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Altomare DF, Galizia G, Mingoli A, Raffaelli M, Roviello F. Scientific requisites for academic advancements in Italy: time to change the rules. Updates Surg 2023; 75:1419-1422. [PMID: 37535190 PMCID: PMC10435642 DOI: 10.1007/s13304-023-01612-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/21/2023] [Indexed: 08/04/2023]
Affiliation(s)
- D F Altomare
- National Scientific Habilitation Committee 2021-2023, Bari, Italy.
- Surgical Unit "M.Rubino" DiMePRE-J, University of Bari, Bari, Italy.
| | - G Galizia
- National Scientific Habilitation Committee 2021-2023, Bari, Italy
- Division of Gastrointestinal Tract Oncological Surgery, University of Naples 'Luigi Vanvitelli', Naples, Italy
| | - A Mingoli
- National Scientific Habilitation Committee 2021-2023, Bari, Italy
- Department of Surgery, Sapienza University, Policlinico Umberto I, Rome, Italy
| | - M Raffaelli
- National Scientific Habilitation Committee 2021-2023, Bari, Italy
- U.O. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - F Roviello
- National Scientific Habilitation Committee 2021-2023, Bari, Italy
- Unit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
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Picciariello A, Rinaldi M, Grossi U, Trompetto M, Graziano G, Altomare DF, Gallo G. Time trend in the surgical management of obstructed defecation syndrome: a multicenter experience on behalf of the Italian Society of Colorectal Surgery (SICCR). Tech Coloproctol 2022; 26:963-971. [PMID: 36104607 DOI: 10.1007/s10151-022-02705-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 09/05/2022] [Indexed: 11/29/2022]
Abstract
Abstract
Background
Surgical management of obstructed defecation syndrome (ODS) is challenging, with several surgical options showing inconsistent functional results over time. The aim of this study was to evaluate the trend in surgical management of ODS in a 10-year timeframe across Italian referral centers.
Methods
Surgeons from referral centers for the management of pelvic floor disorders and affiliated to the Italian Society of Colorectal Surgery provided data on the yearly volume of procedures for ODS from 2010 to 2019. Six common clinical scenarios of ODS were captured, including details on patient’s anal sphincter function and presence of rectocele and/or rectal intussusception. Perineal repair, ventral rectopexy (VRP), transanal repair (internal Delorme), stapled transanal rectal resection (STARR), Contour Transtar, and transvaginal repair were considered in each clinical scenario.
Results
Twenty-five centers were included providing data on 2943 surgical patients. Procedure volumes ranged from 10–20 (54%) to 21–50 (46%) per year across centers. The most performed techniques in patients with good sphincter function were transanal repair for isolated rectocele (243/716 [34%]), transanal repair for isolated rectal intussusception (287/677 [42%]) and VRP for combined abnormalities (464/976 [48%]). When considering poor sphincter function, these were perineal repair (112/194 [57.8%]) for isolated rectocele, and VRP for the other two scenarios (60/120 [50%] and 97/260 [37%], respectively). The use of STARR and Contour Transtar decreased over time in patients with impaired sphincter function.
Conclusions
The complexity of ODS treatment is confirmed by the variety of clinical scenarios that can occur and by the changing trend of surgical management over the last 10 years.
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Picciariello A, Tomasicchio G, Lantone G, Martines G, Dibra R, Trigiante G, d'Amati A, Piscitelli D, Altomare DF. Synchronous "skip" facial metastases from colorectal adenocarcinoma: a case report and review of literature. BMC Gastroenterol 2022; 22:68. [PMID: 35172772 PMCID: PMC8848651 DOI: 10.1186/s12876-022-02141-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 02/06/2022] [Indexed: 11/18/2022] Open
Abstract
Background Skin metastases from colorectal adenocarcinoma are rare conditions that are metachronous in most of cases and may represent the first sign of a recurrence. These lesions are usually located to the abdominal wall on postoperative scars, perineum and chest due to direct spread from the tumor or to the lymphatic and venous dissemination. We describe a rare case of synchronous skin metastases in a patient affected by sigmoid adenocarcinoma with no sign of liver and lung repetitive lesions. Case presentation We admitted a 59 years old male, with no relevant medical history. He was evaluated by our tertiary center of colorectal surgery complaining diarrhoea and abdominal pain. The physical examination revealed a palpable mass in left flank of the abdomen. The colonoscopy showed a sub-stenosis of the sigmoid colon (G2 adenocarcinoma). No repetitive lesions were detected by the preoperative CT scan. The patient reported a rapid grow of a soft supralabial and chin nodules in the last 2 months, which he believed to be related to the use of the mask due to COVID-19 pandemic. A laparoscopic left hemicolectomy with complete mesocolic excision and a local excision of both facial nodules were performed. The histological examination revealed a poorly differentiated signet ring cell colorectal adenocarcinoma with metastases in seven pericolic lymphonodes. The excisional biopsy of the skin nodules revealed a subcutaneous metastases from primary colorectal tumour. Conclusions As far as we know, synchronous facial metastases from colorectal cancer in the absence of any other metastases has never been described before. The onset of new skin nodules in patients affected by colorectal cancer should raise-up the clinical suspicion of metastatic lesions even when repetitive lesions are not detected in the liver or lungs.
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Affiliation(s)
- A Picciariello
- Deparment of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Piazza G Cesare, 11, 70124, Bari, Italy.
| | - G Tomasicchio
- Deparment of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Piazza G Cesare, 11, 70124, Bari, Italy
| | - G Lantone
- Deparment of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Piazza G Cesare, 11, 70124, Bari, Italy
| | - G Martines
- Deparment of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Piazza G Cesare, 11, 70124, Bari, Italy
| | - R Dibra
- Deparment of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Piazza G Cesare, 11, 70124, Bari, Italy
| | - G Trigiante
- Deparment of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Piazza G Cesare, 11, 70124, Bari, Italy
| | - A d'Amati
- Section of Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari "Aldo Moro", Bari, Italy
| | - D Piscitelli
- Section of Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari "Aldo Moro", Bari, Italy
| | - D F Altomare
- Deparment of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Piazza G Cesare, 11, 70124, Bari, Italy.,IRCCS Istituto Tumori Giovanni Paolo II, Bari, Italy
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Picciariello A, Lobascio P, Spazzafumo L, Rinaldi M, Dibra R, Trigiante G, Laforgia R, Pezzolla A, Altomare DF. The REALISE score: a new statistically validated scoring system to assess the severity of anal fissures. Tech Coloproctol 2021; 25:935-940. [PMID: 33987779 PMCID: PMC8289784 DOI: 10.1007/s10151-021-02459-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/04/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND Anal fissure (AF) is a common, painful disease that strongly affects patients' quality of life, however, no scoring system to assess the severity of AF is available in the literature. The aim of this study was to set up and validate a reliable scoring system to quantify the severity of AF, to be used in prospective trials comparing the efficacy and the outcomes of surgical or medical treatments. METHODS The study was conducted on patients with acute or chronic AF and a control group in a tertiary centre for coloproctology in June 2020-September 2020. Two researchers independently carried out a structured interviewer-led questionnaire at two different time points (T1/T2). The questionnaire consisted of five items selected according to the most commonly reported symptoms for AF: the item pain, was scored from 0 to 10 using a visual analogue scale, and quality of life, duration of pain, use of painkillers, and bleeding were scored from 1 to 5 using Likert-scale questions. The scoRing systEm for AnaL fIsSurE (REALISE) score was the sum of the points. Patients with AF and a control group of patients with haemorrhoids, anal fistula, or obstructed defecation syndrome entered the study. Main outcome measures were reliability, inter-/intraobserver agreement, and repeatability. RESULTS One hundred and fifty well-matched patients (75 with AF and 75 controls) were enrolled. A significant difference was found between the mean REALISE score for patients with AF and controls (p < 0.001). The two REALISE scores were highly correlated (r = 0.99). The coefficient of repeatability was 1.45 in T1 and 1.18 in T2. CONCLUSIONS The REALISE score may have an important role in the assessment and management of AF, in grading the severity of AF and comparing results of different treatments.
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Affiliation(s)
- A Picciariello
- Surgical Unit "M. Rubino" Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy. .,Unit of Laparoscopic Surgery, Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy.
| | - P Lobascio
- Surgical Unit "M. Rubino" Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
| | - L Spazzafumo
- Agenzia Regionale Sanitaria (The Regional Agency for Health), Marche Region, Ancona, Italy
| | - M Rinaldi
- Surgical Unit "M. Rubino" Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
| | - R Dibra
- Surgical Unit "M. Rubino" Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
| | - G Trigiante
- Surgical Unit "M. Rubino" Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
| | - R Laforgia
- Surgical Unit "M. Rubino" Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
| | - A Pezzolla
- Surgical Unit "M. Rubino" Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
| | - D F Altomare
- Surgical Unit "M. Rubino" Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
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Picciariello A, O'Connell PR, Hahnloser D, Gallo G, Munoz-Duyos A, Schwandner O, Sileri P, Milito G, Riss S, Boccasanta PA, Naldini G, Arroyo A, de laPortilla F, Tsarkov P, Roche B, Isbert C, Trompetto M, d'Hoore A, Matzel K, Xynos E, Lundby L, Ratto C, Consten E, Infantino A, Panis Y, Terrosu G, Espin E, Faucheron JL, Guttadauro A, Adamina M, Lehur PA, Altomare DF. Obstructed defaecation syndrome: European consensus guidelines on the surgical management. Br J Surg 2021; 108:1149-1153. [PMID: 33864061 DOI: 10.1093/bjs/znab123] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/17/2021] [Accepted: 02/21/2021] [Indexed: 12/24/2022]
Abstract
Management of obstructed defaecation is challenging and remains controversial. No international guidelines have been published.
