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Spinelli C, Ghionzoli M, Ugolini C, Oreglio C, Guglielmo C, Morabito A, Patrizio A, Fallahi P, Ferrari SM, Antonelli A. Does thyroglossal duct arborization play a role in the post-surgical outcome of Sistrunk procedure in children? Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08631-y. [PMID: 38594507 DOI: 10.1007/s00405-024-08631-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 03/19/2024] [Indexed: 04/11/2024]
Abstract
PURPOSE The purpose of the present study is to analyze thyroglossal duct cyst (TGDC) histopathological features, with focus on "arborization", in a cohort of pediatric patients who underwent surgical removal, and evaluate a possible correlation with clinical recurrences. METHODS A retrospective analysis of all patients who underwent surgical resection for TGDC at the division of Pediatric Surgery of the University of Pisa from 2015 to 2020 was performed; for each patient, the following data were recorded: age, sex, clinical presentation, localization, size of the lesion, diagnostic tools, histopathological features, perioperative complications, recurrence and follow-up. RESULTS With respect to arborization, following histopathological analysis 25/30 patients (83.3%) presented thyroglossal duct branching. After a median follow-up of 3.5 years, only 2 out of 30 patients (6.7%), one male and one female, respectively aged 4 y.o. and 6 y.o., presented recurrence within one year from first surgery. CONCLUSION Surgery for TGDC remains a challenge for pediatric surgeons, while arborization was present in most of our cases which underwent surgery. With respect to the role of arborization, our study did not highlight sufficient conclusive data regarding their role in recurrence: instead, it showed wide resection as satisfactory, being the arborization present in most of the cases at histopathology.
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Affiliation(s)
- Claudio Spinelli
- Division of Pediatric and Adolescent Surgery, Department of Surgery, University of Pisa, Pisa, Italy
| | - Marco Ghionzoli
- Division of Pediatric and Adolescent Surgery, Department of Surgery, University of Pisa, Pisa, Italy
| | - Clara Ugolini
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italia
| | - Chiara Oreglio
- Department of Pediatric Surgery, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Carla Guglielmo
- Division of Pediatric and Adolescent Surgery, Department of Surgery, University of Pisa, Pisa, Italy
| | - Antonino Morabito
- Department of Pediatric Surgery, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Armando Patrizio
- Department of Emergency Medicine, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Poupak Fallahi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | | | - Alessandro Antonelli
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italia.
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Infantino I, Tocchioni F, Ghionzoli M, Coletta R, Morini F, Morabito A. Corrigendum: Gut and spleen anomalies associated with DYRK1A syndrome. Front Pediatr 2024; 12:1372269. [PMID: 38434732 PMCID: PMC10908171 DOI: 10.3389/fped.2024.1372269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 03/05/2024] Open
Abstract
[This corrects the article DOI: 10.3389/fped.2022.936732.].
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Affiliation(s)
- I. Infantino
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - F. Tocchioni
- Department of Pediatric and Neonatal Surgery, Meyer Children’s Hospital IRCSS, Florence, Italy
| | - M. Ghionzoli
- Department of Pediatric and Neonatal Surgery, Meyer Children’s Hospital IRCSS, Florence, Italy
| | - R. Coletta
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
- Department of Pediatric and Neonatal Surgery, Meyer Children’s Hospital IRCSS, Florence, Italy
- School of Health and Society, University of Salford, Salford, United Kingdom
| | - F. Morini
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
- Department of Pediatric and Neonatal Surgery, Meyer Children’s Hospital IRCSS, Florence, Italy
| | - A. Morabito
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
- Department of Pediatric and Neonatal Surgery, Meyer Children’s Hospital IRCSS, Florence, Italy
- School of Health and Society, University of Salford, Salford, United Kingdom
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3
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Fallahi P, Patrizio A, Stoppini G, Elia G, Ragusa F, Paparo SR, Balestri E, Mazzi V, Botrini C, Varricchi G, Ulisse S, Ghionzoli M, Antonelli A, Ferrari SM. Simultaneous Occurrence of Medullary Thyroid Carcinoma and Papillary Thyroid Carcinoma: A Case Series with Literature Review. Curr Oncol 2023; 30:10237-10248. [PMID: 38132379 PMCID: PMC10742226 DOI: 10.3390/curroncol30120745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 11/22/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Papillary thyroid carcinoma (PTC) is the most common type of differentiated TC, while medullary TC (MTC) accounts for 4%. The concomitant presence of PTC and MTC is rare. METHODS This is a retrospective, single-center observational study conducted over 16 years (2001-2017). The data were collected from the clinical records of patients who underwent total thyroidectomy at the Endocrine Unit-Department of Medicine of the University Hospital of Pisa, Italy. RESULTS Over 690 analyzed cases, 650 (94.2%) were exclusive DTC, 19 exclusive MTC (2.75%) and 5 PTC/MTC (0.7%). No case of mixed medullary/follicular TC or hereditary MTC (familial MTC/multiple endocrine neoplasia type 2) was found. Among the five PTC/MTC cases, there was a male prevalence (M:F = 3:2), and all PTC components were at stage I, whereas 40% of MTC were at stage I and III and 20% of MTC were at stage II; microPTC (mPTC) was prevalent (80%) and also microMTCs were frequent (40%); 60% of MTC patients recovered, while 40% of patients developed metastatic disease. The search for germline mutations of the RET gene resulted in being negative in all cases. CONCLUSIONS The incidence of PTC/MTC has been increasing over the past 30 years. The etiology of PTC/MTC forms is still unknown, and although this simultaneous occurrence could be only a coincidence, we cannot exclude the hypothesis of a shared genetic origin.
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Affiliation(s)
- Poupak Fallahi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (P.F.); (S.R.P.)
| | - Armando Patrizio
- Department of Emergency Medicine, Azienda Ospedaliero-Universitaria Pisana, 56126 Pisa, Italy;
| | - Giulio Stoppini
- Department of Surgery, Medical and Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy; (G.S.); (G.E.); (F.R.); (E.B.); (V.M.); (C.B.)
| | - Giusy Elia
- Department of Surgery, Medical and Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy; (G.S.); (G.E.); (F.R.); (E.B.); (V.M.); (C.B.)
| | - Francesca Ragusa
- Department of Surgery, Medical and Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy; (G.S.); (G.E.); (F.R.); (E.B.); (V.M.); (C.B.)
| | - Sabrina Rosaria Paparo
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (P.F.); (S.R.P.)
| | - Eugenia Balestri
- Department of Surgery, Medical and Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy; (G.S.); (G.E.); (F.R.); (E.B.); (V.M.); (C.B.)
| | - Valeria Mazzi
- Department of Surgery, Medical and Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy; (G.S.); (G.E.); (F.R.); (E.B.); (V.M.); (C.B.)
| | - Chiara Botrini
- Department of Surgery, Medical and Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy; (G.S.); (G.E.); (F.R.); (E.B.); (V.M.); (C.B.)
| | - Gilda Varricchi
- Department of Translational Medical Sciences, Center for Basic and Clinical Immunology Research (CISI), World Allergy Organization (WAO), Center of Excellence, Institute of Experimental Endocrinology and Oncology (IEOS), National Research Council, University of Naples “Federico II”, 80138 Naples, Italy;
| | - Salvatore Ulisse
- Department of Surgical Sciences, ‘Sapienza’ University of Rome, 00161 Rome, Italy;
| | - Marco Ghionzoli
- Division of Pediatric Surgery, Department of Surgical Pathology, University of Pisa, 56126 Pisa, Italy;
| | - Alessandro Antonelli
- Department of Surgery, Medical and Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy; (G.S.); (G.E.); (F.R.); (E.B.); (V.M.); (C.B.)
| | - Silvia Martina Ferrari
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy;
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Spinelli C, Ghionzoli M, Guglielmo C, Baroncelli G, Tyutyusheva N, Frega A, Patrizio A, Fallahi P, Ferrari SM, Antonelli A. Hypoparathyroidism Associated with Benign Thyroid Nodules in DiGeorge-like Syndrome: A Rare Case Report and Literature Review. Endocr Metab Immune Disord Drug Targets 2023:EMIDDT-EPUB-136172. [PMID: 37986268 DOI: 10.2174/0118715303274582231102094440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/04/2023] [Accepted: 09/28/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND DiGeorge-like syndrome (DGLS) is a rare genetic disorder due to the presence of the same classical clinical manifestations of DiGeorge syndrome (DGS) without its typical deletion. In the DGLS phenotype, hypoparathyroidism seldom occurs and is considered rare. In DGS, hypocalcemia affects up to 70% of patients, and a considerable share often has asymptomatic thyroid abnormalities. CASE DESCRIPTION In this study, we describe an unusual case of a 16-year-old patient with DGLS due to a duplication of 365 kb in the 20p11.22 region, affected by hypoparathyroidism associated with thyroid nodule. The intraoperative parathyroid evaluation ruled out agenesis as a cause of hypoparathyroidism. In addition, we carried out a thorough literature review from 2010 to 2023 of DGLS cases using specific keywords, such as "22q11.2 deletion syndrome", "DiGeorge-like Syndrome", "hypoparathyroidism", "thyroid", and "children", analyzing 119 patients with DGLS. CONCLUSION Interestingly enough, the present case represents, to our knowledge, the first report of a patient with DGLS associated with hypoparathyroidism and the presence of thyroid nodules where an intraoperative observation reported a non-functional parathyroid gland.
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Affiliation(s)
- Claudio Spinelli
- Division of Pediatric and Adolescent Surgery, Department of Surgery, University of Pisa, Pisa, Italy
| | - Marco Ghionzoli
- Division of Pediatric and Adolescent Surgery, Department of Surgery, University of Pisa, Pisa, Italy
| | - Carla Guglielmo
- Division of Pediatric and Adolescent Surgery, Department of Surgery, University of Pisa, Pisa, Italy
| | - Giampiero Baroncelli
- Pediatric Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Nina Tyutyusheva
- Pediatric Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessia Frega
- Division of Pediatric and Adolescent Surgery, Department of Surgery, University of Pisa, Pisa, Italy
| | - Armando Patrizio
- Department of Emergency Medicine, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Poupak Fallahi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | | | - Alessandro Antonelli
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
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5
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Spinelli C, Ghionzoli M, Sahli LI, Guglielmo C, Frascella S, Romano S, Ferrari C, Gennari F, Conzo G, Morganti R, De Napoli L, Quaglietta L, De Martino L, Picariello S, Grandone A, Luongo C, Gambale A, Patrizio A, Fallahi P, Antonelli A, Ferrari SM. DICER1 Syndrome: A Multicenter Surgical Experience and Systematic Review. Cancers (Basel) 2023; 15:3681. [PMID: 37509342 PMCID: PMC10377723 DOI: 10.3390/cancers15143681] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/13/2023] [Accepted: 07/16/2023] [Indexed: 07/30/2023] Open
Abstract
DICER1 syndrome is a rare genetic disorder that predisposes patients to the development of malignant and non-malignant diseases. Presently, DICER1 syndrome diagnosis still occurs late, usually following surgical operations, affecting patients' outcomes, especially for further neoplasms, which are entailed in this syndrome. For this reason, herein we present a multicenter report of DICER1 syndrome, with the prospective aim of enhancing post-surgical surveillance. A cohort of seven patients was collected among the surgical registries of Pediatric Surgery at the University of Pisa with the General and Oncologic Surgery of Federico II, University of Naples, and the Pediatric Surgery, Regina Margherita Hospital, University of Turin. In each case, the following data were analyzed: sex, age at diagnosis, age at first surgery, clinical features, familial, genetic investigations, and follow-up. A comprehensive literature review of DICER1 cases, including case reports and multicenter studies published from 1996 to June 2022, was performed. Eventually, the retrieved data from the literature were compared with the data emerging from our cohort of patients.
