Maurizio Giacomelli | Università degli Studi di Milano - State University of Milan (Italy) (original) (raw)
Papers by Maurizio Giacomelli
Minerva medica, Jan 22, 1984
Minerva medica, Jan 22, 1984
Journal of biological regulators and homeostatic agents
The endocrine effects of ovariectomy need to be further investigated. The present study was carri... more The endocrine effects of ovariectomy need to be further investigated. The present study was carried out to evaluate the influence of the adjuvant ovariectomy on the mastectomy-induced changes in PRL response to TRH in breast cancer. The study included 34 patients with locally limited breast carcinoma, 18 of whom were treated with radical mastectomy, whereas the other 16 underwent mastectomy plus adjuvant ovariectomy. PRL secretion in response to TRH (200 mcg I.V. as bolus) was evaluated one day before and 7 days after surgery. In patients treated with mastectomy only, PRL increase after TRH was significantly higher after surgery than before. On the contrary, no difference was seen in patients treated with mastectomy plus ovariectomy. This study shows that the adjuvant ovariectomy may block the increase in PRL response to TRH induced by mastectomy in breast cancer.
Obesity Surgery, 2002
Background: Laparoscopic adjustable gastric banding (LAGB) is the most common bariatric operation... more Background: Laparoscopic adjustable gastric banding (LAGB) is the most common bariatric operation. This study is a retrospective analysis of the multicenter Italian experience in patients with BMI >50 over the last 4 years. Methods: An electronic data sheet made for LAGBoperated patients since January 1996, was mailed and e-mailed to all surgeons involved in this kind of procedure in Italy. Items regarding patients with BMI >50 were selected. Analysis used Fisher's exact test and logarithmic regression analysis (P<0.05 significant). Data were expressed as mean ± SD. Results: 239 patients (13.3%), out of 1,797 Lap-Band ® operated patients entered the study (179F / 60M), with mean age 37.6±11.3 years (19-69) and mean BMI 54.6±4.8 (50.1-83.6). Laparotomic conversion rate was 5.4% (44/239). Postoperative complications occurred in 24 / 239 patients (9.0%). Follow-up was obtained in 218 / 218, 198 / 198, 121 / 147, 75 / 93, 30 / 38 LAGB patients at 6, 12, 24, 36, and 48 months respectively. At these time periods, mean BMI was 46.7, 43.9, 42.2, 41.9, and 39.3 kg/m 2. At the same intervals, mean %EWL was 24.1, 34.1, 38.8, 38.9, and 52.9%. The number of patients with <25% EWL at 12, 24, 36, and 48 months follow-up were 34, 10, 4, and 0. Serious co-morbidities (189 in 124 of 239, 57%) had completely resolved 1 year postoperatively in 74 / 124 of the patients (59.6%). Conclusion: Although super-obese patients following the LAGB remain obese with BMI >35, in the short-term most lose their co-morbidities, with a very low morbidity and mortality rate.
Obesity Surgery, 2002
Background: There are now a variety of methods to assess body fat distribution, anthropometric (w... more Background: There are now a variety of methods to assess body fat distribution, anthropometric (waist circumference and waist/hip W/H ratio), computed tomography (CT), and ultrasound (US) measurements, with CT considered as the reference method. Bariatric surgery leads to a significant and usually durable weight loss in morbidly obese patients; when assessing its results, it is of interest to measure changes of total fat tissue and of body fat distribution. Methods: In this study, we compared anthropometric, US, and CT measurements of body fat distribution under basal conditions and 1 year after laparoscopic adjustable gastric banding (LAGB); 120 morbidly obese patients were considered at baseline, and 40 patients were re-evaluated 1 year after LAGB. Results: Thickness of visceral and subcutaneous fat measured through CT and US methods was superimposable both under basal conditions and 1 year after LAGB, and the highest correlation was found between CT and US data on visceral fat, followed by CT and US data on subcutaneous fat; a fair correlation was also found between CT and US data on visceral fat and waist circumference. Conclusion: We suggest that evaluation of body fat distribution is accomplished by US instead of CT measurement, because of its lower cost and low exposure risk. Waist circumference stands as a reasonable surrogate of both methods, while W/H ratio is poorly correlated with other measures of body fat distribution.
