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Abstract
The urinary tract reconstruction in renal transplantation is usually performed by a ureterocystoneostomy according to Gregoire-Lich technique. In selected patients, native ureteral ligation with nephrectomy was done when end-to-end anastomosis for ureteroureterostomy was performed. Recently, some Authors have proposed the ligation of the native ureter without nephrectomy. We report our experience in the ligation of the native ureter with no associated nephrectomy. Materials and Methods In 978 renal transplantations performed from April 1986 through December 2006, we evaluated 68 recipients (69.5%) who underwent ureteral ligation without nephrectomy. Mean diuresis was 314 cc/day (range 0–1200 cc/day). Follow-up was 1 to 187 months. Results Only one patient (1.5%) required native nephrectomy for fever and abdominal pain. None of the other patients showed infections involving native kidney or flank pain during the follow-up. Discussion and Conclusion Our experience confirms the safety and feasibility of native ureter ligation without omolateral nephrectomy. Nephrectomy is indicated in the case of coexistent intrinsic renal disease, such as non-treatable nephrovascular hypertension, symptomatic polycystic kidney disease, chronic renal infection.
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Affiliation(s)
- E. Capocasale
- UO di Clinica Chirurgica Generale e dei Trapianti d'Organo
| | - N. Busi
- UO di Chirurgia d'Urgenza, Azienda Ospedaliero-Universitaria di Parma
| | - M.P. Mazzoni
- UO di Clinica Chirurgica Generale e dei Trapianti d'Organo
| | - R. Dalla Valle
- UO di Chirurgia d'Urgenza, Azienda Ospedaliero-Universitaria di Parma
| | - G. Ferreri
- UO di Clinica Chirurgica Generale e dei Trapianti d'Organo
| | - M. Sianesi
- UO di Clinica Chirurgica Generale e dei Trapianti d'Organo
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Sianesi M, Bertocchi E, Rossini M, Del Rio P, Viani L. Ovarian metastases from colorectal cancer: prognostic role of prophylactic oophorectomy. A single center experience. EUR J GYNAECOL ONCOL 2016; 37:792-795. [PMID: 29943922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND The incidence of ovarian metastases (OM) from colorectal cancer (CRC) is uncommon but women with OM from CRC had poorer quality of life and decreased survival. Mateials and Methods: The authors retrospectively categorized women submitted to surgery for CRC from January 2004 to December 2012 considering previous mono- or bilateral-oophorectomy, oophorectomy performed during colorectal resection, and oophorectomy performed after surgery for CRC and its cause. The analysis focused on two groups: women who underwent surgery for CRC before menopause and after menopause. Survival outcome in terms of overall survival (OS) and disease- free survival (DFS) were assessed and appearance of OM was also evaluated. RESULTS In postmenopausal women with CRC who underwent left hemicolectomy or anterior resection of the rectum the incidence of OM was 4 % with a statistical significance (p < 0.05). The mean OS of patients with metachronous OM was 26 months and the patients' age ranged from 60 to 70 years. CONCLUSION The authors suggest prophylactic oophorectomy in postmenopausal women with an age between 60 and 70 years with cancer of left colon or rectum; in these patients there was an increased risk of metachronous OM with related decrease of OS.
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Dell'Abate P, Bertocchi E, Bresciani P, Bonati E, Del Rio P, Sianesi M. A rare case of sclerosing encapsulating peritonitis: can we make a preoperative diagnosis? MINERVA CHIR 2015; 70:493-495. [PMID: 26657759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- P Dell'Abate
- OU General Surgery and Organ Transplantation, Department of Surgical Sciences, University Hospital of Parma, Parma, Italy -
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Capocasale E, De Vecchi E, Mazzoni MP, Dalla Valle R, Pellegrino C, Ferretti S, Sianesi M, Iaria M. Surgical site and early urinary tract infections in 1000 kidney transplants with antimicrobial perioperative prophylaxis. Transplant Proc 2015; 46:3455-8. [PMID: 25498071 DOI: 10.1016/j.transproceed.2014.07.071] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 07/15/2014] [Indexed: 01/14/2023]
Abstract
Surgical site infections (SSIs) and early urinary tract infections (UTIs) are well recognized postoperative kidney transplant complications. These complications seldom lead to graft loss, although they may result in significant morbidity with prolonged hospitalization. Thus, perioperative antibiotic prophylaxis (PAP) has traditionally been used in this setting. Between April 1988 and December 2012, we identified 1000 kidney transplant recipients (33 from living donors) who underwent prophylaxis with ceftriaxone before the surgical procedure. A retrospective analysis was conducted to evaluate both the incidence rate and outcome of SSIs and UTIs. Recipients who developed SSIs were also assessed to identify risk factors and potential correlations with different immunosuppressive regimens. A total of 20 SSIs (2%) and 93 UTIs (9.3%) were observed. The most significant risk factor for SSIs was urine leak (15.38%; odds ratio [OR], 12.3; P < .0001) followed by sirolimus-based maintenance immunosuppression therapy (5%; OR, 2.97; P = .04) and induction therapy with either antithymocyte globulin or basiliximab (3.18%; OR, 3.45; P = .01). Sex was identified as the only risk factor for UTI (female vs male, 17.1% vs 4.6%; P < .0001). We believe universal ceftriaxone-based prophylaxis is useful for preventing SSIs and UTIs, considering its effectiveness and safety profile.
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Affiliation(s)
- E Capocasale
- Division of General Surgery and Organ Transplantation, Department of Surgery, Parma University Hospital, Parma, Italy
| | - E De Vecchi
- Division of General Surgery and Organ Transplantation, Department of Surgery, Parma University Hospital, Parma, Italy
| | - M P Mazzoni
- Division of General Surgery and Organ Transplantation, Department of Surgery, Parma University Hospital, Parma, Italy
| | - R Dalla Valle
- Division of General Surgery and Organ Transplantation, Department of Surgery, Parma University Hospital, Parma, Italy
| | - C Pellegrino
- Division of General Surgery and Organ Transplantation, Department of Surgery, Parma University Hospital, Parma, Italy
| | - S Ferretti
- Division of Urology, Department of Surgery, Parma University Hospital, Parma, Italy
| | - M Sianesi
- Division of General Surgery and Organ Transplantation, Department of Surgery, Parma University Hospital, Parma, Italy
| | - M Iaria
- Division of General Surgery and Organ Transplantation, Department of Surgery, Parma University Hospital, Parma, Italy.
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Del Rio P, De Simone B, Fumagalli M, Viani L, Totaro A, Sianesi M. Ultrasound and thyroiditis in patient candidates for thyroidectomy. MINERVA ENDOCRINOL 2015; 40:1-7. [PMID: 24699707] [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 Thyroiditis is often associated with nodules based on the Bethesda classification system, and the presence of thyroiditis can make thyroid surgery difficult using both conventional techniques and minimally invasive videoassisted approaches (MIVAT). METHODS We analyzed 326 patients who underwent total thyroidectomy in 2012. We collected all data in dedicated database. The patients were divided in 4 groups: group 1 no affected by thyroiditis, group 2 affected by thyroiditis, group 3 only histological diagnosis of thyroiditis, group 4all patients affected by thyroiditis. RESULTS Group 1 included 201 cases, group 2 included 64 patients, group 3 included 61 patients. No statistically significant difference between group 2 and 3 about Ultrasound (US) examination. Statistically significant difference in incidence of "THYR 3-4" between group 1 and group 4. No differences in MIVAT vs. Conventional group. CONCLUSION US examination of the thyroid is essential for the diagnostic study of the gland also in the selection of a surgical approach. Thyroiditis is a relative contraindication to MIVAT but the experience of the endocrine surgeon is the most important factor to reduce intra and postoperative complications together a correct collaboration in multidisciplinart endocrinological team.