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Affiliation(s)
- Claudio Spinelli
- Division of Pediatric Surgery, Department of Surgical Pathology, University of Pisa, 56126 Pisa, Italy
| | - Marco Ghionzoli
- Division of Pediatric Surgery, Department of Surgical Pathology, University of Pisa, 56126 Pisa, Italy
| | - Linda Idrissi Sahli
- Division of Pediatric Surgery, Department of Surgical Pathology, University of Pisa, 56126 Pisa, Italy
| | - Carla Guglielmo
- Division of Pediatric Surgery, Department of Surgical Pathology, University of Pisa, 56126 Pisa, Italy
| | - Silvia Frascella
- Division of Pediatric Surgery, Department of Surgical Pathology, University of Pisa, 56126 Pisa, Italy
| | - Silvia Romano
- Departmental Section of Medical Genetics, S. Chiara Hospital, 56126 Pisa, Italy
| | - Carlo Ferrari
- Division of Pediatric Surgery, Regina Margherita Hospital, 10126 Turin, Italy
| | - Fabrizio Gennari
- Division of Pediatric Surgery, Regina Margherita Hospital, 10126 Turin, Italy
| | - Giovanni Conzo
- Division of General and Oncologic Surgery-Department of Cardiothoracic Sciences, University of Campania "Luigi Vanvitelli", Via Pansini 1, 80131 Naples, Italy
| | - Riccardo Morganti
- Section of Statistics, University Hospital of Pisa, 56124 Pisa, Italy
| | - Luigi De Napoli
- Division of Endocrine Surgery, Department of Surgical, Medical, Molecular Pathology and of the Critic Area, University of Pisa, 56126 Pisa, Italy
| | - Lucia Quaglietta
- Neuro-Oncology Unit, Department of Paediatric Oncology, Santobono-Pausilipon Children's Hospital, 80123 Naples, Italy
| | - Lucia De Martino
- Neuro-Oncology Unit, Department of Paediatric Oncology, Santobono-Pausilipon Children's Hospital, 80123 Naples, Italy
| | - Stefania Picariello
- Neuro-Oncology Unit, Department of Paediatric Oncology, Santobono-Pausilipon Children's Hospital, 80123 Naples, Italy
| | - Anna Grandone
- Department of Woman, Child of General and Specialized Surgery, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Caterina Luongo
- Department of Woman, Child of General and Specialized Surgery, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Antonella Gambale
- CEINGE Advanced Biotechnology, 80131 Naples, Italy
- Integrated Care Department of Laboratory Medicine, Unit of Medical Genetics, Federico II Hospital, 80131 Naples, Italy
| | - Armando Patrizio
- Department of Emergency Medicine, Azienda Ospedaliero-Universitaria Pisana, 56126 Pisa, Italy
| | - Poupak Fallahi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Alessandro Antonelli
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy
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Cianci MC, Tocchioni F, Mantovani A, Ghionzoli M, Morini F. Unexpected Pediatric Uretero-Inguinal Hernia: Case-Report and Literature Review. Urology 2023; 176:178-182. [PMID: 36841359 DOI: 10.1016/j.urology.2023.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 12/15/2022] [Revised: 02/01/2023] [Accepted: 02/06/2023] [Indexed: 02/27/2023]
Abstract
Uretero-inguinal hernia (UIH) is a rare condition in children. We present our experience with an unexpected UIH in a male infant with associated anomalies and a literature review of pediatric cases. A full-term male newborn was referred to our hospital for microcolon and right hydroureteronephrosis. Voiding cystourethrography showed grade-IV right vesicoureteral reflux and a dilated, convoluted, ureter protruding in the right inguinal canal, suggesting a right UIH, which was uneventfully repaired at 2 months of life. UIH is a rare type of inguinal hernia in children that pediatric urologists and surgeons should be aware of. In experienced hands, and when preoperatively suspected, surgical management is safe and effective.
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Affiliation(s)
- Maria Chiara Cianci
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy; Department of Pediatric Surgery, Meyer Children's Hospital IRCCS, Florence, Italy.
| | - Francesca Tocchioni
- Department of Pediatric Surgery, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Alberto Mantovani
- Department of Pediatric Surgery, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Marco Ghionzoli
- Department of Pediatric Surgery, Meyer Children's Hospital IRCCS, Florence, Italy; Department of Surgical, Medical, Molecular Pathology and of the Critical Area, University of Pisa, Adolescent and Young Adults Surgery Division, Pisa, Italy
| | - Francesco Morini
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy; Neonatal Surgery Unit, Meyer Children's Hospital IRCCS, Florence, Italy
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7
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Oreglio C, Tocchioni F, Ghionzoli M, Buccoliero A, Morabito A, Morini F. Intradiaphragmatic pulmonary sequestrations: a surgical challenge. Case series. Front Surg 2023; 10:1181007. [PMID: 37304185 PMCID: PMC10248170 DOI: 10.3389/fsurg.2023.1181007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/05/2023] [Indexed: 06/13/2023] Open
Abstract
Bronchopulmonary sequestrations (BPSs) are rare congenital anomalies characterized by non-functioning embryonic lung tissue receiving anomalous blood supply. They are most commonly located within the thorax (supradiaphragmatic) or into the abdominal cavity (infradiaphragmatic). Intradiaphragmatic extralobar BPs (IDEPS) are an exceptionally rare finding, representing a diagnostic and operative challenge. We report three cases of IDEPS and their surgical management, describing our experience and approach to such rare clinical entities. From 2016 to 2022, we treated 3 cases of IDEPS. Surgical techniques, histopathological findings and clinical outcomes were retrospectively evaluated for each case and compared. Three different surgical techniques were used to approach each lesion, from open thoracotomy to a combined laparoscopic and thoracoscopic approach. Histopathological analysis of the specimens revealed hybrid pathological features, proper of both congenital pulmonary airway malformation (CPAM) and extralobar pulmonary sequestration. IDEPS represent a surgical challenge for pediatric surgeons, given their complex surgical planning. In our experience, the thoracoscopic approach is safe and feasible when performed by trained surgeons, even though a combined thoracoscopic-laparoscopic approach allows for optimal vessels control. The presence of CPAM elements within the lesions supports their surgical removal. Additional studies are required to better characterize IDEPS and their management.
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Affiliation(s)
- Chiara Oreglio
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
- Department of Pediatric and Neonatal Surgery, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Francesca Tocchioni
- Department of Pediatric and Neonatal Surgery, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Marco Ghionzoli
- Department of Pediatric and Adolescent Surgery, University of Pisa, Pisa, Italy
- Department of Surgical, Medical, Molecular Pathology and of the Critic Area, University of Pisa, Pisa, Italy
| | | | - Antonino Morabito
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
- Department of Pediatric and Neonatal Surgery, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Francesco Morini
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
- Department of Pediatric and Neonatal Surgery, Meyer Children’s Hospital IRCCS, Florence, Italy
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Ferrari SM, Paparo SR, Ragusa F, Elia G, Mazzi V, Patrizio A, Ghionzoli M, Varricchi G, Centanni M, Ulisse S, Antonelli A, Fallahi P. Chemokines in thyroid autoimmunity. Best Pract Res Clin Endocrinol Metab 2023; 37:101773. [PMID: 36907786 DOI: 10.1016/j.beem.2023.101773] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
The chemokine receptor CXCR3 and its chemokines CXCL9, CXCL10, and CXCL11 are involved in the pathogenesis of autoimmune diseases. Th1 lymphocytes are recruited by Th1 chemokines, secreted by damaged cells. In inflamed tissues, the attracted Th1 lymphocytes induce the IFN-gamma and TNF-alpha release, that stimulates the secretion of Th1 chemokines, initiating and reiterating an amplification feedback loop. Autoimmune thyroid disorders (AITD) are the most recurrent autoimmune diseases, including Graves' disease (GD) and autoimmune thyroiditis, clinically defined by thyrotoxicosis and hypothyroidism, respectively. Graves' ophthalmopathy is one of GD extrathyroidal manifestations, occurring in ~30-50% of GD patients. In the early phase of AITD, the Th1 immune response is prevalent, and a following switch to a Th2 immune response has been shown in the late, inactive, phase. The reviewed data underline the importance of chemokines in thyroid autoimmunity and suggest CXCR3-receptor and its chemokines as potential targets of novel drugs for these disorders.
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Affiliation(s)
| | - Sabrina Rosaria Paparo
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Francesca Ragusa
- Department of Surgery, Medical and Molecular Pathology and of Critical Area, University of Pisa, Pisa, Italy
| | - Giusy Elia
- Department of Surgery, Medical and Molecular Pathology and of Critical Area, University of Pisa, Pisa, Italy
| | - Valeria Mazzi
- Department of Surgery, Medical and Molecular Pathology and of Critical Area, University of Pisa, Pisa, Italy
| | - Armando Patrizio
- Department of Emergency Medicine, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Marco Ghionzoli
- Department of Pediatric Surgery, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Gilda Varricchi
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy; Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples, Italy; World Allergy Organization (WAO), Center of Excellence, Naples, Italy; Institute of Experimental Endocrinology and Oncology (IEOS), National Research Council, Naples, Italy
| | - Marco Centanni
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Endocrine Unit, AUSL Latina, Latina, Italy
| | - Salvatore Ulisse
- Department of Surgery, "Sapienza" University of Rome, Rome, Italy
| | - Alessandro Antonelli
- Department of Surgery, Medical and Molecular Pathology and of Critical Area, University of Pisa, Pisa, Italy.
| | - Poupak Fallahi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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Infantino I, Tocchioni F, Ghionzoli M, Coletta R, Morini F, Morabito A. Case Report: Gut and spleen anomalies associated with DYRK1A syndrome. Front Pediatr 2023; 10:936732. [PMID: 36741085 PMCID: PMC9890171 DOI: 10.3389/fped.2022.936732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 12/19/2022] [Indexed: 01/19/2023] Open
Abstract
DYRK1A syndrome has been extensively studied primarily with regard to neurologic and other phenotypic features such as skeleton and craniofacial alterations. In the present paper, we aim to highlight unusual anomalies associated with a DYRK1A mutation: a 17-year-old female patient with language and cognitive delay, microcephaly, and an autistic disorder, who was operated upon for spleen torsion with anomalous gut fixation.
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Affiliation(s)
- I. Infantino
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - F. Tocchioni
- Department of Pediatric and Neonatal Surgery, Meyer Children's Hospital IRCSS, Florence, Italy
| | - M. Ghionzoli
- Department of Pediatric and Neonatal Surgery, Meyer Children's Hospital IRCSS, Florence, Italy
| | - R. Coletta
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
- Department of Pediatric and Neonatal Surgery, Meyer Children's Hospital IRCSS, Florence, Italy
- School of Health and Society, University of Salford, Salford, United Kingdom
| | - F. Morini
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
- Department of Pediatric and Neonatal Surgery, Meyer Children's Hospital IRCSS, Florence, Italy
| | - A. Morabito
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
- Department of Pediatric and Neonatal Surgery, Meyer Children's Hospital IRCSS, Florence, Italy
- School of Health and Society, University of Salford, Salford, United Kingdom
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Spinelli C, Ghionzoli M, Strambi S. Primary peritoneal hemangioendothelioma simulating an ovarian cyst: A case report and review of literature. World J Obstet Gynecol 2022; 11:40-46. [DOI: 10.5317/wjog.v11.i4.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/05/2022] [Accepted: 11/23/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Epithelioid hemangioendothelioma (EHE) is an extremely rare tumor with a prevalence of one in a million and a very heterogenous spectrum of disease that varies from an indolent to a metastasizing aggressive disease, with the liver, lung and bone being the primarily involved organs. Peritoneal forms of EHE are even rare, and only 12 cases have been reported to date in the literature.
CASE SUMMARY A 66-year-old female came to our attention complaining low abdominal and perineal pain. Magnetic resonance imaging examination showed a 52 mm × 58 mm × 32 mm cystic mass with some smooth septa, simulating an ovarian cyst. Explorative laparoscopy demonstrated the presence of a peritoneal mass of augmented consistency connected with a sigmoid epiploic appendix in the right side of the Pouch of Douglas, that was surgically removed. Histological exa-mination revealed a primitive peritoneafl hemangioendothelioma. The patient easily recovered from surgery with no residual pain or discomfort. She is regularly attending a 3-years follow-up that is negative for local recurrence of disease or distant metastases.
CONCLUSION Peritoneal form of EHE often simulates masses of other nature, as in our case. Given its unspecific clinical and radiological presentation, patients are often forced to a large series of tests and examinations before reaching a definitive diagnosis, that can only histologically made. The possibility of EHE should always be considered in case of unexplained chronic abdominal pain associated to a non-specific mass.
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Affiliation(s)
- Claudio Spinelli
- Pediatric and Adolescent Surgery Division, Department of Surgical, Medical, Molecular Pathology and of the Critic Area, University of Pisa, Pisa 56126, Italy
| | - Marco Ghionzoli
- Pediatric and Adolescent Surgery Division, Department of Surgical, Medical, Molecular Pathology and of the Critic Area, University of Pisa, Pisa 56126, Italy
| | - Silvia Strambi
- Pediatric and Adolescent Surgery Division, Department of Surgical, Medical, Molecular Pathology and of the Critic Area, University of Pisa, Pisa 56126, Italy
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11
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Mengozzi A, Costantino S, Paneni F, Duranti E, Nannipieri M, Mancini R, Lai M, La Rocca V, Puxeddu I, Antonioli L, Fornai M, Ghionzoli M, Georgiopoulos G, Ippolito C, Bernardini N, Ruschitzka F, Pugliese NR, Taddei S, Virdis* A, Masi S. Targeting SIRT1 Rescues Age- and Obesity-Induced Microvascular Dysfunction in Ex Vivo Human Vessels. Circ Res 2022; 131:476-491. [PMID: 35968712 PMCID: PMC9426744 DOI: 10.1161/circresaha.122.320888] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Experimental evidence suggests a key role of SIRT1 (silent information regulator 1) in age- and metabolic-related vascular dysfunction. Whether these effects hold true in the human microvasculature is unknown. We aimed to investigate the SIRT1 role in very early stages of age- and obesity-related microvascular dysfunction in humans. METHODS Ninety-five subjects undergoing elective laparoscopic surgery were recruited and stratified based on their body mass index status (above or below 30 kg/m2) and age (above or below 40 years) in 4 groups: Young Nonobese, Young Obese, Old Nonobese, and Old Obese. We measured small resistance arteries' endothelial function by pressurized micromyography before and after incubation with a SIRT1 agonist (SRT1720) and a mitochondria reactive oxygen species (mtROS) scavenger (MitoTEMPO). We assessed vascular levels of mtROS and nitric oxide availability by confocal microscopy and vascular gene expression of SIRT1 and mitochondrial proteins by qPCR. Chromatin immunoprecipitation assay was employed to investigate SIRT1-dependent epigenetic regulation of mitochondrial proteins. RESULTS Compared with Young Nonobese, obese and older patients showed lower vascular expression of SIRT1 and antioxidant proteins (FOXO3 [forkhead box protein O3] and SOD2) and higher expression of pro-oxidant and aging mitochondria proteins p66Shc and Arginase II. Old Obese, Young Obese and Old Nonobese groups endothelial dysfunction was rescued by SRT1720. The restoration was comparable to the one obtained with mitoTEMPO. These effects were explained by SIRT1-dependent chromatin changes leading to reduced p66Shc expression and upregulation of proteins involved in mitochondria respiratory chain. CONCLUSIONS SIRT1 is a novel central modulator of the earliest microvascular damage induced by age and obesity. Through a complex epigenetic control mainly involving p66Shc and Arginase II, it influences mtROS levels, NO availability, and the expression of proteins of the mitochondria respiratory chain. Therapeutic modulation of SIRT1 restores obesity- and age-related endothelial dysfunction. Early targeting of SIRT1 might represent a crucial strategy to prevent age- and obesity-related microvascular dysfunction.
