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Sangiovanni A, Alimenti E, Gattai R, Filomia R, Parente E, Valenti L, Marzi L, Pellegatta G, Borgia G, Gambato M, Terreni N, Serio I, Belli L, Oliveri F, Maimone S, Brunacci M, D'Ambrosio R, Forzenigo LV, Russo FP, Rumi M, Barone M, Fracanzani AL, Raimondo G, Giannini EG, Brunetto MR, Villa E, Biganzoli E, Colombo M, Lampertico P. Undefined/non-malignant hepatic nodules are associated with early occurrence of HCC in DAA-treated patients with HCV-related cirrhosis. J Hepatol 2020; 73:593-602. [PMID: 32243959 DOI: 10.1016/j.jhep.2020.03.030] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [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] [Received: 03/04/2019] [Revised: 03/16/2020] [Accepted: 03/17/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIM An unexpected early increase in incidence, recurrence and clinical aggressiveness of hepatocellular carcinoma (HCC) has been reported (and refuted) in patients with HCV-related cirrhosis following direct-acting antiviral (DAA) treatment. To address this controversy, we performed a prospective multicenter study on consecutively enrolled cirrhotic patients, with or without a history of HCC, undergoing DAA therapy. PATIENTS AND METHODS A total of 1,161 HCC-free cirrhotics (group 1) and 124 cirrhotics who had received a curative treatment for an HCC (group 2) were enrolled. Clinical features, including presence of undefined/non-malignant liver nodules (UNMNs), were analyzed with respect to HCC incidence and recurrence. RESULTS During a median study time of 17 months in group 1 and 16 months in group 2, de novo HCC developed in 48 patients (yearly incidence 3.1/100 patient-years, 75% BCLC 0-A) and recurred in 40 (mean yearly incidence 29.9/100 patient-years, 83% BCLC 0-A). A peak of HCC instant incidence was observed at 4.2 months in group 1 patients with UNMNs, and at 7.7 months in group 2. By multivariable Cox regression models, UNMNs (hazard ratio [HR] 3.11; 95% CI 1.47-6.57: p = 0.003), ascites detected any time before enrolment (HR 3.04; 95% CI 1.23-7.51; p = 0.02), and alpha-fetoprotein log-value (HR 1.90; 95% CI 1.05-3.44; p = 0.03) were the variables independently associated with the incidence of de novo HCC, while history of alcohol abuse (HR 2.10; 95% CI 1.08-4.09; p = 0.03) and history of recurrence of HCC (HR 2.87; 95% CI 1.35-6.09; p = 0.006) were associated with HCC recurrence. CONCLUSION An early high incidence of both de novo HCC, in patients with UNMNs, and recurrent HCC was observed in DAA-treated patients; this was not accompanied by increased tumor aggressiveness. LAY SUMMARY This prospective study focuses on the risk of developing de novo or recurrent hepatocellular carcinoma (HCC) after direct-acting antiviral (DAA) treatment in patients with hepatitis C-related cirrhosis. We found that DAA treatment was associated with an early high HCC incidence in patients with undefined or non-malignant nodules, as well as in those with a history of complete response to HCC treatment. Whether this is related to the presence of clinically undetectable nests of cancer cells or to precancerous lesions that may progress to overt HCC upon DAA treatment remains unanswered. No evidence of increased clinical aggressiveness was reported in de novo or recurrent HCC.
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Affiliation(s)
- Angelo Sangiovanni
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico - Division of Gastroenterology and Hepatology - CRC "A. M. and A. Migliavacca" Center for Liver Disease, Milan, Italy.
| | - Eleonora Alimenti
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico - Division of Gastroenterology and Hepatology - CRC "A. M. and A. Migliavacca" Center for Liver Disease, Milan, Italy
| | - Riccardo Gattai
- Hepatology Unit and Laboratory of Molecular Genetics and Pathology of Hepatitis Viruses, University Hospital of Pisa, Pisa, Italy
| | - Roberto Filomia
- Division of Clinical and Molecular Hepatology, University Hospital of Messina, Messina, Italy
| | - Elisabetta Parente
- Gastroenterology Unit, Department of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy
| | - Luca Valenti
- Internal Medicine and Metabolic Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Luca Marzi
- Gastroenterology Unit, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Gaia Pellegatta
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Guglielmo Borgia
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples 'Federico II', Naples, Italy
| | - Martina Gambato
- Multivisceral Transplant Unit, Department of Surgery, Oncology, and Gastroenterology, Padua University Hospital, Padua, Italy
| | | | - Ilaria Serio
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Luca Belli
- UOC Epatologia e Gastroenterologia, Ospedale Niguarda, Milan, Italy