The Journal of Clinical Endocrinology & Metabolism, 2002
Weight loss ameliorates arterial hypertension and glucose metabolism in obese patients, but the d... more Weight loss ameliorates arterial hypertension and glucose metabolism in obese patients, but the dietary approach is unsatisfactory because obesity relapses. Durable reduction of body weight, obtained through major nonreversible surgical procedures, such as jejunal and gastric bypass, allows improvement of glucose metabolism and arterial blood pressure in morbid (grade 3) obesity. Laparoscopic adjustable gastric banding (LAGB) is a minimally invasive and reversible surgical procedure that yields a significant reduction of gastric volume and hunger sensation. In this study, 143 patients with grade 3 obesity [27 men and 116 women; age, 42.9 +/- 0.83 yr; body mass index (BMI), 44.9 +/- 0.53 kg/m(2); normal glucose tolerance (NGT; n = 77); impaired glucose tolerance (IGT; n = 47); type 2 diabetes mellitus (T2DM; n = 19)] underwent LAGB and a 3-yr follow-up for clinical (BMI, waist circumference, waist to hip ratio, and arterial blood pressure) and metabolic variables (glycosylated hemoglobin, fasting insulin and glucose, insulin and glucose response to oral glucose tolerance test, homeostasis model assessment index, total and high-density lipoprotein cholesterol, triglycerides, uric acid, and transaminases). At baseline and 1 yr after LAGB, patients underwent computerized tomography and ultrasound evaluation of visceral and sc adipose tissue. One-year metabolic results were compared with 120 obese patients (51 men and 69 women; age, 42.9 +/- 1.11 yr; BMI, 43.6 +/- 0.46 kg/m(2); NGT, n = 66; IGT, n = 8; T2DM, n = 46) receiving standard dietary treatment. LAGB induced a significant and persistent weight loss and decrease of blood pressure. Greater metabolic effects were observed in T2DM patients than in NGT and IGT patients, so that at 3 yr glycosylated hemoglobin was no longer different in NGT and T2DM subjects. Clinical and metabolic improvements were proportional to the amount of weight loss. LAGB induced a greater reduction of visceral fat than sc fat. At 1-yr evaluation, weight loss and metabolic improvements were greater in LAGB-treated than diet-treated patients. We conclude that LAGB is an effective treatment of grade 3 obesity in inducing long-lasting reduction of body weight and arterial blood pressure, modifying body fat distribution, and improving glucose and lipid metabolism, especially in T2DM.
British Journal of Haematology, 2001
A 79-year-old patient with post-polycythaemic myelofibrosis presented with severe hypersplenism. ... more A 79-year-old patient with post-polycythaemic myelofibrosis presented with severe hypersplenism. After splenic artery catheterization, cytosine arabinoside was given intrasplenically from November 1999 to March 2000 for 5 d/month at 10 mg/m2 and increased each month by 10 mg/m2. It was then administered by continuous infusion until June 2000, starting at 20 mg/m2/d and tapering by 5 mg/m2 every 2 weeks to a final daily dose of 5 mg/m2/d. The drug was then stopped. The spleen had decreased to one third of the initial volume. Clinical conditions and haematological indices improved substantially. Intrasplenic therapy could be a new therapeutic tool for hypersplenism in chronic idiopathic and post-myeloproliferative myelofibrosis.
International surgery
To compare laparoscopic and laparotomic techniques for the excision of incidental adrenal tumors.... more To compare laparoscopic and laparotomic techniques for the excision of incidental adrenal tumors. Twenty patients with silent adrenal tumor underwent adrenalectomy or tumor excision through the laparotomic (LPT Group: 12 cases) or laparoscopic (LPS Group: 8 cases) approach. LPT Group and LPS Group were comparatively analyzed in terms of age, gender, Body Mass Index (BMI), concomitant diseases, previous upper abdominal surgery, tumor side and size, type of operation (excision vs adrenalectomy), associated procedures, and pathology. The two groups were then compared for intra/postoperative complications, length of operation, and postoperative ileus, pain, hospitalization. Comparisons were performed also adjusting for variables (BMI, depression, tumor size) unhomogeneously distributed between the two groups. LPT Group and LPS Group were comparable when evaluated for age, gender, BMI, concomitant diseases (except for depression), previous upper abdominal surgery, tumor side, type of ope...