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Affiliation(s)
- A Picciariello
- Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
| | - P R O'Connell
- Centre for Colorectal Disease, St Vincent's University Hospital, University College Dublin, Dublin, Ireland
| | - D Hahnloser
- Department of Visceral Surgery, University Hospital Lausanne, Lausanne, Switzerland
| | - G Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - A Munoz-Duyos
- Department of General Surgery, Colorectal Unit, Hospital Universitari MútuaTerrassa, Terrassa, Barcelona, Spain
| | - O Schwandner
- Department of Proctology, Krankenhaus Barmherzige Brüder, Regensburg, Germany
| | - P Sileri
- Department of Surgery, Università Vita Salute San Raffaele, Milano, Italy
| | - G Milito
- Department of Surgery, Tor Vergata University, Rome, Italy
| | - S Riss
- Department of Surgery, Division of General Surgery, Medical University Vienna, Vienna, Austria
| | - P A Boccasanta
- Istituto Humanitas Gavazzeni & Castelli, Proctology and Perineology Surgical Unit, Bergamo, Italy
| | - G Naldini
- Proctology and Pelvic Floor Clinical Centre, Cisanello University Hospital, Pisa, Italy
| | - A Arroyo
- Department of General Surgery, Colorectal Unit, Elche University Hospital, Miguel Hernández University, Alicante, Spain
| | - F de laPortilla
- Gastrointestinal Surgery Department, Coloproctology Unit, Virgen del Rocio University Hospital, Seville, Spain
| | - P Tsarkov
- I. M. Sechenov First Moscow State Medical University (Sechenov University), Clinic of Coloproctology and Minimally Invasive Surgery, Moscow, Russia
| | - B Roche
- Division of Digestive Surgery, Proctology Unit, University Hospitals of Geneva, Geneva, Switzerland
| | - C Isbert
- Department of General, Gastrointestinal and Colorectal Surgery, Amalie Sieveking Hospital, Hamburg, Germany
| | - M Trompetto
- Department of Colorectal Surgery, Santa Rita Clinic, Vercelli, Italy
| | - A d'Hoore
- Department of Abdominal Surgery, UZ Leuven, Leuven, Belgium
| | - K Matzel
- Chirurgische Klinik, Universität Erlangen, Erlangen, Germany
| | - E Xynos
- Department of Surgery, Creta Interclinic Hospital of Heraklion, Heraklion, Greece
| | - L Lundby
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - C Ratto
- Proctology Unit, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Rome, Italy
| | - E Consten
- Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - A Infantino
- Department of Surgery, General Surgery Unit, Santa Maria dei Battuti Hospital, Pordenone, Italy
| | - Y Panis
- Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris VII, Clichy, France
| | - G Terrosu
- General Surgery and Transplantation Unit, Department of Medicine, University of Udine, Udine, Italy
| | - E Espin
- Department of Surgery, Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | - J-L Faucheron
- Department of Surgery, Colorectal Unit, Michallon University Hospital, Grenoble, France
| | - A Guttadauro
- General Surgery Department, University of Milano-Bicocca, Istituti Clinici Zucchi, Monza, Italy
| | - M Adamina
- Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - P A Lehur
- Coloproctology Unit, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - D F Altomare
- Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
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6
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Altomare DF, Picciariello A, Di Ciaula A, Rinaldi M, De Fazio M, Portincasa P. Effects of temporary sacral nerve stimulation on gastrointestinal motility and function in patients with chronic refractory slow-transit constipation. Tech Coloproctol 2021; 25:291-297. [PMID: 33185809 PMCID: PMC7932968 DOI: 10.1007/s10151-020-02367-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/23/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The efficacy of sacral nerve stimulation (SNS) on patients with chronic refractory slow-transit constipation is controversial and its mechanism of action on gastrointestinal motility and transit is not fully understood. The aim of this study was to document the effects of temporary SNS on the gastrointestinal and biliary tract motility and on gastrointestinal transit in patients with refractory slow-transit constipation. METHODS This was a prospective interventional study. Patients with slow-transit chronic constipation, unresponsive to any conservative treatment, were enrolled between January 2013 and December 2018. Patients' quality of life [patient assessment of constipation quality of life (PAC-QOL) questionnaire], constipation scores (Cleveland Clinic Constipation Score) colonic transit time (CTT), orocecal transit time (OCTT), gastric and gallbladder kinetics, together with the assessment of the autonomic nerve function were evaluated before and during temporary SNS. RESULTS 14 patients (12 females, median age 38 years, range 24-42 years) had temporary SNS. The Cleveland Clinic Constipation Score did not change compared to baseline (23 ± 3 vs 21.4; p = 070). The PAC-QOL did not improve significantly during the stimulation period. Gallbladder/stomach motility (half-emptying time) did not change significantly before and after SNS. OCTT was delayed at baseline, as compared to standard internal normal values, and did not change during SNS. CTT did not improve significantly, although in two patients it decreased substantially from 97 to 53 h, and from 100 to 65 h. CONCLUSIONS Temporary SNS did not have any effect on upper/lower gastrointestinal motility and transit in patients with severe constipation.
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Affiliation(s)
- D F Altomare
- Department of Emergency and Organ Transplantation, University "Aldo Moro", Bari, Italy.
- IRCCS Istituto Tumori Giovanni Paolo II, Bari, Italy.
| | - A Picciariello
- Department of Emergency and Organ Transplantation, University "Aldo Moro", Bari, Italy
| | - A Di Ciaula
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University "Aldo Moro", Bari, Italy
| | - M Rinaldi
- Department of Emergency and Organ Transplantation, University "Aldo Moro", Bari, Italy
| | - M De Fazio
- Department of Emergency and Organ Transplantation, University "Aldo Moro", Bari, Italy
| | - P Portincasa
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University "Aldo Moro", Bari, Italy.
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Picciariello A, Altomare DF. Big data papers and COVID-19: a "false friend" for academic surgeons. Tech Coloproctol 2021; 25:485. [PMID: 33590439 PMCID: PMC7883963 DOI: 10.1007/s10151-020-02382-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 11/24/2020] [Indexed: 11/17/2022]
Affiliation(s)
- A Picciariello
- Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy.
| | - D F Altomare
- Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
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8
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Panzera P, Picciariello A, Di Salvo M, Lupo LG, Martines G, Papagni V, Altomare DF. Elective versus emergency full-thickness rectal prolapse treatment using a perineal approach - a video vignette. Colorectal Dis 2020; 22:0. [PMID: 32337765 DOI: 10.1111/codi.15092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 04/08/2020] [Indexed: 02/08/2023]
Affiliation(s)
- P Panzera
- Department of Emergency and Organ Transplantation, University 'Aldo Moro' of Bari, Bari, Italy
| | - A Picciariello
- Department of Emergency and Organ Transplantation, University 'Aldo Moro' of Bari, Bari, Italy
| | - M Di Salvo
- Department of Emergency and Organ Transplantation, University 'Aldo Moro' of Bari, Bari, Italy
| | - L G Lupo
- Department of Emergency and Organ Transplantation, University 'Aldo Moro' of Bari, Bari, Italy
| | - G Martines
- Department of Emergency and Organ Transplantation, University 'Aldo Moro' of Bari, Bari, Italy
| | - V Papagni
- Department of Emergency and Organ Transplantation, University 'Aldo Moro' of Bari, Bari, Italy
| | - D F Altomare
- Department of Emergency and Organ Transplantation, University 'Aldo Moro' of Bari, Bari, Italy.,IRCCS Istituto Tumori Giovanni Paolo II, Bari, Italy
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9
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Altomare DF, Picciariello A, Rotelli MT, De Fazio M, Aresta A, Zambonin CG, Vincenti L, Trerotoli P, De Vietro N. Chemical signature of colorectal cancer: case-control study for profiling the breath print. BJS Open 2020; 4:1189-1199. [PMID: 32990407 PMCID: PMC8444279 DOI: 10.1002/bjs5.50354] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/18/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Effective screening for colorectal cancer can reduce mortality by early detection of tumours and colonic polyps. An altered pattern of volatile organic compounds (VOCs) in exhaled breath has been proposed as a potential non-invasive diagnostic tool for detection of cancer. The aim of this study was to evaluate the reliability of breath-testing for colorectal cancer screening and early diagnosis using an advanced breath sampler. METHODS The exhaled breath of patients with colorectal cancer and non-cancer controls with negative findings on colonoscopy was collected using the ReCIVA® Breath Sampler. This portable device is able to capture the alveolar breath fraction without environmental contamination. VOCs were desorbed thermally and analysed by gas chromatography-mass spectrometry. The discriminatory ability of VOCs in detecting colorectal cancer was evaluated by receiver operating characteristic (ROC) curve analysis for each VOC, followed by cross-validation by the leave-one-out method, and by applying stepwise logistic regression analysis. RESULTS The study included 83 patients with colorectal cancer and 90 non-cancer controls. Fourteen VOCs were found to have significant discriminatory ability in detecting patients with colorectal cancer. The model with the diagnosis of cancer versus no cancer resulted in a statistically significant likelihood of discrimination of 173·45 (P < 0·001), with an area under the ROC curve of 0·979. Cross-validation of the model resulted in a true predictive value for colorectal cancer of 93 per cent overall. Reliability of the breath analysis was maintained irrespective of cancer stage. CONCLUSION This study demonstrated that analysis of exhaled VOCs can discriminate patients with colorectal cancer from those without. This finding may eventually lead to the creation of a smart online sensory device, capable of providing a binary answer (cancer/no cancer) and directing to further screening.
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Affiliation(s)
- D. F. Altomare
- Surgical Unit ‘M. Rubino’, Department of Emergency and Organ TransplantationBariItaly
- Apulian Breath Analysis Centre (CeRBA)Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Tumori Giovanni Paolo IIBariItaly
| | - A. Picciariello
- Surgical Unit ‘M. Rubino’, Department of Emergency and Organ TransplantationBariItaly
| | - M. T. Rotelli
- Surgical Unit ‘M. Rubino’, Department of Emergency and Organ TransplantationBariItaly
| | - M. De Fazio
- Surgical Unit ‘M. Rubino’, Department of Emergency and Organ TransplantationBariItaly
| | - A. Aresta
- Department of ChemistryUniversity Aldo Moro of BariBariItaly
| | - C. G. Zambonin
- Department of ChemistryUniversity Aldo Moro of BariBariItaly
| | - L. Vincenti
- Surgical UnitAzienda Ospedaliero‐Universitaria Policlinico BariBariItaly
| | - P. Trerotoli
- Statistical Unit, Department of Biomedical Sciences and Human OncologyBariItaly
| | - N. De Vietro
- Department of ChemistryUniversity Aldo Moro of BariBariItaly
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10
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Picciariello A, Rinaldi M, De Fazio M, Trigiante G, Papagni V, Bucaria V, Altomare DF. Restorative perineal anorectal amputation for a locally advanced desmoid tumour. Int J Colorectal Dis 2020; 35:1333-1334. [PMID: 32358720 DOI: 10.1007/s00384-020-03598-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2020] [Indexed: 02/04/2023]
Affiliation(s)
- Arcangelo Picciariello
- Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Piazza G Cesare, 11, 70124, Bari, Italy.
| | - M Rinaldi
- Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Piazza G Cesare, 11, 70124, Bari, Italy
| | - M De Fazio
- Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Piazza G Cesare, 11, 70124, Bari, Italy
| | - G Trigiante
- Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Piazza G Cesare, 11, 70124, Bari, Italy
| | - V Papagni
- Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Piazza G Cesare, 11, 70124, Bari, Italy
| | - V Bucaria
- IRCCS Istituto Tumori Giovanni Paolo II, Bari, Italy
| | - D F Altomare
- Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Piazza G Cesare, 11, 70124, Bari, Italy.,IRCCS Istituto Tumori Giovanni Paolo II, Bari, Italy
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11
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van Tol RR, Kleijnen J, Watson AJM, Jongen J, Altomare DF, Qvist N, Higuero T, Muris JWM, Breukink SO. European Society of ColoProctology: guideline for haemorrhoidal disease. Colorectal Dis 2020; 22:650-662. [PMID: 32067353 DOI: 10.1111/codi.14975] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 01/03/2020] [Indexed: 12/15/2022]
Abstract
AIM The goal of this European Society of ColoProctology project was to establish a multidisciplinary, international guideline for haemorrhoidal disease (HD) and to provide guidance on the most effective (surgical) treatment for patients with HD. METHODS The development process consisted of six phases. In phase one we defined the scope of the guideline. The patient population included patients with all stages of haemorrhoids. The target group for the guideline was all practitioners treating patients with haemorrhoids and, in addition, healthcare workers and patients who desired information regarding the treatment management of HD. The guideline needed to address both the diagnosis of and the therapeutic modalities for HD. Phase two consisted of the compilation of the guideline development group (GDG). All clinical members needed to have affinity with the diagnosis and treatment of haemorrhoids. Further, attention was paid to the geographical distribution of the clinicians. Each GDG member identified at least one patient in their country who could read English to comment on the draft guideline. In phase three review questions were formulated, using a reversed process, starting with possible recommendations based on the GDG's knowledge. In phase four a literature search was performed in MEDLINE (Ovid), PubMed, Embase (Ovid) and the Cochrane Database of Systematic Reviews. The search was focused on existing systematic reviews addressing each review question, supplemented by other studies published after the time frame covered by the systematic reviews. In phase five data of the included papers were extracted by the surgical resident (RT) and checked by the methodologist (JK) and the GDG. If needed, meta-analysis of the systematic reviews was updated by the surgical resident and the methodologist using Review Manager. During phase six the GDG members decided what recommendations could be made based on the evidence found in the literature using GRADE. RESULTS There were six sections: (i) symptoms, diagnosis and classification; (ii) basic treatment; (iii) outpatient procedures; (iv) surgical interventions; (v) special situations; (vi) other surgical techniques. Thirty-four recommendations were formulated. CONCLUSION This international, multidisciplinary guideline provides an up to date and evidence based summary of the current knowledge of the management of HD and may serve as a useful guide for patients and clinicians.