| | - Filippo Oliveri
- Hepatology Unit and Laboratory of Molecular Genetics and Pathology of Hepatitis Viruses, University Hospital of Pisa, Pisa, Italy
| | - Sergio Maimone
- Division of Clinical and Molecular Hepatology, University Hospital of Messina, Messina, Italy
| | - Matteo Brunacci
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Roberta D'Ambrosio
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico - Division of Gastroenterology and Hepatology - CRC "A. M. and A. Migliavacca" Center for Liver Disease, Milan, Italy
| | | | - Francesco Paolo Russo
- Multivisceral Transplant Unit, Department of Surgery, Oncology, and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Mariagrazia Rumi
- Division of Hepatology, Ospedale San Giuseppe, Università degli Studi di Milano, Milan, Italy
| | - Michele Barone
- Gastroenterology Unit, Department of Emergency and Organ Transplantation (D.E.T.O.), University of Bari, Bari, Italy
| | - Anna Ludovica Fracanzani
- Internal Medicine and Metabolic Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Raimondo
- Division of Clinical and Molecular Hepatology, University Hospital of Messina, Messina, Italy
| | | | - Maurizia Rossana Brunetto
- Hepatology Unit and Laboratory of Molecular Genetics and Pathology of Hepatitis Viruses, University Hospital of Pisa, Pisa, Italy; Internal Medicine, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Erica Villa
- Gastroenterology Unit, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Elia Biganzoli
- Department of Clinical Sciences and Community Health & DSRC, University of Milan, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Massimo Colombo
- Center of Translational Research in Hepatology, Humanitas Hospital, Rozzano, Italy
| | - Pietro Lampertico
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico - Division of Gastroenterology and Hepatology - CRC "A. M. and A. Migliavacca" Center for Liver Disease, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Gerlini G, Tripo L, Sestini S, Brandani P, Giannotti V, Gattai R, Borgognoni L. Melanoma metastases occuring 40 years after primary melanoma. Acta Oncol 2018; 57:1418-1420. [PMID: 29923761 DOI: 10.1080/0284186x.2018.1481295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Gianni Gerlini
- Plastic & Reconstructive Surgery Unit, Regional Melanoma Referral Center and Melanoma & Skin Cancer Unit Tuscan Tumour Institute (ITT), Santa Maria Annunziata Hospital, Florence, Italy
| | - Lara Tripo
- Plastic & Reconstructive Surgery Unit, Regional Melanoma Referral Center and Melanoma & Skin Cancer Unit Tuscan Tumour Institute (ITT), Santa Maria Annunziata Hospital, Florence, Italy
| | - Serena Sestini
- Plastic & Reconstructive Surgery Unit, Regional Melanoma Referral Center and Melanoma & Skin Cancer Unit Tuscan Tumour Institute (ITT), Santa Maria Annunziata Hospital, Florence, Italy
| | - Paola Brandani
- Plastic & Reconstructive Surgery Unit, Regional Melanoma Referral Center and Melanoma & Skin Cancer Unit Tuscan Tumour Institute (ITT), Santa Maria Annunziata Hospital, Florence, Italy
| | - Vanni Giannotti
- Plastic & Reconstructive Surgery Unit, Regional Melanoma Referral Center and Melanoma & Skin Cancer Unit Tuscan Tumour Institute (ITT), Santa Maria Annunziata Hospital, Florence, Italy
| | - Riccardo Gattai
- Unit of Emergency Surgery and Surgery of Oncology and Functional Disease, University of Florence, Florence, Italy
| | - Lorenzo Borgognoni
- Plastic & Reconstructive Surgery Unit, Regional Melanoma Referral Center and Melanoma & Skin Cancer Unit Tuscan Tumour Institute (ITT), Santa Maria Annunziata Hospital, Florence, Italy
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Grandi V, Sessa M, Pisano L, Rossi R, Galvan A, Gattai R, Mori M, Tiradritti L, Bacci S, Zuccati G, Cappugi P, Pimpinelli N. Photodynamic therapy with topical photosensitizers in mucosal and semimucosal areas: Review from a dermatologic perspective. Photodiagnosis Photodyn Ther 2018; 23:119-131. [PMID: 29669264 DOI: 10.1016/j.pdpdt.2018.04.005] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 04/03/2018] [Accepted: 04/10/2018] [Indexed: 02/07/2023]
Abstract
Photodynamic Therapy is a procedure based on the interaction between a Photosensitizer, a light source with a specific wavelength and oxygen. The aim of this review is to provide a brief and updated analysis of scientific reports on the use of PDT with topical PS in the management of oncological, infectious, and inflammatory disorders involving mucosal and semimucosal areas, with a specific focus on diseases of dermatologic interest.
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Affiliation(s)
- Vieri Grandi
- University of Florence School of Health Sciences, Department of Surgical and Translational Medicine, Section of Dermatology, P. Palagi Hospital, Viale Michelangelo 41, 50125, Florence, Italy.