Vascular and Endovascular Surgery, 2002
Several authors believe the crus of the diaphragm or the arcuate ligament is largely implicated i... more Several authors believe the crus of the diaphragm or the arcuate ligament is largely implicated in the etiology of the celiac artery compression syndrome (CACS). An unusual case of CACS successfully treated with laparoscopic decompression is reported. While under general anesthesia, the patient underwent laparoscopic division of the hypertrophic median arcuate ligament and dissection free of the celiac trunk. Postoperative angiography demonstrated improved flow in the celiac artery. The patient was discharged on the second postoperative day. At 6 months, Doppler ultrasound scanning and magnetic resonance angiography revealed good patency of the celiac trunk. The patient reported complete resolution of symptoms and increased weight. A laparoscopic approach allows the surgeon to sufficiently dissect the celiac axis. An excellent clinical result at short-term follow-up was attained. This is the second reported experience with this new procedure and the first successfully performed with only four port sites.
Vascular and Endovascular Surgery, 2002
Several authors believe the crus of the diaphragm or the arcuate ligament is largely implicated i... more Several authors believe the crus of the diaphragm or the arcuate ligament is largely implicated in the etiology of the celiac artery compression syndrome (CACS). An unusual case of CACS successfully treated with laparoscopic decompression is reported. While under general anesthesia, the patient underwent laparoscopic division of the hypertrophic median arcuate ligament and dissection free of the celiac trunk. Postoperative angiography demonstrated improved flow in the celiac artery. The patient was discharged on the second postoperative day. At 6 months, Doppler ultrasound scanning and magnetic resonance angiography revealed good patency of the celiac trunk. The patient reported complete resolution of symptoms and increased weight. A laparoscopic approach allows the surgeon to sufficiently dissect the celiac axis. An excellent clinical result at short-term follow-up was attained. This is the second reported experience with this new procedure and the first successfully performed with only four port sites.
The Journal of International Medical Research, Feb 1, 1982
The effect of a pre-operative high fibre diet on the resolution of ileus following cholecystectom... more The effect of a pre-operative high fibre diet on the resolution of ileus following cholecystectomy has been evaluated. The time needed to restore canalization of the gastro-intestinal tract has been compared in two random groups of patients (a total of thirty-eight) one treated with wheat bran and the other as control without the diet supplementation. The average persistence of ileus was 24 hours in the treated group and 54 hours in the control group. These results suggest that a bran-enriched diet could be an inexpensive and simple treatment to shorten the duration of ileus after abdominal surgery.
Panminerva medica, 1996
To assess retrospectively the effectiveness and the safety of the conservative medical management... more To assess retrospectively the effectiveness and the safety of the conservative medical management of asymptomatic cocaine body-packers. Case series collected during twelve years (1980-1992). Milan Airports Health Center. Department of Surgery and Intensive Care Unit of San Raffaele Hospital-University of Milan. 189 suspected cocaine body packers (143 male, 53 female), aged between 18-53 years, were brought to our observation by customs after disembarking at the Milan International Airports of Malpensa and Linate. 61 subjects (32%) turned to be carriers of packets containing cocaine (ovules). Medical conservative treatment, based on close clinical observation and light solid diet, free assumption of liquids and oily laxatives. Plain abdominal X-ray and ultrasound were performed for the diagnosis of cocaine packet ingestion and then repeated up to the complete evacuation of all ovules. Two laparotomies with surgical removal of ovules in symptomatic patients (bowel obstruction and acut...
Obesity Surgery, 2000
Introduction: Since June 1996 we performed laparoscopic adjustable silicone gastric banding (LASG... more Introduction: Since June 1996 we performed laparoscopic adjustable silicone gastric banding (LASGB), because of low invasivity, absence of malabsorption, reversibility, and postoperative regulation.