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Affiliation(s)
- Alessandro Mengozzi
- Department of Clinical and Experimental Medicine (A.M., E.D., M.N., I.P., L.A., M.F., C.I., N.B., N.R.P., S.T., A.V., S.M.), University of Pisa, Italy.,Scuola Superiore Sant’Anna, Pisa, Italy (A.M., V.L.R., N.B.)
| | - Sarah Costantino
- Center for Molecular Cardiology, University of Zürich, Switzerland (S.C., F.P.)
| | - Francesco Paneni
- Center for Molecular Cardiology, University of Zürich, Switzerland (S.C., F.P.).,Department of Cardiology, University Heart Center (F.P., F.R.), University Hospital Zurich, Switzerland.,Department of Research and Education (F.P.), University Hospital Zurich, Switzerland
| | - Emiliano Duranti
- Department of Clinical and Experimental Medicine (A.M., E.D., M.N., I.P., L.A., M.F., C.I., N.B., N.R.P., S.T., A.V., S.M.), University of Pisa, Italy
| | - Monica Nannipieri
- Department of Clinical and Experimental Medicine (A.M., E.D., M.N., I.P., L.A., M.F., C.I., N.B., N.R.P., S.T., A.V., S.M.), University of Pisa, Italy
| | - Rudj Mancini
- Unit of Bariatric Surgery, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (R.M.)
| | - Michele Lai
- Retrovirus Center and Virology Section, Department of Translational Research and New Technologies in Medicine and Surgery (M.L., V.L.R.), University of Pisa, Italy
| | - Veronica La Rocca
- Retrovirus Center and Virology Section, Department of Translational Research and New Technologies in Medicine and Surgery (M.L., V.L.R.), University of Pisa, Italy.,Scuola Superiore Sant’Anna, Pisa, Italy (A.M., V.L.R., N.B.)
| | - Ilaria Puxeddu
- Department of Clinical and Experimental Medicine (A.M., E.D., M.N., I.P., L.A., M.F., C.I., N.B., N.R.P., S.T., A.V., S.M.), University of Pisa, Italy
| | - Luca Antonioli
- Department of Clinical and Experimental Medicine (A.M., E.D., M.N., I.P., L.A., M.F., C.I., N.B., N.R.P., S.T., A.V., S.M.), University of Pisa, Italy
| | - Matteo Fornai
- Department of Clinical and Experimental Medicine (A.M., E.D., M.N., I.P., L.A., M.F., C.I., N.B., N.R.P., S.T., A.V., S.M.), University of Pisa, Italy
| | - Marco Ghionzoli
- Paediatric Surgery Unit, Meyer Children’s Hospital, Florence, Italy (M.G.)
| | - Georgios Georgiopoulos
- School of Biomedical Engineering and Imaging Sciences, King’s College London, United Kingdom (G.G.).,Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Greece (G.G.)
| | - Chiara Ippolito
- Department of Clinical and Experimental Medicine (A.M., E.D., M.N., I.P., L.A., M.F., C.I., N.B., N.R.P., S.T., A.V., S.M.), University of Pisa, Italy
| | - Nunzia Bernardini
- Department of Clinical and Experimental Medicine (A.M., E.D., M.N., I.P., L.A., M.F., C.I., N.B., N.R.P., S.T., A.V., S.M.), University of Pisa, Italy.,Scuola Superiore Sant’Anna, Pisa, Italy (A.M., V.L.R., N.B.)
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center (F.P., F.R.), University Hospital Zurich, Switzerland
| | - Nicola Riccardo Pugliese
- Department of Clinical and Experimental Medicine (A.M., E.D., M.N., I.P., L.A., M.F., C.I., N.B., N.R.P., S.T., A.V., S.M.), University of Pisa, Italy
| | - Stefano Taddei
- Department of Clinical and Experimental Medicine (A.M., E.D., M.N., I.P., L.A., M.F., C.I., N.B., N.R.P., S.T., A.V., S.M.), University of Pisa, Italy
| | - Agostino Virdis*
- Department of Clinical and Experimental Medicine (A.M., E.D., M.N., I.P., L.A., M.F., C.I., N.B., N.R.P., S.T., A.V., S.M.), University of Pisa, Italy
| | - Stefano Masi
- Department of Clinical and Experimental Medicine (A.M., E.D., M.N., I.P., L.A., M.F., C.I., N.B., N.R.P., S.T., A.V., S.M.), University of Pisa, Italy.,Institute of Cardiovascular Science, University College London, United Kingdom (S.M.)
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12
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Spinelli C, Ghionzoli M, Bertocchini A, Sanna B, Plessi C, Strambi S, De Napoli L, Frustaci G, Materazzi G, Antonelli A, Morganti R, Gennari F, Inserra A, Bisogno G, Gamba P, Ferrari A, Massimino M. Factors associated with postoperative hypocalcemia following thyroidectomy in childhood. Pediatr Blood Cancer 2022; 69:e29576. [PMID: 35129296 DOI: 10.1002/pbc.29576] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 12/19/2021] [Accepted: 12/27/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Postoperative hypocalcemia is a frequent complication after thyroidectomy. Hypoparathyroidism may develop as transient (TtHP), with normalization within six months from surgery, or permanent (PtHP) if the patient requires replacement therapy. We analyzed factors associated with the development of postoperative hypoparathyroidism and in detail PtHP following thyroid surgery in a pediatric population. PROCEDURE A retrospective multicenter study analyzing 326 patients was carried out. We recorded gender, age, tumor size, thyroiditis, extrathyroidal extension, lymph node dissection (central/lateral compartment, unilateral/bilateral), parathyroid autotransplantation, and histology. Additionally, calcium levels were acquired postoperatively. RESULTS We analyzed pediatric patients ≤18 years who underwent thyroidectomy clustered into age groups (≤15 or > 15). Patients' mean follow-up was 5.8 years (1-11 years). Postoperative hypoparathyroidism occurred in 36 (11.0%): 20 cases (6.13%) developed PtHP. Postoperative hypoparathyroidism was more frequent in younger patients (P = 0.014), in larger tumors (P < 0.001), in case of extrathyroidal extension (P = 0.037), and in central compartment (P = 0.020) and bilateral lymph node dissection (P = 0.030). PtHP was more frequent in older patients (P = 0.014), in case of thyroiditis (P < 0.001), and extrathyroidal extension (P < 0.001). Concerning the first postoperative calcium level measurement, in the postoperative hypoparathyroidism group, we registered a 8.17 mg/dL value with 14% pre/postoperative decrease (ΔCa ), whereas in PtHP patient group calcium level was 7.91 mg/dL with 16.7% ΔCa . CONCLUSIONS The risk of postoperative hypoparathyroidism is related to younger age, tumor size, central compartment and bilateral lymph node dissection, extrathyroidal extension, and decrease in postoperative calcium levels. The risk of PtHP is related to older age, thyroiditis, extrathyroidal extension, and decrease in postoperative calcium levels.
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Affiliation(s)
- Claudio Spinelli
- Division of Pediatric Surgery, Department of Surgical Pathology, University of Pisa, Pisa, Italy
| | - Marco Ghionzoli
- Division of Pediatric Surgery, Department of Surgical Pathology, University of Pisa, Pisa, Italy
| | - Alessia Bertocchini
- Division of Pediatric Surgery, Department of Surgical Pathology, University of Pisa, Pisa, Italy
| | - Beatrice Sanna
- Division of Pediatric Surgery, Department of Surgical Pathology, University of Pisa, Pisa, Italy
| | - Carlotta Plessi
- Division of Pediatric Surgery, Department of Surgical Pathology, University of Pisa, Pisa, Italy
| | - Silvia Strambi
- Division of Pediatric Surgery, Department of Surgical Pathology, University of Pisa, Pisa, Italy
| | - Luigi De Napoli
- Department of Surgical Pathology, Endocrine Surgery Division, University of Pisa, Pisa, Italy
| | - Gianluca Frustaci
- Department of Surgical Pathology, Endocrine Surgery Division, University of Pisa, Pisa, Italy
| | - Gabriele Materazzi
- Department of Surgical Pathology, Endocrine Surgery Division, University of Pisa, Pisa, Italy
| | - Alessandro Antonelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Riccardo Morganti
- Division of statistical support to clinical studies, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Fabrizio Gennari
- Division of Pediatric Surgery, "Regina Margherita Hospital,", Turin, Italy
| | - Alessandro Inserra
- General Pediatric and Thoracic Surgery, Bambino Gesù Children's Hospital-Research Institute, Rome, Italy
| | - Gianni Bisogno
- Hematology Oncology Division, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Piergiorgio Gamba
- Pediatric Surgery, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Andrea Ferrari
- Department of Pediatrics, National Cancer Institute, Milan, Italy
| | - Maura Massimino
- Department of Pediatrics, National Cancer Institute, Milan, Italy
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13
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Spinelli C, Sanna B, Ghionzoli M, Micelli E. Therapeutic challenges in metastatic follicular thyroid cancer occurring in pregnancy: A case report. World J Obstet Gynecol 2022; 11:33-39. [DOI: 10.5317/wjog.v11.i3.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/22/2022] [Accepted: 05/28/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hormones could play a role in the evolution of follicular thyroid cancer (FTC) for which we discuss an unusual presentation of FTC occurring during pregnancy.
CASE SUMMARY A pregnant woman was admitted with FTC metastasis resulting in a gluteal mass. Preoperative abdominal computed tomography revealed liver metastasis for which the patient underwent total thyroidectomy and liver resection, oral radioiodine therapy and radiotherapy, followed by embolization of the pelvic mass. The patient died of cerebral hemorrhage 16 mo after the initial diagnosis.
CONCLUSION Human chorionic gonadotropin and estrogen stimulation might have a role in cancer growth, especially during pregnancy. FTC management aims to stop disease progression and overcome hormonal imbalances after thyroidectomy thus reducing fetal complications. It is still under debate whether it is possible to combine optimal timing for treatment to ensure the best possible outcome with reduction of fetal complications and risk of cancer growth.
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Affiliation(s)
- Claudio Spinelli
- Division of Pediatric and Adolescent Surgery, Department of Surgical, Medical, Molecular Pathology and of the Critic Area, University of Pisa, Pisa 56100, Italy
| | - Beatrice Sanna
- Division of Pediatric and Adolescent Surgery, Department of Surgical, Medical, Molecular Pathology and of the Critic Area, University of Pisa, Pisa 56100, Italy
| | - Marco Ghionzoli
- Division of Pediatric and Adolescent Surgery, Department of Surgical, Medical, Molecular Pathology and of the Critic Area, University of Pisa, Pisa 56100, Italy
| | - Elisabetta Micelli
- Division of Gynecology and Obstetrics, University of Pisa, Pisa 56100, Italy
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14
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Garriboli M, Deguchi K, Totonelli G, Georgiades F, Urbani L, Ghionzoli M, Burns AJ, Sebire NJ, Turmaine M, Eaton S, De Coppi P. Development of a porcine acellular bladder matrix for tissue-engineered bladder reconstruction. Pediatr Surg Int 2022; 38:665-677. [PMID: 35316841 PMCID: PMC8983501 DOI: 10.1007/s00383-022-05094-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE Enterocystoplasty is adopted for patients requiring bladder augmentation, but significant long-term complications highlight need for alternatives. We established a protocol for creating a natural-derived bladder extracellular matrix (BEM) for developing tissue-engineered bladder, and investigated its structural and functional characteristics. METHODS Porcine bladders were de-cellularised with a dynamic detergent-enzymatic treatment using peristaltic infusion. Samples and fresh controls were evaluated using histological staining, ultrastructure (electron microscopy), collagen, glycosaminoglycans and DNA quantification and biomechanical testing. Compliance and angiogenic properties (Chicken chorioallantoic membrane [CAM] assay) were evaluated. T test compared stiffness and glycosaminoglycans, collagen and DNA quantity. p value of < 0.05 was regarded as significant. RESULTS Histological evaluation demonstrated absence of cells with preservation of tissue matrix architecture (collagen and elastin). DNA was 0.01 μg/mg, significantly reduced compared to fresh tissue 0.13 μg/mg (p < 0.01). BEM had increased tensile strength (0.259 ± 0.022 vs 0.116 ± 0.006, respectively, p < 0.0001) and stiffness (0.00075 ± 0.00016 vs 0.00726 ± 0.00216, p = 0.011). CAM assay showed significantly increased number of convergent allantoic vessels after 6 days compared to day 1 (p < 0.01). Urodynamic studies showed that BEM maintains or increases capacity and compliance. CONCLUSION Dynamic detergent-enzymatic treatment produces a BEM which retains structural characteristics, increases strength and stiffness and is more compliant than native tissue. Furthermore, BEM shows angiogenic potential. These data suggest the use of BEM for development of tissue-engineered bladder for patients requiring bladder augmentation.