| | - Maurizio Sessa
- University of Campania "Luigi Vanvitelli", Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", Via L. De Crecchio 7, Naples, Italy
| | - Luigi Pisano
- University of Florence School of Health Sciences, Department of Surgical and Translational Medicine, Section of Dermatology, P. Palagi Hospital, Viale Michelangelo 41, 50125, Florence, Italy
| | - Riccardo Rossi
- University of Florence School of Health Sciences, Department of Surgical and Translational Medicine, Section of Dermatology, P. Palagi Hospital, Viale Michelangelo 41, 50125, Florence, Italy
| | - Arturo Galvan
- Private Practice Dermatologist, C.M.R, Via S. Giovanni Bosco, 24, 36015, Schio, Italy
| | - Riccardo Gattai
- University of Florence School of Health Sciences, Department of Surgical and Translational Medicine, Largo Brambilla 3, 50141, Florence, Italy
| | - Moira Mori
- University of Florence School of Health Sciences, Department of Surgical and Translational Medicine, Section of Dermatology, P. Palagi Hospital, Viale Michelangelo 41, 50125, Florence, Italy
| | - Luana Tiradritti
- University of Florence School of Health Sciences, Department of Surgical and Translational Medicine, Section of Dermatology, P. Palagi Hospital, Viale Michelangelo 41, 50125, Florence, Italy
| | - Stefano Bacci
- Department of Clinical and Experimental Medicine, Research Unit of Histology and Embriology, University of Florence, 50141, Florence, Italy
| | - Giuliano Zuccati
- University of Florence School of Health Sciences, Department of Surgical and Translational Medicine, Section of Dermatology, P. Palagi Hospital, Viale Michelangelo 41, 50125, Florence, Italy
| | - Pietro Cappugi
- University of Florence School of Health Sciences, Department of Surgical and Translational Medicine, Section of Dermatology, P. Palagi Hospital, Viale Michelangelo 41, 50125, Florence, Italy
| | - Nicola Pimpinelli
- University of Florence School of Health Sciences, Department of Surgical and Translational Medicine, Section of Dermatology, P. Palagi Hospital, Viale Michelangelo 41, 50125, Florence, Italy
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Oliveri F, Surace L, Cavallone D, Colombatto P, Ricco G, Salvati N, Coco B, Romagnoli V, Gattai R, Salvati A, Moriconi F, Yuan Q, Bonino F, Brunetto MR. Long-term outcome of inactive and active, low viraemic HBeAg-negative-hepatitis B virus infection: Benign course towards HBsAg clearance. Liver Int 2017; 37:1622-1631. [PMID: 28296013 DOI: 10.1111/liv.13416] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [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: 01/13/2017] [Accepted: 03/06/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS The difference between the long-term outcome of low-viraemic (HBV-DNA≤20 000-IU/mL, LV-AC) and inactive HBsAg carriers (HBV-DNA≤2000-IU/mL, IC) remains to be defined. We studied prospectively 153 HBeAg-negative HBsAg-carriers with baseline HBV-DNA≤20 000-IU/mL and normal transaminases. METHODS IC, LV-AC or chronic hepatitis B (CHB) (HBV-DNA persistently ≤2000-IU/mL, ≤20 000-IU/mL or >20 000-IU/mL respectively) were diagnosed after 1-year, 3-monthly monitoring. Thereafter IC and LV-AC were followed-up for additional 57.2 (8.5-158.3) months. HBV-DNA, HBsAg, HBV"core-related"Antigen (HBcrAg) and total-anti-HBc were quantified at baseline. RESULTS After the 1st year diagnostic follow-up CHB [higher HBV-DNA (P=.005), total-anti-HBc (P=.012), ALT (P=.007) and liver-stiffness (P=.021)] was identified in 20 (13.1%) carriers; baseline HBsAg≤1000IU/HBV-DNA≤2000IU/mL excluded the presence of CHB (NPV-100%). Thereafter, during the long-term follow-up none of 87 IC reactivated, 19 (21.8%) cleared HBsAg [older-age (P=.004), lower HBsAg (P<.001), higher yearly HBsAg decline (P<.001)]. Twenty-five of 46 (54.3%) LV-AC remained stable, 20 (43.5%) became IC and 1 (2.2%) developed CHB. The best single-point CHB and IC diagnostic-accuracies were total-anti-HBc (84.2%, NPV-98.2%) and HBV-DNA/total-anti-HBc/HBcrAg combination (89.5%, 93%-sensitivity, 84.8%-specificity) respectively. CONCLUSIONS Viraemia persistently ≤20 000-IU/mL predicts a benign clinical outcome: it was associated with transition to IC in 43% of LV-AC and to Occult HBV Infection in 20% of IC within 5-years. Nevertheless, 13.1% of individuals with low viraemia at presentation develops CHB within 1 year: 1-year HBV-DNA monitoring resulted the most accurate diagnostic approach that can be limited to at least a half of cases by the single point HBV-DNA/HBsAg quantification. The IC-diagnostic-accuracy combining HBV-DNA/total-anti-HBc/HBcrAg needs to be confirmed in further studies.
