Genoveffa Balducci - Academia.edu (original) (raw)
Papers by Genoveffa Balducci
Anticancer Research, Jun 1, 2019
PubMed, Jan 30, 2003
Background: Due to the longer life expectancy of the world's population, the number of elderly ci... more Background: Due to the longer life expectancy of the world's population, the number of elderly cirrhotic patients undergoing surgery for hepatocellular carcinoma (HCC) is increasing. Our study evaluates the benefits of hepatic resections for HCC in cirrhotic patients aged over 65, analysing the early and long-term surgical results. Patients and methods: We retrospectively considered a series of 46 patients receiving hepatic resection for HCC. The clinicopathological data and surgical outcome of 14 (30.4%) patients aged 65 or older (group I) were evaluated and compared to the 32 (69.6%) younger than 65 (group II). Results: No operative mortality was recorded in either group. The hospital mortality rate was 7.1% (1 out of 14) in group I and 9.4% (3 out of 32) in group II (p = 1.00). Hospital morbidity did not differ significantly in the two groups (21.4% vs 34.4%; p = 0.50). At follow-up (median 34 months, interquartile range: 12-63) 3 patients from group I (21.4%) and 16 patients from group II (50%) experienced tumor recurrence (p = 0.14). The five-year disease-free survival rate for group I and group II was 71.4% vs 28.2%, respectively (p = 0.05). The overall 5-year survival rate for group I and group II was, respectively, 77.4% vs 41.8%, (p = 0.3). Conclusion: Elderly cirrhotic patients with HCC can benefit from hepatic resection as well as younger patients; age by itself should not be considered a contraindication to surgery.
PubMed, Mar 1, 2003
Budd-Chiari Syndrome (BCS) is characterized by obstruction of hepatic venous outflow. When obstru... more Budd-Chiari Syndrome (BCS) is characterized by obstruction of hepatic venous outflow. When obstruction is limited to the suprahepatic veins, portocaval shunting provides an immediate relief of symptoms. If the obstacle results also from narrowing of the inferior vena cava (IVC), multimodality treatments seem to offer safer and easier alternative. In the patient herein reported, combination of side-to-side portocaval anastomosis with a cavo-atrial shunt through an expandible metallic stent provided immediate relief of symptoms. The patient is doing well after 85 months from combined treatment. In conclusion infracaval stenting combined to side-to-side portocaval shunting should represent the treatment of choice in acute or subacute forms of BCS.
European Journal of Surgery, 2002
International Journal of Colorectal Disease, Jul 28, 2017
Surgical Infections, Dec 1, 2015
World Journal of Surgery, 1994
Cytopathology
ObjectiveAs of 2017, the pathobiology of gastric cancer (GC) is far from fully understood; conseq... more ObjectiveAs of 2017, the pathobiology of gastric cancer (GC) is far from fully understood; consequently, new methods of basic and advanced research have been proposed and tested. The presence (GL1) vs absence (GL0) of malignant cells exfoliated in gastric lavage (GL) of GC patients was formerly evaluated with diagnostic intent but not for staging or prognostic assessment. We investigated this hitherto unreported application of cytopathology.MethodsGL was preoperatively and prospectively collected from 80 GC patients and cytologically analysed. The results were compared with the classic clinicopathological features of GC and related to survival. The prognostic value of GL1 was assessed through univariate and multivariate analyses.ResultsGL1 was detected in 36 samples (45%) and correlated with advanced tumour depth (T3‐T4), lymphatic metastasis (N+), distant metastasis (M1) and lymphovascular invasion (LVI1; P=.0317, .0024, .003 and .0028, respectively). Overall survival (OS) was sign...
Hernia, 2020
Purpose The incidence of inguinal hernia is higher in elderly because of aging-related diseases l... more Purpose The incidence of inguinal hernia is higher in elderly because of aging-related diseases like prostatism, bronchitis, collagen laxity. A conservative management is common in elderly to reduce surgery-related risks, however watchful waiting can expose to obstruction and strangulation. The aim of the present study was to assess the impact of emergency surgery in a large series of elderly with complicated groin hernia and to identify the independent risk factors for postoperative morbidity and mortality. The predictive performance of prognostic risk scores has been also assessed. Methods This is a prospective observational study carried out between January 2017 and June 2018 in elderly patients who underwent emergency surgery for complicated hernia in 38 Italian hospitals. Pre-operative, surgical and postoperative data were recorded for each patient. ASA score, Charlson’s comorbidity index, P-POSSUM and CR-POSSUM were assessed. Results 259 patients were recruited, mean age was 8...