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Affiliation(s)
- Massimo Garriboli
- Stem Cells and Regenerative Medicine Section, Developmental Biology and Cancer Programme UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
- Department of Nephro-Urology, Evelina London Children's Hospital, Guys and St. Thomas NHS Foundation Trust, London, UK
| | - Koichi Deguchi
- Stem Cells and Regenerative Medicine Section, Developmental Biology and Cancer Programme UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
- Department of Pediatric Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Giorgia Totonelli
- Stem Cells and Regenerative Medicine Section, Developmental Biology and Cancer Programme UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Fanourios Georgiades
- Stem Cells and Regenerative Medicine Section, Developmental Biology and Cancer Programme UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Luca Urbani
- Stem Cells and Regenerative Medicine Section, Developmental Biology and Cancer Programme UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Marco Ghionzoli
- Stem Cells and Regenerative Medicine Section, Developmental Biology and Cancer Programme UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Alan J Burns
- Neural Development Unit, Institute of Child Health, University College London, 30 Guilford Street, London, UK
| | - Neil J Sebire
- Department of Histopathology, Institute of Child Health and Great Ormond Street Hospital, University College London, London, UK
| | - Mark Turmaine
- Division of Bioscience, University College London, London, UK
| | - Simon Eaton
- Stem Cells and Regenerative Medicine Section, Developmental Biology and Cancer Programme UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Paolo De Coppi
- Stem Cells and Regenerative Medicine Section, Developmental Biology and Cancer Programme UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
- Paediatric Surgery Department, Great Ormond Street Hospital, London, UK.
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Casatori L, Pellegrino A, Messineo A, Ghionzoli M, Facchini F, Modesti A, Modesti PA. Differential Influence of Physical Activity on Cardiopulmonary Performance and Stroke Volume Assessed at Cardiopulmonary Exercise Test in Pectus Excavatum: A Pilot Study. Front Physiol 2022; 13:831504. [PMID: 35185624 PMCID: PMC8850936 DOI: 10.3389/fphys.2022.831504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/10/2022] [Indexed: 11/29/2022] Open
Abstract
Background Exercise training increases muscle VO2 by increasing O2 transport and O2 uptake while cardiac output increase might be limited by the conformation of the chest in subjects with pectus excavatum (PE). Aims The aim of the present study was to investigate the influence of physical activity (PA) on functional parameters of cardiopulmonary performance and stroke volume obtained at Cardiopulmonary Exercise Test (CPET) in PE. Methods and Procedures A cohort of adolescents (15 with PE and 15 age- and sex-matched healthy controls, HC) underwent Cardiopulmonary Exercise Test (CPET) and administration of the International Physical Activity Questionnaire – Short Form (IPAQ-SF) with estimation of weekly PA (METs h–1⋅week–1). Determinants of CPET parameters were investigated with multivariable linear regression analysis. Results As expected, when compared to HC, PE had lower VO2 max (37.2 ± 6.6 vs. 45.4 ± 6.4 mL⋅kg–1⋅min–1, p < 0.05), and VO2/HR max (O2 pulse, 12.1 ± 2.4 vs. 16.2 ± 3.6 mL⋅min–1⋅bpm–1, p < 0.05). Importantly, physical activity level was a predictor of VO2 max (adjusted for sex, body mass index, FEV1%, and presence of PE, β = 0.085; 95% Cl 0.010 to 0.160, p = 0.029) whereas O2 pulse was independent from PA level (β = 0.035; 95% Cl −0.004 to 0.074). Conclusion Physical activity is a determinant of VO2 max (cardiopulmonary performance), whereas it appears not to affect O2 pulse (a measure of stroke volume at peak exercise) related to constrained diastolic filling in PE.
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Affiliation(s)
- Lorenzo Casatori
- Department of Clinical and Experimental Medicine, School of Medicine, University of Florence, Florence, Italy
- Sports Medicine Unit, Careggi University Hospital, Florence, Italy
| | - Alessio Pellegrino
- Department of Clinical and Experimental Medicine, School of Medicine, University of Florence, Florence, Italy
- Sports Medicine Unit, Careggi University Hospital, Florence, Italy
| | - Antonio Messineo
- Department of Pediatric Surgery, Meyer Children’s University Hospital, University of Florence, Florence, Italy
| | - Marco Ghionzoli
- Department of Pediatric Surgery, Meyer Children’s University Hospital, University of Florence, Florence, Italy
| | - Flavio Facchini
- Department of Pediatric Surgery, Meyer Children’s University Hospital, University of Florence, Florence, Italy
| | - Alessandra Modesti
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, University of Florence, Florence, Italy
| | - Pietro Amedeo Modesti
- Department of Clinical and Experimental Medicine, School of Medicine, University of Florence, Florence, Italy
- Sports Medicine Unit, Careggi University Hospital, Florence, Italy
- *Correspondence: Pietro Amedeo Modesti,
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16
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Gigola F, Grimaldi C, Bici K, Ghionzoli M, Spinelli C, Muiesan P, Morabito A. Epidemiology and Surgical Management of Foreign Bodies in the Liver in the Pediatric Population: A Systematic Review of the Literature. Children 2022; 9:children9020120. [PMID: 35204841 PMCID: PMC8870636 DOI: 10.3390/children9020120] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/28/2021] [Accepted: 01/11/2022] [Indexed: 11/16/2022]
Abstract
Retention of foreign bodies (FB) in the liver parenchyma is a rare event in children but it can bring a heavy burden in terms of immediate and long-term complications. Multiple materials can migrate inside the liver. Clinical manifestations may vary, depending on the nature of the foreign body, its route of penetration and timing after the initial event. Moreover, the location of the FB inside the liver parenchyma may pose specific issues related to the possible complications of a challenging surgical extraction. Different clinical settings and the need for highly specialized surgical skills may influence the overall management of these children. Given the rarity of this event, a systematic review of the literature on this topic was conducted and confirmed the pivotal role of surgery in the pediatric population.
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Affiliation(s)
- Francesca Gigola
- Department of Pediatric Surgery, Meyer Children’s Hospital, 50139 Florence, Italy; (F.G.); (K.B.); (M.G.); (A.M.)
| | - Chiara Grimaldi
- Department of Pediatric Surgery, Meyer Children’s Hospital, 50139 Florence, Italy; (F.G.); (K.B.); (M.G.); (A.M.)
- Correspondence:
| | - Kejd Bici
- Department of Pediatric Surgery, Meyer Children’s Hospital, 50139 Florence, Italy; (F.G.); (K.B.); (M.G.); (A.M.)
| | - Marco Ghionzoli
- Department of Pediatric Surgery, Meyer Children’s Hospital, 50139 Florence, Italy; (F.G.); (K.B.); (M.G.); (A.M.)
| | - Claudio Spinelli
- Department of Surgical, Medical, Molecular Pathology and of the Critical Area, University of Pisa, 56100 Pisa, Italy;
| | - Paolo Muiesan
- Department of Hepatobiliary Surgery, Careggi University Hospital, 50134 Florence, Italy;
| | - Antonino Morabito
- Department of Pediatric Surgery, Meyer Children’s Hospital, 50139 Florence, Italy; (F.G.); (K.B.); (M.G.); (A.M.)
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Tocchioni F, Caporalini C, Buccoliero A, Facchini F, Ghionzoli M, Morini F. Case Report: Congenital Perineal Lipoma Associated With Additional External Genitalia Anomalies. Front Pediatr 2022; 10:923801. [PMID: 35844732 PMCID: PMC9279900 DOI: 10.3389/fped.2022.923801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/08/2022] [Indexed: 12/26/2022] Open
Abstract
Perineal lipoma is an uncommon congenital benign tumor sometimes associated with genitourinary or anorectal malformations. Accessory scrotum and accessory labioscrotal fold are infrequent features, often concurrent with perineal tumors. We describe a single institution experience with three consecutive cases of perineal lipoma associated with external genital anomalies, and a literature review.
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Affiliation(s)
- Francesca Tocchioni
- Department of Pediatric and Neonatal Surgery, Meyer Children's Hospital, Florence, Italy
| | - Chiara Caporalini
- Pathology Unit, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Annamaria Buccoliero
- Pathology Unit, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Flavio Facchini
- Department of Pediatric and Neonatal Surgery, Meyer Children's Hospital, Florence, Italy
| | - Marco Ghionzoli
- Department of Pediatric and Neonatal Surgery, Meyer Children's Hospital, Florence, Italy
| | - Francesco Morini
- Department of Pediatric and Neonatal Surgery, Meyer Children's Hospital, Florence, Italy
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Spinelli C, Strambi S, Masoni B, Ghionzoli M, Bertocchini A, Sanna B, Morganti R, Messina M, Molinaro F, Tursini S, Briganti V, Lisi G, Lelli Chiesa P. Surgical management of ovarian teratomas in childhood: a multicentric study on 110 cases and a literature review. Gynecol Endocrinol 2021; 37:950-954. [PMID: 34254550 DOI: 10.1080/09513590.2021.1948527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
AIM OF THE STUDY To compare a multicentric surgical experience on ovarian teratomas in childhood with the current management trends. DESIGN A retrospective multicentric pediatric ovarian teratomas surgically treated between January 2000 and August 2020 at four Italian institutions. PubMed database was used to search for Reviews and Systematic Reviews published between January 2010 and August 2020: 15 manuscripts reported 3633 ovarian neoplasms in pediatric age, 1219 (33,5%) of which were ovarian teratomas. RESULTS A hundred-ten patients with a mean age at diagnosis of 11.8 years were enrolled. Mature cystic teratomas accounted for the 90% of the masses. At surgery, 78 were oophorectomies and 32 were ovary sparing surgeries. Laparoscopy occurred in 16.3% of the surgeries.As regarding the current management trends, the mean age at diagnosis was 11.9 years and 80.5% of the cases were represented by mature teratomas. Of 430 procedures, 331 were oophorectomies while 99 were ovary sparing surgeries and laparoscopy was performed in 23.8% of cases. CONCLUSIONS Ovary-sparing surgery with laparoscopic approach is increasingly offered as standard treatment for benign masses that fit the criteria for mature teratomas, in the attempt to achieve the best compromise between the preservation of fertility and the prevention of recurrences. Awareness should be raised among pediatric surgeons to reduce unnecessary radical surgery.
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Affiliation(s)
- Claudio Spinelli
- Department of Surgical, Medical, Molecular Pathology and of the Critical Area, Universita degli Studi di Pisa, Pediatric, Adolescent and Young Adults Surgery Division, Pisa, Italy
| | - Silvia Strambi
- Department of Surgical, Medical, Molecular Pathology and of the Critical Area, Universita degli Studi di Pisa, Pediatric, Adolescent and Young Adults Surgery Division, Pisa, Italy
| | - Benedetta Masoni
- Department of Surgical, Medical, Molecular Pathology and of the Critical Area, Universita degli Studi di Pisa, Pediatric, Adolescent and Young Adults Surgery Division, Pisa, Italy
| | - Marco Ghionzoli
- Department of Surgical, Medical, Molecular Pathology and of the Critical Area, Universita degli Studi di Pisa, Pediatric, Adolescent and Young Adults Surgery Division, Pisa, Italy
| | - Alessia Bertocchini
- Department of Surgical, Medical, Molecular Pathology and of the Critical Area, Universita degli Studi di Pisa, Pediatric, Adolescent and Young Adults Surgery Division, Pisa, Italy
| | - Beatrice Sanna
- Department of Surgical, Medical, Molecular Pathology and of the Critical Area, Universita degli Studi di Pisa, Pediatric, Adolescent and Young Adults Surgery Division, Pisa, Italy
| | - Riccardo Morganti
- Department of Clinical and Experimental Medicine, Universita degli Studi di Pisa, Section of Statistics, Pisa, Italy
| | - Mario Messina
- Division of Pediatric Surgery, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Francesco Molinaro
- Division of Pediatric Surgery, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Stefano Tursini
- Department of Pediatric Surgery and Urology Unit, San Camillo Forlanini Hospital, Roma, Italy
| | - Vito Briganti
- Department of Pediatric Surgery and Urology Unit, San Camillo Forlanini Hospital, Roma, Italy
| | - Gabriele Lisi
- Department of Pediatric Surgery, 'Spirito Santo' Hospital, Università degli Studi Gabriele d'Annunzio Chieti Pescara, Pescara, Chieti, Italy
| | - Pierluigi Lelli Chiesa
- Department of Pediatric Surgery, 'Spirito Santo' Hospital, Università degli Studi Gabriele d'Annunzio Chieti Pescara, Pescara, Chieti, Italy
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Spinelli C, Cito G, Morelli G, Ghionzoli M, Bertocchini A, Sanna B, Galli L, Antonuzzo A, Morganti R, Strambi S. Testicular germ cells tumors in adolescents and young adults: Management and outcomes from a single-center experience. Arch Ital Urol Androl 2021; 93:301-306. [PMID: 34839629 DOI: 10.4081/aiua.2021.3.301] [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] [Received: 03/10/2021] [Accepted: 05/07/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To investigate and compare the effectiveness of active surveillance versus post-surgical active treatment, in patients with testicular germ cells tumor (TGCT). MATERIALS AND METHODS We retrospectively analyzed 52 patients who underwent surgery for TGCT from January 2009 to December 2014. All the patients were divided into two age groups: the Group A included children-adolescents from 18 months to 21 years old, while the Group B comprised young adults from 22 to 39 years old. Clinical, histopathological, therapeutic and follow-up data were collected. RESULTS Overall, 22 patients (42,3%) were enrolled in the Group A and 30 patients (57.7%) were categorized in the Group B. Inguinal orchiectomy was performed in all patients. Retroperitoneal lymphadenectomy was performed in 4 patients (7.7%). Post-surgical management differed based on clinical stage, resulting in active surveillance or adjuvant therapy. After an average 7 years follow-up period (range: 3.5-9.0 years), the overall survival rate is 100%. The relapse risk is significantly higher for the patients in the Group B, displaying a recurrence free-survival rate of 72% versus 95% (Group A); 11 relapses (21.1%) were recorded 2 years after surgery. Of these, 3 recurrences (12.0%) occurred in patients undergoing an active surveillance approach, while 8 (29.6%) in patients subjected to an active treatment. CONCLUSIONS The excellent prognosis in both age groups confirms the high curability of this neoplasia. The active surveillance could represent an optimal option for low recurrence risk tumors. However, post-surgical treatments should be taken into consideration for TGCT with high risk factors, including tumor size, lymphovascular and rete testis invasion.