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Affiliation(s)
- Filippo Oliveri
- Hepatology Unit and Laboratory of Molecular Genetics and Pathology of Hepatitis Viruses, University Hospital of Pisa, Pisa, Italy
| | - Lidia Surace
- Hepatology Unit and Laboratory of Molecular Genetics and Pathology of Hepatitis Viruses, University Hospital of Pisa, Pisa, Italy
| | - Daniela Cavallone
- Hepatology Unit and Laboratory of Molecular Genetics and Pathology of Hepatitis Viruses, University Hospital of Pisa, Pisa, Italy
| | - Piero Colombatto
- Hepatology Unit and Laboratory of Molecular Genetics and Pathology of Hepatitis Viruses, University Hospital of Pisa, Pisa, Italy
| | - Gabriele Ricco
- Hepatology Unit and Laboratory of Molecular Genetics and Pathology of Hepatitis Viruses, University Hospital of Pisa, Pisa, Italy
| | - Nicola Salvati
- Department of Economics and Management, University of Pisa, Pisa, Italy
| | - Barbara Coco
- Hepatology Unit and Laboratory of Molecular Genetics and Pathology of Hepatitis Viruses, University Hospital of Pisa, Pisa, Italy
| | - Veronica Romagnoli
- Hepatology Unit and Laboratory of Molecular Genetics and Pathology of Hepatitis Viruses, University Hospital of Pisa, Pisa, Italy
| | - Riccardo Gattai
- Hepatology Unit and Laboratory of Molecular Genetics and Pathology of Hepatitis Viruses, University Hospital of Pisa, Pisa, Italy
| | - Antonio Salvati
- Hepatology Unit and Laboratory of Molecular Genetics and Pathology of Hepatitis Viruses, University Hospital of Pisa, Pisa, Italy
| | - Francesco Moriconi
- Hepatology Unit and Laboratory of Molecular Genetics and Pathology of Hepatitis Viruses, University Hospital of Pisa, Pisa, Italy
| | - Quan Yuan
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health and School of Life Science, Xiamen University, Xiamen, China
| | - Ferruccio Bonino
- University of Pittsburgh Medical Center Institute for Health, Chianciano-Terme and Fondazione Italiana Fegato, AREA Science Park, Trieste, Italy
| | - Maurizia R Brunetto
- Hepatology Unit and Laboratory of Molecular Genetics and Pathology of Hepatitis Viruses, University Hospital of Pisa, Pisa, Italy.,Internal Medicine, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Chiarugi A, Nardini P, Borgognoni L, Brandani P, Gerlini G, Rubegni P, Lamberti A, Salvini C, Lo Scocco G, Cecchi R, Sirna R, Lorenzi S, Gattai R, Battistini S, Crocetti E. Thick melanoma in Tuscany. GIORN ITAL DERMAT V 2017; 154:638-645. [PMID: 28290624 DOI: 10.23736/s0392-0488.17.05584-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The epidemiologic trends of cutaneous melanoma are similar in several countries with a Western-type lifestyle, where there is a progressively increasing incidence and a low but not decreasing mortality - even increasing in selected cases, especially in the older age groups. Also in Tuscany there is a steady rise in the incidence with prevalence of in situ and invasive thin melanomas, with also an increase of thick melanomas. It is necessary to reduce the frequency of thick melanomas to reduce specific mortality. The objective of the current survey has been to compare, in the Tuscany population, by a case-case study, thin and thick melanoma cases, trying to find out those personal and tumor characteristics which may help to customize preventive interventions. METHODS The study included nine centers involved in the melanoma diagnosis. A consecutive series of incident invasive melanomas diagnosed in a period of about 18 months (July 2010 to December 2011) was collected and matched according in a ratio of one thick melanoma (cutoff thickness: 1 mm) every two thin melanomas. The investigators filled in a questionnaire on patients' self-reported sun exposure, way of melanoma detection, awareness and performance of self-skin examination, as well as propensity to prevention in general. RESULTS The results of this survey confirm that older age and the lower education level are associated with a later detection. The habit of performing skin self-examination is crucial in the early diagnosis of thick melanoma. The results of this survey seem to suggest that population aged over 50 years, with few total and few atypical nevi, and limited sun exposure and burning are at higher risk of late diagnosis. It can be assumed that part of the population is not effectively reached by prevention campaigns because they do not recognize themselves as being at risk for skin cancers. CONCLUSIONS In order to achieve a higher rate of early diagnosis of skin melanoma, a new strategy must be implemented. It could be useful to rethink educational campaigns - which seem to unintentionally leave out subjects more at risk for melanoma - and to renew the active involvement of the general practitioners.
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Affiliation(s)
- Alessandra Chiarugi
- Unit of Secondary Prevention, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy -
| | - Paolo Nardini
- Unit of Secondary Prevention, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Lorenzo Borgognoni
- Unit of Plastic and Reconstructive Surgery, Regional Melanoma Referral Center, S.M. Annunziata Hospital, AUSL Toscana Centro, Florence, Italy
| | - Paola Brandani
- Unit of Plastic and Reconstructive Surgery, Regional Melanoma Referral Center, S.M. Annunziata Hospital, AUSL Toscana Centro, Florence, Italy
| | - Gianni Gerlini
- Unit of Plastic and Reconstructive Surgery, Regional Melanoma Referral Center, S.M. Annunziata Hospital, AUSL Toscana Centro, Florence, Italy
| | - Pietro Rubegni
- Section of Dermatology, Department of Medical, Surgical Sciences and Neurosciences, AUSL Toscana Sud-Est, Siena, Italy
| | - Arianna Lamberti
- Section of Dermatology, Department of Medical, Surgical Sciences and Neurosciences, AUSL Toscana Sud-Est, Siena, Italy
| | - Camilla Salvini
- Department of Dermatology, AUSL Toscana Centro, Prato Hospital, Prato, Italy
| | - Giovanni Lo Scocco
- Department of Dermatology, AUSL Toscana Centro, Prato Hospital, Prato, Italy
| | - Roberto Cecchi
- Unit of Dermatology, S. Jacopo Hospital, AUSL Toscana Centro, Pistoia, Italy
| | - Riccardo Sirna
- Unit of Dermatology, Misericordia Hospital Grosseto, AUSL Toscana Sud-Est, Grosseto, Italy
| | - Stefano Lorenzi
- Unit of Dermatology, S. Luca Hospital, AUSL Toscana Nord-Ovest, Lucca, Italy
| | - Riccardo Gattai
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Silvio Battistini
- Unit of Dermatology, AUSL Toscana Nord-Ovest, Massa, Massa Carrara, Italy
| | - Emanuele Crocetti
- Romagna Cancer Registry, Romagna Cancer Institute (IRST) IRCCS, Meldola, Forlì-Cesena, Italy
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Gattai R, Pantalone D, Migliaccio ML, Bonizzoli M, Peris A, Bechi P. Upper G.I. hemorrhage from glass fragments' ingestion in a patient with jejunal diverticula - Case report. Int J Surg Case Rep 2014; 6C:191-3. [PMID: 25543882 PMCID: PMC4334954 DOI: 10.1016/j.ijscr.2014.11.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 11/21/2014] [Accepted: 11/21/2014] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Acute upper gastrointestinal bleeding is a common emergency. The ingestion of foreign bodies represents a less frequent cause of bleeding, but it is equally life-threatening, especially if the patient does not report the incident. PRESENTATION OF CASE We are reporting the case of a 77-year-old patient with a bleeding caused by ingestion of glass fragments with co-existing jejunal diverticula. DISCUSSION The ingestion of foreign bodies is a rare, mostly accidental event. Another possible source of upper G.I. bleeding is jejunal diverticula; in this case, the examination of the specimens showed evidence of glass ingestion fragments as the likely cause of bleeding. CONCLUSION Surgeons should be aware that patients may fail to report correctly on the possible causes of bleeding, misleading the diagnosis, and delaying the diagnostic routes.
