Therapy discontinuation in inflammatory bowel disease,particularly involving immunomodulators,biologics,and small molecules,remains a controversial and evolving topic.This letter reflects on developments following the...Therapy discontinuation in inflammatory bowel disease,particularly involving immunomodulators,biologics,and small molecules,remains a controversial and evolving topic.This letter reflects on developments following the publication by Meštrovićet al,emphasizing the complex balance between risks of relapse,antidrug antibody formation,and potential complications of long-term immunosuppression.Recent evidence underscores high relapse rates following withdrawal-especially of anti-tumor necrosis factor agents-and highlights the lack of robust data for newer biologics.Updated guidelines from European Crohn’s and Colitis Organization,British Society of Gastroenterology,and American College of Gastroenterology all support cautious and individualized approaches,with strict criteria and close follow-up,particularly in Crohn’s disease.For ulcerative colitis,therapeutic cycling remains insufficiently addressed.We proposed a flowchart to support clinical decision-making and stress the importance of shared decisionmaking in the era of personalized medicine since,despite new drug classes and evolving strategies,the therapeutic ceiling in inflammatory bowel disease has yet to be fully overcome.展开更多
Colorectal cancer(CRC)is one of the leading causes of cancer and cancer-related mortality worldwide.The disease has been traditionally a major health problem in industrial countries,however the CRC rates are increasin...Colorectal cancer(CRC)is one of the leading causes of cancer and cancer-related mortality worldwide.The disease has been traditionally a major health problem in industrial countries,however the CRC rates are increasing in the developing countries that are undergoing economic growth.Several environmental risk factors,mainly changes in diet and life style,have been suggested to underlie the rise of CRC in these populations.Diet and lifestyle impinge on nuclear receptors,on the intestinal microbiota and on crucial molecular pathways that are implicated in intestinal carcinogenesis.In this respect,the epidemiological transition in several regions of the world offers a unique opportunity to better understand CRC carcinogenesis by studying the disease phenotypes and their environmental and molecular associations in different populations.The data from these studies may have important implications for the global prevention and treatment of CRC.展开更多
This article aims to deepen the understanding of the role of Helicobacter pylori(H.pylori)infection in the development of cholelithiasis,initiated by the article by Yao et al,who investigated the potential link betwee...This article aims to deepen the understanding of the role of Helicobacter pylori(H.pylori)infection in the development of cholelithiasis,initiated by the article by Yao et al,who investigated the potential link between H.pylori infection and the development of cholelithiasis through a multicenter retrospective study on an Asian population of over 70000 participants.They also performed a compre-hensive analysis of previously published studies on H.pylori and cholelithiasis,finding a positive association therein[odds ratio(OR)=1.103,P=0.049].Patients positive for H.pylori also had lower levels of total and direct bilirubin,but higher levels of total cholesterol and low-density lipoprotein cholesterol compared to uninfected patients(P<0.05).Cohort studies have confirmed that H.pylori is a risk factor for cholelithiasis(P<0.0001),and aggregate analyses of case-control and cross-sectional studies have shown a positive association between H.pylori and cholelithiasis in Asia(OR=1.599,P=0.034),but not in Europe(OR=1.277,P=0.246).Moreover,H.pylori appears to be related to a higher ratio of choledocho-lithiasis/cholecystolithiasis(OR=3.321,P=0.033).The authors conclude that H.pylori infection is positively correlated with cholelithiasis,particularly with the choledocholithiasis phenotype,especially in Asia,and it is potentially related to bilirubin and cholesterol metabolism.展开更多
