Ugo Cioffi | University of Milan (original) (raw)
Papers by Ugo Cioffi
World Journal of Gastrointestinal Surgery, 2024
BACKGROUND Esophageal perforation or postoperative leak after esophageal surgery remain a life-th... more BACKGROUND Esophageal perforation or postoperative leak after esophageal surgery remain a life-threatening condition. The optimal management strategy is still unclear. AIM To determine clinical outcomes and complications of our 15-year experience in the multidisciplinary management of esophageal perforations and anastomotic leaks. METHODS A retrospective single-center observational study was performed on 60 patients admitted at our department for esophageal perforations or treated for an anastomotic leak developed after esophageal surgery from January 2008 to December 2023. Clinical outcomes were analyzed, and complications were evaluated to investigate the efficacy and safety of our multidisciplinary management based on the preservation of the native or reconstructed esophagus, when feasible. RESULTS Among the whole series of 60 patients, an urgent surgery was required in 8 cases due to a septic state. Fifty-six patients were managed by endoscopic or hybrid treatments, obtaining the resolution of the esophageal leak/perforation without removal of the native or reconstructed esophagus. The mean time to resolution was 54.95 ± 52.64 days, with a median of 35.5 days. No severe complications were recorded. Ten patients out of 56 (17.9%) developed pneumonia that was treated by specific antibiotic therapy, and in 6 cases (10.7%) an atrial fibrillation was recorded. Seven patients (12.5%) developed a stricture within 12 months, requiring one or two endoscopic pneumatic dilations to solve the problem. Mortality was 1.7%. CONCLUSION A proper multidisciplinary approach with the choice of the most appropriate treatment can be the key for success in managing esophageal leaks or perforations and preserving the esophagus.
Journal of clinical medicine, May 29, 2024
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
World journal of gastrointestinal pharmacology and therapeutics, Mar 20, 2024
Irritable bowel syndrome with diarrhea is a very frequent clinical condition characterized by dis... more Irritable bowel syndrome with diarrhea is a very frequent clinical condition characterized by disabling intestinal symptoms. This disease presents with daily abdominal pain for at least 3 months related to defecation and associated with a change in the frequency of bowel movements and the shape of the stool. International surveys about this disease report a global prevalence of about 1.5%. A new amino acid based electrolyte solution has recently been commercialized for oral rehydration in diarrhea. It is composed of water, electrolytes, and five selected amino acids that function as sodium co-transporters without containing glucose. In recent years, some studies explored the effectiveness of the amino acid based electrolyte beverage in oncologic patients with gastrointestinal mucositis, reporting good results. Recently, a prospective study to evaluate the clinical impact of the amino acid based medical beverage was conducted in patients with diarrhea predominant irritable bowel syndrome. The research was based on a real-life methodology minimizing the disruption of the routine care. One hundred patients suffering from irritable bowel syndrome with diarrhea drank a solution based on selected amino acids twice a day for 2 wk. Each enrolled patient completed the study and showed a significant response rate with regard to stool consistency and pain reduction. Based on this data, we can hypothesize that the amino acid based oral rehydration solution could be a valid tool in the treatment of patients affected by irritable bowel syndrome with diarrhea. It is certainly necessary to plan highquality clinical trials comparing glucose based oral solutions and amino acid based solutions in patients with persisting diarrhea. Probably in the near future all oral rehydration solutions will contain amino acids.
Frontiers in Oncology, Jan 7, 2024
Video assisted thoracic surgery (VATS) lobectomy is the treatment of choice for early-stage lung ... more Video assisted thoracic surgery (VATS) lobectomy is the treatment of choice for early-stage lung cancer. It is safe and effective compared to open surgery, as demonstrated by a large body of scientific evidence over the last few decades. VATS lobectomy's evolution was driven by the need to decrease post-operative pain by reducing the extent of surgical accesses, maintaining the same oncological efficacy of open lobectomy with less invasiveness. VATS lobectomy just turned 30 years old, evolving and changing significantly from its origins. The aim of this mini review is to retrace the history, starting from a multiport approach to a single port approach. At the end of this mini review, we will discuss the advanced and the future challenges of the technique that has revolutionized thoracic surgery.