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Affiliation(s)
- Riccardo Gattai
- Department of Surgery and Translational Medicine, University of Florence, Largo Brambilla 3, 50134 Florence Italy.
| | - Desire' Pantalone
- Department of Surgery and Translational Medicine, University of Florence, Largo Brambilla 3, 50134 Florence Italy.
| | - Maria Luisa Migliaccio
- Anestesiology and Emergency and Trauma Intensive Care Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy.
| | - Manuela Bonizzoli
- Anestesiology and Emergency and Trauma Intensive Care Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy.
| | - Adriano Peris
- Anestesiology and Emergency and Trauma Intensive Care Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy.
| | - Paolo Bechi
- Department of Surgery and Translational Medicine, University of Florence, Largo Brambilla 3, 50134 Florence Italy.
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Santini R, Vinci MC, Pandolfi S, Penachioni JY, Montagnani V, Olivito B, Gattai R, Pimpinelli N, Gerlini G, Borgognoni L, Stecca B. Hedgehog-GLI signaling drives self-renewal and tumorigenicity of human melanoma-initiating cells. Stem Cells 2013; 30:1808-18. [PMID: 22730244 DOI: 10.1002/stem.1160] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The question of whether cancer stem/tumor-initiating cells (CSC/TIC) exist in human melanomas has arisen in the last few years. Here, we have used nonadherent spheres and the aldehyde dehydrogenase (ALDH) enzymatic activity to enrich for CSC/TIC in a collection of human melanomas obtained from a broad spectrum of sites and stages. We find that melanomaspheres display extensive in vitro self-renewal ability and sustain tumor growth in vivo, generating human melanoma xenografts that recapitulate the phenotypic composition of the parental tumor. Melanomaspheres express high levels of Hedgehog (HH) pathway components and of embryonic pluripotent stem cell factors SOX2, NANOG, OCT4, and KLF4. We show that human melanomas contain a subset of cells expressing high ALDH activity (ALDH(high)), which is endowed with higher self-renewal and tumorigenic abilities than the ALDH(low) population. A good correlation between the number of ALDH(high) cells and sphere formation efficiency was observed. Notably, both pharmacological inhibition of HH signaling by the SMOOTHENED (SMO) antagonist cyclopamine and GLI antagonist GANT61 and stable expression of shRNA targeting either SMO or GLI1 result in a significant decrease in melanoma stem cell self-renewal in vitro and a reduction in the number of ALDH(high) melanoma stem cells. Finally, we show that interference with the HH-GLI pathway through lentiviral-mediated silencing of SMO and GLI1 drastically diminishes tumor initiation of ALDH(high) melanoma stem cells. In conclusion, our data indicate an essential role of the HH-GLI1 signaling in controlling self-renewal and tumor initiation of melanoma CSC/TIC. Targeting HH-GLI1 is thus predicted to reduce the melanoma stem cell compartment.
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Affiliation(s)
- Roberta Santini
- Laboratory of Tumor Cell Biology, Core Research Laboratory-Istituto Toscano Tumori, Florence, Italy
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Pucciani F, Raggioli M, Gattai R. Rehabilitation of fecal incontinence: What is the influence of anal sphincter lesions? Tech Coloproctol 2012; 17:299-306. [DOI: 10.1007/s10151-012-0923-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 10/08/2012] [Indexed: 01/16/2023]
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Pace M, Gattai R, Mascitelli EM, Millanta L. Results of isolated lower limb perfusion for loco-regional advanced/recurrent melanoma using borderline true hyperthermia plus additional bolus of melphalan. A critical analysis of homogeneous cases. J Surg Oncol 2011; 104:718-23. [PMID: 21721008 DOI: 10.1002/jso.21949] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Accepted: 03/30/2011] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVE This study was conducted to assess the safety and efficacy of our modified ILP treatment with borderline true hyperthermia and high melphalan concentration in stage III lower limb melanoma. METHODS Between March 1990 and December 2006, 91 consecutive patients were given ILP treatment. Forty three patients were treated with double L-PAM bolus combined with D-actinomicin; 48 patients were treated with additional L-PAM bolus alone. RESULTS The mean follow-up period is 68.5 months. The acute regional toxicity occurred with grade II (54%), III (38%), IV (2.1%). The systemic toxic effects were present with transitory hematological disorders. Complete response (CR) rate was observed in 89.2% of stage IIIA-IIIAB unexcised IT-mets. The overall limb recurrent disease in stage III was 39%. In patients with CR recurrent rate occurred in 44% with a mean limb recurrence-free interval (LRFI) of 23.8 months. Distant metastases was attained with a mean time of 29.2 months. After CR, the interval was 32.1 months. The 5-year survival rate was 45%; in patients with CR, was 48%. CONCLUSIONS Our procedure is an important therapeutic option. The results suggest a marked local control of the recurrent disease. The LRFI is longer than for those treated with other treatment schedules.