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Affiliation(s)
- P Del Rio
- Operative Unit of General Surgery and Organ Transplantation Department of Surgical Sciences University of Parma, Parma, Italy -
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Bertocchi E, Arcuri M, Sianesi M. Can we define a role for perisentinel lymph-nodes on breast cancer disease? Eur J Surg Oncol 2015. [DOI: 10.1016/j.ejso.2014.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Viani L, Del Rio P, Sianesi M. Minimally invasive video assisted thyroidectomy (MIVAT) and papillary thyroid carcinoma. Eur J Surg Oncol 2015. [DOI: 10.1016/j.ejso.2014.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Zannoni M, Luzietti E, Viani L, Nisi P, Caramatti C, Sianesi M. Wide resection of inguinal nerves versus simple section to prevent postoperative pain after prosthetic inguinal hernioplasty: our experience. World J Surg 2014; 38:1037-43. [PMID: 24271696 DOI: 10.1007/s00268-013-2363-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND In the literature, chronic groin pain (i.e. lasting >3 months) occurs in about 10 % of patients who undergo inguinal hernioplasty with prosthesis; it is characterized by a broad range of symptoms, and is relative to individual perceptions of pain. In 2-5 % of cases, the painful symptomatology is so intense that it interferes with daily activities, and can be debilitating in 0.5-6 % of cases. The best known cause of inguinodynia is neuropathy, due to implication of one or more inguinal nerves (iliohypogastric, ilioinguinal, and genitofemoral nerves) into fibroblastic processes; or from nervous stimulation caused by prosthetic material on adjacent nervous trunks. Many therapeutic strategies have been proposed to treat chronic groin pain, including intra-operative prophylactic neurectomy. OBJECTIVE The purpose of our study was to perform a comparative analysis between outcomes from wide resections of inguinal nerves versus those from simple nervous section (or minimal resection). PATIENTS AND METHODS We considered 350 patients who had undergone inguinal prosthetic hernioplasty with Trabucco's technique between 2004 and 2010. Wide nervous resection (removal of nerve segments 3-8 cm in length) was performed in 180. The other 170 patients underwent simple section or minimal resection. All patients were checked 1 week, 1 month, and 1 year after surgery. RESULTS Group 1: At 1-week follow-up, 63 patients (35 %) reported no pain, 113 (63 %) reported moderate pain, and 4 (2 %) intense pain; 1 month after the procedure, 152 patients (84.4 %) reported no pain, 25 (14 %) complained of moderate pain, and 3 (1.6 %) of severe pain; 1 year after surgery, only 1 patient (0.5 %) complained of constant pain. Group 2: At 1 week follow-up, 48 patients (28 %) reported no pain, 101 (59 %) reported moderate pain, and 21 (13 %) intense pain; 1 month after the procedure, 81 patients (47.6 %) had no pain, 72 (42.4 %) complained of moderate pain, and 17 (10 %) of severe pain; 1 year after surgery, 11 patients (6.5 %) had constant pain, and two of them were re-admitted for surgery. The lower incidence of chronic pain after long nervous resection is statistically significant (0.5 vs. 6.5 %; p = 0.006); the incidence of moderate pain 1 month after operation is also lower (14 vs. 42.4 %; p < 0.0001); patients who underwent a long resection experienced faster resolution of pain symptomatology, during a month. Also noteworthy is the lower incidence of intense pain in the short and medium term (after 1 week, 13 vs. 2 %, p = 0.0005; after 1 month, 10 vs. 1.6 %, p = 0.0018). CONCLUSIONS The prophylactic wide resection of selected segments of inguinal nerves, despite the apparent paradox of greater tissue damage, appears more effective than simple section at preventing postoperative inguinodynia, given both the lower incidence and the faster resolution of painful symptomatology.
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Affiliation(s)
- M Zannoni
- Department of Surgical Science, University of Parma, Via Gramsci 14, 43126, Parma, Italy,
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Del Rio P, Bonati E, Crafa P, Campanini N, Montana Montana C, Bezer L, Dell'Abate P, Sianesi M. CD133 is a selective marker of CRC? MINERVA CHIR 2013; 68:87-95. [PMID: 23584268] [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: 06/02/2023]
Abstract
AIM The aim of our study is to evaluate the surface glycoprotein CD133 as marker of cancer stem cells, as independent prognostic pattern of survival and its positive expression ratio to a chemotherapy increased resistance. METHODS The study include our patient, affected by colorectal cancer (CRC) and underwent to surgery at University Hospital of Parma, with curative intent, with a follow up of 5 years; 47 cases were considered. All the cancer-case was considered independently by the histological grade. The monoclonal antibody CD133/1 (clone AC133-MAC, Miltenyi Bioetec, Auburn CA 95602, USA) that recognizes the epitope 1 of CD133 was utilized for the immunohistochemical process. RESULTS On the total of 47 patients taken in exam, 8 were excluded for lack of date, 13 were lost during the follow-up. The final number of patients included in the study was 26(17 males and 9 females), medium age of 72.2 years. 2 Stage I, 8 Stage II A, 1 II B, 2 III A, 5 III B, 5 IIIC and 3 IV. Despite for 1, 25 on 26 patients were positive to CD133 (96.5 %), with different dye intensity, directly related at the positive cell pull. The CD133 positivity wasn't therefore related at any other clinic-pathological characteristic. CONCLUSION The results obtained from our study goes in the same direction with others, that confirm a high representation of CD133 on the colic tumoral epithelium. It will be appropriate to do prospected and randomized studies, with a larger casistic, utilizing similar methods and a patients populations with more uniform characteristics, to verify the real role of CD133 and other molecules potentially marker of tumoral stem cell (TSC).
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Affiliation(s)
- P Del Rio
- Unit of Surgery and Organ Transplantation University Hospital of Parma, Parma, Italia -
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Abstract
Schwannoma is a rare benign tumor of nerve fibers that originates from neuronal sheath cells; it is frequently located extramedullary and about 25-45 % of this type of neoplastic lesion is localized in the head and in the neck. Primary schwannoma of the thyroid gland is very uncommon. We report the case of a 50-year-old female patient affected by schwannoma of the thyroid gland underwent total thyroidectomy for nodule of the left lobe suspicious for neoplasm, without complications.
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Affiliation(s)
- B De Simone
- Department of Surgical Science, Unit of General Surgery and Organ Transplantation, University Hospital of Parma, Via Gramsci 14, 43100, Parma, Italy,
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Del Rio P, Bertocchi E, Sommaruga L, Iapichino G, Montana C, Dell'abate P, Sianesi M. Use of preoperative visceral echo-color-Doppler in patients candidates to colonic surgery: preliminary report. MINERVA CHIR 2012; 67:481-487. [PMID: 23334111] [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: 06/01/2023]
Abstract
AIM Postsurgical paralytic ileus is by definition an ileal paralysis longer than three days (72 hours) after a surgery on the gastrointestinal tract. At colorectal surgery we have performed on all candidates a visceral echo-color-Doppler to find a potential correlation with cardiovascular risk factors. METHODS We have tested patients undergone to colorectal surgical resection performed by laparoscopic and laparotomic surgery, looking for their atherosclerosis status using ultrasound scan, postsurgical complication, bowel digestive function, anastomotic leak. We have also analyzed for each case the value of glycemia, azotemia, creatinemia, cholesterolemia, triglyceridemia, leukocytemia, mean cell volume, hemoglobinemia, albuminemia and moreover age, disease, pathology localization, kind of surgery, weight and height, body mass index (BMI), ASA status (American Society of Anesthesiologists, electrocardiographic distortions, nicotine dependency, diabetes mellitus type I and II). RESULTS The study enrolled 23 patients, 10 male and 13 female. Middle age was 68.65 ± 11.85 years (range 39-90). In the female subgroup mean age was 69.48 years (range 39-90), while in the male subgroup it was 68 years (range 54-81). In 17 cases out of 23 (73.9%) there was a delay in digestive function, of over 72 hours, with a mean time duration of the paralytic ileus of 4.74 ± 1.60 days (range 3-9). Furthermore a statistically significant correlation between albuminemia and hemoglobinemia presurgery values and lower sierical albuminemia presurgery values in patients who were canalized too late (P=0.03; P=0.041) was found. The non-parametrical values analysis sec. Kruskal-Wallis emphasized a significant correlation between the canalization day, the elettrocardiographic evidence of the pathological situation (P=0.023) and the patient's smoking history (0.023). Another significant value was the creatininemia value: lower values of creatininemia were related to a delayed canalization (P=0.035). CONCLUSION The statistical analysis does not allow to highlight any correlation between the ultrasound diagnosis of atherosclerosis and the delayed canalization.
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Affiliation(s)
- P Del Rio
- Unit of General Surgery and Organ Transplantation, Department of Surgical Science, University Hospital of Parma, Italy.
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Zannoni M, Viani L, Caramatti C, Iaria M, Sianesi M. Can we pursue minimal invasive surgery in the setting of converted laparoscopic cholecystectomy? Consideration about the "MIVAC" approach. MINERVA CHIR 2012; 67:469-473. [PMID: 23334109] [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: 06/01/2023]
Abstract
AIM Laparoscopic cholecystectomy (LC) is the standard of treatment for symptomatic gallstones disease. Despite surgeon's expertise and laparoscopic technical skills, at times conversion to open laparotomy is still required to carry out safely the surgical procedure. In such cases, we still pursue a minimally invasive approach based on a very short subcostal laparotomy supported by laparoscopic magnification of the reduced surgical field. We named the procedure Minimally Invasive Video-Assisted Cholecystectomy (MIVAC). In the setting of a truly minimal laparotomy, the implementation of a laparoscope makes the difference in terms of improving observation respect to naked eye, providing both details' magnification and deep field illumination. METHODS Between 2003 and 2010, 1054 LC were performed at a single institution. Seventy-two LC were converted to open laparotomy (6.83%). Reasons for conversion included technical difficulties, aberrant biliary anatomy, dense scarring related to severe cholecystitis, biliary injuries and significant operative bleeding. Our primary endpoint was to evaluate the level of post-operative discomfort along with patient satisfaction from an aesthetic standpoint. RESULTS Postoperative pain was comparable to LC while subcuticular running sutures ensured acceptable cosmetic results. Medium hospital stay was 24 hours. Both operative and recovery times were comparable to LC and postoperative liver function tests and routine labs did not differ significantly from the preoperative checks. CONCLUSION The "so called" MIVAC approach appears to be a valid alternative to traditional open cholecystectomy whenever conversion to laparotomy becomes mandatory during the course of LC.
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Affiliation(s)
- M Zannoni
- Division of General Surgery and Organ Transplantation, Department of Surgical Sciences, Parma University Hospital, Italy.