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Affiliation(s)
- R R van Tol
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - J Kleijnen
- Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center+, Maastricht, The Netherlands
| | - A J M Watson
- Department of Surgery, Raigmore Hospital, Inverness, UK
| | - J Jongen
- Department of Surgical Proctology, Proktologische Praxis Kiel,, Kiel, Germany
| | - D F Altomare
- Department of Emergency and Organ Transplantation, University of Aldo Moro of Bari, Bari, Italy
| | - N Qvist
- Surgical Department A, Odense University Hospital, Odense C, Denmark
| | - T Higuero
- Clinique Saint Antoine, Nice, France
| | - J W M Muris
- Department of Family Medicine/General Practice, Research Institute CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - S O Breukink
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
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12
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Gallo G, La Torre M, Pietroletti R, Bianco F, Altomare DF, Pucciarelli S, Gagliardi G, Perinotti R. Italian society of colorectal surgery recommendations for good clinical practice in colorectal surgery during the novel coronavirus pandemic. Tech Coloproctol 2020; 24:501-505. [PMID: 32291566 PMCID: PMC7154569 DOI: 10.1007/s10151-020-02209-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 04/03/2020] [Indexed: 01/12/2023]
Affiliation(s)
- G Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy.
| | - M La Torre
- Coloproctology Unit, S. Anna Clinic, Pomezia, Italy
| | - R Pietroletti
- Coloproctology Unit, Hospital Val Vibrata, University of L'Aquila, L'Aquila, Italy
| | - F Bianco
- General Surgery Unit, S. Leonardo Hospital, Castellammare Di Stabia, Napoli, Italy
| | - D F Altomare
- Functional and Oncologic Colorectal Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
- IRCCS Ospedale Oncologico Giovanni Paolo II, Bari, Italy
| | - S Pucciarelli
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - G Gagliardi
- Department of Surgery, University of Illinois At Chicago, Chicago, IL, USA
| | - R Perinotti
- Colorectal Surgical Unit, Department of Surgery, Infermi Hospital, Biella, Italy
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13
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Picciariello A, Papagni V, Lambo M, Altomare DF. Surgical repair of traumatic cloacal deformity - a video vignette. Colorectal Dis 2019; 21:611-612. [PMID: 30851226 DOI: 10.1111/codi.14604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 03/05/2019] [Indexed: 02/08/2023]
Affiliation(s)
- A Picciariello
- Interdepartmental Research Unit for Pelvic Floor Disease (CIRPAP), Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
| | - V Papagni
- Interdepartmental Research Unit for Pelvic Floor Disease (CIRPAP), Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
| | - M Lambo
- Division of Plastic and Reconstructive Surgery?, Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
| | - D F Altomare
- Interdepartmental Research Unit for Pelvic Floor Disease (CIRPAP), Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
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14
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Picciariello A, Papagni V, Martines G, De Fazio M, Digennaro R, Altomare DF. Post-operative clinical, manometric, and defecographic findings in patients undergoing unsuccessful STARR operation for obstructed defecation. Int J Colorectal Dis 2019; 34:837-842. [PMID: 30783740 DOI: 10.1007/s00384-019-03263-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/06/2019] [Indexed: 02/07/2023]
Abstract
AIM To evaluate the reason for failure of STARR (stapled transanal rectal resection) operation for obstructed defecation. METHODS A retrospective study (June 2012-December 2017) was performed using a prospectively maintained database of patients who underwent STARR operation for ODS (obstructed defecation syndrome), complaining of persisting or de novo occurrence of pelvic floor dysfunctions. Postoperative St Mark's and ODS scores were evaluated. A VAS was used to score pelvic pain. Patients' satisfaction was estimated administering the CPGAS (clinical patient grading assessment scale) questionnaire. Objective evaluation was performed by dynamic proctography and anorectal manometry. RESULTS Ninety patients (83.3% females) operated for ODS using STARR technique were evaluated. Median ODS score was 19 while 20 patients (22%) reported de novo fecal urgency and 4 patients a worsening of their preoperative fecal incontinence. Dynamic proctography performed in 54/90 patients showed a significant (> 3.0 cm) rectocele in 19 patients, recto-rectal intussusception in 10 patients incomplete emptying in 24 patients. When compared with internal normal standards, anorectal manometry showed decreased rectal compliance and maximum tolerable volume in patients with urgency. Nine patients reported a persistent postoperative pelvic pain (median VAS score 6). CONCLUSION Failure of STARR to treat ODS, documented by persisting ODS symptoms, fecal urgency, or chronic pelvic pain, is often justified by the persistence or de novo onset of alteration of the anorectal anatomy at defecation. This occurs in about half of the patients, but in 40% of the cases who complained of incomplete emptying or incontinence, anatomical abnormalities were not recognized.
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Affiliation(s)
- A Picciariello
- Department of Emergency and Organ Transplantation and Inter-Department Research Center for Pelvic Floor Diseases (CIRPAP), University "Aldo Moro" of Bari, Piazza G Cesare, 11, 70124, Bari, Italy.
| | - V Papagni
- Department of Emergency and Organ Transplantation and Inter-Department Research Center for Pelvic Floor Diseases (CIRPAP), University "Aldo Moro" of Bari, Piazza G Cesare, 11, 70124, Bari, Italy
| | - G Martines
- Department of Emergency and Organ Transplantation and Inter-Department Research Center for Pelvic Floor Diseases (CIRPAP), University "Aldo Moro" of Bari, Piazza G Cesare, 11, 70124, Bari, Italy
| | - M De Fazio
- Department of Emergency and Organ Transplantation and Inter-Department Research Center for Pelvic Floor Diseases (CIRPAP), University "Aldo Moro" of Bari, Piazza G Cesare, 11, 70124, Bari, Italy
| | - R Digennaro
- Department of Emergency and Organ Transplantation and Inter-Department Research Center for Pelvic Floor Diseases (CIRPAP), University "Aldo Moro" of Bari, Piazza G Cesare, 11, 70124, Bari, Italy
| | - D F Altomare
- Department of Emergency and Organ Transplantation and Inter-Department Research Center for Pelvic Floor Diseases (CIRPAP), University "Aldo Moro" of Bari, Piazza G Cesare, 11, 70124, Bari, Italy
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15
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Bocchini R, Chiarioni G, Corazziari E, Pucciani F, Torresan F, Alduini P, Bassotti G, Battaglia E, Ferrarini F, Galeazzi F, Londoni C, Rossitti P, Usai Satta P, Iona L, Marchi S, Milazzo G, Altomare DF, Barbera R, Bove A, Calcara C, D'Alba L, De Bona M, Goffredo F, Manfredi G, Naldini G, Neri MC, Turco L, La Torre F, D'Urso AP, Berni I, Balestri MA, Busin N, Boemo C, Bellini M. Pelvic floor rehabilitation for defecation disorders. Tech Coloproctol 2019; 23:101-115. [PMID: 30631977 DOI: 10.1007/s10151-018-1921-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 12/26/2018] [Indexed: 12/17/2022]
Abstract
Pelvic floor rehabilitation is frequently recommended for defecation disorders, in both constipation and fecal incontinence. However, the lack of patient selection, together with the variety of rehabilitation methods and protocols, often jeopardize the results of this approach, causing difficulty in evaluating outcomes and addressing proper management, and above all, in obtaining scientific evidence for the efficacy of these methods for specific indications. The authors represent different gastroenterological and surgical scientific societies in Italy, and their aim was to identify the indications and agree on treatment protocols for pelvic floor rehabilitation of patients with defecation disorders. This was achieved by means of a modified Delphi method, utilizing a working team (10 members) which developed the statements and a consensus group (15 members, different from the previous ones) which voted twice also suggesting modifications of the statements.
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Affiliation(s)
- R Bocchini
- Gastroenterology Unit, Malatesta Novello Private Hospital, Cesena, Italy.
| | - G Chiarioni
- RFF Division of Gastroenterology, University of Verona, Verona, Italy.,Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - E Corazziari
- Department of Gastroenterology, Istituto Clinico Humanitas, Milan, Italy
| | - F Pucciani
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - F Torresan
- Department of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - P Alduini
- Gastroenterology and Endoscopy Unit, San Luca Hospital, Lucca, Italy
| | - G Bassotti
- Gastroenterology and Hepatology Section, Department of Medicine, University of Perugia Medical School, Perugia, Italy
| | - E Battaglia
- Gastroenterology and Endoscopy Unit, Cardinal Massaia Hospital, Asti, Italy
| | - F Ferrarini
- Endoscopy Unit, San Clemente Private Hospital, Mantua, Italy
| | - F Galeazzi
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - C Londoni
- Gastroenterology and Endoscopy Unit, ASST "Maggiore", Crema, Cremona, Italy
| | - P Rossitti
- Gastroenterology Unit, S. Maria della Misericordia Hospital, Udine, Italy
| | - P Usai Satta
- Gastroenterology Unit, G. Brotzu Hospital, Cagliari, Italy
| | - L Iona
- Early Rehabilitation Department, S. Maria della Misericordia Hospital, Udine, Italy
| | - S Marchi
- Gastrointestinal Unit, Departmentt. of General Surgery, University of Pisa, Pisa, Italy
| | - G Milazzo
- U.O.Lungodegenza e Medicina, Ospedale Vittorio Emanuele III, Salemi, Tp, Italy
| | - D F Altomare
- Department of Emergency and Organ Transplantation (DETO) and Interdepart mental Research Center for Pelvic Floor Dysfunction (CIRPAP), University Aldo Moro, Policlinico, Bari, Italy
| | - R Barbera
- San Giuseppe Multimedica Hospital, Milan, Italy
| | - A Bove
- Gastroenterology and Endoscopy Unit, Department of Gastroenterology, A. Cardarelli Hospital, Naples, Italy
| | - C Calcara
- Gastroenterology Unit, SSVD Gastroenterologia, Ospedale SS Trinità, Borgomanero, No, Italy
| | - L D'Alba
- Gastroenterology and Digestive Endoscopy Unit, San Giovanni-Addolorata Hospital, Rome, Italy
| | - M De Bona
- Gastroenterology and Endoscopy Unit, Feltre Hospital, Feltre, Bl, Italy
| | - F Goffredo
- Gastroenterology and Endoscopy Unit, San Camillo-Forlanini Hospital, Rome, Italy
| | - G Manfredi
- Department of Gastroenterology and Digestive Endoscopy, Crema Hospital, ASST CREMA, Crema, Italy
| | - G Naldini
- Proctological and Perineal Surgery Unit, Cisanello University Hospital, Pisa, Italy
| | - M C Neri
- Gastroenterology Unit, Geriatric Institute "Pio Albergo Trivulzio", Milan, Italy
| | - L Turco
- Department of Digestive Physiopathology, Healte Center "Cittadella della Salute", Lecce, Italy
| | - F La Torre
- Department of Surgical Sciences, University "La Sapienza", Policlinico Umberto I, Rome, Italy
| | | | - I Berni
- Rehabilitation Department, San Luca Hospital, Lucca, Italy
| | - M A Balestri
- Proctological and Perineal Surgery Unit, Cisanello University Hospital, Pisa, Italy
| | - N Busin
- Rehabilitation Department, Villa Igea Private Hospital, Forlì, Italy
| | - C Boemo
- Early Rehabilitation Department, S. Maria della Misericordia Hospital, Udine, Italy
| | - M Bellini
- Gastrointestinal Unit, Department of General Surgery, University of Pisa, Pisa, Italy
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16
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Altomare DF, Picciariello A, Pecorella G, Milito G, Naldini G, Amato A, Ratto C, Perinotti R. Surgical management of haemorrhoids: an Italian survey of over 32 000 patients over 17 years. Colorectal Dis 2018; 20:1117-1124. [PMID: 30004171 DOI: 10.1111/codi.14339] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 06/21/2018] [Indexed: 12/30/2022]
Abstract
AIM The management of haemorrhoids has changed significantly in the last two decades as a result of new insights into their pathophysiology and the availability of new surgical devices. The aim of this survey was to evaluate changes in the management of haemorrhoids in Italy over the last 17 years. METHOD An electronic database which recorded details of management relating to the severity of haemorrhoids between 2000 and 2016 was obtained from 18 of 34 colorectal surgeons who were invited to participate. RESULTS A total of 32 458 patients were treated for haemorrhoids by 18 expert coloproctologists during a 17-year period. Patients were classified as Grade II (7542, 23.2%), Grade III(15 360, 47.3%) and Grade IV (9556, 29.4%). Grade II haemorrhoids were treated with rubber band ligation in over 90% of the cases, and patients with Grade IV had a Milligan-Morgan (MM) haemorrhoidectomy in over 90% of the cases. In Grade III, the use of stapled haemorrhoidopexy progressively decreased from 30% to 35% (between 2000 and 2007) to 5% of the cases. Meanwhile, commencing from 2006 the use of Doppler-guided haemorrhoid artery ligation (DGHAL) with mucopexy increased progressively from 6% to 24%. Over the years, the percentage of MM haemorrhoidectomy remained consistent at between 65% and 70% of the cases. CONCLUSION Relevant changes in the surgical choice of haemorrhoid treatment have occurred in Italy over the last 17 years. MM haemorrhoidectomy remains the most frequently performed procedure for Grade III haemorrhoids. Stapled haemorrhoidopexy has become much less popular in contrast to DGHAL with mucopexy which is being performed much more frequently.