The Journal of Clinical Endocrinology & Metabolism, 2002
Weight loss ameliorates arterial hypertension and glucose metabolism in obese patients, but the d... more Weight loss ameliorates arterial hypertension and glucose metabolism in obese patients, but the dietary approach is unsatisfactory because obesity relapses. Durable reduction of body weight, obtained through major nonreversible surgical procedures, such as jejunal and gastric bypass, allows improvement of glucose metabolism and arterial blood pressure in morbid (grade 3) obesity. Laparoscopic adjustable gastric banding (LAGB) is a minimally invasive and reversible surgical procedure that yields a significant reduction of gastric volume and hunger sensation. In this study, 143 patients with grade 3 obesity [27 men and 116 women; age, 42.9 ؎ 0.83 yr; body mass index (BMI), 44.9 ؎ 0.53 kg/m 2 ; normal glucose tolerance (NGT; n ؍ 77); impaired glucose tolerance (IGT; n ؍ 47); type 2 diabetes mellitus (T2DM; n ؍ 19)] underwent LAGB and a 3-yr follow-up for clinical (BMI, waist circumference, waist to hip ratio, and arterial blood pressure) and metabolic variables (glycosylated hemoglobin, fasting insulin and glucose, insulin and glucose response to oral glucose tolerance test, homeostasis model assessment index, total and highdensity lipoprotein cholesterol, triglycerides, uric acid, and transaminases). At baseline and 1 yr after LAGB, patients underwent computerized tomography and ultrasound evaluation of visceral and sc adipose tissue. One-year metabolic results were compared with 120 obese patients (51 men and 69 women; age, 42.9 ؎ 1.11 yr; BMI, 43.6 ؎ 0.46 kg/m 2 ; NGT, n ؍ 66; IGT, n ؍ 8; T2DM, n ؍ 46) receiving standard dietary treatment. LAGB induced a significant and persistent weight loss and decrease of blood pressure. Greater metabolic effects were observed in T2DM patients than in NGT and IGT patients, so that at 3 yr glycosylated hemoglobin was no longer different in NGT and T2DM subjects. Clinical and metabolic improvements were proportional to the amount of weight loss. LAGB induced a greater reduction of visceral fat than sc fat. At 1-yr evaluation, weight loss and metabolic improvements were greater in LAGB-treated than diet-treated patients. We conclude that LAGB is an effective treatment of grade 3 obesity in inducing long-lasting reduction of body weight and arterial blood pressure, modifying body fat distribution, and improving glucose and lipid metabolism, especially in T2DM.
European Journal of Gastroenterology & Hepatology, 1999
The optimal treatment for bile duct stones (in terms of cost, complications and accuracy) is uncl... more The optimal treatment for bile duct stones (in terms of cost, complications and accuracy) is unclear. The aim of our study was to determine the predictive factors for preoperative endoscopic retrograde cholangiopancreatography (ERCP).
Diabetes Care, 2005
The C-174G promoter polymorphism of the interleukin (IL)-6 gene was found to influence transcript... more The C-174G promoter polymorphism of the interleukin (IL)-6 gene was found to influence transcriptional activity and plasma IL-6 levels in humans. We addressed the question of whether the C-174G IL-6 polymorphism contributes to variation of insulin sensitivity. Two cohorts of subjects were genotyped. Cohort 1 includes 275 nondiabetic subjects who underwent a euglycemic-hyperinsulinemic clamp. Cohort 2 includes 77 patients with morbid obesity who underwent laparoscopic adjustable gastric banding (LAGB). The genotypes were consistent with Hardy-Weinberg equilibrium proportions. In cohort 1, insulin sensitivity was reduced in carriers of the -174G/G genotype as compared with subjects carrying the C allele (P = 0.004). Carriers of -174G/G displayed significantly higher plasma IL-6 levels in comparison with carriers of the C allele. In a stepwise linear regression analysis, the C-174G polymorphism was independently associated with insulin sensitivity; however, after inclusion of plasma IL-6 concentrations, the polymorphism was excluded from the model explaining insulin sensitivity variability, thus suggesting that the polymorphism was affecting insulin sensitivity by regulating IL-6 plasma levels. IL-6 mRNA levels were measured by real-time RT-PCR in subcutaneous fat obtained from obese patients of cohort 2 during LAGB. Carriers of -174G/G showed increased IL-6 expression compared with subjects carrying the C allele (P = 0.04). There was a significant correlation between adipose IL-6 mRNA expression and insulin resistance assessed by homeostasis model assessment (rho = 0.28, P = 0.014). These results indicate that the -174G/G genotype of the IL-6 gene may contribute to variations in insulin sensitivity.
Obesity Surgery, 2002
Background: There are now a variety of methods to assess body fat distribution, anthropometric (w... more Background: There are now a variety of methods to assess body fat distribution, anthropometric (waist circumference and waist/hip W/H ratio), computed tomography (CT), and ultrasound (US) measurements, with CT considered as the reference method. Bariatric surgery leads to a significant and usually durable weight loss in morbidly obese patients; when assessing its results, it is of interest to measure changes of total fat tissue and of body fat distribution.