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Del Rio P, Cataldo S, Nizzoli R, Negri M, De Simone S, Sianesi M. Preoperative diagnosis of THYR 3 versus follicular lesion: malignant postoperative ratio. MINERVA CHIR 2012; 67:429-432. [PMID: 23232481] [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: 06/01/2023]
Abstract
AIM In the evaluation of nodular thyroid lesions, cytology is the main diagnostic instrument, associated with ultrasound examination. METHODS We prospectively categorized into a dedicated database, 612 patients submitted to thyroidectomy from January 2009 to December 2011. We selected two groups of patients: the cases with "follicular lesions" and the cases classified as "THYR 3" using Bethesda Classification. RESULTS Of 612 patients submitted to TT, in 68 cases, 8 males (M) and 60 females (F), we recorded a preoperative cytological diagnosis compatible with THYR 3 class. In 56 cases, 82.4% of the patients (5 M, 51 F), we performed a thyroidectomy with Conventional technique (CT) and in 12 cases, 12.6% of the patients (3M, 9F) with video-assisted technique (MIVAT). In 39 cases (57.1%) of the THYR 3 patients treated, a benign disease was found while in the other 29 cases (42.9%) a differentiated thyroid cancer (DTC) were found. In patients with nodules classified as "follicular proliferation", treated in the same period and by the same surgical team, we recorded 97 cases (79 F, 18 M). The patients were treated with TT in 72 cases, with MIVAT in 22 cases; in 3 cases we performed a HT with traditional technique. Adenomatous hyperplasia was found in 51; DTC was found in 21 cases and adenoma in 25 cases. The analysis of the incidence of benign versus malignant disease between the 2 groups showed a P<0.0001. CONCLUSION In our experience, we recommend surgery, TT or HT, for THYR 3 nodules analyzed for the first time by FNAB with sonographic pattern suspicious for malignancy.
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Affiliation(s)
- P Del Rio
- University Hospital of Parma, Unit of General Surgery and Organ Transplanatation, University Hospital of Parma, Italy.
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Del Rio P, Cataldo S, Pisani P, De Simone B, Iapichino G, Sianesi M. Use of oxidized and regenerated cellulose in thyroid surgery: a prospective analysis as cause of postoperative hypocalcemia on 485 patients consecutively treated. MINERVA ENDOCRINOL 2011; 36:157-162. [PMID: 22019746] [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: 05/31/2023]
Abstract
AIM The intraoperative hemorrage determines an higher risk of parathyroid glands lesions, and laryngeal nerve injuries. We have examined if the use of oxidized and regenerated cellulose could be a cause of postoperative hypocalcemia because of the compression on the parathyroid glands or for tissue adhesions METHODS From June 2009 to December 2010 we have examined 485 patients consecutively treated with total thyroidectomy. The cases examined were divided in two groups on the use of ionized cellulose (group A and B). 24 hours after surgical procedure, all patients were submitted to serum calcium evaluation. The data were analyzed with χ2 test and t-student test; P<0.05 was statistically significant. RESULTS We have selected 372 cases out of 485 examined. We have registered after 10 hours from surgical procedure a case of hemorrhage with reintervention in group B (no use of cellulose). The cost of ionized cellulose is € 46; we have used this device in 212 cases on 372 patients undergone to total thyroidectomy, with a cost of € 9 752. The mean value of the serum calcium was statistically different between pre- and postoperative evaluation in all cases (P<0.0001) divided both on gender and on the use of hemostatic devices. CONCLUSION In our experience, there isn't a statistically significant difference on incidence of postoperative hypocalcemia, related to use of ionized and regenerated cellulose on mean surgical time in all patients either treated with traditional surgery or with video-assisted procedure.
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Affiliation(s)
- P Del Rio
- University Hospital of Parma, Parma, Italy.
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Del Rio P, Minelli R, Cataldo S, Ceresini G, Robuschi G, Corcione L, Guazzi A, Nizzoli R, Sianesi M. Can misdiagnosis in pre-operative FNAC of thyroid nodule influence surgical treatment? J Endocrinol Invest 2011; 34:345-8. [PMID: 20588087 DOI: 10.1007/bf03347457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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] [Indexed: 12/30/2022]
Abstract
BACKGROUND Pre-operative cytology in thyroid disease remains the most appropriate diagnostic test for defining the nature of a thyroid nodule before surgical excision. MATERIALS AND METHODS We selected the most recent 825 surgical thyroid procedures performed in our institution from January 2004 to June 2007; 776 were total thyroidectomies, 23 were lobe-isthmectomies, and 26 were radical neck dissections. We distributed the data based on pre-operative cytology. Each cytological diagnosis was compared to results obtained by definitive histology. Tumors were called incidentalomas if they consisted of a neoplastic focus with a low grade of aggressiveness, as demonstrated by dimension <5 mm, non-aggressive histological subtype. RESULTS Of the 541 cases of benign disease, 417 were confirmed as benign. The other 124 cases are listed as follows: 29 follicular adenoma; 76 papillary carcinoma (35 found as incidentalomas), and 19 follicular carcinoma (3 incidentalomas). Cytology suggestive of papillary carcinoma was correct in 95.2% of cases (119/125). The 135 tumors termed "follicular neoplasm" were staged on pathology thus: 56 adenoma (41.4%), 26 carcinoma (19.2%), 13 (9.6%) absence of follicular proliferation, 38 (28.1%) papillary follicular variant, 2 (1.4%) undifferentiated cells. Medullary carcinomas were both confirmed. The "suspicious group" exhibited no malignancy on fine needle aspiration cytology (12 of 21; 57%). CONCLUSIONS Cytology has good reliability in malignant lesions. Incidental tumors occurring in benign disease have little impact on clinical and surgical management; "follicular neoplasm" posed two problems - the impossibility of identifying the nature of the tumor, as well as the newer difficulty in distinguishing papillary follicular subtype.
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Affiliation(s)
- P Del Rio
- Unit of General Surgery and Organ Transplantation, Department of Surgical Science, University Hospital of Parma, Parma, Italy.
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Del Rio P, Casali L, Pelli M, Sianesi M, Dell'abate P. Self-expanding metal stent for benign colonic stricture. A rare case of long-term follow-up in a patient with ischemic colitis due to abdominal aortic aneurysm rupture. MINERVA CHIR 2011; 66:167-168. [PMID: 21593718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Del Rio P, Dell'Abate P, Sianesi N, Fumagalli M, De Simone B, D'Addetta F, Patrelli TS, Sianesi M. Right colon laparoscopic resection with three-trocar access and associated gynecological procedures in patients with colorectal cancer and ovarian metastases. EUR J GYNAECOL ONCOL 2011; 32:509-512. [PMID: 22053663] [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: 05/31/2023]
Abstract
BACKGROUND Right laparoscopic colectomy was introduced to colorectal surgery later than the left colon procedure. Three-trocar laparoscopy has already been used successfully in the treatment of gynecological cancers. In the present study, we aimed to analyze the feasibility of performing an associated gynecological procedure following abdominal laparoscopic exploration and to evaluate the suitability of laparoscopic right colectomy for treating elderly patients. METHODS We conducted a review of prospectively collected data on 100 consecutive patients who were treated with right laparoscopic colectomy using three trocars from January 2005 to April 2010. We recorded the patients' age (<70 or > 70 years), ASA status, body mass index (BMI), pain on postoperative days 1 and 2 (POD 1, 2), nodes retrieved, laparotomic conversion, mean operative time, time to intestinal recovery, and length of postoperative stay. RESULTS All subjects were treated for cancer. Conversion to the laparotomic procedure was performed in 13/100, with no difference in terms of age. Operative time was longer for laparotomic conversion (p <0.05), with a longer postoperative stay. Elderly patients had higher ASA scores (p < 0.005); age did not influence the conversion rate or BMI status. Pain on POD 1 and 2 differed between the laparotomic and laparoscopic groups (p <0.0001). Associated procedures were performed in five subjects (3 oophorectomy and 2 cholecystectomy). CONCLUSIONS Laparoscopy using the three-trocar technique is a safe procedure for treating colon cancer, including in elderly patients, and enables associated gynecological laparoscopic procedures to be performed.
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Affiliation(s)
- P Del Rio
- Department of Surgical Science, University Hospital of Parma, Italy
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Del Rio P, Sommaruga L, Bezer L, Arcuri MF, Cataldo S, Ceresini G, Sianesi M. Preoperative PTH as a marker of risk for post-thyroidectomy hypocalcemia. MINERVA ENDOCRINOL 2010; 35:47-52. [PMID: 20595934] [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: 05/29/2023]
Abstract
AIM There are no common guidelines to identify the population at risk to develop hypocalcemia preoperatively or early in the postoperative course in thyroidectomized patients, therefore the authors suggest to examine the PTH value preoperatively. METHODS We divided 391 patients in two groups according to the preoperative PTH level (normal, ≤ 72 pg/mL vs. increased >73 pg/mL). RESULTS In 92/391 cases (23.52%) preoperative PTH was increased (mean PTH level 112.4+/-24.8 pg/mL; normal range 12-72 pg/mL). Out of these, 43 (46.7%) had hypocalcaemia postoperatively. In 18 out of the 43 patients clinical hypocalcemia also developed. The mean follow-up was of 148+/-13 days. Of the 299 patients with normal preoperative PTH, 127 (42.47%) developed postoperative hypocalcemia (mean calcium level 7.4+/-0.33 mg/dL). In 30 patients it was also clinically evident. The difference in terms of incidence of symptomatic hypocalcemia was statistically significant (increased preoperative PTH 19.5% vs. normal preoperative PTH 10.03% , P=0.036). CONCLUSION All candidates to thyroidectomy should be investigated for preoperative PTH abnormalities.
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Affiliation(s)
- P Del Rio
- Department of Surgical Science, General Surgery and Organ Transplantation, Parma University Hospital, Parma, Italy.