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Affiliation(s)
- Marcello Pace
- Department of Medical and Surgical Critical Care, University of Florence, Regional Reference Centre of Tuscany for Locoregional Perfusion Therapies in Oncology, Florence, Italy.
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Abstract
BACKGROUND Preoperative chemoradiation followed by total mesorectal excision (TME) has become a standard treatment of preoperatively staged T3 low rectal cancers in many institutions; however, a direct comparison of generalized preoperative versus selective adjuvant chemoradiation has never been assessed in a clinical practice setting. PATIENTS Over a 4-year period, 80 patients with T3 primary low adenocarcinoma of the rectum, judged operable at preoperative staging, were offered preoperative chemoradiation. Forty-seven patients (Group I) accepted the neoadjuvant treatment and 33 (Group II) preferred immediate surgery and postoperative chemoradiation if indicated. RESULTS Major postoperative complications occurred in 21% of Group I versus in 11% of Group II (p = 0.3) patients. After a mean follow-up of 92 months, the local recurrence rate was 4 and 9% (p = 0.4), metastasis rate was 30 and 24% (p = 0.5), 5-year survival probability was 0.79 (95% CI = 0.49-0.92) and 0.82 (95% CI = 0.70-1.00) (log-rank test, p = 0.6) for Group I and Group II, respectively. CONCLUSIONS In T3 operable low rectal cancers, selective postoperative radiochemotherapy yielded similar long-term results regarding recurrence rate and survival as extended preoperative chemoradiation.
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Affiliation(s)
- Claudio Fucini
- Department of Medical and Surgical Critical Care, Section of General and Oncological Surgery, University of Florence, Florence, Italy.
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Gattai R, Torchia D, Salvini C, Magini B, Comacchi C, Cappuccini A, Ruffino I, Pinton P, Cappugi P. Photodynamic Therapy for the Treatment of Endoanal Condylomata Acuminata. Clin Infect Dis 2010; 51:1222-3. [DOI: 10.1086/656920] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Pace M, Gattai R, Matteini M, Mascitelli EM, Bechi P. Toxicity and morbility after isolated lower limb perfusion in 242 chemo-hyperthermal treatments for cutaneous melanoma: the experience of the Tuscan Reference Centre. J Exp Clin Cancer Res 2008; 27:67. [PMID: 19014470 PMCID: PMC2602991 DOI: 10.1186/1756-9966-27-67] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2008] [Accepted: 11/12/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this retrospective study was to assess the results concerning the regional and systemic toxicity and complications in 242 chemo-hyperthermal treatments (HILPs) for lower limb melanoma. PATIENTS AND METHODS 60 HILPs (G-A) were performed with mild HT plus L-PAM (10 mg/lt) +/- D-actimomycin; 74 HILPs (G-B) with true HT (40-41.8 degrees C) plus L-PAM (10 mg/lt) +/- D-act; 108 HILPs (G-C) with true HT plus L-PAM (10 mg/lt) +/- D-act plus L-PAM (5 mg/lt) additional bolus. RESULTS Limb toxicity was very low in G-A and in G-B; increasing toxicity (grade III = 37%) in G-C; no grade IV statistical difference was registered in all three groups, with percentage values among 1.6% and 2.7%. Systemic toxicity showed itself only in the haemopoietic parameters. No differences were registered in G-B vs G-A group. In G-C vs G-B a significative increase of systemic toxicity was seen in grade 3 (p < 0.05). Postoperative complications were acceptable. Local and systemic side-effects were transient; no permanent neurological limb deficit was registered. The postoperative mortality was recorded in 3/182 HILPs (1.6%) of the G-B and G-C groups. CONCLUSION These data suggested that the technical implementations reduced the occurrence and the severity of the side effects and complications. The essential requirement for HILP is the quality assurance of the procedures. Although higher regional and systemic toxicity were observed in the G-C group caused by L-PAM additional bolus, the safeness of the procedures under the true hyperthermal regimen and the time increase of the high L-PAM concentration have assured the treatment reliability along with the increased clinical efficacy expectations of the treatments.