Frontiers in oncology, Feb 13, 2024
Objectives: To present a comprehensive review of the current state of artificial intelligence (AI... more Objectives: To present a comprehensive review of the current state of artificial intelligence (AI) applications in lung cancer management, spanning the preoperative, intraoperative, and postoperative phases. Methods: A review of the literature was conducted using PubMed, EMBASE and Cochrane, including relevant studies between 2002 and 2023 to identify the latest research on artificial intelligence and lung cancer. Conclusion: While AI holds promise in managing lung cancer, challenges exist. In the preoperative phase, AI can improve diagnostics and predict biomarkers, particularly in cases with limited biopsy materials. During surgery, AI provides real-time guidance. Postoperatively, AI assists in pathology assessment and predictive modeling. Challenges include interpretability issues, training limitations affecting model use and AI's ineffectiveness beyond classification. Overfitting and global generalization, along with high computational costs and ethical frameworks, pose hurdles. Addressing these challenges requires a careful approach, considering ethical, technical, and regulatory factors. Rigorous analysis, external validation, and a robust regulatory framework are crucial for responsible AI implementation in lung surgery, reflecting the evolving synergy between human expertise and technology.
PubMed, Jun 1, 1998
The onset of GERD depends on several factors leading to a prolonged exposition of the esophageal ... more The onset of GERD depends on several factors leading to a prolonged exposition of the esophageal mucosa to inflammatory agents. Various mechanisms play a role in different patients, but generally, decreased LES tone and delayed esophageal clearance are the major causes. Although pyrosis and regurgitation are the most frequent complaints, the patient may have different symptoms or can be asymptomatic. The symptoms are not necessarily correlated with damaged mucosa. Recognized complications caused by reflux include esophagitis, stricture, hemorrhage, Barrett's epithelium and ulceration, aspiration and respiratory implications. The severity of complications may be an important element in predicting whether the patient can be successfully treated medically or surgically. The exact knowledge of the pathogenesis is mandatory for carrying out the most effective treatment.
J Clin Med, 2024
Technological development in the field of robotics has meant that, in recent years, more and more... more Technological development in the field of robotics has meant that, in recent years, more and more thoracic surgery departments have adopted this type of approach at the expense of VATS, and today robotic surgery boasts numerous applications in malignant and benign thoracic pathology. Because autonomic nervous system surgery is a high-precision surgery, it is conceivable that the application of RATS could lead to improved outcomes and reduced side effects, but its feasibility has
not yet been thoroughly studied. This review identified three main areas of application: (1) standard thoracic sympathectomy, (2) selective procedures, and (3) nerve reconstruction. Regarding standard sympathectomy and its usual areas of application, such as the management of hyperhidrosis and some cardiac and vascular conditions, the use of RATS is almost anecdotal. Instead, its impact can be decisive if we consider selective techniques such as ramicotomy, optimizing selective surgery of the communicating gray branches, which appears to reduce the incidence of compensatory sweating only when performed with the utmost care. Regarding sympathetic nerve reconstruction, there are several studies, although not conclusive, that point to it as a possible solution to reverse surgical nerve RATSinterruption. In conclusion, the characteristics of RATS might make it preferable to other techniques
and, particularly, VATS, but to date, the data in the literature are too weak to draw any evidence
World Journal of Gastrointestinal Pharmacology and Therapeutics, 2024
Irritable bowel syndrome with diarrhea is a very frequent clinical condition characterized by dis... more Irritable bowel syndrome with diarrhea is a very frequent clinical condition characterized by disabling intestinal symptoms. This disease presents with daily abdominal pain for at least 3 months related to defecation and associated with a change in the frequency of bowel movements and the shape of the stool. International surveys about this disease report a global prevalence of about 1.5%. A new amino acid based electrolyte solution has recently been commercialized for oral rehydration in diarrhea. It is composed of water, electrolytes, and five selected amino acids that function as sodium co-transporters without containing glucose.
In recent years, some studies explored the effectiveness of the amino acid based electrolyte beverage in oncologic patients with gastrointestinal mucositis, reporting good results. Recently, a prospective study to evaluate the clinical impact of the amino acid based medical beverage was conducted in patients with diarrhea predominant irritable bowel syndrome. The research was based on a real-life methodology minimizing the disruption of the routine care. One hundred patients suffering from irritable bowel syndrome with diarrhea drank a solution based on
selected amino acids twice a day for 2 wk. Each enrolled patient completed the study and showed a significant response rate with regard to stool consistency and pain reduction. Based on this data, we can hypothesize that the amino acid based oral rehydration solution could be a valid tool in the treatment of patients affected by irritable bowel syndrome with diarrhea. It is certainly necessary to plan highquality
clinical trials comparing glucose based oral solutions and amino acid
based solutions in patients with persisting diarrhea. Probably in the near future all oral rehydration solutions will contain amino acids.