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Del Rio P, Bezer L, Palladino S, Arcuri MF, Iotti E, Sianesi M. Operative time and postoperative pain following minimally invasive video-assisted parathyroidectomy. G Chir 2010; 31:155-158. [PMID: 20444332] [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: 05/29/2023]
Abstract
BACKGROUND Mininvasive surgical techniques have been proposed to treat the patients affected by parathyroid adenoma starting by endoscopically-assisted parathyroidectomy up to video-assisted and radio-guided approaches. PATIENTS AND METHODS Our technique, minimally invasive video-assisted parathyroidectomy (MIVAP), in accord with Miccoli's technique, has been introduced in our center since 2006 after extensive experience with MIVAT (minimally invasive videoassisted thyroidectomy). From September 2006 to October 2008 we performed 32 MIVAP on 32 patients, 21 female and 11 males with a mean age of 53.4 years (range 25-77) affected by parathyroid adenoma. Patients have been divided in two groups in chronological order: Group A included the first 15 patients, Group B the second ones. RESULTS Mean operative time from incision to skin closure has been 47.4+/-14.2 minutes for group A and 34+/-10.3 minutes for group B (p<0.01). Postoperative pain, scored from 0 to 10 evaluated at time 0 and after 24 hours from the procedure, has been of 2.6+/-0.5 and 1.4+/-0.5 in group A (p<0.001) while in group B of 2.58+/-0.51 and 1.16+/-0.38 (p<0.001) respectively. The difference in postoperative pain was not significant between the two groups and the pain was controlled by the administration of paracetamol 1 g. On the other side, the comparison between postoperative pain in patients operated via traditional bilateral cervical exploration and MIVAP (2.61+/-0.5 vs 3.55+/-0.51 and 1.38+/-0.5 vs 2.16+/-0.61 at 0 and 24 hours respectively), was statistically significant (p<0.001) and in favour of MIVAP. CONCLUSIONS We showed a shorter operative time between the A group and B group. 15 cases are sufficient as good learning curve if the surgeon is experienced in videoassisted neck procedure. The postoperative pain is lower in videoassisted procedure than cervical bilateral approach.
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Affiliation(s)
- P Del Rio
- Department of Surgical Science, University of Parma, Italy
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Del Rio P, Arcuri MF, Cataldo S, Palladino S, Sianesi M. Can we use ionized calcium in the evaluation of post-thyroidectomy hypocalcemia? MINERVA ENDOCRINOL 2009; 34:289-293. [PMID: 20046158] [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: 05/28/2023]
Abstract
AIM The postoperative hypocalcaemia has the higher incidence as complications related to thyroidectomy. METHODS From 1 June 2006 to 30 June 2008, we examined 492 patients operated on consecutively in our unit with a total thyroidectomy for thyroid disease. We evaluated the values of ionized calcium in all the cases, matching these with the preoperative and postoperative values of serum calcium. The pre- and postoperative (24 hours after treatment) data for ionized calcium and serum calcium were examined statistically with the Student's t-test; results with a P-value <0.05 were considered to be statistically significant. RESULTS Two-hundred-and-twenty-three of the 492 patients (45.2%) treated with total thyroidectomy had preoperative values of ionized calcium lower than 1.13 mmol/L (normal values 1.13-1.32 mmol/L), while the ionized calcium values were lower than 1.10 mmol/L in 154 of the 223 patients. The mean value of ionized calcium in all 223 cases was 1.04+/-0.07 mmol/L. The mean serum calcium value in these patients was 9.13+/-0.291 mg/dL (normal values 8.3-10.5 mg/dL). In the other 259 cases, the values of ionized calcium and serum calcium were 1.21+/-0.03 mmol/L and 9.1+/-0.29 mg/dL, respectively. In 75 cases on 223 with symptomatic hypocalcemia, the mean value of ionized calcium was 0.88+/-0.05 mmol/L, while, in the remaining 148 cases, the mean value was equal to 0.97+/-0.08 mmol/L (P<0.001). We compared this, in both groups, with the values of postoperative serum calcium; in the 75 cases with clinical hypocalcemia, the value of serum calcium was 7.32+/-0.35 mg/dL, while the value was equal to 8.4+/-0.34 mg/dL in the other cases (P<0.001). CONCLUSIONS The values of ionized calcium must not be used as marker of hypocalcemia but must be seen as a diagnostic aid linked to others laboratory values, such as serum calcium.
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Affiliation(s)
- P Del Rio
- Department of Surgical Science, General Surgery and Organ Transplantation, University Hospital of Parma, Parma, Italy
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Negri M, Del Rio P, Sianesi M. [Brachial cyst: a case report]. G Chir 2009; 30:493-496. [PMID: 20109379] [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: 05/28/2023]
Abstract
The Authors present the clinical case of a 41 years old patient, presenting since two years a right cervical swelling, progressively grown up in the last two months with tight-elastic thickness. Pre-operative diagnostic tests suggested the suspect of II branchial arch cyst. By surgery we removed a cystic formation that appeared, at histopathologic exam with a multi-stratified coating, surrounded by lymphoid tissue, organized in germinative centres, compatible with branchial cyst structure.
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Affiliation(s)
- M Negri
- Università degli Studi di Parma, Dipartimento di Scienze Chirurgiche, Clinica Chirurgica e dei Trapianti d'Organo
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Dell'abate P, Del Rio P, Sommaruga L, Arcuri MF, Sianesi M. Laparoscopic treatment of sigmoid colon intussusception by large malignant tumor. Case report. G Chir 2009; 30:374-376. [PMID: 19735619] [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: 05/28/2023]
Abstract
Intestinal intussusception is rare in adults, but common in children. The ileocolic or appendiceal types are more frequent compared to the colo-colic one. We report successful laparoscopic left hemicolectomy in a patient with intussusception caused by a sigmoid tumor. Abdominal CT demonstrated a colo-colic intussusception at the level of the tumoral lesion with dilation of the proximal colon. The patient underwent urgent laparoscopic oncologically radical left hemicolectomy. A 10 cm Pfannenstiel incision allowed the removal of the resected segment. The laparoscopic approach was feasible because the dilation was moderate; however, if intussusception is due to cancer, laparoscopy can be safely performed if a correct and prompt diagnosis is achieved following oncologic criteria.
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Affiliation(s)
- P Dell'abate
- University of Parma, Surgical Department, Unit of General Surgery and Organ Transplantation
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Franceschin M, Capocasale E, Valle DALLA R, Mazzoni M, Busi N, Sianesi M. Living Donor Nephrectomy: Open versus Laparoscopic Technique. Urologia 2009. [DOI: 10.1177/039156030907600105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background The living donor nephrectomy has to be safe and effective, allowing a good graft function in the recipient. In the past, donor nephrectomy was performed only by open technique; more recently this nephrectomy has also been performed by laparoscopic technique. The best technique has not been established in literature. The purpose of this study is to report the results of open and laparoscopic nephrectomy in living donors. Materials and Methods From January 1992 to August 2008, 37 living donor nephrectomies were performed. 23 nephrectomies were achieved by laparoscopic procedure (LDN) and 14 by open technique (ODN). The 2 groups were comparable regarding both donor and recipient characteristics. Results All laparoscopic nephrectomies were successfully performed without conversion to open procedure. No donor deaths were reported in either groups. 3 complications (13%) in the LDN group and 1 (7.1%) in the ODN group (p=0.6) were observed. Mean operative time was higher in the LDN group (p<0.036). Mean warm and cold ischemia time, resumption of oral intake and hospital stay were shorter in the LDN group (p<0.04)(p<0.03) (p<0.0001), whereas the return to normal occupational life was similar (p<0.52). We had no significant differences in the surgical complication rates, graft and patient survival. Conclusions Our experience suggests that both procedures can be used safely and efficiently, and assure a good renal function in the recipient. Laparoscopic nephrectomy, although more difficult, provides post-operative advantages. However, laparoscopic procedure must be performed by experienced centres only to prevent serious complications in the donor.
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Affiliation(s)
- M. Franceschin
- Dipartimento di Scienze Chirurgiche, Unità Operativa di Clinica Chirurgica Generale e dei Trapianti d'Organo
| | - E. Capocasale
- Dipartimento di Scienze Chirurgiche, Unità Operativa di Clinica Chirurgica Generale e dei Trapianti d'Organo
| | - R. Valle DALLA
- Unità Operativa di Chirurgia d'Urgenza, Azienda Ospedaliero-Universitaria di Parma
| | - M.P. Mazzoni
- Dipartimento di Scienze Chirurgiche, Unità Operativa di Clinica Chirurgica Generale e dei Trapianti d'Organo
| | - N. Busi
- Unità Operativa di Chirurgia d'Urgenza, Azienda Ospedaliero-Universitaria di Parma
| | - M. Sianesi
- Dipartimento di Scienze Chirurgiche, Unità Operativa di Clinica Chirurgica Generale e dei Trapianti d'Organo
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Franceschin M, Capocasale E, Dalla Valle R, Mazzoni MP, Busi N, Sianesi M. [Living donor nephrectomy: open versus laparoscopic technique]. Urologia 2009; 76:36-40. [PMID: 21086327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The living donor nephrectomy has to be safe and effective, allowing a good graft function in the recipient. In the past, donor nephrectomy was performed only by open technique; more recently this nephrectomy has also been performed by laparoscopic technique. The best technique has not been established in literature. The purpose of this study is to report the results of open and laparoscopic nephrectomy in living donors. MATERIALS AND METHODS. From January 1992 to August 2008, 37 living donor nephrectomies were performed. 23 nephrectomies were achieved by laparoscopic procedure (LDN) and 14 by open technique (ODN). The 2 groups were comparable regarding both donor and recipient characteristics. RESULTS. All laparoscopic nephrectomies were successfully performed without conversion to open procedure. No donor deaths were reported in either groups. 3 complications (13%) in the LDN group and 1 (7.1%) in the ODN group (p=0.6) were observed. Mean operative time was higher in the LDN group (p<0.036). Mean warm and cold ischemia time, resumption of oral intake and hospital stay were shorter in the LDN group (p<0.04)( p<0.03) (p<0.0001), whereas the return to normal occupational life was similar (p<0.52). We had no significant differences in the surgical complication rates, graft and patient survival. CONCLUSIONS. Our experience suggests that both procedures can be used safely and efficiently, and assure a good renal function in the recipient. Laparoscopic nephrectomy, although more difficult, provides post-operative advantages. However, laparoscopic procedure must be performed by experienced centres only to prevent serious complications in the donor.