The American Surgeon, 2012
The American Surgeon, 2010
Anticancer Research, 2019
Anticancer Research, 2019
Background/Aim: Although reckoned necessary for survival benefit, neoadjuvant chemotherapy (NAC) ... more Background/Aim: Although reckoned necessary for survival benefit, neoadjuvant chemotherapy (NAC) of gastric cancer (GC) patients has so far provided questionable results. Consequently, searching for new and clearer systems of response to NAC, post-NAC re-evaluation and prognostic prediction appears essential. The purpose of this study was to examine endogastric cytopathology and hemoglobin level count as new features, potentially useful for GC patients after NAC. Patients and Methods: Between April 2012 and October 2018, 21 of 116 patients with resectable GC received NAC and were investigated for the presence of free-floating malignant cells in their gastric lavage (yGL1) and the development of hypohemoglobinia (yAnemia). Results: yGL1 and yAnemia were found in 11 and 12 patients, respectively. yGL1 correlated with the traditional parameters of tumor regression (p=0.0424). Both yGL1 and yAnemia were found to be independent predictive factors of overall and progression-free survival (p≤0.0364). Conclusion: In the light of our results, the yGL1 and yAnemia appear two promising, simple and interesting clinicopathological features which should always be examined for better clarifying GC patients' response to NAC. Despite continuous decrease and effort in screening and faster diagnosis, according to the latest estimates on incidence and mortality provided by the International Agency for Research on Cancer (IARC), gastric carcinoma (GC) (including cardia and non-cardia tumors) maintains a predominant position worldwide; in fact, in both sexes combined, it is responsible for over 1 million new cases in 2018 and an estimated 783,000 deaths, making it the fifth most frequently diagnosed cancer (after lung, female breast, prostate and colorectal cancer) and the third leading cause of neoplastic mortality (after lung and colorectal cancer) (1). Differing from other gastrointestinal malignancies where multistep carcinogenesis is well-recognized (as for colorectal cancer), to date sporadic GC still has a less known and understood pathobiology (2-6). Surgery still represents the mainstay of therapy but, except for early-stage disease (including early GC; EGC), it cannot assure an effective long-term recovery and must be conducted in concert with peri-operative treatment (7-11). Neoadjuvant chemotherapy (NAC), however, despite initial enthusiasm, has sooner showed conflicting results and limitations against this type of cancer (including gastric and junctional lesions) especially in terms of survival (12-16). To clarify these doubts, ascertain its role and, consequently, optimize the management of GC patients, recently evaluation of NAC effectiveness has been addressed with several new systems and markers, both theoretical and practical (15-18). With this purpose, in our study GC patients submitted to NAC were investigated regarding the presence of free malignant cells in their gastric lavage and the development of hypohemoglobinemia, hereinafter referred as yGL and yAnemia, respectively. Our results suggest that investigation of these two parameters could be useful for evaluating response to NAC in GC patients.
ANZ Journal of Surgery, 2017
We thank Bisset et al. for their comments on our previous study. Diabetes is indeed a risk factor... more We thank Bisset et al. for their comments on our previous study. Diabetes is indeed a risk factor for development of perianal abscess. In our study, we reported that diabetic patients have a significantly higher chance of having bacteriological studies done with odds ratios 2.22; 95% confidence interval 1.01–4.87. The observation of patients with bacteriological studies done with higher recurrence could indeed be confounded by diabetes. There is unfortunately insufficient data to do a subcohort analysis in this aspect. Amongst the patients whom are diabetic, we do not have data to compare those with good and poor glycaemic control. Interestingly, we did not encounter any cases of antibiotic resistance in our study cohort but it could be related to the nature of the study and the variable duration of follow-up. Finally, we included only patient with the index case of perianal abscess in order not to confound the analysis as reported in our methodology. References
Annali italiani di chirurgia, 2016
Intestinal obstructions/pseudo-obstruction of the small/large bowel are frequent conditions but t... more Intestinal obstructions/pseudo-obstruction of the small/large bowel are frequent conditions but their management could be challenging. Moreover, a general agreement in this field is currently lacking, thus SICUT Society designed a consensus study aimed to define their optimal workout. The Delphi methodology was used to reach consensus among 47 Italian surgical experts in two study rounds. Consensus was defined as an agreement of 75.0% or greater. Four main topic areas included nosology, diagnosis, management and treatment. A bowel obstruction was defined as an obstacle to the progression of intestinal contents and fluids generally beginning with a sudden onset. The panel identified four major criteria of diagnosis including absence of flatus, presence of >3.5 cm ileal levels or >6 cm colon dilatation and abdominal distension. Panel also recommended a surgical admission, a multidisciplinary approach, and a gastrografin swallow for patients presenting occlusions. Criteria for im...
