Giovanni Tomasello | Università degli Studi di Palermo (original) (raw)

Papers by Giovanni Tomasello

INTRODUCTION Crohn's disease (CD) has no known etiology, but it is thought that in predispose... more INTRODUCTION Crohn's disease (CD) has no known etiology, but it is thought that in predisposed indi-viduals, exogenous (bacterial microflora and infectious agents) and endogenous (mucosal barrier function) factors cause an alteration of the chronic immune response of the enteric mucosa; thus, CD is considered to be caused by an inappropriate immune response to microbial flora. In a small proportion of cases the initial symptoms of Crohn's disease can include osteoarticular manifestations. These include pain caused by degenerative chondropathy of large joints, including knee and shoulder. According to literature, in patients with ulcerative colitis, colectomy surgery often results in a signifi-cant reduction of clinical symptoms including osteoarticular pain; unfortunately, such results are not possible in Crohn's disease due to the involvement of the entire gastroin-testinal tract [1]. However, high molecular weight hyaluronic acid injections can help to improve the qual...

Aim: The aim of this study is to evaluate long-term complications and patients' quality of li... more Aim: The aim of this study is to evaluate long-term complications and patients' quality of life af-ter the endoscopic treatment of benign anastomotic colo-colonic strictures. Patients and Methods: From Jan-uary 2000 to November 2008, 42 patients who had undergone surgery for colorectal cancer were endoscop-ically treated for a postoperative symptomatic stricture. The dilation were performed using a 20-30 mm pneumatic dilator. The clinical results were classified in relation to the abdominal symptomatology reported by the patients, and were evaluated in the short-term (one week) and long-term (mean follow-up: 36 months) period. Results: 15 patients underwent a total of 22 dilating sessions; 9 patients had a single dilat-ing session; 18 patients underwent 5 dilating sessions. Three bowel perforations at the site of dilation, 1 sep-tic complication and a transient mucosal bleeding were registered. Immediate symptomatic relief was achieved in all the cases; the symptoms caused by th...

Pilonidal sinus disease is a complex condition that causes both discomfort and embarrassment to s... more Pilonidal sinus disease is a complex condition that causes both discomfort and embarrassment to sufferers. Direct cost through absence from work is high. Controversy still exists regarding the best surgical technique for its treatment in terms of minimizing disease recurrence and patient discomfort. Thus, we conducted this study to evaluate the results of rhomboid excision and Limberg flap reconstruction in the surgical treatment of pilonidal sinus disease. This prospective study included 81 patients who had pilonidal sinus and were treated by the rhomboid excision and Limberg flap. The mean follow–up was 18 months and all patients were satisfied with the procedure. There were lower complication rates, minimal discomfort, patients discharged in 2-3 days and only two recurrences. The authors recommend the Limberg Flap procedure for pilonidal sinus disease. It is effective, with short hospitalization, low recurrence rate and shorter time off work. Introduction Pilonidal sinus disease is a common medical condition that accounts for almost 15% of anal suppuration and is responsible for significant morbidity [1]. It is usually seen in young adults [2]. Males are affected more frequently than females by a ratio of 3:1, probably due to their more hirsute nature [3]. The origin of pilonidal sinus disease is not fully understood. There are many theories associated with its pathogenesis: The most important are the acquired and the congenital theories. However, the majority of opinion favors the acquired theory, which postulates that the sacro-coccygeal pilonidal infection originates in the natal cleft hair follicle that has become distended with kera

Aim. Intestinal dysbiosis seems to be the leading cause of inflammatory bowel diseases, and probi... more Aim. Intestinal dysbiosis seems to be the leading cause of inflammatory bowel diseases, and probiotics seems to represent the proper support against their occurrence. Actually, probiotic blends and anti-inflammatory drugs represent a weapon against inflammatory bowel diseases. The present study evaluates the long-term (2 years) effects of combination therapy (mesalazine plus a probiotic blend of Lactobacillus salivarius, Lactobacillus acidophilus and Bifidobacterium bifidus strain BGN4) on ulcerative colitis activity. Method. Sixty patients with moderate-to-severe ulcerative colitis were enrolled: 30 of them were treated with a single daily oral administration of mesalazine 1200 mg; 30 patients received a single daily oral administration of mesalazine 1200 mg and a double daily administration of a probiotic blend of Lactobacillus salivarius, Lactobacillus acidophilus and Bifidobacterium bifidus strain BGN4. The treatment was carried out for two years and the clinical response evaluated according to the Modified Mayo Disease Activity Index. Results. All patients treated with combination therapy showed better improvement compared to the controls. In particular, the beneficial effects of probiotics were evident even after two years of treatment. Conclusions. A long-term treatment modality of anti-inflammatory drugs and probiotics is viable and could be an alternative to corticosteroids in mild-to moderate ulcerative colitis.