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Sommaruga L, Del Rio P, Accardi FG, Cademartiri F, Arcuri MF, Sianesi M. [Severe obstruction of upper airway by cervicomediastinal goitre in patients with cardiopulmonary insufficiency]. G Chir 2008; 29:354-358. [PMID: 18834568] [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: 05/26/2023]
Abstract
The symptoms of the retrosternal goitre are due to the compression especially on airway, by thyroid growth in mediastinum. We present a case of an old woman affected by chronic obstructive broncopneumopathy, atrial fibrillation and mediastinal goitre. The previous growth in mediastinum was the cause of compression on airway with unexpected worsening of respiratory function. The risk of total thyroidectomy was related to the possible tracheomalacia. The surgery improved respiratory performance.
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Affiliation(s)
- L Sommaruga
- Università degli Studi di Parma, Dipartimento di Scienze Chirurgiche, Clinica Chirurgica Generale e Trapianti d'Organo
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Del Rio P, Cataldo S, Sommaruga L, Arcuri MF, Massa M, Sianesi M. Localization of pathological gland's site in primary hyperparathyroidism: ten years experience with MIBI scintigraphy. G Chir 2008; 29:186-189. [PMID: 18419988] [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: 05/26/2023]
Abstract
BACKGROUND Primary hyperparathyroidism (PHPT) is characterised by pathological hyperfunctioning of one or more of the parathyroid glands leading to excessive parathyroid hormone (PTH) secretion. The aim of this study was to assess the diagnostic capacity of scintigraphy with MIBI, considering the surgical findings and the level of agreement with the result of cervical ultrasonography. PATIENTS AND METHODS In the period January 1996 to January 2006, 84 cases with PHPT were included in the study, in which scintigraphy with MIBI was used in addition to cervical ultrasonography. All were hospitalised as "short stay surgery" patients and then seen as outpatients at follow-up visits (at 7, 14 and 30 days), during which calcium, phosphorus and PTH values were measured. RESULTS In 55 cases (65.5%), the site of the pathology was suspected on the basis of the cervical ultrasonography. Scintigraphy with MIBI was positive in 76 cases (90.4%) and negative in the other eight (9.6%). In six of these eight cases the site had been detected by the cervical ultrasonography. In the remaining two cases (2.4%), neither of these examinations gave positive diagnostic findings. In 58 patients we proceeded with the removal of a single adenoma, in 19 cases with the removal of two out of the four glands, and in seven cases with the removal of three out of the four glands, the single formations removed not showing clearly-defined macroscopic characteristics; in two of the seven patients in whom three of the four glands were removed, the preoperative diagnostic examinations had not shown any evidence of gland pathology. CONCLUSIONS We regard scintigraphy with MIBI as a preoperative diagnostic examination that has modified the surgical approach to PHPT, inclining surgeons towards a mini-invasive surgical procedures. We consider CT, MRI and SPECT techniques to be indicated only in cases of relapse of PHPT, possibly associated with ectopic localisation of the parathyroid gland not identified in the course of previous surgical procedures.
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Affiliation(s)
- P Del Rio
- Department of Surgical Sciences, University of Parma, Parma
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Del Rio P, Cataldo S, Sommaruga L, Concione L, Arcuri MF, Sianesi M. The association between papillary carcinoma and chronic lymphocytic thyroiditis: does it modify the prognosis of cancer? MINERVA ENDOCRINOL 2008; 33:1-5. [PMID: 18277374] [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: 05/25/2023]
Abstract
AIM The association between papillary thyroid carcinoma (PTC) and chronic lymphocytic thyroiditis (CLT) has been reported in literature. The aim of this study was to examine this association evaluating the lesser or greater neoplastic aggressiveness. METHODS One hundred and eighty-nine patients were examined from June 2004 to June 2007; they were divided into two groups: Group A included all the patients affected by PTC without CLT and Group B all the patients affected by PTC with CLT association. The surgical treatment was in all the patients the total thyroidectomy (TT). For the study age, sex, tumour features (dimensions, angioinvasion, capsular infiltration, multifocality and lymphnode metastases) were taken into consideration. The analysis was carried on with Student t test and chi squared analysis (statistically significant P<0.05). RESULTS Group A included 117 patients; Group B 72 patients. No statistical difference in sex (P=0.989), age (P=0.480); tumour dimension (P=0.832). The capsular infiltration was present in 23 cases in Group A and 19 in Group B (P=0.368). The difference in average diameter was found to be 1.161+/-0.5812 and 1.485+/-1.082 cm in Group A and in Group B (P=0.290), respectively. The angioinvasion was found in 9 cases of Group A and in 3 cases in Group B (P=0.510). Multifocality was found in 35 patients in Group A and in 26 in Group B (P=0.469). CONCLUSION The CLT may have only a minimum impact in the development of the tumour. In this study the association does not modify the aggressiveness.
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Affiliation(s)
- P Del Rio
- Department of Surgical Science, General Surgery and Organ transplantation, University of Parma, Parma, Italy.
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Del Rio P, Sommaruga L, Cataldo S, Robuschi G, Arcuri M, Sianesi M. Minimally Invasive Video-Assisted Thyroidectomy: The Learning Curve. Eur Surg Res 2008; 41:33-36. [DOI: 10.1159/000127404] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
<i>Background:</i> MIVAT (minimally invasive video-assisted thyroidectomy) is a recent technique that requires a learning curve. <i>Materials and Methods:</i> From July 2005 to December 2006, we treated 100 from a total of 467 thyroidectomy patients with MIVAT. We divided the patients into 3 groups. The first 2 groups consisted of 25 patients each: group A (cases 1–25) and group B (26–50). We also divided patients into 2 groups based on our surgical experience: group A + B (cases 1–50) and group C (cases 51–100). <i>Results:</i> The operative times for groups A and B were 101.7 and 84.6 min, respectively (p < 0.03); those for groups A + B and C were 91.07 and 63.06 min, respectively (p < 0.004). Complications of hypocalcemia were observed in 6 cases (4 in the first 50 cases and 2 in the second 50), and complications of nerve palsy were observed in 2 cases from group A. <i>Conclusions:</i> After 25 cases, we observed that the MIVAT procedure allows for a lower mean operative time and a reduction of complications.
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Del Rio P, Berti M, Sommaruga L, Arcuri MF, Cataldo S, Sianesi M. Pain after minimally invasive videoassisted and after minimally invasive open thyroidectomy--results of a prospective outcome study. Langenbecks Arch Surg 2007; 393:271-3. [PMID: 17909847 DOI: 10.1007/s00423-007-0229-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2007] [Accepted: 09/10/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Substantial modifications in surgical treatment of thyroid disease have changed the postoperative management of thyroidectomized patients. The reduction of postoperative pain permit a short-stay surgery. MATERIALS AND METHODS We have analyzed the patients treated in our Unit from July 2006 to December 2006, with minimally invasive cervicotomy and mini-invasive video-assisted thyroidectomy. We have registered the postoperative pain applying an evaluation protocol numeric scale. The results were analyzed by t test. RESULTS One hundred thirteen patients were divided in two groups: group A, minimally invasive cervicotomy (15 male and 46 female patients); group B, mini-invasive video-assisted thyroidectomy (9 male and 43 female patients). Upon returning to the ward, the pain scale group A vs B was 2.77 +/- 1.16 vs 2.5 +/- 0.762 (p = 0.22) .At 24 h after surgery, the pain scale in group A was 1.82 +/- 1.258 vs 1.031 +/- 0.8608 (p < 0.005). CONCLUSIONS Both methods are safe, but mini-invasive video-assisted thyroidectomy gives not only a better cosmetic result but a reduction of postoperative pain especially at 24 h.
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Affiliation(s)
- P Del Rio
- Department of Surgical Science, General Surgery and Organ Transplantation, University of Parma, Parma, Italy.