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Affiliation(s)
- D F Altomare
- Functional and Oncologic Colorectal Unit, Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy.,Interdepartmental Research Unit for Pelvic Floor Disease (CIRPAP), University Aldo Moro of Bari, Bari, Italy
| | - A Picciariello
- Functional and Oncologic Colorectal Unit, Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy.,Interdepartmental Research Unit for Pelvic Floor Disease (CIRPAP), University Aldo Moro of Bari, Bari, Italy
| | - G Pecorella
- Department of General Surgery Coloproctological Unit, University of Catania, Catania, Italy
| | - G Milito
- Department of Surgery, University Hospital of Tor Vergata 'PTV', Rome, Italy
| | - G Naldini
- Proctological and Perineal Surgery Unit, Cisanello University Hospital, Pisa, Italy
| | - A Amato
- Unit of Coloproctology, Department of General Surgery, Sanremo Hospital, Sanremo, Italy
| | - C Ratto
- Proctology Unit, University Hospital 'A. Gemelli', Catholic University, Rome, Italy
| | - R Perinotti
- Department of General Surgery, Degli Infermi Hospital, Biella, Italy
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17
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Colucci M, Altomare DF, Chetta G, Triggiani R, Cavallo LG, Semeraro N. Impaired Fibrinolysis in Obstructive Jaundice - Evidence from Clinical and Experimental Studies. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1647628] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryMicrovascular thrombosis is considered an important pathogenetic factor in renal failure associated with obstructive jaundice but the mechanisms leading to fibrin deposition are still unknown. The plasma levels of plasminogen activator inhibitor (PAI) in 29 patients with obstructive jaundice were found significantly increased as compared to 20 nonjaundiced patients. Fibrin autography of plasma supplemented with tissue plasminogen activator (t-PA) revealed that in icteric samples most of the added activator migrated with an apparent Mr of 100 kDa, corresponding to t-PA-PAI complex, whereas in control samples virtually all t-PA migrated as free enzyme. PAI activity detected in icteric samples is similar to the endothelial type PAI since it is neutralized by a monoclonal antibody against PAI-1.Venous stasis in jaundiced patients was neither associated with an increase in blood fibrinolytic activity nor with a decrease in PAI activity. Immunologic assay showed that t-PA release was impaired in 3 out of 4 patients. In controls, venous occlusion induced an increase in both fibrinolytic activity and t-PA antigen and a reduction in PAI activity. Bile duct recanalization in jaundiced patients subjected to surgery was accompanied by a decrease in plasma PAI activity which paralleled the decrease in serum bilirubin levels. In nonjaundiced patients, surgical treatment did not cause significant changes in either parameter. Rabbits made icteric by bile duct ligation showed an early and progressive increase in plasma PAI activity indicating that obstructive jaundice itself causes the elevation of circulating PAI. It is concluded that obstructive jaundice is associated with a severe impairment of fibrinolysis which might contribute to microvascular thrombosis and renal failure.
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Affiliation(s)
- M Colucci
- The Istituto di Patologia Generale, Bari, Italy
| | - D F Altomare
- The Istituto di Clinica Chirurgica, Università di Bari, Bari, Italy
| | - G Chetta
- The Istituto di Clinica Chirurgica, Università di Bari, Bari, Italy
| | - R Triggiani
- The Istituto di Patologia Generale, Bari, Italy
| | - L G Cavallo
- The Istituto di Patologia Generale, Bari, Italy
| | - N Semeraro
- The Istituto di Patologia Generale, Bari, Italy
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18
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Altomare DF, Picciariello A, Ferrara C, Digennaro R, Ribas Y, De Fazio M. Short-term outcome of percutaneous tibial nerve stimulation for low anterior resection syndrome: results of a pilot study. Colorectal Dis 2017; 19:851-856. [PMID: 28371160 DOI: 10.1111/codi.13669] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 01/17/2017] [Indexed: 12/13/2022]
Abstract
AIM Percutaneous tibial nerve stimulation (PTNS) is a minimally invasive procedure which has been demonstrated to be effective in faecal/urinary incontinence but has never been tested in low anterior resection syndrome (LARS). The severity of LARS may be evaluated by the LARS score, but rectal cancer treatments may also affect urinary and sexual function, which are not explored by the LARS score. The Three Axial Perineal Evaluation (TAPE) score is a new validated index addressing the overall pelvic floor functions. This study aims to assess the efficacy of PTNS in LARS patients and to evaluate the results by the LARS and TAPE scores. METHODS Twenty-one patients operated on for rectal cancer between 2009 and 2014 complaining of LARS underwent PTNS (12 sessions of 30 min each). Six patients reported urinary incontinence and all except two (men) were sexually inactive. The LARS score and the TAPE score questionnaires were administered at baseline and after 6 months of follow-up. RESULTS At 6 months' follow-up, nine patients reported a significant improvement of faecal incontinence and 3/6 an improvement of urinary incontinence after PTNS. Median LARS score significantly decreased from 32 to 27 (P = 0.009), while the median TAPE score improved significantly from 55 to 58 (P = 0.004). CONCLUSIONS PTNS may be a further option in the treatment of selected patients with LARS and in addition may improve associated urinary incontinence. The severity of LARS can be detected by the LARS score; however, the adoption of the TAPE score is preferred in the case of concomitant urinary and/or sexual problems not explored by the LARS score.
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Affiliation(s)
- D F Altomare
- Department of Emergency and Organ Transplantation and Inter-department Research Center for Pelvic Floor Diseases (CIRPAP), University 'Aldo Moro' of Bari, Bari, Italy
| | - A Picciariello
- Department of Emergency and Organ Transplantation and Inter-department Research Center for Pelvic Floor Diseases (CIRPAP), University 'Aldo Moro' of Bari, Bari, Italy
| | - C Ferrara
- Department of Emergency and Organ Transplantation and Inter-department Research Center for Pelvic Floor Diseases (CIRPAP), University 'Aldo Moro' of Bari, Bari, Italy
| | - R Digennaro
- Department of Emergency and Organ Transplantation and Inter-department Research Center for Pelvic Floor Diseases (CIRPAP), University 'Aldo Moro' of Bari, Bari, Italy
| | - Y Ribas
- Department of Surgery, Consorci Sanitari de Terrassa, Terrassa (Barcelona), Spain
| | - M De Fazio
- Department of Emergency and Organ Transplantation and Inter-department Research Center for Pelvic Floor Diseases (CIRPAP), University 'Aldo Moro' of Bari, Bari, Italy
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19
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Altomare DF, Pecorella G, Tegon G, Aquilino F, Pennisi D, De Fazio M. Does a more extensive mucosal excision prevent haemorrhoidal recurrence after stapled haemorrhoidopexy? Long-term outcome of a randomized controlled trial. Colorectal Dis 2017; 19:559-562. [PMID: 27801539 DOI: 10.1111/codi.13549] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 08/11/2016] [Indexed: 02/08/2023]
Abstract
AIM The study aimed in a multicentric randomized controlled trial to define the role of a more extensive mucosal resection on recurrence of mucosal prolapse in patients with Stage III haemorrhoids undergoing stapled haemorrhoidopexy. METHOD In all, 135 patients were randomized to treatment with a PPH-01/03 (Ethicon EndoSurgery) or an EEA (Covidien) stapler. They were reviewed after a minimum follow-up of 4 years to determine the rate of recurrent mucosal prolapse and general condition (wellness evaluation score). Postoperative bowel dysfunction was assessed using the Rome III criteria. RESULTS Eighty-seven (65%) of the 135 patients (48 in the EEA stapler group and 37 in the PPH group) were available for long-term follow-up. The two groups were comparable for age, gender and duration of follow-up (mean 49.3 ± 5.4 months and 49.0 ± 5.3 months respectively). In the EEA group, 11 (23%) patients had some degree of recurrent prolapse compared with 12 (32%) in the PPH group (P = 0.409). Persistence of anal bleeding was significantly higher in the PPH group (P = 0.04) while the postoperative Haemorrhoid Symptom Score was significantly better in the EEA group (1.73 ± 1.65 vs 3.17 ± 1.94, P < 0.001). The wellness evaluation score was significantly better in the EEA group (1.2 ± 1.27 vs 0.6 ± 1.0, P = 0.028). Furthermore, 7 (15%) of the patients in the EEA group complained of some evacuation disturbance compared with 13 (36%) in the PPH group (P = 0.021). CONCLUSION The study failed to demonstrate any significant difference in the long-term recurrence rate of Stage III haemorrhoids using EEA or PPH. Nevertheless, use of the larger volume EEA provides better symptom resolution compared with PPH.