The intestinal inflammatory bowel disease (IBD) are a group of inflammatory patholo-gies of the d... more The intestinal inflammatory bowel disease (IBD) are a group of inflammatory patholo-gies of the digestive line with chronicity and recurrent characteristics. The IBDs mostly recognized are the ulcerative colitis and Crohn's disease; they are more frequent in the industrialized countries and among the caucasian populations that among those africans or oriental. The secondary artropaties to IBD recognize a multifactorial gene-sis in subjects predisposed as a result genetically of environmental factors; a fundamental role of the intestinal dysbiosis they are hypothesized. Introduction The predominant etiological opinion is that the IBDs recognize a multifactorial genesis. Currently the more accredited pathogenetic hypotheses foresee the presence of three principal factors: genetic susceptibility; environmental factors; immune-pathogenetic factors [1,2]; instigating events that determine an alteration of the intestinal immune-regulation and his permeability with consequent inflammatory damage [3-5]. The elevated frequency of agreement for the illness among homozygote twins points out the importance of genetic factors in to determine the family distribution. The evidence of an agreement among monozygotic and dizygotic twins respectively of 37% and of 7% it corresponds to areduced penetrance of the genotype and it shows the importance of the environmental factors in the development of the illness [6,7]. Studies of linkage of the whole genome have allowed to identify different locus of susceptibility for the IBDs.The data most meaningful respect to an association between environmental fac

Introducere: Pacienåii care au suferit rezolvare primarã a herniei inghinale raporteazã o ratã ma... more Introducere: Pacienåii care au suferit rezolvare primarã a herniei inghinale raporteazã o ratã mai mare a durerii postoperatorii dupã operaåie, din cauza efectului de fixare al plasei de suturã. O alternativã este utilizarea de adeziv de fibrinã umanã. Am comparat cele douã tehnici. Metode: 468 de pacienåi au suferit în mod aleatoriu o intervenåie pentru rezolvarea primarã Lichtenstein a herniei inghinale, cu fixarea protezei prin suturi sau adeziv de fibrinã umanã; în ambele cazuri plasa fost fixatã la peretele posterior al canalului inghinal aei la ligamentul inghinal. Rezultate: Nu s-au înregistrat diferenåe semnificative între cele douã grupuri în ceea ce priveaete complicaåiile, în timp ce tehnica cu adeziv de fibrinã reduce timpul operator aei durerea postoperatorie. Concluzii: O tehnicã utilizatã la scarã largã în tratamentul herniei inghinale este aplicarea unei plase prin procedura Lichtenstein. Proteza poate fi fixatã prin suturã clasicã sau folosind o nouã metodã de fixare sutureless cu materiale adezive, care demonstreazã o tolerabilitate localã excelentã aei lipsa de efecte adverse aei contraindicaåii.

Acta bio-medica : Atenei Parmensis, 2016

Endotracheal intubation in the rat is difficult because of the extremely small size of anatomical... more Endotracheal intubation in the rat is difficult because of the extremely small size of anatomical structures (oral cavity, epiglottis and vocal cords), small inlet for an endotracheal tube and the lack of proper technical instruments. In this study we used seventy rats weighting 400-500 g. The equipment needed for the intubation was an operating table, a longish of cotton, a cotton tip, orotracheal tube, neonatal laryngoscope blades, KTR4 small animal ventilator and isoflurane for inhalation anaesthesia. Premedication was carried out by medetomidine hydrochloride 1 mg/mL; then, thanks to a closed glass chamber, a mixture of oxygen and isoflurane was administered. By means of a neonatal laryngoscope the orotracheal tube was advanced into the oral cavity until the wire guide was visualized trough the vocal cords; then it was passed through them. The tube was introduced directly into the larynx over the wire guide; successively, the guide was removed and the tube placed into the trache...

Nutraceuticals constitute a group of functional foods that provide added health benefits for vari... more Nutraceuticals constitute a group of functional foods that provide added health benefits for various disorders including inflammatory bowel disease (IBD) and colorectal cancer (CRC). The main groups of nutraceuticals include probiotics, prebiotics, omega 3 and antioxidants. Studies on Nutraceutical showed that this type of food possessed similar proprieties to drugs but with the benefit of not having side effects. This mini review shows that probiotics and prebiotics, when administered simultaneously with traditional therapies, reduce IBD symptoms and reduce synthesis of enzymes probably involved in colorectal carcinogenesis. Moreover, Omega 3 reduces the synthesis of inflammation mediators and prevents carcinogenesis through interaction with the signaling pathway NOTCH1/MMP9. Moreover, antioxidants reduce the inflam-matory process by inhibiting the synthesis of inflammatory mediators, and inhibit the mechanisms of cell proliferation by inducing apoptosis. In brief, nutraceuticals have gained a huge clinical interest since they could be used along with traditional therapy. Bioavailability studies of nutraceutical supplements guarantee a correct intake of the substance by oral administration, a matter which would not have been possible to have entirely with the consumption of regular food only.