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Frattini A, Capocasale E, Granelli P, Mazzoni M, Maestroni U, Valle RD, Salsi P, Busi N, Ferreri G, Cortellini P, Sianesi M. Endourological Management of Ureteral Stenosis and Vesicoureteral Reflux after Renal Transplantation. Urologia 2007. [DOI: 10.1177/039156030707400404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction and Objectives Ureteral stenosis and vesicocoureteral reflux after renal transplantation represent a key concern because of their incidence and the associated morbidity. Prompt diagnosis and minimally invasive treatment are mandatory in immunosuppressed patients with single kidney. The aim of this study is to evaluate the success rate of the endourological techniques in the management of such complications. Materials and Methods Between January 1996 and December 2006, 647 kidney transplants were performed. Urinary tract continuity was re-established by ureteroneocystostomy according to Gregoir-Lich technique. We observed 13 cases of ureteral stenosis (2%) and 11 cases of symptomatic vesicoureteric reflux (1.7%). The endourogical procedure was performed in 13 patients: 5 cases of II-III grade vesicoureteric reflux, 4 early ureteral stenosis and 4 late ureteral stenosis. Patients with vesicoureteric reflux underwent endoscopic injection of macroplastique in 4 cases and Durasphere in 1. Early ureteral stenoses were treated using balloon dilation in 2 cases, balloon dilation and laser endoureterotomy in 3, ureteral stent placement in the other. Recipients with late stenosis underwent laser incision and balloon dilation in 2 cases, balloon dilation in 1 and a laser incision only in the last case. Combined antegrade and retrograde endoscopic approach was performed in 7 patients, whereas retrograde access in 1. Results Endourologic treatment was successful in 9 cases (69.2%); 2 patients required open reconstructive surgery due to endourological technique failure (early ureteropelvic junction stricture, late ureterovesical anastomotic stricture). Vesicoureteric reflux was corrected in 3 patients (60%), 2 patients underwent uretero-ureterostomy for recurrent reflux. No technique-related morbidity was observed. With a mean follow-up of 81.6 months, 8 patients show normal renal function, 5 patients have returned to haemodialysis (4 for chronic rejection, 1 for carcinoma in the graft). Conclusions Considering their low morbidity and the satisfactory success rate, we claim that endourological procedures should be considered the preferred treatment for ureteral stenosis and vesicoureteric reflux in selected patients.
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Affiliation(s)
- A. Frattini
- Dipartimento di Scienze Chirurgiche, Unità Operativa di Urologia
- Unità Operativa di Clinica Chirurgica Generale e dei Trapianti d'Organo
- Unità Operativa di Chirurgia d'Urgenza, Azienda Ospedaliero-Universitaria di Parma
| | - E. Capocasale
- Dipartimento di Scienze Chirurgiche, Unità Operativa di Urologia
- Unità Operativa di Clinica Chirurgica Generale e dei Trapianti d'Organo
- Unità Operativa di Chirurgia d'Urgenza, Azienda Ospedaliero-Universitaria di Parma
| | - P Granelli
- Dipartimento di Scienze Chirurgiche, Unità Operativa di Urologia
- Unità Operativa di Clinica Chirurgica Generale e dei Trapianti d'Organo
- Unità Operativa di Chirurgia d'Urgenza, Azienda Ospedaliero-Universitaria di Parma
| | - M.P. Mazzoni
- Dipartimento di Scienze Chirurgiche, Unità Operativa di Urologia
- Unità Operativa di Clinica Chirurgica Generale e dei Trapianti d'Organo
- Unità Operativa di Chirurgia d'Urgenza, Azienda Ospedaliero-Universitaria di Parma
| | - U. Maestroni
- Dipartimento di Scienze Chirurgiche, Unità Operativa di Urologia
- Unità Operativa di Clinica Chirurgica Generale e dei Trapianti d'Organo
- Unità Operativa di Chirurgia d'Urgenza, Azienda Ospedaliero-Universitaria di Parma
| | - R. Dalla Valle
- Dipartimento di Scienze Chirurgiche, Unità Operativa di Urologia
- Unità Operativa di Clinica Chirurgica Generale e dei Trapianti d'Organo
- Unità Operativa di Chirurgia d'Urgenza, Azienda Ospedaliero-Universitaria di Parma
| | - P Salsi
- Dipartimento di Scienze Chirurgiche, Unità Operativa di Urologia
- Unità Operativa di Clinica Chirurgica Generale e dei Trapianti d'Organo
- Unità Operativa di Chirurgia d'Urgenza, Azienda Ospedaliero-Universitaria di Parma
| | - N. Busi
- Dipartimento di Scienze Chirurgiche, Unità Operativa di Urologia
- Unità Operativa di Clinica Chirurgica Generale e dei Trapianti d'Organo
- Unità Operativa di Chirurgia d'Urgenza, Azienda Ospedaliero-Universitaria di Parma
| | - G. Ferreri
- Dipartimento di Scienze Chirurgiche, Unità Operativa di Urologia
- Unità Operativa di Clinica Chirurgica Generale e dei Trapianti d'Organo
- Unità Operativa di Chirurgia d'Urgenza, Azienda Ospedaliero-Universitaria di Parma
| | - P Cortellini
- Dipartimento di Scienze Chirurgiche, Unità Operativa di Urologia
- Unità Operativa di Clinica Chirurgica Generale e dei Trapianti d'Organo
- Unità Operativa di Chirurgia d'Urgenza, Azienda Ospedaliero-Universitaria di Parma
| | - M. Sianesi
- Dipartimento di Scienze Chirurgiche, Unità Operativa di Urologia
- Unità Operativa di Clinica Chirurgica Generale e dei Trapianti d'Organo
- Unità Operativa di Chirurgia d'Urgenza, Azienda Ospedaliero-Universitaria di Parma
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Arcuri MF, Del Rio P, Martella EM, Bezer L, Sianesi M. Giant malignant phylloides tumor: case report. G Chir 2007; 28:251-2. [PMID: 17626767] [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: 05/16/2023]
Abstract
The incidence of phylloides breast tumors is less than 1% in the population affected by breast cancers. The age at higher risk is between 35 and 45 years. These neoplasms are characterized by a proliferation of mesenchimal and epithelial cells. We present a rare case of giant malignant phylloides tumor (28 x 21 x 15 cm) with a complet substitution of the gland. The clinical presentation of phylloides tumors is heterogenous; the surgical treatment is a conservative one of the gland if the neoplastic lesion size is less than 5 cm with a free margin of 1 cm and a mastectomy if the diameter of lesion is more than 5 cm. Complementary therapies still remain controversial.
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Affiliation(s)
- M F Arcuri
- University of Parma, Department of General Surgery and Organ Transplantation, Italy
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Del Rio P, Dell'Abate P, Soliani P, Arcuri MF, Ghirarduzzi A, Sianesi M. Complications of percutaneous endoscopic gastrostomy: a surgical experience. G Chir 2006; 27:388-91. [PMID: 17147854] [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: 05/12/2023]
Abstract
AIM Percutaneous endoscopic gastrostomy (PEG) is a practical and safe option to place an alimentary gastrostomy. We observed that a relevant rate of complications are related to management of PEG. PATIENTS AND METHODS We registered the patients treated in our Unit from September 1994 to December 2005. We placed 293 PEG (243 pts). Preferably using a tube 16 Fr, in 7 cases 18 Fr, in 21 cases 20 Fr and only in 3 cases 9 Fr. The median age was 69.8 years; ratio female:male 3:1. In 67 cases the treatment was carried out in not hospitalized patients. RESULTS The incidence of late and early complications is statistically higher in hospitalized patients than at home. CONCLUSION We think that a correct management of PEG (nurses correct information) and the experience of endoscopist and a dietician can significantly reduce the rate of complications.
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Affiliation(s)
- P Del Rio
- University of Parma, School of Medicine
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Del Rio P, Dell'Abate P, Soliani P, Tacci S, Arcuri MF, Sianesi M. Standardized laparoscopic right hemicolectomy technique for colon cancer. MINERVA CHIR 2006; 61:293-7. [PMID: 17122761] [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: 05/12/2023]
Abstract
AIM We analysed our experience of laparoscopic surgical treatment vs traditional surgery of right colon cancer. METHODS A series of 27 patients was treated from January 2001 to December 2005 out of a total of 927 surgical colorectal operations in the same period (147 with the laparoscopic approach). Inclusion and exclusion criteria are reported. We compared this group with 25 patients treated by the same surgical group with open surgery. The mean operative time, the distance from the distal margin of resection, the number of lymphnodes, the mean period of canalization and the mean hospital stay are reported. RESULTS In the laparoscopic group, the mean operative time was 124.8+/-36.3 min vs open surgery group of 94+/-23.6 min; the distance from the distal margin was 6.7+/-3.1 cm vs 6.4+/-2.1 cm; number of lymphnodes was 15.2+/-4.3 vs 18.7+/-2.9 nodes; and canalization 1.7+/-0.9 vs 2.7+/-0.7 days. The hospital stay was 6.8+/-1.7 vs 7.2+/-0.8 days. CONCLUSIONS We consider laparoscopic right colon resection a safe procedure but it needs good laparoscopic practice and the observance of inclusion criteria.
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Affiliation(s)
- P Del Rio
- Department of Surgical Science, General Surgery and Organ Transplantation, University of Parma, Parma, Italy.