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Affiliation(s)
- D F Altomare
- Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
| | - G Pecorella
- Colorectal Unit, Surgical Clinic, University of Catania, Catania, Italy
| | - G Tegon
- Colorectal Unit, 'San Camillo' Hospital, Treviso, Italy
| | - F Aquilino
- Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
| | - D Pennisi
- Colorectal Unit, Surgical Clinic, University of Catania, Catania, Italy
| | - M De Fazio
- Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
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20
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Rubbini M, Altomare DF, D'Hoore A, Espin E, Laurberg S, Lefevre J. What Brexit and students are teaching us. Colorectal Dis 2017; 19:395-396. [PMID: 28214383 DOI: 10.1111/codi.13633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 02/05/2017] [Indexed: 02/08/2023]
Affiliation(s)
- M Rubbini
- Department of Surgery, University of Ferrara, Ferrara, Italy
| | - D F Altomare
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - A D'Hoore
- Abdominal Surgery, University Hospital Gasthuisberg, Leuven, Belgium
| | - E Espin
- Department of General and Digestive Surgery, Hospital Vall d'Hebron, Barcelona, Spain
| | - S Laurberg
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - J Lefevre
- General Surgery, Hopital Saint-Antoine, Paris, France
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Bianco F, De Franciscis S, Belli A, Falato A, Fusco R, Altomare DF, Amato A, Asteria CR, Avallone A, Binda GA, Boccia L, Buzzo P, Carvello M, Coco C, Delrio P, De Nardi P, Di Lena M, Failla A, La Torre F, La Torre M, Lemma M, Luffarelli P, Manca G, Maretto I, Marino F, Muratore A, Pascariello A, Pucciarelli S, Rega D, Ripetti V, Rizzo G, Serventi A, Spinelli A, Tatangelo F, Urso EDL, Romano GM. T1 colon cancer in the era of screening: risk factors and treatment. Tech Coloproctol 2017; 21:139-147. [DOI: 10.1007/s10151-017-1586-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 10/03/2016] [Indexed: 02/07/2023]
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Di Lena M, Porcelli F, Altomare DF. Volatile organic compounds as new biomarkers for colorectal cancer: a review. Colorectal Dis 2016; 18:654-63. [PMID: 26752703 DOI: 10.1111/codi.13271] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 11/24/2015] [Indexed: 12/12/2022]
Abstract
Analysis of the volatile part of the metabolome (volatile organic compounds, VOC) present in the gas phase of excreted materials is a promising new screening tool for several cancers, including colorectal cancer (CRC). The VOC signature can reflect health status, like a 'fingerprint', and can be modified in several diseases. Technical difficulties still limit the widespread use of VOC analysis in the clinical setting, but this approach has already been applied successfully in the diagnosis of CRC. The present study reviews the available data on VOC present in the headspace (the gaseous constituents of a closed space above a liquid or solid) of blood, urine, faeces and breath as a potential screening tool for CRC. A systematic electronic literature search was conducted in PubMed, Scirus and Google using the following keywords: Metabolomic, Volatile Organic Compounds (VOC), Electronic-nose and Colorectal Cancer. Only articles published in English between 2000 and 2015 were selected and these were independently checked by two of the authors. Ten papers describing the reliability of VOC analysis in breath and faeces, blood and urine were selected; all indicated good reliability in detecting CRC. The use of different substrates and different analytical platforms has led to the identification of different patterns of VOC. The reliability of a metabolomic approach as a noninvasive biomarker for use in CRC screening is supported by this review despite several limitations due to the number of patients included in each study, the different analytical platforms and biological materials used and different VOC identified.
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Affiliation(s)
- M Di Lena
- Department of Emergency and Organ Transplantation, University 'Aldo Moro' of Bari, Bari, Italy
| | - F Porcelli
- Department of Biology, University 'Aldo Moro' of Bari, Bari, Italy
| | - D F Altomare
- Department of Emergency and Organ Transplantation, University 'Aldo Moro' of Bari, Bari, Italy.
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Ratto C, Buntzen S, Aigner F, Altomare DF, Heydari A, Donisi L, Lundby L, Parello A. Multicentre observational study of the Gatekeeper for faecal incontinence. Br J Surg 2015; 103:290-9. [PMID: 26621029 PMCID: PMC5063193 DOI: 10.1002/bjs.10050] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 07/24/2015] [Accepted: 10/07/2015] [Indexed: 12/13/2022]
Abstract
Background A variety of therapeutic approaches are available for faecal incontinence. Implantation of Gatekeeper™ prostheses is a new promising option. The primary endpoint of this prospective observational multicentre study was to assess the clinical efficacy of Gatekeeper™ implantation in patients with faecal incontinence. Secondary endpoints included the assessment of patients' quality of life, and the feasibility and safety of implantation. Methods Patients with faecal incontinence, with either intact sphincters or internal anal sphincter lesions extending for less than 60° of the anal circumference, were selected. Intersphincteric implantation of six prostheses was performed. At baseline, and 1, 3 and 12 months after implantation, the number of faecal incontinence episodes, Cleveland Clinic Faecal Incontinence, Vaizey and American Medical Systems, Faecal Incontinence Quality of Life Scale and Short Form 36 Health Survey scores were recorded. Endoanal ultrasonography was performed at baseline and follow‐up. Results Fifty‐four patients were implanted. After Gatekeeper™ implantation, incontinence to gas, liquid and solid stool improved significantly, soiling was reduced, and ability to defer defaecation enhanced. All faecal incontinence severity scores were significantly reduced, and patients' quality of life improved. At 12 months, 30 patients (56 per cent) showed at least 75 per cent improvement in all faecal incontinence parameters, and seven (13 per cent) became fully continent. In three patients a single prosthesis was extruded during surgery, but was replaced immediately. After implantation, prosthesis dislodgement occurred in three patients; no replacement was required. Conclusion Anal implantation of the Gatekeeper™ in patients with faecal incontinence was effective and safe. Clinical benefits were sustained at 1‐year follow‐up. GatekeeperTM effective
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Affiliation(s)
- C. Ratto
- Proctology Unit, Department of Surgical SciencesCatholic UniversityRomeItaly
| | - S. Buntzen
- Department of Surgery PAarhus University HospitalAarhusDenmark
| | - F. Aigner
- Department of Visceral, Transplant and Thoracic SurgeryInnsbruck Medical UniversityInnsbruckAustria
- Department of General, Visceral and Transplant SurgeryCharité Universitätsmedizin BerlinCampus Virchow‐KlinikumBerlinGermany
| | - D. F. Altomare
- Department of Emergency and Organ Transplantation, General Surgery UnitUniversity of BariBariItaly
| | - A. Heydari
- Department of General SurgeryNuovo Ospedale Civile Sant'Agostino EstenseModenaItaly
| | - L. Donisi
- Proctology Unit, Department of Surgical SciencesCatholic UniversityRomeItaly
| | - L. Lundby
- Department of Surgery PAarhus University HospitalAarhusDenmark
| | - A. Parello
- Proctology Unit, Department of Surgical SciencesCatholic UniversityRomeItaly
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Rotelli MT, Bocale D, De Fazio M, Ancona P, Scalera I, Memeo R, Travaglio E, Zbar AP, Altomare DF. IN-VITRO evidence for the protective properties of the main components of the Mediterranean diet against colorectal cancer: A systematic review. Surg Oncol 2015; 24:145-52. [PMID: 26303826 DOI: 10.1016/j.suronc.2015.08.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 07/21/2015] [Accepted: 08/04/2015] [Indexed: 02/07/2023]
Abstract
AIM Epidemiological studies have shown that the incidence and mortality rates of colorectal cancer (CRC) vary over 10-fold worldwide where within Westernized societies lower rates are observed amongst populations living within the Mediterranean basin, suggesting a significant influence of environment and dietary style in CRC carcinogenesis. Interpretation of the data concerning the benefits of mediterranean (MD) diet is difficult in vivo because of the variability of alimentary regimens used, the differing compliance with dietary supplementation and because of the non-uniform duration of patient cohort observation. Therefore, the aim of this review is to evaluate the in-vitro effects on colorectal cancer cell lines. METHODS the literature concerning the in-vitro effects of 4 of the principal components symbolizing the MD such as olive oil (polyphenol), red chili (capsaicin), tomato (lycopene) and red grapes (resveratrol) have been systematically reviewed. RESULTS Several studies have demonstrated that polyphenols form olive oil, lycopene, resveratrol and capsaicin have multiple anticancer properties affecting several metabolic pathways involved in cancerogenesis, apoptosis, and metastasis in CRC cell lines. CONCLUSION This review summarizes some of the most recent data potentially supportive of the use of MD in CRC chemoprevention, analyzing the in vitro effects of individual components of the MD on CRC cell development, progression, metastasis and apoptosis.
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Affiliation(s)
- M T Rotelli
- DETO Dept of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Italy.
| | - D Bocale
- DETO Dept of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Italy
| | - M De Fazio
- DETO Dept of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Italy
| | - P Ancona
- DETO Dept of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Italy
| | - I Scalera
- DETO Dept of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Italy
| | - R Memeo
- DETO Dept of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Italy
| | - E Travaglio
- DETO Dept of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Italy
| | - A P Zbar
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Israel; Sackler School of Medicine, Tel Aviv University, Israel; Department of Anatomy, School of Medical Sciences, Centre for Bioengineering and Nanomedicine, University of Otago, Dunedin, New Zealand
| | - D F Altomare
- DETO Dept of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Italy
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25
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Affiliation(s)
- D F Altomare
- Department of Emergency and Organ Transplantation, Aldo Moro University, Bari, Italy,
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Altomare DF, Di Lena M, Andriola V, Giuratrabocchetta S, Giannini I, Ferrara C. TriAxial perineal evaluation score: the male version. Colorectal Dis 2015; 17:544-5. [PMID: 25808091 DOI: 10.1111/codi.12956] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 02/23/2015] [Indexed: 02/08/2023]
Affiliation(s)
- D F Altomare
- Colorectal Unit, Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy. .,Inter-Department Research Center for Pelvic Floor Disease (CIRPAP), University Aldo Moro of Bari, Bari, Italy.
| | - M Di Lena
- Colorectal Unit, Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy.,Inter-Department Research Center for Pelvic Floor Disease (CIRPAP), University Aldo Moro of Bari, Bari, Italy
| | - V Andriola
- Colorectal Unit, Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy.,Inter-Department Research Center for Pelvic Floor Disease (CIRPAP), University Aldo Moro of Bari, Bari, Italy
| | - S Giuratrabocchetta
- Colorectal Unit, Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy.,Inter-Department Research Center for Pelvic Floor Disease (CIRPAP), University Aldo Moro of Bari, Bari, Italy
| | - I Giannini
- Colorectal Unit, Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy.,Inter-Department Research Center for Pelvic Floor Disease (CIRPAP), University Aldo Moro of Bari, Bari, Italy
| | - C Ferrara
- Colorectal Unit, Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy.,Inter-Department Research Center for Pelvic Floor Disease (CIRPAP), University Aldo Moro of Bari, Bari, Italy
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Altomare DF, Giuratrabocchetta S, Knowles CH, Muñoz Duyos A, Robert-Yap J, Matzel KE. Long-term outcomes of sacral nerve stimulation for faecal incontinence. Br J Surg 2015; 102:407-15. [PMID: 25644687 DOI: 10.1002/bjs.9740] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 10/22/2014] [Accepted: 11/10/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Sacral nerve stimulation (SNS) has proven short- to medium-term effectiveness for the treatment of faecal incontinence (FI); fewer long-term outcomes have been presented and usually in small series. Here, the long-term effectiveness of SNS was evaluated in a large European cohort of patients with a minimum of 5 years' follow-up. METHODS Prospectively registered data from patients with FI who had received SNS for at least 5 years from ten European centres were collated by survey. Daily stool diaries, and Cleveland Clinic and St Mark's incontinence scores were evaluated at baseline, after implantation and at the last follow-up. SNS was considered successful when at least 50 per cent symptom improvement was maintained at last follow-up. RESULTS A total of 407 patients underwent temporary stimulation, of whom 272 (66·8 per cent) had an impulse generator implanted; 228 (56·0 per cent) were available for long-term follow-up at a median of 84 (i.q.r. 70-113) months. Significant reductions in the number of FI episodes per week (from median 7 to 0·25) and summative symptom scores (median Cleveland Clinic score from 16 to 7, St Mark's score from 19 to 6) were recorded after implantation (all P < 0·001) and maintained in long-term follow-up. In per-protocol analysis, long-term success was maintained in 71·3 per cent of patients and full continence was achieved in 50·0 per cent; respective values based on intention-to-treat analysis were 47·7 and 33·4 per cent. Predictive analyses determined no significant association between pretreatment variables and successful outcomes. Risk of long-term failure correlated with minor symptom score improvement during the temporary test phase. CONCLUSION SNS remains an effective treatment for FI in the long term for approximately half of the patients starting therapy.
