the recurrence rate was similar to those reported for other laparoscopic studies and for open resection of HCC., Conclusions: LLR for HCC in selected patients is a safe procedure with good short-term results. It can also be proposed in tumor locations with a difficult surgical access maintaining a low morbidity rate and good oncologic adequacy. This approach could have an impact on the therapeutic strategy of HCC complicating cirrhosis as a treatment with curative intent or as a bridge to liver transplantation.
- Published
- 2012
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