Journal of Laparoendoscopic & Advanced Surgical Techniques, Jun 1, 1999
This retrospective study reports the results of our 5-year experience in the diagnosis and treatm... more This retrospective study reports the results of our 5-year experience in the diagnosis and treatment of rectal prolapse with fecal incontinence by the abdominal (laparotomy or laparoscopy) and perineal approaches. Twenty-five patients (group A; 22 women and 3 men; mean age 57.3 years; range 22-76 years) were operated on by the abdominal approach and ten (group B; 8 women and 2 men; mean age 68.9 years; range 58-84 years) by the perineal approach. All patients were evaluated by clinical examination, proctosigmoidoscopy, pancolonic transit time, dynamic defecography, anorectal manometry, and anal electromyography preparatory to surgery. In patients of group A, we performed an abdominal rectopexy in 19 cases (7 by laparoscopy) and in the remaining 6 cases, a sigmoid resection-rectopexy (3 of which were by laparoscopy). All patients of group B were treated by a perineal operation using Delorme's mucosectomy in 4 cases and Altemeier's rectosigmoidectomy with total perineoplasty in 6 cases. The mean follow-up was 38.8 months in group A and 25.7 months in group B. The postoperative complication rate was 8% (two cases) in group A, whereas no significant complications occurred in group B. Dyschezia and fecal incontinence improved significantly in both groups (P < 0.05 in group A and P < 0.005 in group B), whereas anoperineal pain was not significantly reduced. At 1-year follow-up, the recurrences rates were 8% in group A and 30% in group B. Rectopexy or resection-rectopexy proved to be a safe and effective procedure for external prolapse, without a discernible difference between the laparotomie and laparoscopic techniques. In selected cases, the perineal approach gives good results regarding fecal incontinence without complications, even if in these patients, the likelihood of recurrence is high.
United European gastroenterology journal, Nov 13, 1999
An 80-year-old female patient presented to the emergency room for dyspnea and “tirage” caused by ... more An 80-year-old female patient presented to the emergency room for dyspnea and “tirage” caused by massive thyroid cancer. In these cases tracheal dilation by rigid bronchoscopy is the treatment of choice. Before the procedure we performed progressive dilatation with repeated intubations using conventional tube with increased diameters. No adverse events occurred. She was discharged from ICU to the ward on the day after the operation. This procedure allows being more confident in terms of patient ventilation, less trauma to the stenotic tracheal mucosa, less ICU stay, easy material availability and less cost for public health.
PubMed, Apr 1, 1999
Background: Endoscopic ultrasonography (EUS) is a relatively new diagnostic method to assess the ... more Background: Endoscopic ultrasonography (EUS) is a relatively new diagnostic method to assess the extent and the depth of infiltration of esophageal carcinoma. Methods: From October 1990, 100 patients affected by esophageal squamous cell carcinoma underwent preoperative evaluation with endoscopic ultrasonography, 85 of whom were operated on. The first 23 patients underwent endosonography with an Olympus GF-EUM2 with a 7.5 MHz echo-probe; the remaining 77 patients underwent EUS with an Olympus GF-EUM3 with a 7.5-12 MHz echo-probe. Results: In 33 cases (33%), the procedure was not completed because of the impossibility of passing through the neoplastic stenosis. The depth of infiltration was correctly defined by EUS in 73 of 85 patients (86%) compared with 47% of Computed Tomography (CT) (p < 0.05). Overestimation occurred in 6 patients (7%), whereas underestimation occurred in 6 cases (7%). Lymph-node involvement was correctly classified by EUS in 50 of 57 patients (88%) compared with 39% of CT. Conclusions: EUS provides a high degree of accuracy in assessing both T and N parameters in staging esophageal cancer. The major problem of the method is still the frequent impossibility of passing through a neoplastic stenosis.
PubMed, Sep 1, 1990
Lung transplant has now become a viable clinical option for the treatment of irreversible end-sta... more Lung transplant has now become a viable clinical option for the treatment of irreversible end-stage respiratory failures. The first successful single lung transplant was performed by Cooper and coworkers in Canada in 1983, and the first successful double lung transplant was performed by the same group in 1986. The history of lung transplantation is followed by a discussion of the current surgical indications for single and double lung transplants. The criteria for the evaluation and pre-operative management of potential candidates are reported. The surgical techniques used for harvesting, preserving and transplanting one or both lungs are then described, including the latest procedure of sequential bilateral lung transplantation. Almost 250 patients have undergone single or double lung transplants all over the world with a survival rate of more than 65%. Lung function and exercise tolerance have satisfactorily improved. Despite a number of problems in airway anastomosis and in diagnosis and treating rejection still to be resolved, lung transplantation is rapidly gaining ground worldwide.