Minerva medica, Jan 22, 1984
Minerva medica, Jan 22, 1984
Journal of biological regulators and homeostatic agents
The endocrine effects of ovariectomy need to be further investigated. The present study was carri... more The endocrine effects of ovariectomy need to be further investigated. The present study was carried out to evaluate the influence of the adjuvant ovariectomy on the mastectomy-induced changes in PRL response to TRH in breast cancer. The study included 34 patients with locally limited breast carcinoma, 18 of whom were treated with radical mastectomy, whereas the other 16 underwent mastectomy plus adjuvant ovariectomy. PRL secretion in response to TRH (200 mcg I.V. as bolus) was evaluated one day before and 7 days after surgery. In patients treated with mastectomy only, PRL increase after TRH was significantly higher after surgery than before. On the contrary, no difference was seen in patients treated with mastectomy plus ovariectomy. This study shows that the adjuvant ovariectomy may block the increase in PRL response to TRH induced by mastectomy in breast cancer.
Obesity Surgery, 2002
Background: Laparoscopic adjustable gastric banding (LAGB) is the most common bariatric operation... more Background: Laparoscopic adjustable gastric banding (LAGB) is the most common bariatric operation. This study is a retrospective analysis of the multicenter Italian experience in patients with BMI >50 over the last 4 years. Methods: An electronic data sheet made for LAGBoperated patients since January 1996, was mailed and e-mailed to all surgeons involved in this kind of procedure in Italy. Items regarding patients with BMI >50 were selected. Analysis used Fisher's exact test and logarithmic regression analysis (P<0.05 significant). Data were expressed as mean ± SD. Results: 239 patients (13.3%), out of 1,797 Lap-Band ® operated patients entered the study (179F / 60M), with mean age 37.6±11.3 years (19-69) and mean BMI 54.6±4.8 (50.1-83.6). Laparotomic conversion rate was 5.4% (44/239). Postoperative complications occurred in 24 / 239 patients (9.0%). Follow-up was obtained in 218 / 218, 198 / 198, 121 / 147, 75 / 93, 30 / 38 LAGB patients at 6, 12, 24, 36, and 48 months respectively. At these time periods, mean BMI was 46.7, 43.9, 42.2, 41.9, and 39.3 kg/m 2. At the same intervals, mean %EWL was 24.1, 34.1, 38.8, 38.9, and 52.9%. The number of patients with <25% EWL at 12, 24, 36, and 48 months follow-up were 34, 10, 4, and 0. Serious co-morbidities (189 in 124 of 239, 57%) had completely resolved 1 year postoperatively in 74 / 124 of the patients (59.6%). Conclusion: Although super-obese patients following the LAGB remain obese with BMI >35, in the short-term most lose their co-morbidities, with a very low morbidity and mortality rate.
Obesity Surgery, 2002
Background: There are now a variety of methods to assess body fat distribution, anthropometric (w... more Background: There are now a variety of methods to assess body fat distribution, anthropometric (waist circumference and waist/hip W/H ratio), computed tomography (CT), and ultrasound (US) measurements, with CT considered as the reference method. Bariatric surgery leads to a significant and usually durable weight loss in morbidly obese patients; when assessing its results, it is of interest to measure changes of total fat tissue and of body fat distribution. Methods: In this study, we compared anthropometric, US, and CT measurements of body fat distribution under basal conditions and 1 year after laparoscopic adjustable gastric banding (LAGB); 120 morbidly obese patients were considered at baseline, and 40 patients were re-evaluated 1 year after LAGB. Results: Thickness of visceral and subcutaneous fat measured through CT and US methods was superimposable both under basal conditions and 1 year after LAGB, and the highest correlation was found between CT and US data on visceral fat, followed by CT and US data on subcutaneous fat; a fair correlation was also found between CT and US data on visceral fat and waist circumference. Conclusion: We suggest that evaluation of body fat distribution is accomplished by US instead of CT measurement, because of its lower cost and low exposure risk. Waist circumference stands as a reasonable surrogate of both methods, while W/H ratio is poorly correlated with other measures of body fat distribution.