Objective:Since the introduction of the Da Vinci®robotic system,robot-assisted colon resection has gained popularity because of its the potential technical advantages.Recently,two new CE-marked platforms have bec...Objective:Since the introduction of the Da Vinci®robotic system,robot-assisted colon resection has gained popularity because of its the potential technical advantages.Recently,two new CE-marked platforms have become available in Europe:Hugo™RAS and Versius®.We present the firstprospective case series comparing these three robotic systems.Methods:This exploratory,prospective study enrolled 45 consecutive adult patients undergoing robotic colon resection between February and December 2024,as part of the COMPAR trial.Two experienced colorectal surgeons performed all procedures across two surgical units.Each robotic platform was used in 15 cases.The primary outcomes were conversion to laparoscopy or open surgery and intra-operative complications.The secondary outcomes included post-operative recovery,oncological results,and platform-specifictechnical parameters.Results:The mean age was 66.8 years and 68.9%of patients underwent surgery for colon cancer.No conversions occurred in the Da Vinci group,whereas 2 and 3 conversions to laparoscopy were recorded with Hugo™RAS and Versius®,respectively.One intra-operative instrument malfunction occurred with Hugo™RAS,and one surgical complication was reported in each group.No significantdifferences emerged in post-operative recovery or oncological outcomes.Versius®cases required more frequent use of laparoscopic energy devices(p<0.001).Hugo™RAS was associated with a longer total operating room time(p=0.022)and longer incision length(p=0.005).Conclusion:Robotic colorectal surgery with all three platforms is feasible when performed by expert surgeons.While early outcomes are encouraging,larger comparative trials are needed to confirmdifferences in recovery and oncological efficacy.展开更多
AIMTo treated with electrochemotherapy (ECT) a prospective case series of patients with liver cirrhosis and Vp3-Vp4- portal vein tumor thrombus (PVTT) from hepatocellular carcinoma (HCC), in order to evaluate the feas...AIMTo treated with electrochemotherapy (ECT) a prospective case series of patients with liver cirrhosis and Vp3-Vp4- portal vein tumor thrombus (PVTT) from hepatocellular carcinoma (HCC), in order to evaluate the feasibility, safety and efficacy of this new non thermal ablative technique in those patients.METHODSSix patients (5 males and 1 female), aged 61-85 years (mean age, 70 years), four in Child-Pugh A and two in Child-Pugh B class, entered our study series. All patients were studied with three-phase computed tomography (CT), contrast enhanced ultrasound (CEUS) and ultrasound-guided percutaneous biopsy of the thrombus before ECT. All patients underwent ECT treatment (Cliniporator Vitae<sup>®</sup>, IGEA SpA, Carpi, Modena, Italy) of Vp3-Vp4 PVTT in a single session. At the end of the procedure a post-treatment biopsy of the thrombus was performed. Scheduled follow-up in all patients entailed: CEUS within 24 h after treatment; triphasic contrast-enhanced CT and CEUS at 3 mo after treatment and every six months thereafter.RESULTSPost-treatment CEUS showed complete absence of enhancement of the treated thrombus in all cases. Post-treatment biopsy showed apoptosis and necrosis of tumor cells in all cases. The follow-up ranged from 9 to 20 mo (median, 14 mo). In 2 patients, the follow-up CT and CEUS demonstrated complete patency of the treated portal vein. Other 3 patients showed a persistent avascular non-tumoral shrinked thrombus at CEUS and CT during follow-up. No local recurrence was observed at follow-up CT and CEUS in 5/6 patients. One patient was lost to follow-up because of death from gastrointestinal hemorrage 5 wk after ECT.CONCLUSIONIn patients with cirrhosis, ECT seems effective and safe for curative treatment of Vp3-Vp4 PVTT from HCC.展开更多
Objective To investigate the efficacy of hematopoietic stem cell （HSC） transplantation via the hepatic artery vs. the portal vein for end-stage liver disease （ESLD）. Methods Patients with hepatic decompensation w...Objective To investigate the efficacy of hematopoietic stem cell （HSC） transplantation via the hepatic artery vs. the portal vein for end-stage liver disease （ESLD）. Methods Patients with hepatic decompensation were prospectively recruited from September 2010 to September 2012 to receive HSC transplantation via the hepatic artery or the portal vein. Liver function was examined at 3, 6, and 12 months after transplantation. Liver biopsy results were analyzed using the Knodell score. Results Eighty patients （58 males and 22 females） were enrolled in the study. The Child-Pugh score was grade B in 69 cases, and grade C in the remaining 11 cases. HSC transplantation was performed via the portal vein in 36 patients and via the hepatic artery in 44 patients. ALT levels decreased while serum albumin levels increased significantly in both groups at 6 and 12 months after HSC transplantation （P〈0.05 compared with pre-transplantation levels）. Total biliruhin levels decreased significandy in both groups at 3, 6, and 12 months after HSC transplantation （P〈0.05 compared with pre-transplantation levels）. Additionally, prothromhin time decreased in both groups at 12 months after HSC transplantation （P〈0.05 compared with pre-transplantation level）. There were no significant differences in ALT, total bilirubin and prothromhin time between the two groups either before or after transplantation. Moreover, Knodell score decreased significantly at 6 and 12 months. Histological examination showed that liver cell edema, degeneration, necrosis, and inflammation were significantly relieved at 3, 6, and 12 months after transplantation. The incidence of portal vein thrombosis, upper gastrointestinal bleeding, and hepatic encephalopathy were 1.25%, 3.75%, and 2.5% respectively. The one-year survival rate was 100%. Conclusions Autologous HSC transplantation improves liver function and histology in ESLD patients The administration route of HSC has no significant impact on the efficacy of transplantation.展开更多