PubMed, May 1, 1997
Background/aims: We studied the effectiveness of ultrasonography in evaluating the cervical esoph... more Background/aims: We studied the effectiveness of ultrasonography in evaluating the cervical esophagus for the presence of large masses arising from the esophageal wall and consequently, the modifications of the visceral lumen. Materials and methods: The cervical esophagus can be evaluated by ultrasound with longitudinal and axial scans, using the left thyroid lobe as an acoustic window. The cervical esophagus can be visualized from the C5 to D2 vertebrae. From November 1992 to July 1996, 220 patients with esophageal cancer and 120 subjects without esophageal disease (control group) were examined with ultrasonography. Examination of the cervical esophagus was performed with a linear high definition small parts probe with a frequency of 7.5-10 Mhz. Results: In all 31 patients with cancer of the cervical esophagus, ultrasonography of the cervical region showed the presence of an expanding mass from the esophageal wall as well as the modifications in the visceral lumen. The neoplasm of the cervical esophagus was visualized when its diameter exceeded 5 mm. Conclusions: The experience of the authors shows that, during ultrasound examination of the cervical region, it is possible to accurately evaluate the cervical esophagus, either morphologically or functionally.
Abdominal Imaging, May 1, 1998
The detection of cervical lymph node metastases plays an important role in staging of patients af... more The detection of cervical lymph node metastases plays an important role in staging of patients affected by esophageal cancer to perform the best therapeutic approach. We report our experience concerning the ultrasound evaluation of the cervical area in 174 patients with esophageal cancer. Ultrasonographic evaluation of the neck can be done with a 7.5- or 10 MHz transducer in all cases, with selective scanning of the lymph node chains of the internal jugular veins and supraclavicular regions. The short-to-long axis ratio (S/L) was a useful way to detect lymph node metastasis. Histopathologic diagnoses were obtained by sonographically guided fine-needle aspiration biopsy. At ultrasound examination, we found 18 (10.3%) patients with metastatic cervical nodes. Of these, 17 (94.4%) had metastatic cervical lymph nodes confirmed by cytology from fine-needle biopsy. Lymph node exceeding 5 mm in long axis and with an S/L over 0.5 showed a higher incidence of metastasis than those with an S/L under 0.5. Our experience shows a high incidence of lymph node metastases in patients with esophageal cancer localized to the thoracic supracarinal tract and in patients with cervical and lower esophageal cancer. In the ultrasound evaluation of nodes, the most useful parameters are size of nodes, heterogeneity of internal echoes, morphology of the margins, and the deformation caused by compressive instrumental manipulation. These criteria, indicated by the Japanese Society for Esophageal Diseases, yield a high sensitivity and diagnostic specificity when the ultrasonographic studies are performed.
Frontiers in Medicine, May 17, 2022
World Journal of Gastrointestinal Surgery, 2024
BACKGROUND Esophageal perforation or postoperative leak after esophageal surgery remain a life-th... more BACKGROUND Esophageal perforation or postoperative leak after esophageal surgery remain a life-threatening condition. The optimal management strategy is still unclear. AIM To determine clinical outcomes and complications of our 15-year experience in the multidisciplinary management of esophageal perforations and anastomotic leaks. METHODS A retrospective single-center observational study was performed on 60 patients admitted at our department for esophageal perforations or treated for an anastomotic leak developed after esophageal surgery from January 2008 to December 2023. Clinical outcomes were analyzed, and complications were evaluated to investigate the efficacy and safety of our multidisciplinary management based on the preservation of the native or reconstructed esophagus, when feasible. RESULTS Among the whole series of 60 patients, an urgent surgery was required in 8 cases due to a septic state. Fifty-six patients were managed by endoscopic or hybrid treatments, obtaining the resolution of the esophageal leak/perforation without removal of the native or reconstructed esophagus. The mean time to resolution was 54.95 ± 52.64 days, with a median of 35.5 days. No severe complications were recorded. Ten patients out of 56 (17.9%) developed pneumonia that was treated by specific antibiotic therapy, and in 6 cases (10.7%) an atrial fibrillation was recorded. Seven patients (12.5%) developed a stricture within 12 months, requiring one or two endoscopic pneumatic dilations to solve the problem. Mortality was 1.7%. CONCLUSION A proper multidisciplinary approach with the choice of the most appropriate treatment can be the key for success in managing esophageal leaks or perforations and preserving the esophagus.