The Journal of Clinical Endocrinology & Metabolism, 2002
Weight loss ameliorates arterial hypertension and glucose metabolism in obese patients, but the d... more Weight loss ameliorates arterial hypertension and glucose metabolism in obese patients, but the dietary approach is unsatisfactory because obesity relapses. Durable reduction of body weight, obtained through major nonreversible surgical procedures, such as jejunal and gastric bypass, allows improvement of glucose metabolism and arterial blood pressure in morbid (grade 3) obesity. Laparoscopic adjustable gastric banding (LAGB) is a minimally invasive and reversible surgical procedure that yields a significant reduction of gastric volume and hunger sensation. In this study, 143 patients with grade 3 obesity [27 men and 116 women; age, 42.9 +/- 0.83 yr; body mass index (BMI), 44.9 +/- 0.53 kg/m(2); normal glucose tolerance (NGT; n = 77); impaired glucose tolerance (IGT; n = 47); type 2 diabetes mellitus (T2DM; n = 19)] underwent LAGB and a 3-yr follow-up for clinical (BMI, waist circumference, waist to hip ratio, and arterial blood pressure) and metabolic variables (glycosylated hemoglobin, fasting insulin and glucose, insulin and glucose response to oral glucose tolerance test, homeostasis model assessment index, total and high-density lipoprotein cholesterol, triglycerides, uric acid, and transaminases). At baseline and 1 yr after LAGB, patients underwent computerized tomography and ultrasound evaluation of visceral and sc adipose tissue. One-year metabolic results were compared with 120 obese patients (51 men and 69 women; age, 42.9 +/- 1.11 yr; BMI, 43.6 +/- 0.46 kg/m(2); NGT, n = 66; IGT, n = 8; T2DM, n = 46) receiving standard dietary treatment. LAGB induced a significant and persistent weight loss and decrease of blood pressure. Greater metabolic effects were observed in T2DM patients than in NGT and IGT patients, so that at 3 yr glycosylated hemoglobin was no longer different in NGT and T2DM subjects. Clinical and metabolic improvements were proportional to the amount of weight loss. LAGB induced a greater reduction of visceral fat than sc fat. At 1-yr evaluation, weight loss and metabolic improvements were greater in LAGB-treated than diet-treated patients. We conclude that LAGB is an effective treatment of grade 3 obesity in inducing long-lasting reduction of body weight and arterial blood pressure, modifying body fat distribution, and improving glucose and lipid metabolism, especially in T2DM.
British Journal of Haematology, 2001
A 79-year-old patient with post-polycythaemic myelofibrosis presented with severe hypersplenism. ... more A 79-year-old patient with post-polycythaemic myelofibrosis presented with severe hypersplenism. After splenic artery catheterization, cytosine arabinoside was given intrasplenically from November 1999 to March 2000 for 5 d/month at 10 mg/m2 and increased each month by 10 mg/m2. It was then administered by continuous infusion until June 2000, starting at 20 mg/m2/d and tapering by 5 mg/m2 every 2 weeks to a final daily dose of 5 mg/m2/d. The drug was then stopped. The spleen had decreased to one third of the initial volume. Clinical conditions and haematological indices improved substantially. Intrasplenic therapy could be a new therapeutic tool for hypersplenism in chronic idiopathic and post-myeloproliferative myelofibrosis.
International surgery
To compare laparoscopic and laparotomic techniques for the excision of incidental adrenal tumors.... more To compare laparoscopic and laparotomic techniques for the excision of incidental adrenal tumors. Twenty patients with silent adrenal tumor underwent adrenalectomy or tumor excision through the laparotomic (LPT Group: 12 cases) or laparoscopic (LPS Group: 8 cases) approach. LPT Group and LPS Group were comparatively analyzed in terms of age, gender, Body Mass Index (BMI), concomitant diseases, previous upper abdominal surgery, tumor side and size, type of operation (excision vs adrenalectomy), associated procedures, and pathology. The two groups were then compared for intra/postoperative complications, length of operation, and postoperative ileus, pain, hospitalization. Comparisons were performed also adjusting for variables (BMI, depression, tumor size) unhomogeneously distributed between the two groups. LPT Group and LPS Group were comparable when evaluated for age, gender, BMI, concomitant diseases (except for depression), previous upper abdominal surgery, tumor side, type of ope...