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Affiliation(s)
- Claudio Spinelli
- Division of Pediatric, Adolescents and Young Adults Surgery, Department of Surgical Pathology, Medical, Molecular and Critical Area, University of Pisa.
| | - Gianmartin Cito
- Department of Urology and Andrology Surgery, Careggi Hospital, University of Florence.
| | - Girolamo Morelli
- Department of Urology and Andrology Surgery, University of Pisa.
| | - Marco Ghionzoli
- Division of Pediatric, Adolescents and Young Adults Surgery, Department of Surgical Pathology, Medical, Molecular and Critical Area, University of Pisa.
| | - Alessia Bertocchini
- Division of Pediatric, Adolescents and Young Adults Surgery, Department of Surgical Pathology, Medical, Molecular and Critical Area, University of Pisa.
| | - Beatrice Sanna
- Division of Pediatric, Adolescents and Young Adults Surgery, Department of Surgical Pathology, Medical, Molecular and Critical Area, University of Pisa.
| | - Luca Galli
- Medical Oncology II, University of Pisa, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa.
| | - Andrea Antonuzzo
- Medical Oncology I, National Health Service Department of Translational Medicine Research and New Technologies in Medicine and Surgery, University of Pisa.
| | - Riccardo Morganti
- Section of Statistics, Department of Clinical and Experimental Medicine, University of Pisa.
| | - Silvia Strambi
- Division of Pediatric, Adolescents and Young Adults Surgery, Department of Surgical Pathology, Medical, Molecular and Critical Area, University of Pisa.
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Spinelli C, Morelli G, Cito G, Bertocchini A, Ghionzoli M, Pucci A, Cocci A, Morganti R, Strambi S. Correlation between testicular volume and histological findings in children with unilateral cryptorchidism: Potential impact on future fertility. Urologia 2021; 89:292-297. [PMID: 33781144 DOI: 10.1177/03915603211004732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Our aim is to assess the correlation between testicular volume and histological findings in children with unilateral cryptorchidism. METHODS From September 2016 to August 2018, from 60 patients surgically treated for cryptorchidism, 45 children were enrolled in this single-center prospective study. Depending on the degree of testicular volume reduction, patients were divided into Group 1 with <20% reduction and Group 2 with reduction ⩾20%. Patients underwent unilateral orchidopexy and simultaneous biopsy of the undescended testis. Tanner stage was assigned. Tubular Fertility Index was measured. RESULTS Group 1 included 20 patients (44.4%) and Group 2 included 25 patients (55.5%). Mean age was 2.10 years (range 12 months-3.8 years) in Group 1 and 2.8 years (range 18 months-4.41 years) in Group 2. Although there is a positive correlation between testicular volume and Tubular Fertility Index, no significant association was found between groups (p-value = 0.29). Furthermore, histological patterns did not differ significantly among groups. CONCLUSIONS The degree of volume reduction in undescended testis does not seem to correlate significantly with the severity of histological changes that accompany cryptorchidism. Tubular Fertility Index could serve as objective tool for the assessment of future fertility.
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Affiliation(s)
- Claudio Spinelli
- Pediatric and Adolescent Surgery Division, Department of Medical, Molecular and Pathology Surgery, University of Pisa, Pisa, Italy
| | - Girolamo Morelli
- Department of Urology and Andrology Surgery, University of Pisa, Pisa, Italy
| | - Gianmartin Cito
- Department of Urology and Andrology Surgery, Careggi Hospital, University of Florence, Florence, Italy
| | - Alessia Bertocchini
- Pediatric and Adolescent Surgery Division, Department of Medical, Molecular and Pathology Surgery, University of Pisa, Pisa, Italy
| | - Marco Ghionzoli
- Pediatric and Adolescent Surgery Division, Department of Medical, Molecular and Pathology Surgery, University of Pisa, Pisa, Italy
| | - Angela Pucci
- Division of Pathology, University of Pisa, Pisa, Italy
| | - Andrea Cocci
- Department of Urology and Andrology Surgery, Careggi Hospital, University of Florence, Florence, Italy
| | - Riccardo Morganti
- Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy
| | - Silvia Strambi
- Pediatric and Adolescent Surgery Division, Department of Medical, Molecular and Pathology Surgery, University of Pisa, Pisa, Italy
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Servi M, Furferi R, Santerelli C, Uccheddu F, Volpe Y, Ghionzoli M, Messineo A. Outpatient monitoring of Pectus Excavatum: a Neural Network-based approach. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2020:5388-5393. [PMID: 33019199 DOI: 10.1109/embc44109.2020.9176494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Pectus Excavatum (PE) is a congenital anomaly of the ribcage, at the level of the sterno-costal plane, which consists of an inward angle of the sternum, in the direction of the spine. PE is the most common of all thoracic malformations, with an incidence of 1 in 300-400 people. To monitor the progress of the pathology, severity indices, or thoracic indices, have been used over the years. Among these indices, recent studies focus on the calculation of optical measures, calculated on the optical scan of the patient's chest, which can be very accurate without exposing the patient to invasive treatments such as CT scans. In this work, data from a sample of PE patients and corresponding doctors' severity assessments have been collected and used to create a decision tool to automatically assign a severity value to the patient. The idea is to provide the physician with an objective and easy to use measuring instrument that can be exploited in an outpatient clinic context. Among several classification tools, a Probabilistic Neural Network was chosen for this task for its simple structure and learning mode.
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Servi M, Buonamici F, Carfagni M, Volpe Y, Facchini F, Ghionzoli M, Messineo A. CAD-based automatic modelling of customized cutting templates for Pectus Arcuatum surgical correction. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2020:6044-6048. [PMID: 33019349 DOI: 10.1109/embc44109.2020.9175824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pectus Arcuatum (PA) is a congenital chest wall deformity which produces a superior manubrial and sternal protrusion, particularly at the sternal angle. PA surgical correction to reduce the angle of the sternum always includes the removal of bone portion by means of horizontal sternal osteotomies, resection of deformed rib cartilage and finally stabilization of the anterior thoracic wall. Within this process an incorrect assessment of the sternotomy angle during the procedure may lead to the need for bone or cartilage grafts to fill the left voids. This problem has been addressed with a patient-specific cutting template, realized with Reverse Engineering and Additive Manufacturing techniques, which proved to be a key element to simplify the procedure and avoid the occurrence of this type of complications. In this work is presented and validated a procedure that, through common CAD operations, realizes in a completely automatic way the CAD model of the custom cutting template, so as to make non-expert users independent in the realization of the medical device.
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Carnaghan H, James CP, Charlesworth PB, Ghionzoli M, Pereira S, Elkhouli M, Baud D, De Coppi P, Ryan G, Shah PS, Davenport M, David AL, Pierro A, Eaton S. Antenatal corticosteroids and outcomes in gastroschisis: A multicenter retrospective cohort study. Prenat Diagn 2020; 40:991-997. [PMID: 32400889 DOI: 10.1002/pd.5727] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/08/2020] [Accepted: 04/25/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE In gastroschisis, there is evidence to suggest that gut dysfunction develops secondary to bowel inflammation; we aimed to evaluate the effect of maternal antenatal corticosteroids administered for obstetric reasons on time to full enteral feeds in a multicenter cohort study of gastroschisis infants. METHODS A three center, retrospective cohort study (1992-2013) with linked fetal/neonatal gastroschisis data was conducted. The primary outcome measure was time to full enteral feeds (a surrogate measure for bowel function) and secondary outcome measure was length of hospital stay. Analysis included Mann-Whitney and Cox regression. RESULTS Of 500 patients included in the study, 69 (GA at birth 34 [25-38] weeks) received antenatal corticosteroids and 431 (GA at birth 37 [31-41] weeks) did not. Antenatal corticosteroids had no effect on the rate of reaching full feeds (Hazard ratio HR 1.0 [95% CI: 0.8-1.4]). However, complex gastroschisis (HR 0.3 [95% CI: 0.2-0.4]) was associated with an increased time to reach full feeds and later GA at birth (HR 1.1 per week increase in GA [95% CI: 1.1-1.2]) was associated with a decreased time to reach full feeds. CONCLUSION Maternal antenatal corticosteroids use, under current antenatal steroid protocols, in gastroschisis is not associated with an improvement in neonatal outcomes such as time to full enteral feeds or length of hospital stay.
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Affiliation(s)
- Helen Carnaghan
- UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
| | | | | | - Marco Ghionzoli
- UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
| | - Susana Pereira
- Departamento de Obstetrícia e Ginecologia, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Mohamed Elkhouli
- Fetal Medicine Unit, University College London Hospital, London, UK
| | - David Baud
- Fetal Medicine Unit, Mount Sinai Hospital, University of Toronto, Ontario, Canada
- Materno-fetal and Obstetrics Research Unit, Department of Gynaecology and Obstetrics, University Hospital of Lausanne CHUV, Lausanne, Switzerland
| | - Paolo De Coppi
- UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
| | - Greg Ryan
- Fetal Medicine Unit, Mount Sinai Hospital, University of Toronto, Ontario, Canada
| | - Prakesh S Shah
- Division of Neonatology, Mount Sinai Hospital, University of Toronto, Ontario, Canada
| | - Mark Davenport
- Paediatric Surgery Unit, King's College Hospital, London, UK
| | - Anna L David
- Fetal Medicine Unit, University College London Hospital, London, UK
| | - Agostino Pierro
- Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Simon Eaton
- UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
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Batazzi A, Leng S, Ghionzoli M, Lo Piccolo R, Martin A, Facchini F, Messineo A. Thyroglossal duct cyst: Factors affecting cosmetic outcome and recurrence. Pediatr Int 2019; 61:1020-1024. [PMID: 31282046 DOI: 10.1111/ped.13955] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 04/09/2019] [Accepted: 05/24/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND Thyroglossal duct cyst (TDC) is the most common congenital abnormality in the neck in children. The purpose of this study was to perform a comprehensive review of all cases of TDC surgically treated at a single institution and to evaluate the factors that influence the rate of recurrence, and the aesthetic outcome of the surgery on follow up. METHODS All cases of TDC surgically treated at the Department of Pediatric Surgery at Meyer Hospital from January 2005 to December 2016 were selected. Charts from 248 patients were reviewed and risk factors for recurrence evaluated. A questionnaire was submitted to the patients' parents to determine if postoperative complications were present and standardized neck pictures were requested, to evaluate the cosmetic result . Microsoft Office Excel 2007 for Windows and Graphpad Prism 6 were used for data management and statistical analysis. RESULTS Simple cyst excision and post-inflammatory fibrosis (P < 0.05) were assessed as important risk factors for the recurrence of TDC. Recurrence rate on Sistrunk procedure was 5%. Variables such as post-inflammatory fibrosis before surgery (P < 0.001), the positioning of a drain (P < 0.01) and the development of recurrence (P < 0.001), negatively influenced the cosmetic result. No thyroglossal duct cyst carcinoma and no long-term postoperative complications were observed. CONCLUSIONS Recurrence rates were higher in patients who underwent simple cyst excision instead of the Sistrunk procedure, as already reported in literature. Presence of post-inflammatory fibrosis and positioning of the drain at surgery were associated with higher rates of recurrence, as well as worse cosmetic outcome.
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Affiliation(s)
- Andrea Batazzi
- Department of Pediatric Surgery, Children's Hospital A. Meyer, Florence, Italy
| | - Stella Leng
- Department of Pediatric Surgery, Children's Hospital A. Meyer, Florence, Italy
| | - Marco Ghionzoli
- Department of Pediatric Surgery, Children's Hospital A. Meyer, Florence, Italy
| | - Roberto Lo Piccolo
- Department of Pediatric Surgery, Children's Hospital A. Meyer, Florence, Italy
| | - Alessandra Martin
- Department of Pediatric Surgery, Children's Hospital A. Meyer, Florence, Italy
| | - Flavio Facchini
- Department of Pediatric Surgery, Children's Hospital A. Meyer, Florence, Italy
| | - Antonio Messineo
- Department of Pediatric Surgery, Children's Hospital A. Meyer, Florence, Italy
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Leng S, Bici K, Facchini F, Volpe Y, Uccheddu F, Furferi R, Governi L, Carfagni M, Ghionzoli M, Messineo A. Customized Cutting Template to Assist Sternotomy in Pectus Arcuatum. Ann Thorac Surg 2018; 107:1253-1258. [PMID: 30508532 DOI: 10.1016/j.athoracsur.2018.10.057] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/07/2018] [Accepted: 10/25/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE Pectus arcuatum is an anterior chest wall deformity that requires transverse wedge sternotomy. Determining and delivering the correct cutting angle are crucial for successful correction. This report describes the early clinical experience with a novel cutting template technology able to deliver the optimal cutting angle. DESCRIPTION From patients' computed tomographic scans, the optimal cutting angle is obtained using computer-aided design. A template comprising slots tilted at the right cutting angle and a safety block to avoid damaging the posterior periosteum is printed through additive manufacturing. EVALUATION The template allows surgeons to perform a precise wedge sternotomy, safely sparing the posterior periosteum in all patients, without complications. Postoperative chest roentgenograms and clinical photographs demonstrate optimal sternal realignment and cosmetic outcome. In this report, the mean operative time was 110 minutes. All patients were successfully discharged, with a mean length of stay of 4 days. CONCLUSIONS Transverse wedge sternotomy aided by a computer-aided design-devised cutting template may reduce the technical challenge of this procedure, thereby increasing its safety and reducing operative times and hospital stay. Further research on long-term patient outcomes is necessary.