Journal of clinical medicine, May 29, 2024
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
World journal of gastrointestinal pharmacology and therapeutics, Mar 20, 2024
Irritable bowel syndrome with diarrhea is a very frequent clinical condition characterized by dis... more Irritable bowel syndrome with diarrhea is a very frequent clinical condition characterized by disabling intestinal symptoms. This disease presents with daily abdominal pain for at least 3 months related to defecation and associated with a change in the frequency of bowel movements and the shape of the stool. International surveys about this disease report a global prevalence of about 1.5%. A new amino acid based electrolyte solution has recently been commercialized for oral rehydration in diarrhea. It is composed of water, electrolytes, and five selected amino acids that function as sodium co-transporters without containing glucose. In recent years, some studies explored the effectiveness of the amino acid based electrolyte beverage in oncologic patients with gastrointestinal mucositis, reporting good results. Recently, a prospective study to evaluate the clinical impact of the amino acid based medical beverage was conducted in patients with diarrhea predominant irritable bowel syndrome. The research was based on a real-life methodology minimizing the disruption of the routine care. One hundred patients suffering from irritable bowel syndrome with diarrhea drank a solution based on selected amino acids twice a day for 2 wk. Each enrolled patient completed the study and showed a significant response rate with regard to stool consistency and pain reduction. Based on this data, we can hypothesize that the amino acid based oral rehydration solution could be a valid tool in the treatment of patients affected by irritable bowel syndrome with diarrhea. It is certainly necessary to plan highquality clinical trials comparing glucose based oral solutions and amino acid based solutions in patients with persisting diarrhea. Probably in the near future all oral rehydration solutions will contain amino acids.
Frontiers in Oncology, Jan 7, 2024
Video assisted thoracic surgery (VATS) lobectomy is the treatment of choice for early-stage lung ... more Video assisted thoracic surgery (VATS) lobectomy is the treatment of choice for early-stage lung cancer. It is safe and effective compared to open surgery, as demonstrated by a large body of scientific evidence over the last few decades. VATS lobectomy's evolution was driven by the need to decrease post-operative pain by reducing the extent of surgical accesses, maintaining the same oncological efficacy of open lobectomy with less invasiveness. VATS lobectomy just turned 30 years old, evolving and changing significantly from its origins. The aim of this mini review is to retrace the history, starting from a multiport approach to a single port approach. At the end of this mini review, we will discuss the advanced and the future challenges of the technique that has revolutionized thoracic surgery.
Frontiers in oncology, Feb 13, 2024
Objectives: To present a comprehensive review of the current state of artificial intelligence (AI... more Objectives: To present a comprehensive review of the current state of artificial intelligence (AI) applications in lung cancer management, spanning the preoperative, intraoperative, and postoperative phases. Methods: A review of the literature was conducted using PubMed, EMBASE and Cochrane, including relevant studies between 2002 and 2023 to identify the latest research on artificial intelligence and lung cancer. Conclusion: While AI holds promise in managing lung cancer, challenges exist. In the preoperative phase, AI can improve diagnostics and predict biomarkers, particularly in cases with limited biopsy materials. During surgery, AI provides real-time guidance. Postoperatively, AI assists in pathology assessment and predictive modeling. Challenges include interpretability issues, training limitations affecting model use and AI's ineffectiveness beyond classification. Overfitting and global generalization, along with high computational costs and ethical frameworks, pose hurdles. Addressing these challenges requires a careful approach, considering ethical, technical, and regulatory factors. Rigorous analysis, external validation, and a robust regulatory framework are crucial for responsible AI implementation in lung surgery, reflecting the evolving synergy between human expertise and technology.
PubMed, Jun 1, 1998
The onset of GERD depends on several factors leading to a prolonged exposition of the esophageal ... more The onset of GERD depends on several factors leading to a prolonged exposition of the esophageal mucosa to inflammatory agents. Various mechanisms play a role in different patients, but generally, decreased LES tone and delayed esophageal clearance are the major causes. Although pyrosis and regurgitation are the most frequent complaints, the patient may have different symptoms or can be asymptomatic. The symptoms are not necessarily correlated with damaged mucosa. Recognized complications caused by reflux include esophagitis, stricture, hemorrhage, Barrett's epithelium and ulceration, aspiration and respiratory implications. The severity of complications may be an important element in predicting whether the patient can be successfully treated medically or surgically. The exact knowledge of the pathogenesis is mandatory for carrying out the most effective treatment.