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Capocasale E, Busi N, Valle RD, Mazzoni MP, Bignardi L, Maggiore U, Buzio C, Sianesi M. Octreotide in the Treatment of Lymphorrhea After Renal Transplantation: A Preliminary Experience. Transplant Proc 2006; 38:1047-8. [PMID: 16757259 DOI: 10.1016/j.transproceed.2006.03.040] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Lymphorrhea is a minor complication after kidney transplantation but may develop into a lymphocele and prolong hospital stay. Treatment is conservative based on percutaneous drainage until lymphatic leakage cessation. It has been reported that octreotide has beneficial effects to treat lymphorrhea after axillary node dissection and excision of lymphatic malformations. The aim of this study was to report preliminary experience about octreotide treatment in lymphorrea after kidney transplantation. MATERIALS AND METHODS This retrospective study included 20 recipients of cadaveric kidney allografts with posttransplant lymphorrhea including 10 treated with instillation of povidone iodate solution, and the other 10 with octreotide (0.1 mg three times a day subcutaneously). We reviewed the daily amount of fluid collection, duration of lymphorrhea, complications, lymphocele formation, rejection episodes, graft outcomes, and hospital stay. RESULTS The average duration of lymphorrhea was 8.5 (+/-4.5) and 16.3 (+/-7.3) days for the octreotide versus the povidone groups, respectively (P = .001). No complications occurred among the octreotide group, while three lymphoceles grew among patients treated with povidone solution. No differences were observed for acute rejection episodes or renal function between the groups. No octreotide-related adverse events were noted. CONCLUSION The mean length of lymphorrhea was lower with octreotide versus iodate povidone solution treatment. There was a shorter hospital stay and minor patient discomfort. In conclusion, lymphatic leakage after kidney transplantation may be successfully managed by octreotide administration.
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Affiliation(s)
- E Capocasale
- General Surgery and Organ Transplantation, University of Parma, Italy
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Dalla Valle R, Mazzoni MP, Capocasale E, Busi N, Pietrabissa A, Moretto C, Gualtierotti M, Massa M, Mosca F, Sianesi M. Laparoscopic Donor Nephrectomy: Short Learning Curve. Transplant Proc 2006; 38:1001-2. [PMID: 16757244 DOI: 10.1016/j.transproceed.2006.03.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The learning curve of laparoscopic donor nephrectomy (LDN) may represent a great technical challenge at centers with low volume of living donors. The number of LDNs required to overcome the learning curve is still unclear. Here we report the modality of approach to LDN at a low-volume living donor transplant center. MATERIALS AND METHODS We reviewed the records of two groups of donors operated by two different surgeons between January 2002 and October 2005. We compared donor hospital stay, operative time, presence of multiple renal arteries, blood loss, operative details, and complications. RESULTS The first six operations (group A) were performed by a well-trained laparoscopic surgeon (A.P.) with a consolidated experience in the LDN procedure, attended by our training surgeon (R.D.V.) who conducted the other six cases (group B). No conversion to an open procedure was necessary and there were no major minor complications. Mean operative time was 267.5 (+/-55.9) minutes in group A and 300 (+/-43.4) minutes in group B (P = .28). Mean warm ischemia time was 125 (+/-61.6) seconds in group A and 189.2 (+/-18.6) seconds in group B (P = .035). Mean hospital stay was 5.3 days in group A and 5.6 days in group B. CONCLUSIONS LDN can be performed safely and efficiently in transplant centers with initial experience. A collaborative approach to this difficult procedure with a surgeon skilled in donor nephrectomy minimizes the risk to the donor and reduces the learning curve.
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Affiliation(s)
- R Dalla Valle
- General Surgery and Organ Transplantation, University of Parma, Italy.
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Abstract
INTRODUCTION Acute diverticulitis with colon perforation is a serious condition in transplant recipients. The aim of this study was to analyze our experience with colon perforations among 875 renal transplant recipients between January 1986 and September 2004. METHODS Patients were analyzed by age, gender, steroid dosage, time interval from the transplantation, delay between symptoms and surgery, clinical presentation, surgical procedure, graft and patient outcomes. RESULTS We identified 8 patients with colon perforation. The incidence of perforation was 0.9%. Mean age at the the time of perforation was 58.5 years. Fever, abdominal pain, localized or diffuse signs of peritonitis, and leukocytosis were present in 7 patients (87.5%). Three patients (37.5%) were on steroid-free immunosuppression, whereas in 2 cases (25%) the steroid dosage was >20 mg/d. The mean interval between transplantation and perforation was 4.1 years. Two episodes (25%) occurred within 1 month following transplantation and the other 6 (75%) between 1 and 15 years. The interval between the onset of symptoms and surgery was longer than 48 hours in 1 patient (12.5%). In 5 cases (62.5%), a Hartmann procedure was performed; in 2 patients (25%), a resection with primary anastomosis was preferred. The last patient had a direct suture of the colon. Mortality rate was 12.5%. At a median follow-up of 6.1 years, 6 patients (75%) are alive with 5 functioning grafts. CONCLUSIONS Colon perforations in renal transplant recipients remain a challenging surgical problem. An aggressive diagnostic attitude and an immediate surgical treatment may contribute to significantly decrease the incidence and the mortality of this complication.
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Affiliation(s)
- R Dalla Valle
- Department of Surgery and Transplantation, University of Parma, Parma, Italy.
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Dell'Abate P, Ferrieri G, Del Rio P, Soliani P, Sianesi M. [Longo hemorrhoidopexy vs Milligan-Morgan hemorrhoidectomy: perspective analysis]. G Chir 2005; 26:443-5. [PMID: 16472425] [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: 05/06/2023]
Abstract
The authors analyzed their experience from January 2001 to February 2005 on 117 patients treated with Longo hemorrhoidopexy (46 cases) and Milligan-Morgan hemorroidectomy (71 cases). All the patients were observed after a week and one month after surgical procedure; at 6 months the Authors controlled 70 patients treated with Milligan-Morgan and 33 treated with Longo technique. The pain after 24 hours was the same in two groups but after a week a significative difference between two groups (p<0.05) was registered with a better quality of life for hemorrhoidopexy group. At 6 months pain during defecation was present in two cases of Longo group and in 6 cases of Milligan-Morgan group. In author's experience the Longo technique is a safe treatment with lower postsurgical pain and lower complications.
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Affiliation(s)
- P Dell'Abate
- Clinica Chirurgica Generale e Trapianti d'Organo, Dipartimento di Scienze Chirurgiche, Università degli Studi di Parma
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Capocasale E, Larini P, Mazzoni MP, Marcato C, Dalla Valle R, Busi N, Monaco D, Benozzi L, Sianesi M. Percutaneous Renal Artery Embolization of Nonfunctioning Allograft: Preliminary Experience. Transplant Proc 2005; 37:2523-4. [PMID: 16182732 DOI: 10.1016/j.transproceed.2005.06.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Percutaneous renal artery embolization has been introduced as an alternative to nephrectomy for patients with a nonfunctioning allograft and Graft Intolerance Syndrome. The symptoms resulting from this syndrome include fever, local pain, hypertension, and hematuria. From April 2003 to October 2003, 5 patients were treated with this technique. The intraparenchymal renal arteries were embolized by injection of calibrated tris-acryl gelatin microspheres of increasing size (from 100-330 to 700-900 microm) and completed with the insertion of 5-mm-8-mm steel coils in the renal artery. The procedure was well tolerated in all cases; no major complications occurred. In 3 patients, the symptoms disappeared immediately. In 1 patient, it was necessary to perform a second embolization due to collateral circulation developing from a lumbar artery; this further procedure resolved the symptoms. In the last case, the patient underwent nephrectomy because of septic fever. In conclusion, patients with this syndrome refractory to medical treatment may be treated by the effective and minimally invasive procedures of percutaneous allograft artery embolization with no significant short-term or late complications.
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Affiliation(s)
- E Capocasale
- Department of Surgery, Institute of General Surgery and Organ Transplantation, University of Parma, Italy
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Dalla Valle R, Capocasale E, Mazzoni MP, Busi N, Piazza P, Benozzi L, Sianesi M. Embolization of a Ruptured Pseudoaneurysm With Massive Hemorrhage Following Pancreas Transplantation: A Case Report. Transplant Proc 2005; 37:2275-7. [PMID: 15964398 DOI: 10.1016/j.transproceed.2005.03.125] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2005] [Indexed: 11/16/2022]
Abstract
Pseudoaneurysm associated with an arterioenteric fistula is rare, but its clinical manifestations may represent a dramatic event that involves diagnostic and therapeutic problems. We report a case of an arterioduodenal fistula related to a ruptured pseudoaneurysm after simultaneous pancreas-kidney transplantation (SPK) with massive gastrointestinal hemorrhage treated by embolization of the Y graft. A 51-year-old man with type I diabetes and end-stage renal disease underwent SPK. No rejection episodes were documented; the patient was discharged with normal pancreatic and renal function. Two months later the patient was readmitted for an episode of massive lower digestive bleeding and hypotension. The Y-graft was embolized in order to obtain a prompt arrest of the bleeding. The procedure was successful and the patient progressively recovered. Once the hypovolemia was completely corrected, the graft was removed. An arterioenteric fistula between donor mesenteric artery and duodenum was confirmed. Few reports exist in the literature regarding the development of a pseudoaneurysm after pancreas transplantation. To our best knowledge only one case of pseudoaneurysm rupture into donor duodenum has been recently published. In our case angiography recognized the site of the pseudoaneurysm and its rupture into donor duodenum. Embolization of the Y-graft appeared the most rapid, simple, and safe approach to obtain the prompt arrest of the massive bleeding. Embolization of the Y-graft may represent a valid option in the presence of life-threatening hemorrhage.
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Affiliation(s)
- R Dalla Valle
- General Surgery and Organ Transplantation, University of Parma, Via Gramsci 14, Parma PR 43100, Italy
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Abstract
INTRODUCTION We reviewed our clinical experience to assess the role of cholecystectomy transplant candidates pre- and posttransplantation. METHODS Between April 1986 and December 2003, 57 (6.8%) candidates among 839 kidney transplants were found during routine pretransplant screening to show gallstones. RESULTS Thirty nine (68.4%) symptomatic patients underwent cholecystectomy before transplantation. Among 18 (31.6%) asymptomatic patients monitored after transplantation, the 7 (39%) who developed biliary tract symptoms underwent laparoscopy or minilaparocholecystectomy without postoperative morbidity, mortality, or graft loss. CONCLUSIONS Symptomatic gallstones have to be treated using the laparoscopic cholecystectomy or minilaparotomy technique. In asymptomatic cholelithiasis prophylactic cholecystectomy is only reserved for patients with biliary "intrinsic" risk factors. An early diagnosis and prompt surgical treatment yields good results.