Gastrointestinal stromal tumors(GISTs) represent the most common mesenchymal tumors of the alimentary tract. These tumors may have different clinical and biological behaviors. Malignant forms usually spread via a hema...Gastrointestinal stromal tumors(GISTs) represent the most common mesenchymal tumors of the alimentary tract. These tumors may have different clinical and biological behaviors. Malignant forms usually spread via a hematogenous route, and lymph node metastases rarely occur. Herein, we report a patient with a jejunal GIST who developed supraclavicular lymph node metastasis. We conclude that lymphatic diffusion via the mediastinal lymphatic station to the supraclavicular lymph nodes can be a potential metastatic route for GISTs.展开更多
The new coronavirus disease 2019 (COVID-19) pandemic has resulted in a globalhealth emergency that has also caused profound changes in the treatment ofcancer. The management of hepatocellular carcinoma (HCC) across th...The new coronavirus disease 2019 (COVID-19) pandemic has resulted in a globalhealth emergency that has also caused profound changes in the treatment ofcancer. The management of hepatocellular carcinoma (HCC) across the world hasbeen modified according to the scarcity of care resources that have been divertedmostly to face the surge of hospitalized COVID-19 patients. Oncological andhepatobiliary societies have drafted recommendations regarding the adaptation ofguidelines for the management of HCC to the current healthcare situation. Thisreview focuses on specific recommendations for the surgical treatment of HCC (i.e., hepatic resection and liver transplantation), which still represents the bestchance of cure for patients with very early and early HCC. While surgery shouldbe pursued for very selected patients in institutions where standards of care aremaintained, alternative or bridging methods, mostly thermoablation and transarterialtherapies, can be used until surgery can be performed. The prognosis ofpatients with HCC largely depends on both the characteristics of the tumour andthe stage of underlying liver disease. Risk stratification plays a pivotal role indetermining the most appropriate treatment for each case and needs to balancethe chance of cure and the risk of COVID-19 infection during hospitalization.Current recommendations have been critically reviewed to provide a reference forbest practices in the clinical setting, with adaptation based on pandemic trendsand categorization according to COVID-19 prevalence.展开更多
BACKGROUND： The necessity to obtain a tissue diagnosis of cancer prior to pancreatic surgery still remains an open debate. In fact, a non-negligible percentage of patients under- going pancreaticoduodenectomy （PD） ...BACKGROUND： The necessity to obtain a tissue diagnosis of cancer prior to pancreatic surgery still remains an open debate. In fact, a non-negligible percentage of patients under- going pancreaticoduodenectomy （PD） for suspected cancer has a benign lesion at final histology. We describe an approach for patients with diagnostic uncertainty between cancer and chronic pancreatitis, with the aim of minimizing the incidence of PD for suspicious malignancy finally diagnosed as benign disease. METHODS： Eighty-eight patients （85.4%） with a clinicoradio- logical picture highly suggestive for malignancy received for- mal PD （group 1）. Fifteen patients （14.6%） in whom preopera- tive diagnosis was uncertain between pancreatic cancer and chronic pancreatitis underwent pancreatic head excavation （PHEX） for intraoperative tissue diagnosis （group 2）： those diagnosed as having cancer received PD, whereas those with chronic pancreatitis received pancreaticojejunostomy （P]）. RESULTS： No patient received PD for benign disease. All pa- tients in group I had adenocarcinoma on final histology. Eight patients of group 2 （53.3%） received PD after intraoperative diagnosis of cancer, whereas 7 （46.7%） received PJ because no malignancy was found at introperative frozen sections. No signs of cancer were encountered in patients receiving PHEX and PJ after a median follow-up of 42 months. Overall survival did not differ between patients receiving PD for cancer in the group 1 and those receiving PD for cancer after PHEX in the group 2 （P=0.509）. CONCLUSION： Although the described technique has been used in a very selected group of patients, our results suggest that PHEX for tissue diagnosis may reduce rates of unnecessary PD, when the preoperative diagnosis is uncertain between cancer and chronic pancreatitis.展开更多