J Clin Med, 2024
Technological development in the field of robotics has meant that, in recent years, more and more... more Technological development in the field of robotics has meant that, in recent years, more and more thoracic surgery departments have adopted this type of approach at the expense of VATS, and today robotic surgery boasts numerous applications in malignant and benign thoracic pathology. Because autonomic nervous system surgery is a high-precision surgery, it is conceivable that the application of RATS could lead to improved outcomes and reduced side effects, but its feasibility has
not yet been thoroughly studied. This review identified three main areas of application: (1) standard thoracic sympathectomy, (2) selective procedures, and (3) nerve reconstruction. Regarding standard sympathectomy and its usual areas of application, such as the management of hyperhidrosis and some cardiac and vascular conditions, the use of RATS is almost anecdotal. Instead, its impact can be decisive if we consider selective techniques such as ramicotomy, optimizing selective surgery of the communicating gray branches, which appears to reduce the incidence of compensatory sweating only when performed with the utmost care. Regarding sympathetic nerve reconstruction, there are several studies, although not conclusive, that point to it as a possible solution to reverse surgical nerve RATSinterruption. In conclusion, the characteristics of RATS might make it preferable to other techniques
and, particularly, VATS, but to date, the data in the literature are too weak to draw any evidence
World Journal of Gastrointestinal Pharmacology and Therapeutics, 2024
Irritable bowel syndrome with diarrhea is a very frequent clinical condition characterized by dis... more Irritable bowel syndrome with diarrhea is a very frequent clinical condition characterized by disabling intestinal symptoms. This disease presents with daily abdominal pain for at least 3 months related to defecation and associated with a change in the frequency of bowel movements and the shape of the stool. International surveys about this disease report a global prevalence of about 1.5%. A new amino acid based electrolyte solution has recently been commercialized for oral rehydration in diarrhea. It is composed of water, electrolytes, and five selected amino acids that function as sodium co-transporters without containing glucose.
In recent years, some studies explored the effectiveness of the amino acid based electrolyte beverage in oncologic patients with gastrointestinal mucositis, reporting good results. Recently, a prospective study to evaluate the clinical impact of the amino acid based medical beverage was conducted in patients with diarrhea predominant irritable bowel syndrome. The research was based on a real-life methodology minimizing the disruption of the routine care. One hundred patients suffering from irritable bowel syndrome with diarrhea drank a solution based on
selected amino acids twice a day for 2 wk. Each enrolled patient completed the study and showed a significant response rate with regard to stool consistency and pain reduction. Based on this data, we can hypothesize that the amino acid based oral rehydration solution could be a valid tool in the treatment of patients affected by irritable bowel syndrome with diarrhea. It is certainly necessary to plan highquality
clinical trials comparing glucose based oral solutions and amino acid
based solutions in patients with persisting diarrhea. Probably in the near future all oral rehydration solutions will contain amino acids.
Journal of Laparoendoscopic & Advanced Surgical Techniques, Jun 1, 1999
This retrospective study reports the results of our 5-year experience in the diagnosis and treatm... more This retrospective study reports the results of our 5-year experience in the diagnosis and treatment of rectal prolapse with fecal incontinence by the abdominal (laparotomy or laparoscopy) and perineal approaches. Twenty-five patients (group A; 22 women and 3 men; mean age 57.3 years; range 22-76 years) were operated on by the abdominal approach and ten (group B; 8 women and 2 men; mean age 68.9 years; range 58-84 years) by the perineal approach. All patients were evaluated by clinical examination, proctosigmoidoscopy, pancolonic transit time, dynamic defecography, anorectal manometry, and anal electromyography preparatory to surgery. In patients of group A, we performed an abdominal rectopexy in 19 cases (7 by laparoscopy) and in the remaining 6 cases, a sigmoid resection-rectopexy (3 of which were by laparoscopy). All patients of group B were treated by a perineal operation using Delorme's mucosectomy in 4 cases and Altemeier's rectosigmoidectomy with total perineoplasty in 6 cases. The mean follow-up was 38.8 months in group A and 25.7 months in group B. The postoperative complication rate was 8% (two cases) in group A, whereas no significant complications occurred in group B. Dyschezia and fecal incontinence improved significantly in both groups (P < 0.05 in group A and P < 0.005 in group B), whereas anoperineal pain was not significantly reduced. At 1-year follow-up, the recurrences rates were 8% in group A and 30% in group B. Rectopexy or resection-rectopexy proved to be a safe and effective procedure for external prolapse, without a discernible difference between the laparotomie and laparoscopic techniques. In selected cases, the perineal approach gives good results regarding fecal incontinence without complications, even if in these patients, the likelihood of recurrence is high.
United European gastroenterology journal, Nov 13, 1999
An 80-year-old female patient presented to the emergency room for dyspnea and “tirage” caused by ... more An 80-year-old female patient presented to the emergency room for dyspnea and “tirage” caused by massive thyroid cancer. In these cases tracheal dilation by rigid bronchoscopy is the treatment of choice. Before the procedure we performed progressive dilatation with repeated intubations using conventional tube with increased diameters. No adverse events occurred. She was discharged from ICU to the ward on the day after the operation. This procedure allows being more confident in terms of patient ventilation, less trauma to the stenotic tracheal mucosa, less ICU stay, easy material availability and less cost for public health.