Introduction: Endotracheal intubation in the rat is difficult because of the extremely small size... more Introduction: Endotracheal intubation in the rat is difficult because of the extremely small size of anatomical structures (oral cavity, epiglottis and vocal cords), small inlet for an endotracheal tube and the lack of proper technical instruments. Material and Methods: In this study we used seventy rats weighting 400–500 g. The equipment needed for the intubation was an operating table, a longish of cotton, a cotton tip, orotra-cheal tube, neonatal laryngoscope blades, KTR4 small animal ventilator and isoflurane for inhalation anaesthesia. Premedication was carried out by medetomidine hydrochloride 1 mg/mL; then, thanks to a closed glass chamber, a mixture of oxygen and isoflurane was administered. By means of a neonatal laryngoscope the orotracheal tube was advanced into the oral cavity until the wire guide was visualized trough the vocal cords; then it was passed through them. The tube was introduced directly into the larynx over the wire guide; successively, the guide was removed and the tube placed into the trachea. Breathing was confirmed using a glove, cut at the end of a finger, simulating a small balloon. Results: We achieved a fast and simple orotracheal intubation in all animals employed. Conclusions: We believe that our procedure is easier and faster than those previously reported in scientific literature. (www.actabiomedica.it) Key words: endotracheal intubation in the rat, simple and fast orotracheal intubation, rat model, inhalation anesthesia, experimental surgery

of genetic alterations leading to transformation of normal mucosa into dysplasia and, lastly, ade... more of genetic alterations leading to transformation of normal mucosa
into dysplasia and, lastly, adenocarcinoma. It is pertinent
to elucidate the molecular changes occurring in the preneoplastic
lesions to facilitate early diagnosis and treatment.
Heat shock proteins (Hsps), many of which are molecular
chaperones, are implicated in carcinogenesis, and their variations
with tumor progression encourage their study as biomarkers.
There are many reports on Hsps and cancer but none
to our knowledge on their systematic quantification in preneoplastic
lesions of the large bowel.We performed immunohistochemical
determinations of Hsp10, Hsp60, Hsp70, and
Hsp90 in biopsies of large bowel tubular adenomas with moderate
grade of dysplasia and compared to normal mucosa and
adenocarcinoma with a moderate grade of differentiation
(G2). A significant elevation of Hsp10 and Hsp60 only, i.e.,
in the absence of elevation of Hsp70 or Hsp90, in both epithelium
and lamina propria was found in tubular adenoma by
comparison with normal mucosa. In contrast, adenocarcinoma was characterized by the highest levels of Hsp10 and Hsp60 in
epithelium and lamina propria, accompanied by the highest
levels of Hsp70 only in epithelium and of Hsp90 only in
lamina propria, by comparison with normal and tubular adenoma
counterparts. Hsp10 and Hsp60 are promising biomarkers
for early diagnosis of tubular adenoma and for its
differentiation from more advanced malignant lesions.
Hsp10 and Hsp60 may be implicated in carcinogenesis from
its very early steps and, thus, are potentially convenient targets
for therapy.

Surgical Endoscopy, 1994

An audit of routine intraoperative cholangiography in a consecutive series of 496 patients underg... more An audit of routine intraoperative cholangiography in a consecutive series of 496 patients undergoing laparoscopic cholecystectomy has been performed. Cannulation of the cystic duct was possible in 483 patients (97%). The use of portable, digitized C-arm fluorocholangiography was vastly superior to the employment of a mobile x-ray machine and static films in terms of reduced time to carry out the procedure and total abolition of unsatisfactory radiological exposure of the biliary tract. Repeat of the procedure was necessary in 22% of cases when the mobile x-ray equipment was used. Aside from the detection of unsuspected stones in 18 patients (3.9%), routine intraoperative cholangiography identified four patients (0.8%) whose management would undoubtedly have been disadvantaged if intraoperative cholangiography had not been performed.