BACKGROUND Liver resection and radiofrequency ablation are considered curative options for hepatocellular carcinoma.The choice between these techniques is still controversial especially in cases of hepatocellular carc...BACKGROUND Liver resection and radiofrequency ablation are considered curative options for hepatocellular carcinoma.The choice between these techniques is still controversial especially in cases of hepatocellular carcinoma affecting posterosuperior segments in elderly patients.AIM To compare post-operative outcomes between liver resection and radiofrequency ablation in elderly with single hepatocellular carcinoma located in posterosuperior segments.METHODS A retrospective multicentric study was performed enrolling 77 patients age≥70-years-old with single hepatocellular carcinoma(≤30 mm),located in posterosuperior segments(4a,7,8).Patients were divided into liver resection and radiofrequency ablation groups and preoperative,peri-operative and long-term outcomes were retrospectively analyzed and compared using a 1:1 propensity score matching.RESULTS After propensity score matching,twenty-six patients were included in each group.Operative time and overall postoperative complications were higher in the resection group compared to the ablation group(165 min vs 20 min,P<0.01;54%vs 19%P=0.02 respectively).A median hospital stay was significantly longer in the resection group than in the ablation group(7.5 d vs 3 d,P<0.01).Ninety-day mortality was comparable between the two groups.There were no significant differences between resection and ablation group in terms of overall survival and disease free survival at 1,3,and 5 years.CONCLUSION Radiofrequency ablation in posterosuperior segments in elderly is safe and feasible and ensures a short hospital stay,better quality of life and does not modify the overall and disease-free survival.展开更多
In this editorial,we have analyzed the historical evolution of rectal and breast cancer surgery,focusing on the progressive reduction of demolitive approaches and the increasing use of more conservative strategies,acc...In this editorial,we have analyzed the historical evolution of rectal and breast cancer surgery,focusing on the progressive reduction of demolitive approaches and the increasing use of more conservative strategies,accompanied by a growing emphasis on perioperative treatments aimed at enhancing surgical outcomes.All of these changes have been made possible due to an increased awareness and understanding of oncological diseases and improved perioperative treatments.展开更多
Total pancreatectomy(TP) is a surgical procedure which includes the complete removal of the pancreatic gland, the spleen, the duodenum, the gallbladder, and the distal part of the stomach. TP represents the curative t...Total pancreatectomy(TP) is a surgical procedure which includes the complete removal of the pancreatic gland, the spleen, the duodenum, the gallbladder, and the distal part of the stomach. TP represents the curative treatment of pancreatic cancer which simultaneously involves the head and the body/tail of the pancreas. Other possible indications for TP comprise multifocal parenchymal diseases, such as intraductal papillary mucinous neoplasms, pancreatic neuroendocrine tumors, multiple endocrine neoplasms, and chronic pancreatitis. Sometimes, TP is carried out in patients scheduled for pancreaticoduodenectomy(where only the head of the pancreas is removed) when a cancer located in the pancreatic head is intraoperatively found to also extend to the pancreatic body [1].展开更多
To the Editor:Extrahepatic cholangiocarcinoma(ECC)is an uncommon neoplasm associated with a poor prognosis[1-3].Surgical resection represents the only curative approach,since systemic treatments have scarce efficacy i...To the Editor:Extrahepatic cholangiocarcinoma(ECC)is an uncommon neoplasm associated with a poor prognosis[1-3].Surgical resection represents the only curative approach,since systemic treatments have scarce efficacy in achieving disease control.However,only 10%-40%of patients with ECC are resectable at diagnosis[1].Ma-jor hepatectomy and portal lymphadenectomy are usually required for hilar ECC,while pancreatoduodenectomy is the standard operation for distal ECC[3-5].However,ECC may spread horizon-tally along the biliary tree,causing tumor involvement of the entire extrahepatic biliary system.In these circumstances,hep-atopancreatoduodenectomy(HPD)has been proposed as a pro-cedure with curative intent[2,6,7].展开更多
