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35 results on '"ARCERITO, MASSIMO"'

21. Hiatal hernia size affects lower esophageal sphincter function, esophageal acid exposure, and the degree of mucosal injury

Author

Patti, Marco G., Goldberg, Henry I., Arcerito, Massimo, Bortolasi, Luca, Tong, Jenny, and Way, Lawrence W.

Subjects
Gastroesophageal reflux -- Complications, Hiatal hernia -- Physiological aspects, Esophagitis -- Health aspects, Health
Abstract

BACKGROUND: Since the role of a hiatal hernia in the pathophysiology of gastroesophageal reflux disease (GERD) has not been fully elucidated, we studied the effects of hiatal hernias on the function of the lower esophageal sphincter (LES) and esophageal acid clearance. PATIENTS AND METHODS: Ninety-five consecutive patients with GERD diagnosed by 24-hour pH monitoring underwent upper gastrointestinal series (UGI), endoscopy, and esophageal manometry. Based on the presence (H+) or absence (H-) of a hiatal hernia on UGI series, they were divided into two groups: H+ (n = 51) and H- (n = 44). Then, using the size of the hiatal hernia, the H+ group was divided into three subgroups: I, H 5 cm (n = 6). RESULTS: Esophageal manometry showed that patients with larger hiatal hernias (groups II and III) had a weaker and shorter LES and less effective peristalsis compared to patients with a small or no hiatal hernia. Prolonged pH monitoring showed that patients with larger hiatal hernias were exposed to more refluxed acid and had more severely abnormal acid clearance. Endoscopy showed more severe esophagitis among patients with GERD and hiatal hernia compared with GERD patients without hiatal hernia, and the degree of esophagitis was proportionate to the size of the hernia. CONCLUSIONS: Among patients with proven GERD, those with a small hiatal hernia and those with no hiatal hernia had similar abnormalities of LES function and acid clearance. In patients with larger hiatal hernias, however, the LES was shorter and weaker, the amount of reflux was greater, and acid clearance was less efficient. Consequently, the degree of esophagitis was worse in the presence of a large hiatal hernia. Am J Surg. 1996;171:182-186.

Published
1996

31. Minimally Invasive Surgery for Achalasia

Author

Patti, Marco G., primary, Pellegrini, Carlos A., additional, Horgan, Santiago, additional, Arcerito, Massimo, additional, Omelanczuk, Pablo, additional, Tamburini, Andrea, additional, Diener, Urs, additional, Eubanks, Thomas R., additional, and Way, Lawrence W., additional

Published
1999
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34. Laparoscopic Repair of Paraesophageal Hiatal Hernias

Author

Gantert, Walter A., MD, Patti, Marco G., MD, FACS, Arcerito, Massimo, MD, Feo, Carlo, MD, Stewart, Lygia, MD, FACS, DePinto, Mario, MD, Bhoyrul, Sunil, MD, Rangel, Shawn, BS, Tyrrell, Dana, MD, Fujino, Yukio, MD, Mulvihill, Sean J., MD, FACS, and Way, Lawrence W., MD, FACS

Published
1998
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35. Impact of Adjuvant Chemotherapy on Resected Intraductal Papillary Mucinous Neoplasm-Derived Pancreatic Cancer: Results From an International Multicenter Study.

Author

Habib JR, Kinny-Köster B, Javed AA, Zelga P, Saadat LV, Kim RC, Gorris M, Allegrini V, Watanabe S, Sharib J, Arcerito M, Kaiser J, Lafaro KJ, Tu M, Bhandre M, Shi C, Kim MP, Correa C, Daamen LA, Oberstein PE, Schmidt CM, Hanna NN, Allen P, Loos M, Shrikhande SV, Molenaar IQ, Frigerio I, Katz MHG, Soares KC, Miao Y, Del Chiaro M, He J, Hackert T, Salvia R, Büchler MW, Castillo CF, Besselink MG, Marchegiani G, and Wolfgang CL

Abstract

Purpose: The benefit of adjuvant therapy for intraductal papillary mucinous neoplasm (IPMN)-derived pancreatic ductal adenocarcinoma (PDAC) remains unclear because of severely limited evidence. Although biologically distinct entities, adjuvant therapy practices for IPMN-derived PDAC are largely founded on pancreatic intraepithelial neoplasia-derived PDAC. We aimed to evaluate the role of adjuvant chemotherapy in IPMN-derived PDAC., Methods: This international multicenter retrospective cohort study (2005-2018) was conceived at the Verona Evidence-Based Medicine meeting. Cox regressions were performed to identify risk-adjusted hazard ratios (HR) associated with overall survival (OS). Kaplan-Meier curves and log-rank tests were employed for survival analysis. Logistic regression was performed to identify factors motivating adjuvant chemotherapy administration. A decision tree was proposed and categorized patients into overtreated, undertreated, and optimally treated cohorts., Results: In 1,031 patients from 16 centers, nodal disease (HR, 2.88, P < .001) and elevated (≥37 to <200 µ/mL, HR, 1.44, P = .006) or markedly elevated (≥200 µ/mL, HR, 2.53, P < .001) carbohydrate antigen 19-9 (CA19-9) were associated with worse OS. Node-positive patients with elevated CA19-9 had an associated 34.4-month improvement in median OS ( P = .047) after adjuvant chemotherapy while those with positive nodes and markedly elevated CA19-9 had an associated 12.6-month survival benefit ( P < .001). Node-negative patients, regardless of CA19-9, did not have an associated benefit from adjuvant chemotherapy (all P > .05). Based on this model, we observed undertreatment in 18.1% and overtreatment in 61.2% of patients. Factors associated with chemotherapy administration included younger age, R1-margin, poorer differentiation, and nodal disease., Conclusion: Almost half of patients with resected IPMN-derived PDAC may be overtreated or undertreated. In patients with node-negative disease or normal CA19-9, adjuvant chemotherapy is not associated with a survival benefit, whereas those with node-positive disease and elevated CA19-9 have an associated benefit from adjuvant chemotherapy. A decision tree was proposed. Randomized controlled trials are needed for validation.

Published
2024
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