Annali italiani di chirurgia, 2016
Hollows viscus injury (HVI) is a rare occurrence and represents a clinical challenge because of i... more Hollows viscus injury (HVI) is a rare occurrence and represents a clinical challenge because of its subtle and nonspecific clinical findings. The specific aims of this study were to determine the overall frequency of HVI in blunt trauma patients occurring in large urban area, the relative frequency of various hollow organ injuries, and the outcomes of such injuries. A retrospective trauma registry review was performed by analysing data from the University Hospital Sant' Andrea in Rome and data from the Emergency Surgery and Trauma Care Unit of S. Filippo Neri Hospital in Rome The clinical records of all blunt abdominal trauma observed between January 2006 and December 2014 were blind analysed. Variables considered for analysis were: sex, age, time/type of trauma, associated injuries, timing/characteristics of operative treatment, ISS, AIS, length of hospital stay, morbidity and mortality. Seventy-one, 7.5% of all abdominal trauma recorded, were coded having 89 HVI. The overall m...
Dermatologic Surgery, 2015
We praise Wortsman and colleagues along with Zarchi and Jemecfor their articles focused on the im... more We praise Wortsman and colleagues along with Zarchi and Jemecfor their articles focused on the important role of ultrasound examination in identifying the subclinical lesions and optimizing the staging of anogenital hidradenitis suppurativa (HS). We would also like readers to consider the use of magnetic resonance imaging (MRI) in advanced cases of anogential HS. As of 2014, resorting to MRI for anogenital HS has been reported only by two works. Although probably underestimated, the contribution offered by this radiological tool to describing the extent, evolution or complications of this disease seems to be of great value. Our experience is in keeping with the two works previously reported
Recenti progressi in medicina, 1990
The authors report a review of the literature and describe their personal experience with treatin... more The authors report a review of the literature and describe their personal experience with treating esophageal varices; all types of surgical approaches (selective and total shunts, esophageal transection) are examined and compared to the results obtained with non surgical treatment (particularly endoscopic sclerotherapy). Indications and results of surgical treatment are discussed from three definitive viewpoints: prevention of first bleeding or prophylactic treatment, control of acute bleeding or emergency treatment and prevention of rebleeding or elective treatment.
Anticancer Research, Jun 1, 2019
PubMed, Jan 30, 2003
Background: Due to the longer life expectancy of the world's population, the number of elderly ci... more Background: Due to the longer life expectancy of the world's population, the number of elderly cirrhotic patients undergoing surgery for hepatocellular carcinoma (HCC) is increasing. Our study evaluates the benefits of hepatic resections for HCC in cirrhotic patients aged over 65, analysing the early and long-term surgical results. Patients and methods: We retrospectively considered a series of 46 patients receiving hepatic resection for HCC. The clinicopathological data and surgical outcome of 14 (30.4%) patients aged 65 or older (group I) were evaluated and compared to the 32 (69.6%) younger than 65 (group II). Results: No operative mortality was recorded in either group. The hospital mortality rate was 7.1% (1 out of 14) in group I and 9.4% (3 out of 32) in group II (p = 1.00). Hospital morbidity did not differ significantly in the two groups (21.4% vs 34.4%; p = 0.50). At follow-up (median 34 months, interquartile range: 12-63) 3 patients from group I (21.4%) and 16 patients from group II (50%) experienced tumor recurrence (p = 0.14). The five-year disease-free survival rate for group I and group II was 71.4% vs 28.2%, respectively (p = 0.05). The overall 5-year survival rate for group I and group II was, respectively, 77.4% vs 41.8%, (p = 0.3). Conclusion: Elderly cirrhotic patients with HCC can benefit from hepatic resection as well as younger patients; age by itself should not be considered a contraindication to surgery.
PubMed, Mar 1, 2003
Budd-Chiari Syndrome (BCS) is characterized by obstruction of hepatic venous outflow. When obstru... more Budd-Chiari Syndrome (BCS) is characterized by obstruction of hepatic venous outflow. When obstruction is limited to the suprahepatic veins, portocaval shunting provides an immediate relief of symptoms. If the obstacle results also from narrowing of the inferior vena cava (IVC), multimodality treatments seem to offer safer and easier alternative. In the patient herein reported, combination of side-to-side portocaval anastomosis with a cavo-atrial shunt through an expandible metallic stent provided immediate relief of symptoms. The patient is doing well after 85 months from combined treatment. In conclusion infracaval stenting combined to side-to-side portocaval shunting should represent the treatment of choice in acute or subacute forms of BCS.