PubMed, Apr 1, 1999
Background: Endoscopic ultrasonography (EUS) is a relatively new diagnostic method to assess the ... more Background: Endoscopic ultrasonography (EUS) is a relatively new diagnostic method to assess the extent and the depth of infiltration of esophageal carcinoma. Methods: From October 1990, 100 patients affected by esophageal squamous cell carcinoma underwent preoperative evaluation with endoscopic ultrasonography, 85 of whom were operated on. The first 23 patients underwent endosonography with an Olympus GF-EUM2 with a 7.5 MHz echo-probe; the remaining 77 patients underwent EUS with an Olympus GF-EUM3 with a 7.5-12 MHz echo-probe. Results: In 33 cases (33%), the procedure was not completed because of the impossibility of passing through the neoplastic stenosis. The depth of infiltration was correctly defined by EUS in 73 of 85 patients (86%) compared with 47% of Computed Tomography (CT) (p < 0.05). Overestimation occurred in 6 patients (7%), whereas underestimation occurred in 6 cases (7%). Lymph-node involvement was correctly classified by EUS in 50 of 57 patients (88%) compared with 39% of CT. Conclusions: EUS provides a high degree of accuracy in assessing both T and N parameters in staging esophageal cancer. The major problem of the method is still the frequent impossibility of passing through a neoplastic stenosis.
PubMed, Sep 1, 1990
Lung transplant has now become a viable clinical option for the treatment of irreversible end-sta... more Lung transplant has now become a viable clinical option for the treatment of irreversible end-stage respiratory failures. The first successful single lung transplant was performed by Cooper and coworkers in Canada in 1983, and the first successful double lung transplant was performed by the same group in 1986. The history of lung transplantation is followed by a discussion of the current surgical indications for single and double lung transplants. The criteria for the evaluation and pre-operative management of potential candidates are reported. The surgical techniques used for harvesting, preserving and transplanting one or both lungs are then described, including the latest procedure of sequential bilateral lung transplantation. Almost 250 patients have undergone single or double lung transplants all over the world with a survival rate of more than 65%. Lung function and exercise tolerance have satisfactorily improved. Despite a number of problems in airway anastomosis and in diagnosis and treating rejection still to be resolved, lung transplantation is rapidly gaining ground worldwide.
PubMed, May 1, 1997
Background/aims: We studied the effectiveness of ultrasonography in evaluating the cervical esoph... more Background/aims: We studied the effectiveness of ultrasonography in evaluating the cervical esophagus for the presence of large masses arising from the esophageal wall and consequently, the modifications of the visceral lumen. Materials and methods: The cervical esophagus can be evaluated by ultrasound with longitudinal and axial scans, using the left thyroid lobe as an acoustic window. The cervical esophagus can be visualized from the C5 to D2 vertebrae. From November 1992 to July 1996, 220 patients with esophageal cancer and 120 subjects without esophageal disease (control group) were examined with ultrasonography. Examination of the cervical esophagus was performed with a linear high definition small parts probe with a frequency of 7.5-10 Mhz. Results: In all 31 patients with cancer of the cervical esophagus, ultrasonography of the cervical region showed the presence of an expanding mass from the esophageal wall as well as the modifications in the visceral lumen. The neoplasm of the cervical esophagus was visualized when its diameter exceeded 5 mm. Conclusions: The experience of the authors shows that, during ultrasound examination of the cervical region, it is possible to accurately evaluate the cervical esophagus, either morphologically or functionally.
Abdominal Imaging, May 1, 1998
The detection of cervical lymph node metastases plays an important role in staging of patients af... more The detection of cervical lymph node metastases plays an important role in staging of patients affected by esophageal cancer to perform the best therapeutic approach. We report our experience concerning the ultrasound evaluation of the cervical area in 174 patients with esophageal cancer. Ultrasonographic evaluation of the neck can be done with a 7.5- or 10 MHz transducer in all cases, with selective scanning of the lymph node chains of the internal jugular veins and supraclavicular regions. The short-to-long axis ratio (S/L) was a useful way to detect lymph node metastasis. Histopathologic diagnoses were obtained by sonographically guided fine-needle aspiration biopsy. At ultrasound examination, we found 18 (10.3%) patients with metastatic cervical nodes. Of these, 17 (94.4%) had metastatic cervical lymph nodes confirmed by cytology from fine-needle biopsy. Lymph node exceeding 5 mm in long axis and with an S/L over 0.5 showed a higher incidence of metastasis than those with an S/L under 0.5. Our experience shows a high incidence of lymph node metastases in patients with esophageal cancer localized to the thoracic supracarinal tract and in patients with cervical and lower esophageal cancer. In the ultrasound evaluation of nodes, the most useful parameters are size of nodes, heterogeneity of internal echoes, morphology of the margins, and the deformation caused by compressive instrumental manipulation. These criteria, indicated by the Japanese Society for Esophageal Diseases, yield a high sensitivity and diagnostic specificity when the ultrasonographic studies are performed.