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Affiliation(s)
- M Sianesi
- Department of Surgery, Institute of General Surgery and Organ Transplantation, University of Parma, Enzi Capocasale, Via Bizzozero 7, 43100 Parma, Italy.
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Dell'Abate P, Del Rio P, Soliani P, Arcuri MF, Sianesi M. Laparoscopic technique in enlarged cystic duct. G Chir 2004; 25:412-3. [PMID: 15803818] [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: 05/02/2023]
Abstract
The risk of dislodgment of endoclips placed during laparoscopic cholecystectomy in enlarged cystic duct is higher with minor bile leak. From January 2000 to April 2004, we performed 1013 procedures; in 12 patients we have showed a enlarged duct ligated with 4 laparoscopic cholecystectomy endoclips after a 180 degrees rotation of the gallbladder during a retrograde cholecystectomy. We haven't registered complications and all the cases were discharged the first postoperative day. The method is safe and economically sound.
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Affiliation(s)
- P Dell'Abate
- University of Parma--Italy, School of Medicine Institute of General Surgery and Organ Transplant
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Dalla Valle R, Zinicola R, Sianesi M, de'Angelis GL, Michiara M, Rasheed S, Phillips RK. Distal duodenal surveillance in familial adenomatous polyposis. Dig Liver Dis 2004; 36:559-60. [PMID: 15334781 DOI: 10.1016/j.dld.2004.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 12/11/2022]
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del Rio P, dell’Abate P, Soliani P, Ziegler S, Arcuri M, Sianesi M. Perkutane endoskopische Gastrostomie zur Magenfixierung bei einer kongenitalen Zwerchfellhernie. Visc Med 2004. [DOI: 10.1159/000078074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Dell'Abate P, Del Rio P, Giannino G, Arcuri MF, Soliani P, Sianesi M. [Laparoscopic colectomy in the treatment of colon cancer: prospective study]. G Chir 2004; 25:121-4. [PMID: 15283401] [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: 04/30/2023]
Abstract
The Authors report their experience on laparoscopic colectomy in 38 patients treated between June 2001-September 2003 in General Surgery and Organ Transplantation Department of University of Parma, Italy. The patients were 23 male and 15 female, with average age 58.4 years. All patients were studied with TC and colonoscopy performed by the surgeon. The conversion rate was 15.8% and the average hospital stay 6.9 days (range 6-15 days). The patient's general clinical conditions and the results showed that the laparoscopic colectomy is a safe surgical option.
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Affiliation(s)
- P Dell'Abate
- Università degli Studi di Parma, Clinica Chirurgica Generale e Trapianti d'Organo
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Dalla Valle R, Mazzoni MP, Bignardi L, Busi N, Benozzi L, Gualtierotti M, Alessandri L, Bezer L, Iapichino G, Capocasale E, Sianesi M. Renal vein extension in right kidney transplantation. Transplant Proc 2004; 36:509-10. [PMID: 15110574 DOI: 10.1016/j.transproceed.2004.02.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A short right renal vein may be associated with technical problems in renal transplantation. For this reason, a vena caval extension may be useful to improve exposure of the anastomosis and graft placement. This report evaluates the safety and the effectiveness of renal vein extension, which was routinely performed in right renal transplantation. From April 1986 to December 2002, we performed 371 right kidney transplantations with 252 using the standard technique (group A) and 119 using the renal vein extension (group B). No statistical differences were found between the 2 groups in terms of renal vein thrombosis incidence, delayed graft function, morbidity, and graft loss. Indeed, mean warm ischemia time was reduced in the venoplasty group. In conclusion, renal vein extension is an easy, safe technique that reduces warm ischemia time. We suggest more extensive use of this procedure in right kidney transplantation.
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Affiliation(s)
- R Dalla Valle
- General Surgery and Organ Transplantation, Department of Surgery, University of Parma, Parma, Italy.
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Soliani P, Ziegler S, Franzini C, Dell'Abate P, Del Rio P, Di Mario F, Cavestro M, Sianesi M. The size of pancreatic pseudocyst does not influence the outcome of invasive treatments. Dig Liver Dis 2004; 36:135-40. [PMID: 15002822 DOI: 10.1016/j.dld.2003.06.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [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] [Indexed: 12/11/2022]
Abstract
BACKGROUND Authors generally agree that Giant Pancreatic Pseudocysts (> 10 cm) have a lower spontaneous resolution and are more difficult to treat than smaller pancreatic pseudocysts. This study was carried out on two groups of patients with larger and smaller pancreatic pseudocysts (pancreatic pseudocysts > 10 cm versus pancreatic pseudocysts < 10 cm), and aims to establish whether the size of pancreatic pseudocysts is a factor influencing treatment outcomes. PATIENTS AND METHODS In a retrospective study, we examined 71 patients with pancreatic pseudocysts following an episode of acute pancreatitis, which were treated in our hospital from 1980 to 2000. Forty-one (57.5%) patients had a large pancreatic pseudocyst. Most patients underwent invasive treatments: 9 (12.6%) had percutaneous drainage, 37 (52.1%) open surgery and 13 (18.3%) endoscopic cyst gastrostomy. 12 patients (16.9%) of the 71 were cured with medical therapy alone. RESULTS As far as the aetiology of the pancreatitis, location and number of the cysts were concerned, no major differences emerged between the two groups, although large pancreatic pseudocysts followed more severe pancreatitis (P = 0.0005). All giant pancreatic pseudocysts required invasive treatments; 40% of the pancreatic pseudocysts < 10 cm were successfully treated with medical therapy alone. No statistical differences were found regarding hospital mortality, morbidity, recurrence rate and hospital stay among the patients treated invasively. CONCLUSIONS Giant pancreatic pseudocysts more often require invasive therapy due to persistent symptoms or complications. Treatment outcomes do not seem to be influenced by the size of the pancreatic pseudocysts.
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Affiliation(s)
- P Soliani
- Department of General Surgery and Organ Transplantation, University of Parma, Via Gramsci, 14, 43100 Parma, Italy.
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Del Rio P, Dell'Abate P, Arcuri MF, Ziegler S, Sianesi M. [Parathyroid carcinoma: clinical aspects and therapy]. G Chir 2003; 24:399-401. [PMID: 15018406] [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: 04/29/2023]
Abstract
Parathyroid carcinoma is a rare entity with an 0,5-1% of incidence on primary hyperparathyroidism (HPP) in literature. The very high values of calcium and parathormone (PTH) and the clinical aspects of hypercalcemia are the characteristics findings in these patients. We present our experience on 6 pts on 153 cases with HPP treated (3,9%). The clinical and diagnostic suspects are frequently intraoperative findings and the decision making for the surgeon is not always easy (parathyroidectomy with or without hemithyroidectomy, lymphadenectomy, surgical resection of other tissues). The mortality rate is high and we have registered three deaths at 8,14 and 64 months.
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Affiliation(s)
- P Del Rio
- Università degli Studi di Parma, Clinica Chirurgica Generale e Trapianti d'Organo
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48
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Vagliasindi A, Sivelli R, Gualtierotti M, Piccolo D, Bertagni A, Sianesi M. [Are small-size depressed-type colorectal neoplasias really the expression of a early stage of colorectal cancer. Apropos of a clinical case]. Tumori 2003; 89:155-8. [PMID: 12903578] [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: 03/04/2023]
Abstract
A route of colorectal cancer development other than the adenoma-carcinoma sequence has recently become an issue due to the discovery of the depressed-type early colorectal cancers. Despite the protruding shapes of depressed-type early colorectal cancers, they probably have biological characteristics which differ from those of the usual polyp lesions. They show more aggressive behavior than the polypoid type and can arise de novo. Depressed-type lesions, in contrast to flat-type or protruded-type lesions, tend to invade the submucosa rapidly, so it is better treat them surgically from the outset. We report a case of a small depressed-type colorectal cancer involving the caecum of a 79-year-old male patient.
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Affiliation(s)
- A Vagliasindi
- UO di Chirurgia Generale II, Modulo di Chirurgia Oncologica, Ospedale GB Morgagni-L Pierantoni, Forlì
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Dell'Abate P, Del Rio P, Colla G, Soliani P, Arcuri M, Ziegler S, Sianesi M. Self-Expanding Metal Stents in the Treatment of Colonic Obstruction. Visc Med 2003. [DOI: 10.1159/000070522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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50
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Dell'Abate P, Del Rio P, Soliani P, Sianesi M. [Endoscopic polypectomy with the use of endoloop in giant gastric polyp: a case report]. Acta Biomed Ateneo Parmense 2002; 72:105-8. [PMID: 12233267] [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] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
The gastric polyps are lesions found in 2-3% of endoscopic procedures. We point out the hystologic nature of these lesions to a correct therapeutic evaluation. The endoscopic polypectomy is today safe; we report our experience in an endoscopic polypectomy with use of endoloop for a giant gastric polyp.
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Affiliation(s)
- P Dell'Abate
- Istituto di Clinica Chirurgica Generale e dei Trapianti d'Organo, Università di Parma
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