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Affiliation(s)
- D F Altomare
- Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
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Altomare DF. Transanal dearterialization with targeted mucopexy is effective for advanced haemorrhoids--a clear classification is needed. Colorectal Dis 2014; 16:740. [PMID: 24961360 DOI: 10.1111/codi.12690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 05/17/2014] [Indexed: 02/08/2023]
Affiliation(s)
- D F Altomare
- Department of Emergency and Organ Transplantation, General Surgery and Liver Transplantation Units, University of Bari, Policlinico, Piazza G. Cesare, 11, Bari, 70124, Italy.
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Altomare DF, Rockwood T. Reply to Commentary on 'The TAPE score: a new scoring system for comprehensive evaluation of pelvic floor function' by Professor Søren Laurberg. Colorectal Dis 2014; 16:640-1. [PMID: 24840543 DOI: 10.1111/codi.12668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 05/07/2014] [Indexed: 02/08/2023]
Affiliation(s)
- D F Altomare
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.
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Loizzi V, Cormio G, Lobascio PL, Marino F, De Fazio M, Falagario M, Leone L, Difiore G, Scardigno D, Selvaggi L, Altomare DF. Bowel dysfunction following nerve-sparing radical hysterectomy for cervical cancer: a prospective study. Oncology 2014; 86:239-43. [PMID: 24902494 DOI: 10.1159/000362213] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 03/10/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To objectively assess anorectal dysfunction following nerve-sparing radical hysterectomy in stage I-II cervical carcinoma patients. MATERIAL AND METHODS Between 2008 and 2012, 21 patients with primary cervical cancer stage FIGO I-II were enrolled in this prospective study. All women underwent nerve-sparing radical hysterectomy. Anorectal manometry was performed preoperatively and 6 months after surgery. A paired Student t test was used to assess the statistical difference between the manometric evaluations. A p value <0.05 was considered statistically significant. RESULTS Twenty-one patients were available for follow-up. Maximal and mean anal resting and squeezing pressures were unaffected by the surgical procedure, rectoanal inhibitory reflex and length of the high anal pressure zone did not change after the operation. The minimal volume to elicit rectal sensation, urge to defecate and maximal tolerable volume did not change significantly in the postoperative period, although they decreased in 2 and increased in 3 patients. In addition, rectal compliance did not change after surgery. Furthermore, no significant differences were found between patients who were or were not treated with adjuvant radiotherapy. CONCLUSIONS Our findings suggest that nerve-sparing radical hysterectomy for cervical cancer does not seem to be associated with long-term anorectal dysfunction. © 2014 S. Karger AG, Basel.
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Affiliation(s)
- V Loizzi
- Department of Biomedical Science and Human Oncology, Obstetrics and Gynecology Unit, IRCCS Bari, Bari, Italy
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Altomare DF, Di Lena M, Giuratrabocchetta S, Giannini I, Falagario M, Zbar AP, Rockwood T. The Three Axial Perineal Evaluation (TAPE) score: a new scoring system for comprehensive evaluation of pelvic floor function. Colorectal Dis 2014; 16:459-68. [PMID: 24450861 DOI: 10.1111/codi.12567] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 11/27/2013] [Indexed: 12/14/2022]
Abstract
AIM Abnormalities of one pelvic floor compartment are usually associated with anomalies in the other compartments. Therapies which specifically address one clinical problem may potentially adversely affect other pelvic floor activities. A new comprehensive holistic scoring system defining global pelvic function is presented. METHOD A novel scoring system with a software program is presented expressing faecal, urinary and gynaecological functions as a geometric polygon based on symptom-specific questionnaires [the three axial pelvic evaluation (TAPE) score] where differences in overall geometric area vary from normal. After validation in healthy volunteers, its clinical performance was tested on patients with obstructed defaecation, genital prolapse and urinary/faecal incontinence treated by the stapled transanal rectal resection (STARR) procedure, colpo-hysterectomy and sacral nerve modulation, respectively. The TAPE score was correlated with the Pelvic Floor Impact Questionnaire 7 quality of life score. RESULTS There was good inter-observer variation and internal consistency between two observers recording the TAPE score in normal volunteers. In the STARR patients, constipation improved but the TAPE score was unchanged because of deterioration in other pelvic floor functions leading to an unchanged overall postoperative recorded quality of life. Conversely, incontinent patients treated with sacral nerve stimulation improved their function showing concomitant improvements in TAPE scores and quality of life indices. Similar correlative improvements were noted in patients undergoing hysterectomy for genital prolapse. CONCLUSION The TAPE score defines the impact of symptom-specific treatments on the pelvic floor and may provide an opportunity for comparison of clinical data between units and in clinical trials of specific medical and surgical pelvic floor management.
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Affiliation(s)
- D F Altomare
- Department of Emergency and Organ Transplantation, University 'Aldo Moro' of Bari, Bari, Italy
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Giannini I, Pecorella G, Pennisi D, Santangelo G, Digennaro R, Latorre F, Giuliani G, Altomare DF. Control of post-hemorrhoidectomy symptoms and wound healing by Triclosan: a randomized, double-blind, controlled trial. MINERVA CHIR 2014; 69:75-82. [PMID: 24847894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM Milligan-Morgan hemorrhoidectomy (MM) is still the most common treatment for grades III and IV hemorrhoids despite prolonged post-operative anal pain and wound healing. This multicenter, double blind, randomized, controlled trial was designed to assess the safety and the efficacy of anal wound cleansing with Triclosan (Proctocid®) in the control of symptoms and healing time after MM. METHODS A total of 113 patients with grades III and IV hemorrhoids, undergoing open hemorroidectomy by diathermy or Ligasure vessel sealing device, were randomly assigned to Triclosan or sodium hypochlorite solution. All patients received analgesics and a fiber-rich diet after hemorrhoidectomy. Postoperative anal pain, bleeding and/or secretion and itch were assessed 7, 14 and 21 days after hemorrhoidectomy by a Visual Analogue Scale (VAS) and the day of complete re-epithelialization of anal wounds was recorded. RESULTS Fifty-five patients were randomized for Triclosan treatment and 58 for the control drug. The two groups were comparable for demographics, severity of hemorrhoids and technique used for the hemorrhoidectomy. The comparison of days to get complete anal wound healing shows a trend of significance (P=0.05) for the Triclosan group. Bleeding and/or secretion, anal pain and itch were significantly better (P=0.003; P<0.0001 and P=0.01, respectively). CONCLUSION Triclosan solution for the treatment of post-hemorrhoidectomy wounds is safe and improves the control of post-operative symptoms and wound healing time compared to sodium hypochlorite.
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Affiliation(s)
- I Giannini
- Department of Emergency and Organ Transplantation University of Bari, Bari, Italy -
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Affiliation(s)
- M Di Lena
- Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
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Altomare DF, Giannini I, Giuratrabocchetta S, Digennaro R. The effects of sacral nerve stimulation on continence are temporarily maintained after turning the stimulator off. Colorectal Dis 2013; 15:e741-8. [PMID: 24102954 DOI: 10.1111/codi.12418] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 05/27/2013] [Indexed: 12/14/2022]
Abstract
AIM Sacral nerve stimulation is an effective treatment for urinary and faecal incontinence even though its mechanism of action is uncertain. Central nervous system involvement by 'setting-up' neurological mechanisms appointed to control pelvic function has been hypothesized. The study aimed to evaluate whether the effects of long-term sacral nerve stimulation are memorized and therefore maintained after switching off the stimulator. METHOD Patients having sacral nerve stimulation for faecal and/or urinary incontinence for at least 1 year had the stimulator turned off and the results monitored. Data recorded with the stimulator off were compared with post-implant data. If symptoms recurred the stimulator was switched back on. Nineteen patients entered the study. Fourteen had faecal and/or urinary incontinence and five had faecal incontinence alone. The symptoms were assessed by means of a bowel function diary and dedicated questionnaire. RESULTS In 10 patients symptoms recurred at different intervals after a median off period of 3.4 months with a probability of symptom relapse of 55%. The Fecal Incontinence Quality of Life (FIQL) score did not show any significant difference in nine patients with the stimulator off for at least 1 year. No factors predictive of symptom recurrence were identified although an idiopathic aetiology, severity of disease and urinary incontinence had higher hazard ratios. During the off period, none of the scores and episodes of incontinence showed significant changes compared with the on period. CONCLUSION The effects of sacral nerve stimulation on faecal and urinary incontinence were maintained in about half of patients after switching the stimulator off, but in some symptoms returned after different periods of time. The data shed new light on possible effects of sacral nerve stimulation on brain neuroplasticity in the control of continence.
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Affiliation(s)
- D F Altomare
- Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
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Altomare DF. Author's reply: exhaled volatile organic compounds identify patients with colorectal cancer (Br J Surg 2013; 100: 144-150). Br J Surg 2013; 100:980. [PMID: 23640674 DOI: 10.1002/bjs.9149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Barone M, Altomare DF, Rotelli MT, Scavo MP, Piscitelli D, De Tullio N, Bocale D, Di Leo A. Disseminated tumour cells in bone marrow in experimental colon cancer: metastatic or resident? Colorectal Dis 2013; 15:667-73. [PMID: 23398657 DOI: 10.1111/codi.12169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 02/02/2013] [Indexed: 02/05/2023]
Abstract
AIM There are conflicting data on the biological and prognostic significance of disseminated tumour cells (DTCs) in the bone marrow of colorectal cancer patients since bone metastasis is rare in this disease. The study aimed to determine the origin of bone marrow DTCs using human colorectal cancer cells in in vivo and in vitro experimental settings. METHOD CD1 nude female mice were xenotransplanted with SW620 cells (a colorectal cancer cell line isolated from a male patient) injected in the colon wall. At autopsy, the presence of SW620 in the bone marrow (BM), colon and other organs/tissues was recognized by detection of the epithelial marker cytokeratin-19 (CK19) and Y chromosome. In addition SW620 cells or their conditioned medium were cultured with human BM cells. RESULTS Macroscopically evident CK19+/Y-chromosome-positive tumours developed only in five mice receiving SW620 cells while putative DTCs (CK19+) were found in the bone marrow of all treated mice. Most of these CK19+ cells were Y chromosome negative, only few being Y chromosome positive. In vitro SW620 cells or their conditioned medium induced CK19 expression in cultured human bone marrow cells. CONCLUSION Experimental colorectal cancer can induce the appearance of two distinct CK19+ cell populations in the bone marrow, one of metastatic origin and the other of murine origin. These findings suggest that bone marrow cells may undergo phenotypic modifications induced by cancer cells.