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Affiliation(s)
- Marcello Pace
- Dept. of Medical and Surgical Critical Care, University of Florence, Regional Reference Centre of Tuscany for Locoregional Perfusional Therapies in Oncology, Florence, Italy
| | | | - Maria Matteini
- Dept. of Medical and Surgical Critical Care, University of Florence, Regional Reference Centre of Tuscany for Locoregional Perfusional Therapies in Oncology, Florence, Italy
| | | | - Paolo Bechi
- Dept. of Medical and Surgical Critical Care, University of Florence, Regional Reference Centre of Tuscany for Locoregional Perfusional Therapies in Oncology, Florence, Italy
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Fucini C, Gattai R, Urena C, Bandettini L, Elbetti C. Quality of life among five-year survivors after treatment for very low rectal cancer with or without a permanent abdominal stoma. Ann Surg Oncol 2008; 15:1099-106. [PMID: 18181002 DOI: 10.1245/s10434-007-9748-2] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2007] [Revised: 11/05/2007] [Accepted: 11/14/2007] [Indexed: 11/18/2022]
Abstract
BACKGROUND Low rectal cancers situated less than 5 cm from the anal margin are still usually treated with abdomino-perineal excision (APE). Our aim is to compare the quality of life (QOL) of five-year survivors treated for low or very low rectal cancer with an advanced/complex coloanal procedure with the QOL of patients submitted to a standard APE with a definitive abdominal stoma. METHODS Sixty-two patients, operated on radically for low or very low rectal cancer, who came for their fifth year follow-up visit and were free from cancer, were studied. Thirty patients (group 1) had an APE with permanent abdominal stoma. Thirty-two patients (group 2) had undergone a radical advanced and complex procedure to avoid the abdominal stoma. The patients received the European Organisation for the Research and Treatment of Cancer (EORTC) QOL-30 generic and the CR38 colorectal cancer QOL questionnaires with the recommendation to return the questionnaire to the hospital. The Mann-Whitney U-test and chi (2) Fisher test were employed for statistical analysis. RESULTS All questionnaires were returned. Patients without a terminal abdominal stoma had a better score in six categories of the QOL 30 and in two categories of the CR38. No differences were observed in the other variables examined. CONCLUSIONS After five years, cancer-free patients operated on for low or very low rectal cancer have a better QOL if a definitive terminal abdominal stoma was avoided.
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Affiliation(s)
- C Fucini
- Department of Medical and Surgical Critical Care, Section of General and Oncological Surgery, University of Florence, Viale Morgagni, 85, 50134, Firenze, Italy.
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Pace M, Millanta L, Gattai R, Matteini M, Vaggelli L, Macera Mascitelli E, Bechi P. Key factors for best control of the systemic leakage during hyperthermic isolated limb perfusion (HILP) in ECC. A critical synthesis of our experience. J Exp Clin Cancer Res 2007; 26:433-442. [PMID: 18365536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The L-PAM-ILP procedures under true hyperthermal regime (41.5-41.8 degrees C) require both close control of the physical parameters of the treatment (temperatures profiles and time duration, artero-venous pressure, perfusate flow rate) and medical rationale (drug, dosage, fractioning, timing). All the above essential procedures must be supported by rigorous methodology, reliable operation of the medical devices and apparatus and real-time monitoring of the treatment parameters. Real-time monitoring is essential for proper trimming and modulation of the parameters during treatment. This paper delineates the technical improvements that we have implemented for drug leakage monitoring and control in the systemic circulation aimed at improving the therapeutic efficacy and at reducing the occurrence of unexpected complications.
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Affiliation(s)
- M Pace
- Dept. of Medical and Surgical Critical Care, University of Florence, Regional Reference Centre of Tuscany for Locoregional Perfusional Therapies in Oncology, Italy.
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Gattai R, Mascitelli EM, Bechi P, Pace M. [Integrated therapeutic strategy in large bowel neoplastic occlusion. An innovative therapeutic protocol]. Ann Ital Chir 2007; 78:295-301. [PMID: 17990604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Occlusive complication is a common event in the colo-rectal cancer (20-30% of cases). Operative mortality and 5 yrs survival of not occlusive cancer vs occlusive cancer is 11% vs 23% and 45% vs 25% rispectively. In occlusive cancer the level of parietal infiltration affects considerably the local and peritoneal recurrence. 50% of all patients underwent a surgical re-operation for colo-rectal cancer have peritoneal neoplastic implant. AIM The resolution of occlusive complication in immediate or delayed urgency with decompressive derivation, it allows to perform an integrated treatment of choice that it could guarantee the oncological radical procedure. RATIONALE-METHODS: The intraperitoneal hyperthermic chemotherapy (IPHC) combined with radical or cytoriductive surgery performs its action through sinergistic effects of high dosage and concentration of drugs and hyperthermia. These agents perform a cell killing with a direct contact against micro and/or macroscopic neoplastic residue. EXPECTED RESULTS In radical surgery with curative intent, the association with IPHC ("preventive" adjuvant) has got as objective the distruction of microscopic local or peritoneal metastasis. In occlusive cancer with synchronous or metachronous peritoneal carcinomatosis, the performance of the cytoreductive surgery with IPHC ("therapeutic" adjuvant) is the only treatment that improves the survival and the quality of remainig life. CONCLUSIONS The clinical results reported by many Istitutions indicates that the 2-5 yrs survivals are 45-60% and 20-30% rispectively. These data lead us to believe that an optimal eradication of micro and/or macroscopic peritoneal spreading could be optained also in occlusive colo-rectal cancer.
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Affiliation(s)
- Riccardo Gattai
- Università degli Studi di Firenze, Azienda Ospedaliera Universitaria Careggi, Centro di Riferimento Regionale di Terapie Locoregionali Perfusionali in Oncologia
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Pace M, Millanta L, Polignano M, Gattai R, Macera Mascitelli E. Optimal procedure for thermal delivery in hyperthermic/chemotherapeutic treatments in the isolated perfusion of the the limbs. J Exp Clin Cancer Res 2005; 24:35-42. [PMID: 15943029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Isolated locoregional limbs perfusion treatments of various malignancies have demonstrated synergistic efficacy when hyperthermia was associated with chemotherapy. This paper delineates the criteria, the technical provisions and the specifications that have been improved and implemented at our Institution. It is believed that, following the indications offered in this paper, several, apparently still unsolved problems of treatment planning and implementation will be overcome, offering closely controlled and highly reproducible procedures with a significant progress in the feasibility of reliable comparisons of the results among different research centres and in the reduction of the occurrence of controversial results or unexpected complications.