European Journal of Surgery, 2002
International Journal of Colorectal Disease, Jul 28, 2017
Surgical Infections, Dec 1, 2015
World Journal of Surgery, 1994
Cytopathology
ObjectiveAs of 2017, the pathobiology of gastric cancer (GC) is far from fully understood; conseq... more ObjectiveAs of 2017, the pathobiology of gastric cancer (GC) is far from fully understood; consequently, new methods of basic and advanced research have been proposed and tested. The presence (GL1) vs absence (GL0) of malignant cells exfoliated in gastric lavage (GL) of GC patients was formerly evaluated with diagnostic intent but not for staging or prognostic assessment. We investigated this hitherto unreported application of cytopathology.MethodsGL was preoperatively and prospectively collected from 80 GC patients and cytologically analysed. The results were compared with the classic clinicopathological features of GC and related to survival. The prognostic value of GL1 was assessed through univariate and multivariate analyses.ResultsGL1 was detected in 36 samples (45%) and correlated with advanced tumour depth (T3‐T4), lymphatic metastasis (N+), distant metastasis (M1) and lymphovascular invasion (LVI1; P=.0317, .0024, .003 and .0028, respectively). Overall survival (OS) was sign...
Hernia, 2020
Purpose The incidence of inguinal hernia is higher in elderly because of aging-related diseases l... more Purpose The incidence of inguinal hernia is higher in elderly because of aging-related diseases like prostatism, bronchitis, collagen laxity. A conservative management is common in elderly to reduce surgery-related risks, however watchful waiting can expose to obstruction and strangulation. The aim of the present study was to assess the impact of emergency surgery in a large series of elderly with complicated groin hernia and to identify the independent risk factors for postoperative morbidity and mortality. The predictive performance of prognostic risk scores has been also assessed. Methods This is a prospective observational study carried out between January 2017 and June 2018 in elderly patients who underwent emergency surgery for complicated hernia in 38 Italian hospitals. Pre-operative, surgical and postoperative data were recorded for each patient. ASA score, Charlson’s comorbidity index, P-POSSUM and CR-POSSUM were assessed. Results 259 patients were recruited, mean age was 8...
The American Surgeon, 2012
The American Surgeon, 2010
Anticancer Research, 2019
Anticancer Research, 2019
Background/Aim: Although reckoned necessary for survival benefit, neoadjuvant chemotherapy (NAC) ... more Background/Aim: Although reckoned necessary for survival benefit, neoadjuvant chemotherapy (NAC) of gastric cancer (GC) patients has so far provided questionable results. Consequently, searching for new and clearer systems of response to NAC, post-NAC re-evaluation and prognostic prediction appears essential. The purpose of this study was to examine endogastric cytopathology and hemoglobin level count as new features, potentially useful for GC patients after NAC. Patients and Methods: Between April 2012 and October 2018, 21 of 116 patients with resectable GC received NAC and were investigated for the presence of free-floating malignant cells in their gastric lavage (yGL1) and the development of hypohemoglobinia (yAnemia). Results: yGL1 and yAnemia were found in 11 and 12 patients, respectively. yGL1 correlated with the traditional parameters of tumor regression (p=0.0424). Both yGL1 and yAnemia were found to be independent predictive factors of overall and progression-free survival (p≤0.0364). Conclusion: In the light of our results, the yGL1 and yAnemia appear two promising, simple and interesting clinicopathological features which should always be examined for better clarifying GC patients' response to NAC. Despite continuous decrease and effort in screening and faster diagnosis, according to the latest estimates on incidence and mortality provided by the International Agency for Research on Cancer (IARC), gastric carcinoma (GC) (including cardia and non-cardia tumors) maintains a predominant position worldwide; in fact, in both sexes combined, it is responsible for over 1 million new cases in 2018 and an estimated 783,000 deaths, making it the fifth most frequently diagnosed cancer (after lung, female breast, prostate and colorectal cancer) and the third leading cause of neoplastic mortality (after lung and colorectal cancer) (1). Differing from other gastrointestinal malignancies where multistep carcinogenesis is well-recognized (as for colorectal cancer), to date sporadic GC still has a less known and understood pathobiology (2-6). Surgery still represents the mainstay of therapy but, except for early-stage disease (including early GC; EGC), it cannot assure an effective long-term recovery and must be conducted in concert with peri-operative treatment (7-11). Neoadjuvant chemotherapy (NAC), however, despite initial enthusiasm, has sooner showed conflicting results and limitations against this type of cancer (including gastric and junctional lesions) especially in terms of survival (12-16). To clarify these doubts, ascertain its role and, consequently, optimize the management of GC patients, recently evaluation of NAC effectiveness has been addressed with several new systems and markers, both theoretical and practical (15-18). With this purpose, in our study GC patients submitted to NAC were investigated regarding the presence of free malignant cells in their gastric lavage and the development of hypohemoglobinemia, hereinafter referred as yGL and yAnemia, respectively. Our results suggest that investigation of these two parameters could be useful for evaluating response to NAC in GC patients.