Experimental studies have highlighted that the administration of 3,5-diiodo-L-thyronine (T2) to r... more Experimental studies have highlighted that the administration of 3,5-diiodo-L-thyronine (T2) to rats fed diets rich in lipids induces a decrease of cholesterol and triglycerides plasma levels and body weight (BW) without inducing liver steatosis. On the basis of these observations we carried out some experimental in vivo studies to assess the effects of multiple high doses of T2 on the pituitary thyroid axis of rats fed diet rich in lipids. Fifteen male Wistar rats were divided into three groups of five animals each. The first group (N group) received standard diet, the second group was fed with a high fat diet (HFD group), while the third group (HFDT2 group) was additionally given T2 intraperitoneally at a dose level of 70 mg/100 g of BW three times a week up to four weeks. At the end of the treatment, blood sample from each animal was collected, centrifuged and the serum was stored at-20°C. The serum concentrations of thyroid-stimulating hormone (TSH), triiodothyronine, thyroxine, adrenocor-ticotropic hormone, triglycerides, cholesterol, glucose, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase were then determined. In addition, liver of rats was examined by his-tology in order to assess the presence and degree of steatosis. The administration of T2 to rats fed with a high fat diet suppressed TSH secretion (P=0.013) while no steatosis was observed in the liver of these animals. Our data show that multiple administrations of high doses of T2 to rats fed diets rich in lipid inhibit TSH secretion and prevent the onset of liver steatosis in these animals.

Background: There is no standard practice in the induction of colitis by 2,4,6-trinitrobenzene su... more Background: There is no standard practice in the induction of colitis by 2,4,6-trinitrobenzene sul-fonic (TNBS) acid. Usually, the repeated administration of TNBS is preferred, because it will result in a local Th1 response that has the characteristics of Crohn`s disease. Materials and Methods: A total of 30 rats were randomized into two groups, consisting of a saline control group of ten rats and a TNBS groups of 20 rats. After the animals were anesthetized, 0.5 ml of either 0.9% saline (controls) or TNBS 50 mg/kg dissolved in 50% ethanol were instilled into the colon through a rubber catheter. The experiment was repeated weekly for four weeks, then, the rats were killed at day 40, and the distal colon removed. Results: At day 40, the bowel wall was basically normal in the control group. In the TNBS group, the bowel lumen became narrow with thickened wall, and the mucosal surface presented adherent membrane with brown black, linear ulcers, prolif-erous lymphocyte tissue, inflammatory granulomas and submucosal neutrophil infiltration. The median score of the severity of the colonic damage was 0 in the control group, and 4,75 (range 4-5) in the TNBS group; the mean weight of the rats was 180+35 g in the TNBS group, while it was 215+25 in the control group. Conclusions: The presented experiment is a cost-effective and safe method to induce Crohn-like colonic damage using a lower dose of TNBS, thus avoiding the risk of a massive loss of rats. This model is rather suitable for the assessment of the effects of potential therapeutic agents. (www.actabiomedica.it)

With the high occurrence of cardiovascular disease and increasing numbers of patients requiring v... more With the high occurrence of cardiovascular disease and increasing numbers of patients requiring vascular access, there is a significant need for small-diameter (<6 mm inner diameter) vascular graft that can provide long-term patency. Despite the technological improvements, restenosis and graft thrombosis continue to hamper the success of the implants. Vascular tissue engineering is a new field that has undergone enormous growth over the last decade and has proposed valid solutions for blood vessels repair. The goal of vascular tissue engineering is to produce neovessels and neoorgan tissue from autologous cells using a biodegradable polymer as a scaffold. The most important advantage of tissue-engineered implants is that these tissues can grow, remodel, rebuild, and respond to injury. This review describes the development of polymeric materials over the years and current tissue engineering strategies for the improvement of vascular conduits.

Up to 15% of patients with colorectal cancer (CRC) present with large bowel obstruction. Currentl... more Up to 15% of patients with colorectal cancer (CRC) present with large bowel obstruction. Currently, computed tomography colonography (CTC) is regarded as a promising technique for complete evaluation of the proximal colon and simultaneous assessment of extraluminal status. Aim of this retrospective, observational study is to evaluate the feasibility of using CTC for preoperative examination of the proximal colon before metallic stent placement in patients with colon obstruction caused by CRC. Sixteen patients who demonstrated colonic obstruction caused by CRC, underwent CTC immediately after incomplete colonoscopy. Per-patient sensitivity of CTC for lesions 5 mm or larger in diameter in the colon proximal to the stent was 100% (95% CI: 0.4385-1). Per-patient specificity for lesions 5 mm and larger in the proximal colon was 92.3% (95% CI:0.6669-0.9863). CTC did not generate any false diagnosis of synchronous cancer. False positive findings at CTC did not result in a change in surgical plan for any patients. Although the small number of

[Uso di protesi sagomata Dual Mesh in ePTFE nell'ernia inguinale permagna]

Acta bio-medica : Atenei Parmensis, 2016

Surgical Endoscopy, 1994

[Uso di protesi sagomata Dual Mesh in ePTFE nell'ernia inguinale permagna]