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Affiliation(s)
- M Barone
- Gastroenterology Unit, University Aldo Moro of Bari, Bari, Italy
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Falletto E, Ganio E, Naldini G, Ratto C, Altomare DF. Sacral neuromodulation for bowel dysfunction: a consensus statement from the Italian group. Tech Coloproctol 2013; 18:53-64. [PMID: 23564270 DOI: 10.1007/s10151-013-1002-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 03/07/2013] [Indexed: 12/31/2022]
Abstract
BACKGROUND Representatives from the Italian centers experienced in sacral neuromodulation (SNM) for the treatment of bowel dysfunction met in order to define the current clinical practice in Italy and to produce a consensus statement regarding indications for this therapy and patient management. METHODS Fifty Italian colonproctologists were asked to complete a questionnaire concerning their clinical practice in SNM (290 questions, grouped within 4 broad areas). Physicians expressed their opinion by completing the questionnaire, assigning to each statement their level of agreement according to the 5-point Likert scale; the data were analyzed by attributing to each expert's answers a weight proportional to the degree of experience. During a meeting held 2 months later, the critical aspects of the therapy were re-examined and discussions held with the goal of reaching an agreement on controversial topics. The available literature was reviewed. RESULTS Patient selection criteria, etiology, diagnostic investigations, test procedures and implantation, follow-up and evaluation of results have been reviewed. The aim was to achieve an algorithm for patient management, showing the place of SNM in the treatment of bowel dysfunction. The approach in case of treatment failure was also discussed. CONCLUSIONS Analysis of the data collected reveals substantial consensus at the national level concerning all the main points with regard to the therapy. The recommendations expressed in this article can be considered as national guidelines and taken into account by the principal international implantation centers.
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Affiliation(s)
- E Falletto
- Department of Surgery, Città della Scienza e della Salute, San Giovanni Battista Hospital, Corso Bramante 88, Turin, Italy,
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Giuratrabocchetta S, Pecorella G, Stazi A, Tegon G, De Fazio M, Altomare DF. Safety and short-term effectiveness of EEA stapler vs PPH stapler in the treatment of degree III haemorrhoids: prospective randomized controlled trial. Colorectal Dis 2013; 15:354-8. [PMID: 22776142 DOI: 10.1111/j.1463-1318.2012.03172.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIM Stapled haemorrhoidopexy has gained wide acceptance due to less postoperative pain although postoperative bleeding and prolapse recurrence are among the major drawbacks of this technique compared with the standard Milligan-Morgan hemorrhoidectomy. The aim was to investigate a new stapler device designed to overcome these side effects. METHOD In all, 135 patients (71 men, mean age 42 years) with degree III haemorrhoids were randomly allotted to stapled haemorrhoidopexy with PPH® staplers (Ethicon EndoSurgery) (63 patients) or with an EEA® stapler (Covidien) (72 patients) in four referral colorectal centres. The number of haemostatic overstitches apposed on the stapled suture, the area of the resected mucosa (in square centimetres) and any postoperative bleeding within 30 days were recorded. RESULTS The mean area of the resected mucosa was significantly wider in EEA than PPH patients (35.75 ± 17.51 vs 28.05 ± 10.23 cm(2), P = 0.002). The median number of haemostatic stitches apposed in the EEA group was significantly lower than in the PPH groups (median value 1, vs 3, interquartile range 0-2, vs 2-5, P < 0.0001). Intraoperative haemostasis was better in the EEA group compared with the PPH01 and PPH03 groups. Postoperative bleeding occurred only in two PPH patients. CONCLUSION Data suggest that the EEA stapler has better haemostatic properties than the PPH stapler and allows resection of a larger area of mucosal prolapse with potential benefits over the recurrence rate of haemorrhoid prolapse.
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Affiliation(s)
- S Giuratrabocchetta
- Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
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Altomare DF, Di Lena M, Porcelli F, Trizio L, Travaglio E, Tutino M, Dragonieri S, Memeo V, de Gennaro G. Exhaled volatile organic compounds identify patients with colorectal cancer. Br J Surg 2013; 100:144-50. [PMID: 23212621 DOI: 10.1002/bjs.8942] [Citation(s) in RCA: 168] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2012] [Indexed: 12/17/2022]
Abstract
BACKGROUND An effective screening tool for colorectal cancer is still lacking. Analysis of the volatile organic compounds (VOCs) linked to cancer is a new frontier in cancer screening, as tumour growth involves several metabolic changes leading to the production of specific compounds that can be detected in exhaled breath. This study investigated whether patients with colorectal cancer have a specific VOC pattern compared with the healthy population. METHODS Exhaled breath was collected in an inert bag (Tedlar(®) ) from patients with colorectal cancer and healthy controls (negative at colonoscopy), and processed offline by thermal-desorber gas chromatography-mass spectrometry to evaluate the VOC profile. During the trial phase VOCs of interest were identified and selected, and VOC patterns able to discriminate patients from controls were set up; in the validation phase their discriminant performance was tested on blinded samples. A probabilistic neural network (PNN) validated by the leave-one-out method was used to identify the pattern of VOCs that better discriminated between the two groups. RESULTS Some 37 patients and 41 controls were included in the trial phase. Application of a PNN to a pattern of 15 compounds showed a discriminant performance with a sensitivity of 86 per cent, a specificity of 83 per cent and an accuracy of 85 per cent (area under the receiver operating characteristic (ROC) curve 0·852). The accuracy of PNN analysis was confirmed in the validation phase on a further 25 subjects; the model correctly assigned 19 patients, giving an overall accuracy of 76 per cent. CONCLUSION The pattern of VOCs in patients with colorectal cancer was different from that in healthy controls. The PNN in this study was able to discriminate patients with colorectal cancer with an accuracy of over 75 per cent. Breath VOC analysis appears to have potential clinical application in colorectal cancer screening, although further studies are required to confirm its reliability in heterogeneous clinical settings.
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Affiliation(s)
- D F Altomare
- Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy.
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Binda GA, Serventi A, Altomare DF. Multicentre observational study of the natural history of left-sided acute diverticulitis (Br J Surg 2012; 99: 276-285) (Br J Surg 2012; 99: 285-286). Br J Surg 2012; 99:738. [PMID: 22473281 DOI: 10.1002/bjs.8768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
The Editors welcome topical correspondence from readers relating to articles published in the Journal. Responses should be sent electronically via the BJS website (http://www.bjs.co.uk). All letters will be reviewed and, if approved, appear on the website. A selection of these will be edited and published in the Journal. Letters must be no more than 250 words in length.
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Infantino A, Altomare DF, Bottini C, Bonanno M, Mancini S, Yalti T, Giamundo P, Hoch J, El Gaddal A, Pagano C. Prospective randomized multicentre study comparing stapler haemorrhoidopexy with Doppler-guided transanal haemorrhoid dearterialization for third-degree haemorrhoids. Colorectal Dis 2012; 14:205-11. [PMID: 21689317 DOI: 10.1111/j.1463-1318.2011.02628.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AIM Doppler-guided transanal haemorrhoid dearterialization (THD) and stapler haemorrhoidopexy (SH) have been demonstrated to be less painful than the Milligan-Morgan procedure. The aim of this study was to compare the effectiveness of THD vs SH in the treatment of third-degree haemorrhoids in an equivalent trial. METHOD One hundred and sixty-nine patients with third-degree haemorrhoids were randomized online to receive THD (n = 85) or SH (n = 84) in 10 Colorectal Units in which the staff were well trained in both techniques. The mean follow-up period was 17 (range 15-20) months. RESULTS Early minor postoperative complications occurred in 30.6% of patients in the THD group and in 32.1% of patients in the SH group. Milder spontaneous pain and pain on defecation were reported in the THD group in the first postoperative week, but this was not statistically significant. Late complications were significantly higher (P = 0.028) in the SH group. Residual haemorrhoids persisted in 12 patients in the THD group and in six patients in the SH group (P = 0.14). Six patients in the SH group and 10 in the THD group underwent further treatment of haemorrhoids (P = 0.34). No differences were found in postoperative incontinence. The obstructed defecation score (ODS) was significantly higher in the SH group (P < 0.02). Improvement in quality of life was similar in both groups. Postoperative in-hospital stay was 1.14 days in the THD group and 1.31 days in the SH group (P = 0.03). CONCLUSION Both THD and SH techniques are effective for the treatment of third-degree haemorrhoids in the medium term. THD has a better cost-effective ratio and lower (not significant) pain compared with SH. Postoperative pain and recurrence did not differ significantly between the two groups.
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Affiliation(s)
- A Infantino
- Department of Surgery, S. Maria dei Battuti Hospital, S. Vito al Tagliamento, PN, Italy.
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Abstract
AIM The treatment of desmoid tumours (DTs) is controversial. Anti-oestrogen therapy has frequently been used, but clear information of its efficacy is lacking. In this systematic review we have undertaken a comprehensive analysis to assess the effectiveness of anti-oestrogen therapy in terms of ability to induce partial or complete regression of DTs. METHOD A systematic review of articles published in English between January 1983 and December 2009 was carried out according to the RECIST criteria. A literature search was performed on electronic databases including: United States National Library of Medicine (MEDLINE-PubMed), Excerpta Medica (EMBASE), Cochrane Library and Google search engine. Two-hundred articles dealing with DTs were identified but only fourty-one were were selected as appropriate for the study. The chi-square test was used for statistical analysis. RESULTS Data on 168 DTs treated with anti-oestrogen agents, alone or in combination with nonsteroidal anti-inflammatory drugs, were identified with an overall response rate of 51%. There was no difference in response according to the type of DTs or between different anti-oestrogen therapies. Combination with anti-inflammatory drugs did not improve the outcome. Toremifene was sometimes effective in cases resistant to tamoxifen. Response did not seem to be related to oestrogen receptor status. CONCLUSIONS Despite potential inaccuracies in the methodology, the results of the review indicate that anti-oestrogen therapy produces some effect in about one half of patients with DTs. Its indication compared with other treatments is discussed.
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Affiliation(s)
- D Bocale
- Department of Emergency and Organ Transplantation, General Surgery and Liver Transplantation Units, University Aldo Moro of Bari, Bari, Italy
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Binda GA, Arezzo A, Serventi A, Bonelli L, Facchini M, Prandi M, Carraro PS, Reitano MC, Clerico G, Garibotto L, Aloesio R, Sganzaroli A, Zanoni M, Zanandrea G, Pellegrini F, Mancini S, Amato A, Barisone P, Bottini C, Altomare DF, Milito G. Multicentre observational study of the natural history of left-sided acute diverticulitis. Br J Surg 2011; 99:276-85. [PMID: 22105809 DOI: 10.1002/bjs.7723] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2011] [Indexed: 12/16/2022]
Abstract
BACKGROUND The natural history of acute diverticulitis (AD) is still unclear. This study investigated the recurrence rate, and the risks of emergency surgery, associated stoma and death following initial medical or surgical treatment of AD. METHODS The Italian Study Group on Complicated Diverticulosis conducted a 4-year multicentre retrospective and prospective database analysis of patients admitted to hospital for medical or surgical treatment of AD and then followed for a minimum of 9 years. The persistence of symptoms, recurrent episodes of AD, new hospital admissions, medical or surgical treatment, and their outcome were recorded during follow-up. RESULTS Of 1046 patients enrolled at 17 centres, 743 were eligible for the study (407 recruited retrospectively and 336 prospectively); 242 patients (32·6 per cent) underwent emergency surgery at accrual. After a mean follow-up of 10·7 years, rates of recurrence (17·2 versus 5·8 per cent; P < 0·001) and emergency surgery (6·9 versus 1·3 per cent; P = 0·021) were higher for medically treated patients than for those treated surgically. Among patients who had initial medical treatment, age less than 40 years and a history of at least three episodes of AD were associated with an increased risk of AD recurrence. There was no association between any of the investigated parameters and subsequent emergency surgery. The risk of stoma formation was below 1 per cent and disease-related mortality was zero in this group. The disease-related mortality rate was 0·6 per cent among patients who had surgical treatment. CONCLUSION Long-term risks of recurrent AD or emergency surgery were limited and colectomy did not fully protect against recurrence.