ANZ Journal of Surgery, 2017
We thank Bisset et al. for their comments on our previous study. Diabetes is indeed a risk factor... more We thank Bisset et al. for their comments on our previous study. Diabetes is indeed a risk factor for development of perianal abscess. In our study, we reported that diabetic patients have a significantly higher chance of having bacteriological studies done with odds ratios 2.22; 95% confidence interval 1.01–4.87. The observation of patients with bacteriological studies done with higher recurrence could indeed be confounded by diabetes. There is unfortunately insufficient data to do a subcohort analysis in this aspect. Amongst the patients whom are diabetic, we do not have data to compare those with good and poor glycaemic control. Interestingly, we did not encounter any cases of antibiotic resistance in our study cohort but it could be related to the nature of the study and the variable duration of follow-up. Finally, we included only patient with the index case of perianal abscess in order not to confound the analysis as reported in our methodology. References
Annali italiani di chirurgia, 2016
Intestinal obstructions/pseudo-obstruction of the small/large bowel are frequent conditions but t... more Intestinal obstructions/pseudo-obstruction of the small/large bowel are frequent conditions but their management could be challenging. Moreover, a general agreement in this field is currently lacking, thus SICUT Society designed a consensus study aimed to define their optimal workout. The Delphi methodology was used to reach consensus among 47 Italian surgical experts in two study rounds. Consensus was defined as an agreement of 75.0% or greater. Four main topic areas included nosology, diagnosis, management and treatment. A bowel obstruction was defined as an obstacle to the progression of intestinal contents and fluids generally beginning with a sudden onset. The panel identified four major criteria of diagnosis including absence of flatus, presence of >3.5 cm ileal levels or >6 cm colon dilatation and abdominal distension. Panel also recommended a surgical admission, a multidisciplinary approach, and a gastrografin swallow for patients presenting occlusions. Criteria for im...
Annali italiani di chirurgia, 2016
Hollows viscus injury (HVI) is a rare occurrence and represents a clinical challenge because of i... more Hollows viscus injury (HVI) is a rare occurrence and represents a clinical challenge because of its subtle and nonspecific clinical findings. The specific aims of this study were to determine the overall frequency of HVI in blunt trauma patients occurring in large urban area, the relative frequency of various hollow organ injuries, and the outcomes of such injuries. A retrospective trauma registry review was performed by analysing data from the University Hospital Sant' Andrea in Rome and data from the Emergency Surgery and Trauma Care Unit of S. Filippo Neri Hospital in Rome The clinical records of all blunt abdominal trauma observed between January 2006 and December 2014 were blind analysed. Variables considered for analysis were: sex, age, time/type of trauma, associated injuries, timing/characteristics of operative treatment, ISS, AIS, length of hospital stay, morbidity and mortality. Seventy-one, 7.5% of all abdominal trauma recorded, were coded having 89 HVI. The overall m...
Dermatologic Surgery, 2015
We praise Wortsman and colleagues along with Zarchi and Jemecfor their articles focused on the im... more We praise Wortsman and colleagues along with Zarchi and Jemecfor their articles focused on the important role of ultrasound examination in identifying the subclinical lesions and optimizing the staging of anogenital hidradenitis suppurativa (HS). We would also like readers to consider the use of magnetic resonance imaging (MRI) in advanced cases of anogential HS. As of 2014, resorting to MRI for anogenital HS has been reported only by two works. Although probably underestimated, the contribution offered by this radiological tool to describing the extent, evolution or complications of this disease seems to be of great value. Our experience is in keeping with the two works previously reported
Recenti progressi in medicina, 1990
The authors report a review of the literature and describe their personal experience with treatin... more The authors report a review of the literature and describe their personal experience with treating esophageal varices; all types of surgical approaches (selective and total shunts, esophageal transection) are examined and compared to the results obtained with non surgical treatment (particularly endoscopic sclerotherapy). Indications and results of surgical treatment are discussed from three definitive viewpoints: prevention of first bleeding or prophylactic treatment, control of acute bleeding or emergency treatment and prevention of rebleeding or elective treatment.