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Affiliation(s)
- M Pace
- Dept. of Medical and Surgical Care, Section of General and Oncological Surgery University of Florence, Italy
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Mazzanti R, Giallombardo AL, Mini E, Nobili S, Neri B, Arena U, Pantaleo P, Fabbroni V, Ghilardi M, Gattai R, Bandettini L. Treatment of locally advanced hepatocellular carcinoma by hepatic intra-artery chemotherapy: a pilot study. Dig Liver Dis 2004; 36:278-85. [PMID: 15115341 DOI: 10.1016/j.dld.2003.12.013] [Citation(s) in RCA: 6] [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] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hepatocarcinoma is one of the most common malignant tumours world-wide with poor prognosis. Treatment of locally advanced hepatocarcinoma is still controversial. Transcatheter arterial (chemo-)embolisation of hepatocarcinoma are widely used methods but some aspects regarding their use and usefulness have not yet been clarified. Systemic remedies have not yet been proven to affect patient survival. AIMS To determine if intra-arterial chemotherapy with 5-flurouracil and folinic acid in locally advanced hepatocarcinoma is a viable alternative to existing therapies. PATIENTS Twenty-four inoperable consecutive patients with locally advanced hepatocarcinoma were enrolled. They all underwent intra-arterial chemotherapy via a surgically implanted port-a-cath, and folinic acid (100 mg/m2) and 5-flurouracil (up to 550 mg/m2) were administered with a 1-week or a 2-week schedule. RESULTS Nineteen patients completed the study: 2 showed a complete positive response, 11 a partial response, 6 stable disease, while 4 showed a disease progression. Median survival time was 19 (range 4-85) months. Child A patients showed a significant longer survival. CONCLUSIONS Intra-arterial chemotherapy using folinic acid and 5-flurouracil may be useful in the treatment of locally advanced hepatocarcinoma in cirrhotic patients even in the presence of thrombosis. This treatment could be also useful in comparing transarterial chemoembolisation to a curative treatment.
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Affiliation(s)
- R Mazzanti
- Section of Medical Oncology, Department of Internal Medicine, School of Medicine, University of Florence, Viale G. B. Morgagni, 85, I-50134 Florence, Italy.
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Giallombardo A, Bandettini L, Arena U, Mini E, Gattai R, Mazzanti R. Treatment of locally advanced hepatocellular carcinoma (HCC) by hepatic intra-artery-chemotherapy (IACT): a pilot study. Eur J Cancer 2001. [DOI: 10.1016/s0959-8049(01)81652-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Marranci M, Dianda D, Gattai R, Nesi S, Bandettini L. [Umbilical endometriosis: report of a case and review of the literature]. Ann Ital Chir 2000; 71:389-92. [PMID: 11014021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
The authors present a clinical of umbilical endometriosis in a young woman. This patient never underwent any operation or diagnostic abdominal procedures. The case is very interesting because of problems concerning differential diagnosis with other umbilical and periumbilical diseases and pathogenetic theories. In this study the authors suggest a hypothesis to explain the localization of ectopic endometrium in this site. We review the literature, with some comments on therapeutic options; finally we compare the medical and the surgical approach and we suggest an advisable therapy.
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Affiliation(s)
- M Marranci
- Istituto di Clinica Chirurgica Generale e Terapia Chirurgica I, Università degli Studi di Firenze
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Bandettini L, Gattai R, Pace M. [Biofragmentable anastomosis ring (BAR) in surgery of the digestive system]. MINERVA CHIR 1999; 54:685-95. [PMID: 10575890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Twenty-six patients submitted to surgery using BAR in intestinal anastomosis have been studied. The results were compared with data of the literature concerning this device of anastomosis and about mechanical staplers and manual suture. The following data were taken into consideration: type of operation, type of anastomosis, average time of execution, complications, days of postoperative canalization and feeding, costs of three anastomosis types. Postoperative complications rate were 23% with a postoperative death rate of 7.6%. There was only one intraoperative complication during a colorectal anastomosis. The average time, to package an intestinal anastomosis using BAR, was 69.9 minutes. The average type of postoperative canalization was 3.7 days and average period in hospital was 10.3 days. The costs of manual suture, of mechanical staplers and of BAR are respectively L. 50,000, 1,340,000 and 583,000. BAR complications are similar to the other techniques; this study shows a reduction of operative time, postoperative canalization and period in hospital, with a consequent decreasing of global costs. The execution of intestinal anastomosis using BAR is easier then the other techniques, the learning time is least and the procedure is uniform. The introduction of this technique in the common operative practice together with manual suture and stapler is stressed.
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Affiliation(s)
- L Bandettini
- Clinica Chirurgia I, Università degli Studi, Firenze
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Pace M, Bandettini L, Brugnola D, Galli A, Gattai R. Patient selection in perfusional heated chemotherapy in advanced abdominal tumors. Eur J Cancer 1999. [DOI: 10.1016/s0959-8049(99)81911-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Gattai R. Antiche teorie dell’influenza dei vermi sull’organismo ed i precursori italiani della parassitologia (Magati, Bassi, Rivolta) (con 3 ill.). Archeion 1924. [DOI: 10.1484/j.arch.3.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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