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Affiliation(s)
- Stella Leng
- Department of Pediatric Surgery, Meyer Children's University Hospital, University of Florence, Florence, Italy
| | - Kejd Bici
- Department of Pediatric Surgery, Meyer Children's University Hospital, University of Florence, Florence, Italy
| | - Flavio Facchini
- Department of Pediatric Surgery, Meyer Children's University Hospital, University of Florence, Florence, Italy
| | - Yary Volpe
- Department of Industrial Engineering, University of Florence, Florence, Italy
| | - Francesca Uccheddu
- Department of Industrial Engineering, University of Florence, Florence, Italy
| | - Rocco Furferi
- Department of Industrial Engineering, University of Florence, Florence, Italy
| | - Lapo Governi
- Department of Industrial Engineering, University of Florence, Florence, Italy
| | - Monica Carfagni
- Department of Industrial Engineering, University of Florence, Florence, Italy
| | - Marco Ghionzoli
- Department of Pediatric Surgery, Meyer Children's University Hospital, University of Florence, Florence, Italy
| | - Antonio Messineo
- Department of Pediatric Surgery, Meyer Children's University Hospital, University of Florence, Florence, Italy.
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Abstract
INTRODUCTION Lymphangiomas are benign tumors/malformations, characterized by proliferation of the lymphatic vessels. They may arise anywhere, although the most common localizations are the head-neck region and the axilla. To date, only 21 cases of lymphangioma of the ovary in a 60-year literature survey have been reported. CASE REPORT A 16-year-old female patient with long standing abdominal distension had 40 cm × 15 cm × 29 cm ovarian lymphangioma. CONCLUSIONS Our case highlights that lymphangiomas can occur in the adolescent population and should be added to the differential diagnosis of ovarian masses in this age group.
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Affiliation(s)
- Elisa Pani
- a Department of Pediatric Surgery , University of Florence and Children's University Hospital , Florence , Italy
| | - Alessandra Martin
- a Department of Pediatric Surgery , University of Florence and Children's University Hospital , Florence , Italy
| | - Annamaria Buccoliero
- a Department of Pediatric Surgery , University of Florence and Children's University Hospital , Florence , Italy
| | - Marco Ghionzoli
- a Department of Pediatric Surgery , University of Florence and Children's University Hospital , Florence , Italy
| | - Antonio Messineo
- a Department of Pediatric Surgery , University of Florence and Children's University Hospital , Florence , Italy
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Tocchioni F, Lombardi E, Ghionzoli M, Ciardini E, Noccioli B, Messineo A. Long-term lung function in children following lobectomy for congenital lung malformation. J Pediatr Surg 2017; 52:1891-1897. [PMID: 28951013 DOI: 10.1016/j.jpedsurg.2017.08.059] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 08/28/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND/PURPOSE To date, the optimal management of asymptomatic congenital lung malformations (CLMs) is still debated. There is still scant and controversial information regarding the long-term assessment of pulmonary function (PF) after lobectomy in children. The aim of this study is to evaluate PF in children who underwent lobectomy for CLM in infancy, hypothesizing that patients operated during the first year of life retain a normal lung function. METHODS Children operated between 2005 and 2016 at our institution underwent PF evaluation through spirometry/whole-body plethysmography, forced oscillation technique, and multiple-breath inert gas wash-out. RESULTS Out of 85 patients who underwent lobectomy at a median age of 5months, 50 met the inclusion criteria, and 28 patients were tested. More than 80% of patients had normal FEV1 and FVC. The mean FEV1, FVC, FEF25-75% values were higher in the patients operated before reaching one year of age. CONCLUSIONS The long-term outcome after lobectomy was excellent for most patients, as they retained a normal long-term PF. Therefore, for asymptomatic patients, a surgical approach before one year of age to avoid complications such as malignancy and to ensure an optimal PF catch-up could be beneficial. LEVEL OF EVIDENCE III - Treatment Studies.
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Affiliation(s)
- Francesca Tocchioni
- Department of Pediatric Surgery, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Enrico Lombardi
- Pediatric Pulmonary Unit, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Marco Ghionzoli
- Department of Pediatric Surgery, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Enrico Ciardini
- Department of Neonatal and Emergency Surgery, Meyer Children's Hospital, Florence, Italy
| | - Bruno Noccioli
- Department of Neonatal and Emergency Surgery, Meyer Children's Hospital, Florence, Italy
| | - Antonio Messineo
- Department of Pediatric Surgery, Meyer Children's Hospital, University of Florence, Florence, Italy.
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Incerti F, Bertocchini A, Ghionzoli M, Messineo A. Ultrasound-Guided Bar Edge Labeling in the Perioperative Assessment of Nuss Bar Removal. J Laparoendosc Adv Surg Tech A 2017; 27:1326-1327. [PMID: 29087764 DOI: 10.1089/lap.2017.0322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Nuss bar removal after minimally invasive repair of pectus excavatum in patients where bar ends are not palpable, can be a challenging procedure for the surgeon; a blind dissection toward the bar edges may lead to intercostal vessels or deep intercostal muscle injuries. In this article, we describe a fast, repeatable, low-cost technique to detect bar edge and stabilizers. METHODS A perioperative scan is performed by means of a portable ultrasonograph a few minutes before the operation. The bar edge stabilizer is detected as a hyperechogenic image with a concentric crescent while the bar edge is detected as a hyperechogenic dashed line with net edges. The scan is performed, and the actual projection on the skin of the metal plaque bulk is then labeled on the patient's chest by an ink marker. CONCLUSIONS We believe that this method may improve morbidity, operative time, and consequently, hospitalization length and costs.
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Affiliation(s)
- Filippo Incerti
- Department of Pediatric Surgery, Children's Hospital A. Meyer , Florence, Italy
| | - Alessia Bertocchini
- Department of Pediatric Surgery, Children's Hospital A. Meyer , Florence, Italy
| | - Marco Ghionzoli
- Department of Pediatric Surgery, Children's Hospital A. Meyer , Florence, Italy
| | - Antonio Messineo
- Department of Pediatric Surgery, Children's Hospital A. Meyer , Florence, Italy
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Carfagni M, Facchini F, Furferi R, Ghionzoli M, Governi L, Messineo A, Servi M, Uccheddu F, Volpe Y. A semi-automatic computer-aided method for personalized Vacuum Bell design. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/16864360.2017.1375676] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Facchini F, Ghionzoli M, Martin A, Tanini S, Ugolini S, Lo Piccolo R, Messineo A. Regenerative Surgery in the Treatment of Cosmetic Defect Following Nuss Procedure. J Laparoendosc Adv Surg Tech A 2017; 27:748-753. [DOI: 10.1089/lap.2016.0217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Flavio Facchini
- Department of Pediatric Surgery, A. Meyer Children's University Hospital, University of Florence, Florence, Italy
| | - Marco Ghionzoli
- Department of Pediatric Surgery, A. Meyer Children's University Hospital, University of Florence, Florence, Italy
| | - Alessandra Martin
- Department of Pediatric Surgery, A. Meyer Children's University Hospital, University of Florence, Florence, Italy
| | - Sara Tanini
- Department of Pediatric Surgery, A. Meyer Children's University Hospital, University of Florence, Florence, Italy
| | - Sara Ugolini
- Department of Pediatric Surgery, A. Meyer Children's University Hospital, University of Florence, Florence, Italy
| | - Roberto Lo Piccolo
- Department of Pediatric Surgery, A. Meyer Children's University Hospital, University of Florence, Florence, Italy
| | - Antonio Messineo
- Department of Pediatric Surgery, A. Meyer Children's University Hospital, University of Florence, Florence, Italy
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Ghionzoli M, Deaconu DE, Ugolini S, Lo Piccolo R, Messineo A. Left anterolateral emergency thoracotomy during the Nuss procedure: Lifesaving shortcut. Pediatr Int 2017; 59:103-104. [PMID: 28102634 DOI: 10.1111/ped.13033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 04/19/2016] [Accepted: 04/25/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Marco Ghionzoli
- Department of Pediatric Surgery, University of Florence and Children's University Hospital A. Meyer, Florence, Italy
| | - Diana E Deaconu
- Department of Pediatric Surgery, University of Florence and Children's University Hospital A. Meyer, Florence, Italy
| | - Sara Ugolini
- Department of Pediatric Surgery, University of Florence and Children's University Hospital A. Meyer, Florence, Italy
| | - Roberto Lo Piccolo
- Department of Pediatric Surgery, University of Florence and Children's University Hospital A. Meyer, Florence, Italy
| | - Antonio Messineo
- Department of Pediatric Surgery, University of Florence and Children's University Hospital A. Meyer, Florence, Italy
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Leng S, Ghionzoli M, Caporalini C, Buccoliero AM. Long-term intestinal bleeding in a child: a rare case of heterotopic gastric mucosa in the jejunum. BMJ Case Rep 2016; 2016:bcr-2016-216949. [PMID: 27888219 DOI: 10.1136/bcr-2016-216949] [Citation(s) in RCA: 6] [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: 12/27/2022] Open
Abstract
We report a rare case of heterotopic gastric mucosa presenting in a jejunal polyp of a 9-year-old girl, diagnosed with capsule endoscopy and laparoscopic exploration, after a 15-month history of lower gastrointestinal bleeding and anaemia. During surgery, the jejunal segment containing the polyp was resected and pathological examination revealed a polyp with gastric heterotopia. Heterotopic gastric mucosa is a rare pathology characterised by the presence of gastric mucosa outside of the stomach. Heterotopic gastric mucosa usually occurs in the oesophagus, duodenum, Meckel's diverticulum and enteric duplication cysts. It can be either congenital (heterotopic) or acquired (metaplastic). Symptoms vary from mild dyspepsia to massive gastrointestinal bleeding.
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Tocchioni F, Tani C, Bartolini L, Moriondo M, Nieddu F, Pecile P, Azzari C, Messineo A, Ghionzoli M. The Role of DNA Amplification and Cultural Growth in Complicated Acute Appendicitis. Pediatr Rep 2016; 8:6487. [PMID: 27777701 PMCID: PMC5066096 DOI: 10.4081/pr.2016.6487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 07/04/2016] [Accepted: 07/29/2016] [Indexed: 12/25/2022] Open
Abstract
Bacterial growth of peritoneal fluid specimens obtained during surgical procedures for acute appendicitis may be useful to optimize further antibiotic therapy in complicated cases. DNA amplification represents a fast technique to detect microbial sequences. We aimed to compare the potential of DNA amplification versus traditional bacterial growth culture highlighting advantages and drawbacks in a surgical setting. Peritoneal fluid specimens were collected during surgery from 36 children who underwent appendectomy between May and December 2012. Real-time polymerase chain reaction (RT-PCR) and cultures were performed on each sample. RT-PCR showed an amplification of 16S in 18/36 samples, Escherichia coli (in 7 cases), Pseudomonas aeruginosa (3), Fusobacterium necrophorum (3), Adenovirus (2), E.coli (1), Klebsiella pneumoniae (1), Serratia marcescens/Enterobacter cloacae (1). Bacterial growth was instead observed only in four patients (3 E.coli and 1 P.aeruginosa and Bacteroides ovatus). Preoperative C-reactive protein and inflammation degree, the most reliable indicators of bacterial translocation, were elevated as expected. DNA amplification was a quick and useful method to detect pathogens and it was even more valuable in detecting aggressive pathogens such as anaerobes, difficult to preserve in biological cultures; its drawbacks were the lack of biological growths and of antibiograms. In our pilot study RT-PCR and cultures did not influence the way patients were treated.