Vascular and Endovascular Surgery, 2002
Several authors believe the crus of the diaphragm or the arcuate ligament is largely implicated i... more Several authors believe the crus of the diaphragm or the arcuate ligament is largely implicated in the etiology of the celiac artery compression syndrome (CACS). An unusual case of CACS successfully treated with laparoscopic decompression is reported. While under general anesthesia, the patient underwent laparoscopic division of the hypertrophic median arcuate ligament and dissection free of the celiac trunk. Postoperative angiography demonstrated improved flow in the celiac artery. The patient was discharged on the second postoperative day. At 6 months, Doppler ultrasound scanning and magnetic resonance angiography revealed good patency of the celiac trunk. The patient reported complete resolution of symptoms and increased weight. A laparoscopic approach allows the surgeon to sufficiently dissect the celiac axis. An excellent clinical result at short-term follow-up was attained. This is the second reported experience with this new procedure and the first successfully performed with only four port sites.
Vascular and Endovascular Surgery, 2002
Several authors believe the crus of the diaphragm or the arcuate ligament is largely implicated i... more Several authors believe the crus of the diaphragm or the arcuate ligament is largely implicated in the etiology of the celiac artery compression syndrome (CACS). An unusual case of CACS successfully treated with laparoscopic decompression is reported. While under general anesthesia, the patient underwent laparoscopic division of the hypertrophic median arcuate ligament and dissection free of the celiac trunk. Postoperative angiography demonstrated improved flow in the celiac artery. The patient was discharged on the second postoperative day. At 6 months, Doppler ultrasound scanning and magnetic resonance angiography revealed good patency of the celiac trunk. The patient reported complete resolution of symptoms and increased weight. A laparoscopic approach allows the surgeon to sufficiently dissect the celiac axis. An excellent clinical result at short-term follow-up was attained. This is the second reported experience with this new procedure and the first successfully performed with only four port sites.
The Journal of International Medical Research, Feb 1, 1982
The effect of a pre-operative high fibre diet on the resolution of ileus following cholecystectom... more The effect of a pre-operative high fibre diet on the resolution of ileus following cholecystectomy has been evaluated. The time needed to restore canalization of the gastro-intestinal tract has been compared in two random groups of patients (a total of thirty-eight) one treated with wheat bran and the other as control without the diet supplementation. The average persistence of ileus was 24 hours in the treated group and 54 hours in the control group. These results suggest that a bran-enriched diet could be an inexpensive and simple treatment to shorten the duration of ileus after abdominal surgery.
Panminerva medica, 1996
To assess retrospectively the effectiveness and the safety of the conservative medical management... more To assess retrospectively the effectiveness and the safety of the conservative medical management of asymptomatic cocaine body-packers. Case series collected during twelve years (1980-1992). Milan Airports Health Center. Department of Surgery and Intensive Care Unit of San Raffaele Hospital-University of Milan. 189 suspected cocaine body packers (143 male, 53 female), aged between 18-53 years, were brought to our observation by customs after disembarking at the Milan International Airports of Malpensa and Linate. 61 subjects (32%) turned to be carriers of packets containing cocaine (ovules). Medical conservative treatment, based on close clinical observation and light solid diet, free assumption of liquids and oily laxatives. Plain abdominal X-ray and ultrasound were performed for the diagnosis of cocaine packet ingestion and then repeated up to the complete evacuation of all ovules. Two laparotomies with surgical removal of ovules in symptomatic patients (bowel obstruction and acut...
Obesity Surgery, 2000
Introduction: Since June 1996 we performed laparoscopic adjustable silicone gastric banding (LASG... more Introduction: Since June 1996 we performed laparoscopic adjustable silicone gastric banding (LASGB), because of low invasivity, absence of malabsorption, reversibility, and postoperative regulation.