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Affiliation(s)
- G A Binda
- Department of General Surgery, Galliera Hospital, Genoa, Italy.
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Altomare DF, Binda GA, Canuti S, Landolfi V, Trompetto M, Villani RD. The management of patients with primary chronic anal fissure: a position paper. Tech Coloproctol 2011; 15:135-41. [PMID: 21538013 PMCID: PMC3099002 DOI: 10.1007/s10151-011-0683-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2010] [Accepted: 03/15/2011] [Indexed: 12/26/2022]
Abstract
Anal fissure is one of the most common and painful proctologic diseases. Its treatment has long been discussed and several different therapeutic options have been proposed. In the last decades, the understanding of its pathophysiology has led to a progressive reduction of invasive and potentially invalidating treatments in favor of conservative treatment based on anal sphincter muscle relaxation. Despite some systematic reviews and an American position statement, there is ongoing debate about the best treatment for anal fissure. This review is aimed at identifying the best treatment option drawing on evidence-based medicine and on the expert advice of 6 colorectal surgeons with extensive experience in this field in order to produce an Italian position statement for anal fissures. While there is little chance of a cure with conservative behavioral therapy, medical treatment with calcium channel blockers, diltiazem and nifepidine or glyceryl trinitrate, had a considerable success rate ranging from 50 to 90%. Use of 0.4% glyceryl trinitrate in standardized fashion seems to have the best results despite a higher percentage of headache, while the use of botulinum toxin had inconsistent results. Nonresponding patients should undergo lateral internal sphincterotomy. The risk of incontinence after this procedure seems to have been overemphasized in the past. Only a carefully selected group of patients, without anal hypertonia, could benefit from anoplasty.
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Affiliation(s)
- D F Altomare
- Department of Emergency and Organ Transplantation, University Aldo Moro, Policlinico, piazza G Cesare 11, 70124, Bari, Italy.
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Altomare DF, Rinaldi M, Lobascio P, Marino F, Giuliani RT, Cuccia F. Factors affecting the outcome of temporary sacral nerve stimulation for faecal incontinence. The value of the new tined lead electrode. Colorectal Dis 2011; 13:198-202. [PMID: 19863601 DOI: 10.1111/j.1463-1318.2009.02088.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM Sacral nerve stimulation (SNS) is an effective but expensive treatment for faecal incontinence. About 50% of the patients are unresponsive for unknown reasons, hence knowledge of any factors predictive of success would be highly desirable. The aim of this study was to analyse the potential factors associated with a successful outcome of the temporary test of electrostimulation. METHOD Eighty-five patients with faecal incontinence were tested for SNS. The cause was idiopathic in 45, iatrogenic or obstetric in 28, spinal lesion or neurological diseases in nine and anal malformation in three patients; 43 were tested with a unipolar electrode and 42 with a quadripolar electrode. The severity of faecal incontinence was evaluated using the American Medical System (AMS) score and Wexner's score. RESULTS A positive response was obtained in 45 patients (53%); 40 (47%) were implanted with a permanent pulse generator. Responders and nonresponders were comparable in age, duration of incontinence, anal manometry, pudendal nerve terminal motor latency and diabetes. Unipolar electrode test (PNE test) was able to elicit positive responses in 18 of 43 (42%) and the quadripolar in 27 of 42 patients (P < 0.001). Type of incontinence and gender did not affect the success rate. Patients with idiopathic incontinence had a significantly higher response rate (P =0.022). Multivariate regression analysis indicated use of a quadripolar electrode as the only independent variable predicting the success of SNS (OR = 5.58, P = 0.009). CONCLUSION Use of the quadripolar electrode is the only factor significantly related to the success of SNS.
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Affiliation(s)
- D F Altomare
- Department of Emergency and Organ Transplantation, General Surgery and Liver transplantation Units, University of Bari, Bari, Italy.
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Giuratrabocchetta S, Rinaldi M, Cuccia F, Lemma M, Piscitelli D, Polidoro P, Altomare DF. Protection of intestinal anastomosis with biological glues: an experimental randomized controlled trial. Tech Coloproctol 2011; 15:153-8. [PMID: 21264676 DOI: 10.1007/s10151-010-0674-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Accepted: 12/22/2010] [Indexed: 01/19/2023]
Abstract
BACKGROUND The aim of the study was to compare the degree of healing and air tightness of hand-sewn colonic anastomoses provided by different biological glues. METHODS Thirty colonic anastomoses were fashioned in ten rabbits, at 5, 10, 15 cm from the ileocecal valve, with 4/0 PDS running sutures. Each suture was randomized to treatment with fibrin sealant (Tissucol®), a synthetic glue (Coseal®), or nothing (control). After 15 days, the rabbits were killed and the anastomoses examined for their integrity and resistance to bursting. The van der Hamm scale was used to evaluate postoperative adhesions. A blind histological evaluation of the newly formed tissue was made (Ehrlich-Hunt scale). RESULTS Two rabbits developed an intraabdominal abscess, one in the control anastomosis group without glue. Postoperative adhesions were present in all animals. Median anastomosis bursting pressures were 0.9 atm in all three groups: Tissucol, Coseal, and control. Pressure values were 0.9, 1.0, and 0.9 atm in the three different proximodistal sites, respectively. A trend toward an increased resistance was observed in the glued anastomosis, although this was not significant. Lymphocyte infiltration, fibroblast activity, blood vessel density, and collagen deposition were lower in controls. Anastomoses treated with Tissucol had the highest lymphocyte infiltration level. The Coseal group developed the highest rates of fibroblast activity, collagen deposition, and blood vessel neogenesis. CONCLUSION The use of biological glues did not result in a statistically significantly increased bursting resistance. Histological evaluation demonstrated more intense tissue neoformation in the glue groups, particularly in the Coseal group. The role of biological glues in decreasing the leakage rate of intestinal anastomoses is uncertain, and larger trials using different protective agents are warranted.
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Affiliation(s)
- S Giuratrabocchetta
- Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy
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Altomare DF, Greco VJ, Tricomi N, Arcanà F, Mancini S, Rinaldi M, Pulvirenti d'Urso A, La Torre F. Seton or glue for trans-sphincteric anal fistulae: a prospective randomized crossover clinical trial. Colorectal Dis 2011; 13:82-6. [PMID: 19832873 DOI: 10.1111/j.1463-1318.2009.02056.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Fibrin glue treatment of anal fistulae has been proposed to minimize the risk of faecal incontinence but its acceptance by coloproctologists is still poor because the published data is controversial. Therefore, we carried out a prospective randomized crossover trial comparing treatment with a commercial fibrin glue to classical seton treatment, with healing rate, hospital stay, healing time, faecal incontinence and postoperative pain as study outcomes. METHOD Sixty-four homogeneous patients with trans-sphincteric anal fistulae referred to seven colorectal units were randomized to undergo fibrin glue (39 patients) or seton (25 patients) treatment. Patients failing to heal after treatment with fibrin glue were re-randomized to undergo a second injection with glue or seton treatment. RESULTS Sixty-two of the 64 patients completed the minimum 1-year follow-up period. Twenty-one of 24 patients healed in the seton group compared with 15/38 in the fibrin glue group (P = 0.0007). The 23 failures after glue treatment were re-randomized to have a second glue injection (eight patients) or a seton treatment (15 patients). Four of the eight (50%) patients treated with a second injection of glue, and nine out of the 15 (60%) patients in the seton group, healed. Patients treated with fibrin glue reported less postoperative pain and had a shorter hospital stay than patients treated with a seton; furthermore, faecal continence and anal manometry significantly worsened after seton treatment. CONCLUSION Seton treatment has a significantly higher probability of success compared with fibrin glue treatment but poses a higher risk of faecal incontinence. Fibrin glue could be considered as a first line of treatment for patients at risk of faecal incontinence or other comorbidities.
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Affiliation(s)
- D F Altomare
- Department of Emergency and Organ Transplantation, University of Bari, Italy.
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Altomare DF. Scoring the obstructed defaecation syndrome: need for clarity. Colorectal Dis 2010; 12:1274-5. [PMID: 20955510 DOI: 10.1111/j.1463-1318.2010.02445.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Infantino A, Bellomo R, Dal Monte PP, Salafia C, Tagariello C, Tonizzo CA, Spazzafumo L, Romano G, Altomare DF. Transanal haemorrhoidal artery echodoppler ligation and anopexy (THD) is effective for II and III degree haemorrhoids: a prospective multicentric study. Colorectal Dis 2010; 12:804-9. [PMID: 19508513 DOI: 10.1111/j.1463-1318.2009.01915.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM We report a multicentric prospective study which aimed to evaluate Doppler-assisted ligation of the terminal haemorrhoidal arteries (THD) for II and III degree haemorrhoids. METHOD A total of 112 patients from five colorectal units, including 81 men, mean age 48 +/- 13 years, with II degree (39) and III degree (73) haemorrhoids were treated by Doppler-guided transanal de-arterialization and anopexy using a new device (THD). RESULTS The mean operative time was 33.9 +/- 8.8 minutes, and the mean number of ligatures applied was 7.2 +/- 1.5. Postoperatively, 72% of patients did not need analgesics and the other 28% used nonsteroidal antiinflammatory drugs 1-3 times/day for less than 2 days. All the patients were operated as a day case. Early postoperative complications included haemorrhoidal thrombosis (2 patients), bleeding (1) treated by haemostatic suture, dysuria (6) and acute urinary retention (1). After a mean follow-up of 15.6 +/- 6.5 months (range 6-32), 2/105 (20.9%) patients complained of minor bleeding, while mild pain was still present in 4/51 patients (7.8%). There were no statistically significant differences in the sample population regarding the gender or stage of the disease. Tenesmus was cured in 15/17 patients, dyschaezia in 20/22 patients and mucous soiling in 10/10 patients. No new cases of altered defaecation or faecal incontinence were recorded. Overall, 85.7% of patients were cured and 7.1% improved. Residual haemorrhoids were treated by elastic band ligation in nine (8%) patients and by surgical excision in further five patients (4.5%). CONCLUSION Doppler-assisted ligation of the terminal branches of the haemorrhoidal arteries for II and III degree haemorrhoids is highly effective and painless. Complications are few and the technique can be performed as a day case.
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Affiliation(s)
- A Infantino
- Surgical Unit, Santa Maria dei Battuti Hospital, S. Vito al Tagliamento (PN), Italy.
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Verriello V, Altomare M, Masiello G, Curatolo C, Balacco G, Altomare DF. Treatment of post-prostatectomy rectourethral fistula with fibrin sealant (Quixil™) injection: a novel application. Tech Coloproctol 2010; 14:341-3. [PMID: 20549535 DOI: 10.1007/s10151-010-0590-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Accepted: 05/24/2010] [Indexed: 11/28/2022]
Abstract
Rectourethral fistulas in adults is a rare but potentially devastating postoperative condition requiring complex and demanding surgery. Fibrin glue treatment has been used with some success in anal and rectovaginal fistulas, and in the case we present here this indication has been extended to a postoperative rectourethral fistula following radical prostatectomy. For the first time, to our knowledge, a fibrin sealant (Quixil) was injected into the fistula tract, and a rectal mucosal flap was used to close the internal opening. The fistula healed in few weeks, and the patient is symptom free after 1 year of follow-up.
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Affiliation(s)
- V Verriello
- Urological Department, Don Tonino Bello Hospital, ASL BA, Molfetta, Italy
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