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Affiliation(s)
- Francesca Tocchioni
- Department of Pediatric Surgery, University of Florence and Children's University Hospital A. Meyer
| | - Chiara Tani
- Department of Pediatric Surgery, University of Florence and Children's University Hospital A. Meyer
| | | | - Maria Moriondo
- Department of Clinical Immunology, University of Florence and Children's University Hospital A. Meyer , Italy
| | - Francesco Nieddu
- Department of Clinical Immunology, University of Florence and Children's University Hospital A. Meyer , Italy
| | | | - Chiara Azzari
- Department of Clinical Immunology, University of Florence and Children's University Hospital A. Meyer , Italy
| | - Antonio Messineo
- Department of Pediatric Surgery, University of Florence and Children's University Hospital A. Meyer
| | - Marco Ghionzoli
- Department of Pediatric Surgery, University of Florence and Children's University Hospital A. Meyer
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34
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Ghionzoli M, Martin A, Bongini M, Bongini U, Ciuti G, Grisotto L, Monaco V, Menciassi A, Defilippi C, Messineo A. Scoliosis and Pectus Excavatum in Adolescents: Does the Nuss Procedure Affect the Scoliotic Curvature? J Laparoendosc Adv Surg Tech A 2016; 26:734-9. [DOI: 10.1089/lap.2016.0168] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Marco Ghionzoli
- Department of Emergency, Critical Area and Pediatric Surgery, University of Florence and Children's University Hospital “A. Meyer,” Florence, Italy
| | - Alessandra Martin
- Department of Emergency, Critical Area and Pediatric Surgery, University of Florence and Children's University Hospital “A. Meyer,” Florence, Italy
| | - Martina Bongini
- Department of Emergency, Critical Area and Pediatric Surgery, University of Florence and Children's University Hospital “A. Meyer,” Florence, Italy
| | - Ubaldo Bongini
- Department of Emergency, Critical Area and Pediatric Surgery, University of Florence and Children's University Hospital “A. Meyer,” Florence, Italy
| | - Gastone Ciuti
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Pisa, Italy
| | - Laura Grisotto
- Department of Emergency, Critical Area and Pediatric Surgery, University of Florence and Children's University Hospital “A. Meyer,” Florence, Italy
| | - Vito Monaco
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Pisa, Italy
| | - Arianna Menciassi
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Pisa, Italy
| | - Claudio Defilippi
- Department of Emergency, Critical Area and Pediatric Surgery, University of Florence and Children's University Hospital “A. Meyer,” Florence, Italy
| | - Antonio Messineo
- Department of Emergency, Critical Area and Pediatric Surgery, University of Florence and Children's University Hospital “A. Meyer,” Florence, Italy
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35
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Ghionzoli M, Bongini M, Piccolo RL, Martin A, Persano G, Deaconu DE, Messineo A. Role of thoracoscopy in traumatic diaphragmatic hernia. Pediatr Int 2016; 58:601-3. [PMID: 27072876 DOI: 10.1111/ped.12887] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 09/17/2015] [Accepted: 11/04/2015] [Indexed: 11/30/2022]
Abstract
Thoraco-abdominal trauma can in rare cases involve diaphragmatic rupture and subsequent herniation of intra-abdominal contents. We report a case of this complication in a 5-year-old boy who was injured in a car crash, and who manifested respiratory distress and hemodynamic instability after 48 h of being monitored in the pediatric intensive care unit. Multiple radiologic investigations were inconclusive and the definite diagnosis was established only on thoracoscopic exploration.
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Affiliation(s)
- Marco Ghionzoli
- Department of Emergency, Critical Area and Pediatric Surgery, University of Florence and Children's University Hospital "A. Meyer", Florence, Italy
| | - Martina Bongini
- Department of Emergency, Critical Area and Pediatric Surgery, University of Florence and Children's University Hospital "A. Meyer", Florence, Italy
| | - Roberto Lo Piccolo
- Department of Emergency, Critical Area and Pediatric Surgery, University of Florence and Children's University Hospital "A. Meyer", Florence, Italy
| | - Alessandra Martin
- Department of Emergency, Critical Area and Pediatric Surgery, University of Florence and Children's University Hospital "A. Meyer", Florence, Italy
| | - Giorgio Persano
- Department of Emergency, Critical Area and Pediatric Surgery, University of Florence and Children's University Hospital "A. Meyer", Florence, Italy
| | - Diana E Deaconu
- Department of Emergency, Critical Area and Pediatric Surgery, University of Florence and Children's University Hospital "A. Meyer", Florence, Italy
| | - Antonio Messineo
- Department of Emergency, Critical Area and Pediatric Surgery, University of Florence and Children's University Hospital "A. Meyer", Florence, Italy
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36
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Tocchioni F, Ghionzoli M, Lo Piccolo R, Deaconu DE, Facchini F, Milanez De Campos JR, Messineo A. Sternal Cleft and Pectus Excavatum: A Combined Approach for the Correction of a Complex Anterior Chest Wall Malformation in a Teenager. Ann Thorac Surg 2015; 99:e131-5. [PMID: 26046903 DOI: 10.1016/j.athoracsur.2015.03.050] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 03/07/2015] [Accepted: 03/12/2015] [Indexed: 10/23/2022]
Abstract
Congenital sternal cleft is a rare chest wall malformation. Because of the flexibility of the chest in infants, surgical repair should be performed by primary closure in the neonatal period. In adolescents and adults, different techniques have been suggested to overcome the lack of sternal bone tissue. We describe a very rare case of an 18-year-old woman with a complete bifid sternum associated with pectus excavatum for whom a satisfactory cosmetic and functional result was obtained by adequate surgical planning, which entailed a combination of two standardized surgical techniques.
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Affiliation(s)
- Francesca Tocchioni
- Department of Emergency, Critical Care and Pediatric Surgery, University of Florence and Children's University Hospital A. Meyer, Florence, Italy
| | - Marco Ghionzoli
- Department of Emergency, Critical Care and Pediatric Surgery, University of Florence and Children's University Hospital A. Meyer, Florence, Italy
| | - Roberto Lo Piccolo
- Department of Emergency, Critical Care and Pediatric Surgery, University of Florence and Children's University Hospital A. Meyer, Florence, Italy
| | - Diana E Deaconu
- Department of Emergency, Critical Care and Pediatric Surgery, University of Florence and Children's University Hospital A. Meyer, Florence, Italy
| | - Flavio Facchini
- Department of Emergency, Critical Care and Pediatric Surgery, University of Florence and Children's University Hospital A. Meyer, Florence, Italy
| | - Jose R Milanez De Campos
- Thoracic Surgery Department, San Paulo University Medical School General Hospital, San Paulo, Brazil
| | - Antonio Messineo
- Department of Emergency, Critical Care and Pediatric Surgery, University of Florence and Children's University Hospital A. Meyer, Florence, Italy.
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Deaconu DE, Buccoliero AM, Martin A, Messineo A, Ghionzoli M. Unique case of epidermoid cyst located in the omentum. Pediatr Int 2015; 57:724-6. [PMID: 25869095 DOI: 10.1111/ped.12576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 10/20/2014] [Accepted: 11/17/2014] [Indexed: 11/29/2022]
Abstract
Cystic lesions deriving from the omentum are rare benign clinical conditions of uncertain etiopathogenesis. In this report we describe a case of antenatal diagnosed intra-abdominal cystic mass, which, due to the absence of symptomatology and constant ultrasound morphology over time, did not require immediate treatment. The present patient was followed up until surgery, which was performed at 4 years of age: on laparoscopy a cyst within the greater omentum was identified and excised. Histopathology indicated a cyst with epidermoid structure, which is unusual among the omental cysts reported in the literature.
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Affiliation(s)
- Diana-Elena Deaconu
- Department of Pediatric Surgery, University of Florence and Children's University Hospital A. Meyer, Florence, Italy
| | - Anna Maria Buccoliero
- Department of Pediatric Surgery, University of Florence and Children's University Hospital A. Meyer, Florence, Italy
| | - Alessandra Martin
- Department of Pediatric Surgery, University of Florence and Children's University Hospital A. Meyer, Florence, Italy
| | - Antonio Messineo
- Department of Pediatric Surgery, University of Florence and Children's University Hospital A. Meyer, Florence, Italy
| | - Marco Ghionzoli
- Department of Pediatric Surgery, University of Florence and Children's University Hospital A. Meyer, Florence, Italy
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38
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Messineo A, Ghionzoli M, Lo Piccolo R, Milanez De Campos JR. A simplified method to pass the bar through the mediastinum in the Nuss technique. Ann Thorac Surg 2015; 99:717-8. [PMID: 25639424 DOI: 10.1016/j.athoracsur.2014.09.072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 09/04/2014] [Accepted: 09/12/2014] [Indexed: 11/17/2022]
Abstract
In the minimally invasive repair of pectus excavatum, as reported by Nuss, the introducer is inserted into the thoracic cavity, making its way through the mediastinum, and emerges through a left intercostal space. Then, 2 umbilical tapes are tied to the introducer tip as a guide to pass into this tunnel the curved bar with the concave side up. When fat tissue is present in the anterior mediastinum or bars with notched ends are used, passage of the umbilical tape could be challenging and eventually lead to bleeding. In this report, we describe a different and simple technique to allow this passage, from left to right, in a very safe and effective way.
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Affiliation(s)
- Antonio Messineo
- Department of Emergency, Critical Care and Pediatric Surgery, A. Meyer Children's Hospital, Florence, Italy.
| | - Marco Ghionzoli
- Department of Emergency, Critical Care and Pediatric Surgery, A. Meyer Children's Hospital, Florence, Italy
| | - Roberto Lo Piccolo
- Department of Emergency, Critical Care and Pediatric Surgery, A. Meyer Children's Hospital, Florence, Italy
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Abstract
Cervical thymic cysts are rare cervical masses which usually present in the first decade of life accounting for 0.3% - 1% of all congenital neck masses. Due to its rarity thymic cysts are seldom included in the differential diagnosis of cystic cervical mass and are often mistaken for more common conditions such as branchial cleft cyst or cystic hygroma. Herein we present a case of a 6-year-old girl with a right lateral cervical cystic mass with multiple septae extended from mandibular angle along the neurovascular bundle of the neck which revealed to be a thymic cyst at histopathology.
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Affiliation(s)
- Marta Betti
- 1University of Florence and Children's University Hospital, Department of emergency, Critical Area and Pediatric surgery , Viale Pieraccini 24, Florence , Italy
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Buccoliero AM, Ghionzoli M, Castiglione F, Paglierani M, Baroni G, Messineo A, Taddei GL. Inflammatory myofibroblastic tumor: Clinical, morphological, immunohistochemical and molecular features of a pediatric case. Pathol Res Pract 2014; 210:1152-5. [DOI: 10.1016/j.prp.2014.03.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 02/20/2014] [Accepted: 03/25/2014] [Indexed: 11/27/2022]
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41
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Affiliation(s)
- Giorgio Persano
- Department of Pediatric Surgery, University of Florence and Children's University Hospital A. Meyer, Florence, Italy
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Ricotti L, Ciuti G, Ghionzoli M, Messineo A, Menciassi A. Metal/polymer composite Nuss bar for minimally invasive bar removal after Pectus Excavatum treatment: FEM simulations. Int J Numer Method Biomed Eng 2014; 30:1530-1540. [PMID: 25208771 DOI: 10.1002/cnm.2682] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 07/31/2014] [Accepted: 09/01/2014] [Indexed: 06/03/2023]
Abstract
This study aims at assessing the mechanical behavior of a composite metal/polymer bar to be implanted in the retrosternal position, in order to correct chest wall deformities, such as Pectus Excavatum. A 300-mm-long, 12.7-mm-wide, and 3.5-mm-thick Nuss bar was considered, made of different metals and biodegradable polymers, fixed at its extremities, and with a constant force of 250 N applied on its center. Two different geometries for the metal elements to be embedded in the polymeric matrix were tested: in the former, thin metal sheets and in the latter, cylindrical metal reinforcing rods were considered. Finite element method simulation results are reported, in terms of maximum stress and strain of the bar. Furthermore, the maximum stress values obtained by varying metal sheet thickness or rod diameter (and therefore the volumetric percentage of metal within the matrix) for different material combinations are also shown; optimal configuration for the Pectus Excavatum treatment was finally identified for a composite Nuss bar.
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Affiliation(s)
- Leonardo Ricotti
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, (Pisa), Italy
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Carnaghan H, Pereira S, James CP, Charlesworth PB, Ghionzoli M, Mohamed E, Cross KMK, Kiely E, Patel S, Desai A, Nicolaides K, Curry JI, Ade-Ajayi N, De Coppi P, Davenport M, David AL, Pierro A, Eaton S. Is early delivery beneficial in gastroschisis? J Pediatr Surg 2014; 49:928-33; discussion 933. [PMID: 24888837 DOI: 10.1016/j.jpedsurg.2014.01.027] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 01/27/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Gastroschisis neonates have delayed time to full enteral feeds (ENT), possibly due to bowel exposure to amniotic fluid. We investigated whether delivery at <37weeks improves neonatal outcomes of gastroschisis and impact of intra/extra-abdominal bowel dilatation (IABD/EABD). METHODS A retrospective review of gastroschisis (1992-2012) linked fetal/neonatal data at 2 tertiary referral centers was performed. Primary outcomes were ENT and length of hospital stay (LOS). Data (median [range]) were analyzed using parametric/non-parametric tests, positive/negative predictive values, and regression analysis. RESULTS Two hundred forty-six patients were included. Thirty-two were complex (atresia/necrosis/perforation/stenosis). ENT (p<0.0001) and LOS (p<0.0001) were reduced with increasing gestational age. IABD persisted to last scan in 92 patients, 68 (74%) simple (intact/uncompromised bowel), 24 (26%) complex. IABD or EABD diameter in complex patients was not significantly greater than simple gastroschisis. Combined IABD/EABD was present in 22 patients (14 simple, 8 complex). When present at <30weeks, the positive predictive value for complex gastroschisis was 75%. Two patients with necrosis and one atresia had IABD and collapsed extra-abdominal bowel from <30weeks. CONCLUSION Early delivery is associated with prolonged ENT/LOS, suggesting elective delivery at <37weeks is not beneficial. Combined IABD/EABD or IABD/collapsed extra-abdominal bowel is suggestive of complex gastroschisis.