Frontiers in Medicine, May 17, 2022
In: Sergi CM, editor. Metastasis. Brisbane (AU): Exon Publications. Online first 2022 Mar 14., 2022
Lung cancer is the second most diagnosed cancer and was the primary cause of cancer death worldwi... more Lung cancer is the second most diagnosed cancer and was the primary cause of cancer death worldwide in 2020. Lung cancer treatment is associated with huge costs for patients and society. Consequently, there is an increasing interest on prevention, early detection with screening, and development of new treatments. Surgical management accounts for at least 90% of the activity of thoracic surgery departments. Surgery is the treatment of choice for stages I and II non-small cell lung cancer. In this chapter, we discuss the state of art of thoracic surgery for surgical management of lung cancer. We start describing the milestones of lung cancer treatment, Note to the Reader: This chapter is part of the book Metastasis (ISBN: 978-0-6453320-2-5), scheduled for publication in April 2022. The book is being published by Exon Publications,
Surgery is considered the best choice for stage I non-small cell lung cancer therapy and for sele... more Surgery is considered the best choice for stage I non-small cell lung cancer therapy and for selected patients with lung metastasis. However, surgery is often a high-risk procedure because of severe medical co-morbidities affecting this cohort of patients. Thermal Ablation (TA) has been recently proposed to achieve destruction of lung tumors whilst avoiding the use of general anesthesia and parenchyma resection, thereby limiting the invasiveness of the procedure. Two technique of TA based on tissue heating have been described: Radio Frequency Ablation (RFA) and Microwave Ablation (MWA). Both are mini-invasive procedures, delivering energy to the tumor through single or multiple percutaneous needles introduced under guidance of computed tomography. The procedure may be performed under conscious sedation or general anesthesia to avoid pain caused by needle insertion and tissue heating. We have reviewed the literature and International License, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited. reported our experience with the aim to understand whether these techniques are successful and should be proposed. In summary, we found that local efficacy is directly correlated to tumor target size: concerning RFA, tumors smaller than 2 cm can be completed ablated in 78-96% of cases; concerning MWA, according to the largest available study, 95% of initial ablations are reported to be successful for tumors smaller than 5 cm. Very few series provide survival data beyond 3 years. For nodules smaller than 3 cm, the registered survival rate is higher: 50% at five years. Data collected in the last 10 years allow to conclude that TA is an established alternative treatment for patients whose cannot undergo surgery because of compromised general condition. In the case of pulmonary metastasis, most authors agree to offer TA only if lesions are smaller than 5 cm.
Pancreatic incidentaloma is an asymptomatic incidentally lesion detected on a radiologic imaging ... more Pancreatic incidentaloma is an asymptomatic incidentally lesion detected on a radiologic imaging performed for unrelated indication. This definition has been proposed for adrenal mass but actually the term is used for asymptomatic masses discovered in different solid organs such as pituitary gland, kidney, liver, prostate and pancreas. Its incidence is increasing because of the widespread use of cross-sectional imaging. The small size of lesions and the location in the body and tail of the pancreas could give reason of the lack of symptoms for left-sided locations. Pancreatic incidentalomas (PIs) include a variety of benign, premalignant, malignant lesions, and unusual histotypes are frequently encountered. Specific guidelines for diagnosis and treatment of PIs are lacking and consequently their diagnostic assessment and clinical management is still debated. Fig. 1. A. Surgical specimen of distal pancreatectomy containing a 9.5 cm large encapsulated pancreatic tail mass with areas of cystic degeneration. The histological diagnosis was solid pseudopapillary neoplasm. B. The microscopic pattern of the neoplasm is solid and pseudopapillary with poorly cohesive monomorfic cells, admixed with thin-walled blood vessels. In the center of the image there are the characteristic cholesterol crystals, surrounded by foreign-body giant cells (hematoxylin-eosin; magnification 200X). Currently, intravenous contrast-enhanced multidetector CT is considered the pivotal radiologic technique for the detection and staging of pancreatic tumors allowing the definition of size, localization, texture (solid or cystic), and vascularization of the mass. Magnetic resonance imaging and endoscopic ultrasonography should be performed selectively. Endoscopic ultrasound (EUS) with fine-needle aspiration has become increasingly used in the differential diagnosis of pancreatic masses. This exam provides high-resolution images of the pancreas and it presents a relevant sensibility and specificity for the solid lesions of the pancreatic head. PIs could be categorized into solid and cystic lesions. Cystic PIs frequently present a benign or premalignant nature while solid PIs are usually considered malignant tumors.