The Journal of Clinical Endocrinology & Metabolism, 2002
Weight loss ameliorates arterial hypertension and glucose metabolism in obese patients, but the d... more Weight loss ameliorates arterial hypertension and glucose metabolism in obese patients, but the dietary approach is unsatisfactory because obesity relapses. Durable reduction of body weight, obtained through major nonreversible surgical procedures, such as jejunal and gastric bypass, allows improvement of glucose metabolism and arterial blood pressure in morbid (grade 3) obesity. Laparoscopic adjustable gastric banding (LAGB) is a minimally invasive and reversible surgical procedure that yields a significant reduction of gastric volume and hunger sensation. In this study, 143 patients with grade 3 obesity [27 men and 116 women; age, 42.9 ؎ 0.83 yr; body mass index (BMI), 44.9 ؎ 0.53 kg/m 2 ; normal glucose tolerance (NGT; n ؍ 77); impaired glucose tolerance (IGT; n ؍ 47); type 2 diabetes mellitus (T2DM; n ؍ 19)] underwent LAGB and a 3-yr follow-up for clinical (BMI, waist circumference, waist to hip ratio, and arterial blood pressure) and metabolic variables (glycosylated hemoglobin, fasting insulin and glucose, insulin and glucose response to oral glucose tolerance test, homeostasis model assessment index, total and highdensity lipoprotein cholesterol, triglycerides, uric acid, and transaminases). At baseline and 1 yr after LAGB, patients underwent computerized tomography and ultrasound evaluation of visceral and sc adipose tissue. One-year metabolic results were compared with 120 obese patients (51 men and 69 women; age, 42.9 ؎ 1.11 yr; BMI, 43.6 ؎ 0.46 kg/m 2 ; NGT, n ؍ 66; IGT, n ؍ 8; T2DM, n ؍ 46) receiving standard dietary treatment. LAGB induced a significant and persistent weight loss and decrease of blood pressure. Greater metabolic effects were observed in T2DM patients than in NGT and IGT patients, so that at 3 yr glycosylated hemoglobin was no longer different in NGT and T2DM subjects. Clinical and metabolic improvements were proportional to the amount of weight loss. LAGB induced a greater reduction of visceral fat than sc fat. At 1-yr evaluation, weight loss and metabolic improvements were greater in LAGB-treated than diet-treated patients. We conclude that LAGB is an effective treatment of grade 3 obesity in inducing long-lasting reduction of body weight and arterial blood pressure, modifying body fat distribution, and improving glucose and lipid metabolism, especially in T2DM.
European Journal of Gastroenterology & Hepatology, 1999
The optimal treatment for bile duct stones (in terms of cost, complications and accuracy) is uncl... more The optimal treatment for bile duct stones (in terms of cost, complications and accuracy) is unclear. The aim of our study was to determine the predictive factors for preoperative endoscopic retrograde cholangiopancreatography (ERCP).
Diabetes Care, 2005
The C-174G promoter polymorphism of the interleukin (IL)-6 gene was found to influence transcript... more The C-174G promoter polymorphism of the interleukin (IL)-6 gene was found to influence transcriptional activity and plasma IL-6 levels in humans. We addressed the question of whether the C-174G IL-6 polymorphism contributes to variation of insulin sensitivity. Two cohorts of subjects were genotyped. Cohort 1 includes 275 nondiabetic subjects who underwent a euglycemic-hyperinsulinemic clamp. Cohort 2 includes 77 patients with morbid obesity who underwent laparoscopic adjustable gastric banding (LAGB). The genotypes were consistent with Hardy-Weinberg equilibrium proportions. In cohort 1, insulin sensitivity was reduced in carriers of the -174G/G genotype as compared with subjects carrying the C allele (P = 0.004). Carriers of -174G/G displayed significantly higher plasma IL-6 levels in comparison with carriers of the C allele. In a stepwise linear regression analysis, the C-174G polymorphism was independently associated with insulin sensitivity; however, after inclusion of plasma IL-6 concentrations, the polymorphism was excluded from the model explaining insulin sensitivity variability, thus suggesting that the polymorphism was affecting insulin sensitivity by regulating IL-6 plasma levels. IL-6 mRNA levels were measured by real-time RT-PCR in subcutaneous fat obtained from obese patients of cohort 2 during LAGB. Carriers of -174G/G showed increased IL-6 expression compared with subjects carrying the C allele (P = 0.04). There was a significant correlation between adipose IL-6 mRNA expression and insulin resistance assessed by homeostasis model assessment (rho = 0.28, P = 0.014). These results indicate that the -174G/G genotype of the IL-6 gene may contribute to variations in insulin sensitivity.
Obesity Surgery, 2002
Background: There are now a variety of methods to assess body fat distribution, anthropometric (w... more Background: There are now a variety of methods to assess body fat distribution, anthropometric (waist circumference and waist/hip W/H ratio), computed tomography (CT), and ultrasound (US) measurements, with CT considered as the reference method. Bariatric surgery leads to a significant and usually durable weight loss in morbidly obese patients; when assessing its results, it is of interest to measure changes of total fat tissue and of body fat distribution.