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Affiliation(s)
- Helen Carnaghan
- UCL Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
| | - Susana Pereira
- The Harris Birthright Centre for Fetal Medicine, King's College Hospital, London, UK
| | | | | | - Marco Ghionzoli
- UCL Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
| | - Elkhouli Mohamed
- Fetal Medicine Unit, University College London Hospital, London, UK
| | - Kate M K Cross
- UCL Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
| | - Edward Kiely
- UCL Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
| | - Shailesh Patel
- Paediatric Surgery Unit, King's College Hospital, London, UK
| | - Ashish Desai
- Paediatric Surgery Unit, King's College Hospital, London, UK
| | - Kypros Nicolaides
- The Harris Birthright Centre for Fetal Medicine, King's College Hospital, London, UK
| | - Joseph I Curry
- UCL Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
| | - Niyi Ade-Ajayi
- Paediatric Surgery Unit, King's College Hospital, London, UK
| | - Paolo De Coppi
- UCL Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
| | - Mark Davenport
- Paediatric Surgery Unit, King's College Hospital, London, UK
| | - Anna L David
- Fetal Medicine Unit, University College London Hospital, London, UK
| | - Agostino Pierro
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Simon Eaton
- UCL Institute of Child Health and Great Ormond Street Hospital for Children, London, UK.
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44
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Zani A, Cananzi M, Fascetti-Leon F, Lauriti G, Smith VV, Bollini S, Ghionzoli M, D'Arrigo A, Pozzobon M, Piccoli M, Hicks A, Wells J, Siow B, Sebire NJ, Bishop C, Leon A, Atala A, Lythgoe MF, Pierro A, Eaton S, De Coppi P. Amniotic fluid stem cells improve survival and enhance repair of damaged intestine in necrotising enterocolitis via a COX-2 dependent mechanism. Gut 2014; 63:300-9. [PMID: 23525603 DOI: 10.1136/gutjnl-2012-303735] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Necrotising enterocolitis (NEC) remains one of the primary causes of morbidity and mortality in neonates and alternative strategies are needed. Stem cells have become a therapeutic option for other intestinal diseases, which share some features with NEC. We tested the hypothesis that amniotic fluid stem (AFS) cells exerted a beneficial effect in a neonatal rat model of NEC. DESIGN Rats intraperitoneally injected with AFS cells and their controls (bone marrow mesenchymal stem cells, myoblast) were analysed for survival, behaviour, bowel imaging (MRI scan), histology, bowel absorption and motility, immunofluorescence for AFS cell detection, degree of gut inflammation (myeloperoxidase and malondialdehyde), and enterocyte apoptosis and proliferation. RESULTS AFS cells integrated in the bowel wall and improved rat survival and clinical conditions, decreased NEC incidence and macroscopic gut damage, improved intestinal function, decreased bowel inflammation, increased enterocyte proliferation and reduced apoptosis. The beneficial effect was achieved via modulation of stromal cells expressing cyclooxygenase 2 in the lamina propria, as shown by survival studies using selective and non-selective cyclooxygenase 2 inhibitors. Interestingly, AFS cells differentially expressed genes of the Wnt/β-catenin pathway, which regulate intestinal epithelial stem cell function and cell migration and growth factors known to maintain gut epithelial integrity and reduce mucosal injury. CONCLUSIONS We demonstrated here for the first time that AFS cells injected in an established model of NEC improve survival, clinical status, gut structure and function. Understanding the mechanism of this effect may help us to develop new cellular or pharmacological therapies for infants with NEC.
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Affiliation(s)
- Augusto Zani
- Surgery Unit, University College London Institute of Child Health, , London, UK
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45
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Ghionzoli M, Repele A, Sartiani L, Costanzi G, Parenti A, Spinelli V, David AL, Garriboli M, Totonelli G, Tian J, Andreadis ST, Cerbai E, Mugelli A, Messineo A, Pierro A, Eaton S, De Coppi P. Human amniotic fluid stem cell differentiation along smooth muscle lineage. FASEB J 2013; 27:4853-65. [PMID: 23995291 PMCID: PMC6188351 DOI: 10.1096/fj.12-218578] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 08/19/2013] [Indexed: 12/11/2022]
Abstract
Functional smooth muscle engineering requires isolation and expansion of smooth muscle cells (SMCs), and this process is particularly challenging for visceral smooth muscle tissue where progenitor cells have not been clearly identified. Herein we showed for the first time that efficient SMCs can be obtained from human amniotic fluid stem cells (hAFSCs). Clonal lines were generated from c-kit(+) hAFSCs. Differentiation toward SM lineage (SMhAFSCs) was obtained using a medium conditioned by PDGF-BB and TGF-β1. Molecular assays revealed higher level of α smooth muscle actin (α-SMA), desmin, calponin, and smoothelin in SMhAFSCs when compared to hAFSCs. Ultrastructural analysis demonstrated that SMhAFSCs also presented in the cytoplasm increased intermediate filaments, dense bodies, and glycogen deposits like SMCs. SMhAFSC metabolism evaluated via mass spectrometry showed higher glucose oxidation and an enhanced response to mitogenic stimuli in comparison to hAFSCs. Patch clamp of transduced hAFSCs with lentiviral vectors encoding ZsGreen under the control of the α-SMA promoter was performed demonstrating that SMhAFSCs retained a smooth muscle cell-like electrophysiological fingerprint. Eventually SMhAFSCs contractility was evident both at single cell level and on a collagen gel. In conclusion, we showed here that hAFSCs under selective culture conditions are able to give rise to functional SMCs.
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Affiliation(s)
- Marco Ghionzoli
- 2UCL Institute of Child Health and Great Ormond St. Hospital for Children, 30 Guilford St., London WC1N 1EH, UK.
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46
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Tocchioni F, Ghionzoli M, Calosi L, Guasti D, Romagnoli P, Messineo A. Rib cartilage characterization in patients affected by pectus excavatum. Anat Rec (Hoboken) 2013; 296:1813-20. [PMID: 24170345 DOI: 10.1002/ar.22824] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 09/25/2013] [Indexed: 11/07/2022]
Abstract
Pectus excavatum (PE) is the most frequent anterior chest deformity which may be frequently associated with connective tissue disorders. We performed microscopic analyses to better understand cartilage behavior and obtain clues on its pathogenesis. In 37 PE patients, none with Marfan syndrome, we analyzed costal cartilage by light microscopy, immunohistochemistry and transmission electron microscopy. Control tissue specimens were harvested from four patients without any connective tissue disease. In both control and PE patients, chondrocytes were on the average <15 µm in diameter and occupied <10% of tissue volume; in most cases the extracellular matrix was stained by alcian blue, instead of safranin; no difference between PE and control samples was significant. All samples showed an uneven collagen type II immunolabeling both within the cells and pericellular matrix, and occasionally of the territorial matrix. In all cases numerous cells underwent apoptosis accompanied by matrix condensation as shown by electron microscopy. Our results suggest that matrix composition and the cell number and size of costal cartilage are dependent on the subject and not on the disease; the microscopic organization of cartilage is correlated with the stabilization of the defective shape rather than with the onset of the deformity.
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Affiliation(s)
- Francesca Tocchioni
- Department of Pediatric Surgery, University of Florence and Children's University Hospital A. Meyer, Florence, Italy
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Tocchioni F, Ghionzoli M, Messineo A, Romagnoli P. Pectus excavatum and heritable disorders of the connective tissue. Pediatr Rep 2013; 5:e15. [PMID: 24198927 PMCID: PMC3812532 DOI: 10.4081/pr.2013.e15] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 06/20/2013] [Accepted: 08/13/2013] [Indexed: 12/03/2022] Open
Abstract
Pectus excavatum, the most frequent congenital chest wall deformity, may be rarely observed as a sole deformity or as a sign of an underlying connective tissue disorder. To date, only few studies have described correlations between this deformity and heritable connective tissue disorders such as Marfan, Ehlers-Danlos, Poland, MASS (Mitral valve prolapse, not progressive Aortic enlargement, Skeletal and Skin alterations) phenotype among others. When concurring with connective tissue disorder, cardiopulmonary and vascular involvement may be associated to the thoracic defect. Ruling out the concomitance of pectus excavatum and connective tissue disorders, therefore, may have a direct implication both on surgical outcome and long term prognosis. In this review we focused on biological bases of connective tissue disorders which may be relevant to the pathogenesis of pectus excavatum, portraying surgical and clinical implication of their concurrence.
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Pederiva F, Ghionzoli M, Pierro A, De Coppi P, Tovar JA. Amniotic fluid stem cells rescue both in vitro and in vivo growth, innervation, and motility in nitrofen-exposed hypoplastic rat lungs through paracrine effects. Cell Transplant 2012; 22:1683-94. [PMID: 23050982 DOI: 10.3727/096368912x657756] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Lung hypoplasia can be prevented in vitro by retinoic acid (RA). Recent evidence suggests that amniotic fluid stem (AFS) cells may integrate injured lungs and influence their recovery. We tested the hypothesis that AFS cells might improve lung growth and motility by paracrine mechanisms. Pregnant rats received either nitrofen or vehicle on E9.5. In vitro E13 embryonic lungs were cultured in the presence of culture medium alone or with RA, basophils, or AFS cells. In vivo green fluorescent protein-expressing (GFP(+)) rat AFS cells were transplanted in nitrofen-exposed rats on E10.5. E13 lung explants were cultured before analysis. The surface, the number of terminal buds, and the frequency of bronchial contractions were assessed. Protein gene product 9.5 (PGP 9.5) and α-actin protein levels were measured. The lung explants transplanted with AFS cells were stained for α-actin, PGP 9.5, and TTF-1. The levels of FGF-10, VEGFα, and TGF-β1 secreted by the AFS cells in the culture medium were measured. Comparison between groups was made by ANOVA. In vitro, the surface, the number of terminal buds, and the bronchial peristalsis were increased in nitrofen+AFS cell explants in comparison with nitrofen-exposed lungs. While nitrofen+RA lungs were similar to nitrofen+AFS ones, basophils did not normalize these measurements. PGP 9.5 protein was decreased in nitrofen lungs, but after adding AFS cells, the value was similar to controls. No differences were found in the expression of α-actin. In vivo, the surface, number of terminal buds, and peristalsis were similar to control after injection of AFS cells in nitrofen-exposed rats. Colocalization with TTF-1-positive cells was found. The levels of FGF-10 and VEGFα were increased in nitrofen+AFS cell explants, while the levels of TGF-β1 were similar to controls. Lung growth, bronchial motility, and innervation were decreased in nitrofen explants and rescued by AFS cells both in vitro and in vivo, similarly to that observed before with RA. The AFS cell beneficial effect was probably related to paracrine action of growth factor secretion.
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Affiliation(s)
- F Pederiva
- Department of Pediatric Surgery and Research Laboratory, Hospital Universitario La Paz, 28046 Madrid, Spain.
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Ghionzoli M, Brandigi E, Messineo A, Messeri A. Pain and anxiety management in minimally invasive repair of pectus excavatum. Korean J Pain 2012; 25:267-71. [PMID: 23091689 PMCID: PMC3468805 DOI: 10.3344/kjp.2012.25.4.267] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 06/29/2012] [Accepted: 06/29/2012] [Indexed: 11/25/2022] Open
Abstract
The Nuss procedure for the correction of Pectus Excavatum (PE) is associated with intense postoperative pain. Our strategy to control early postoperative pain is to combine epidural with intravenous analgesia. Our aim was to analyse our pain control strategy by reviewing all the PE cases treated at our institution. Sixty consecutive patients, aged between 12 and 26 years old, received the PE operation at our institution from January, 2007 to September, 2010. The median age was 16 (12-27) with a male/female ratio of about 7/1. An epidural catheter was employed in all the cases, with 38 patients (63%) requiring additional drugs to control pain, which remained in place for 74 hours (72-96). The pain score was higher in male patients, but lower in those younger than 16 years old. Moreover, patients that consumed benzodiazepines had a significant decrease in cumulative opioid intake (P = 0.0408). Both gender and age had an impact on pain control, while we noticed a synergistic effect between opiates and tranquillizers.
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Affiliation(s)
- Marco Ghionzoli
- Department of Pediatric Surgery, Children's Hospital A. Meyer, Florence, Italy
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Abstract
INTRODUCTION Severe pectus excavatum (PE) is a deep chest wall deformity that generates both a cosmetic damage and a cardiac/respiratory function impairment. Excluding the scarce reports on Marfan's syndrome (MFS) and Ehlers-Danlos's syndrome (EDS), few studies have examined the relation between severe PE and connective tissue disorders. The aim of this study is to verify the clinical significance of such correlation. SUBJECTS AND METHODS Ninety-two consecutive patients, of whom 79 were males, between 6 and 34 years old, classified as having severe PE, were seen at our institution from June 2005 to September 2010. All patients underwent clinical, ophthalmological, cardiac, and radiological (chest and spine magnetic resonance imaging) screening. The following features were observed: skin stretch marks, scoliosis, joint hypermobility, echocardiographic signs, spinal defects, and myopia. RESULTS Classical connectivopathies such as MFS or EDS were present in only 5 patients (approximately 5%), whereas a single deformity was present in 4. The largest group (approximately 71%) was represented by phenotypical alterations such as mitral valve prolapse, aortic root enlargement, and skeletal and skin alterations (MASS). Among those patients, the most frequent clinical manifestations were the skeletal ones, followed by skin marks and mitral valve prolapse. CONCLUSIONS PE showed an evident association with an array of features that we describe as MASS. Although not one of this subgroup of patients has been described with increased aortic root diameter when screened (a feature widely present in MFS patients), they probably would require a thorough and longer follow-up than those affected by isolated PE because of the potential occurrence of severe cardiovascular complications such as aneurysms and dissection, which are major causes of morbidity and mortality in MFS.
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Affiliation(s)
- Francesca Tocchioni
- Department of Pediatric Surgery, Children's Hospital A Meyer, Florence, Italy
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