Otitis media is a frequent problem in preschool children and one of the most common reasons for treatment with antibiotics in children. The exact diagnosis is important for proper management. The diagnosis of otitis m...Otitis media is a frequent problem in preschool children and one of the most common reasons for treatment with antibiotics in children. The exact diagnosis is important for proper management. The diagnosis of otitis media is often difficult. Pneumatic otoscopy, otomicroscopy, and tympanometry can improve the diagnostic quality by indicating fluid or no fluid in the middle ear and thus improve the quality of treatment. The aim of this review is to explain why and how tympanometry can improve the diagnostic quality in otitis media, and to identify some barriers and difficulties encountered when using tympanometry in daily practice. The current literature on tympanometry and own experiences during 38 years are used to elucidate the aim. Tympanometry is difficult to understand and use, when the procedure is not properly trained. The problems are both of a technical nature, and it is difficult to understand and use the information from the curve and the figures on the display. If the use of tympanometry in general practice is increased, the diagnostic quality will improve and hopefully antibiotics will be prescribed on more appropriate indications and less frequently. More demand on tympanometry will hopefully reduce the price of the tympanometer, making it more accessible for GPs. First in that situation the use will be nearly as common as the use of the otoscope.展开更多
This study describes a glucocapparin determination method. Based on rapeseed determination of glucosinolate (GSL), the equation of the average straight regression line is Y = 100.42X – 0.03 (R2 = 0.9998). Enzymatic h...This study describes a glucocapparin determination method. Based on rapeseed determination of glucosinolate (GSL), the equation of the average straight regression line is Y = 100.42X – 0.03 (R2 = 0.9998). Enzymatic hydrolysis of glucocapparin extracted from leaves and fruits of B. senegalensis, analyzed by SPME-GC-MS confirmed the presence of methylisothiocyanate as the main hydrolysis glucocapparin product. Monitoring glucocapparin contents in B. senegalensis leaves and fruits collected in 4 localities in Senegal showed differences between organs according localities and periods of harvest. Glucocapparin content was very high in dry season particularly in January and the lowest rates were recorded during the rainy period between August and November.展开更多
Background: Tympanic paragangliomas are common middle ear benign neoplasias that develop from endocrines cells situated along the great blood vessels of the head and neck, as well as those of the thoracic and lumbar s...Background: Tympanic paragangliomas are common middle ear benign neoplasias that develop from endocrines cells situated along the great blood vessels of the head and neck, as well as those of the thoracic and lumbar spine. Primary symptoms of tympanic locations include hearing loss and pulsatile tinnitus. Otoscopy often shows a retrotympanic reddish mass, causing tympanic bulging. Computerized tomography scan findings include a tissue density regular mass located at the promontory and limited within the middle ear cavity. Surgical management comprises tumour excision with control of bleeding, with or without prior embolization. Aim: The aim of this presentation is to report an unusual case of tympanic paraganglioma. Case Presentation: We report the case of a 56-year-old patient whose clinical and paraclinical presentations were consistent with cholesteatoma, though a tympanic paraganglioma was discovered per-operatively. Conclusion: In some rare cases, tympanic paraganglioma can be present like a cholesteatoma.展开更多
Radical gastrectomy with an adequate lymphadenectomy is the main procedure which makes it possible to cure patients with resectable gastric cancer (GC). A number of randomized controlled trials and meta-analysis provi...Radical gastrectomy with an adequate lymphadenectomy is the main procedure which makes it possible to cure patients with resectable gastric cancer (GC). A number of randomized controlled trials and meta-analysis provide phase III evidence that laparoscopic gastrectomy is technically safe and that it yields better short-term outcomes than conventional open gastrectomy for early-stage GC. While laparoscopic gastrectomy has become standard therapy for early-stage GC, especially in Asian countries such as Japan and South Korea, the use of minimally invasive techniques is still controversial for the treatment of more advanced tumours, principally due to existing concerns about its oncological adequacy and capacity to carry out an adequately extended lymphadenectomy. Some intrinsic drawbacks of the conventional laparoscopic technique have prevented the worldwide spread of laparoscopic gastrectomy for cancer and, despite technological advances in recent year, it remains a technically challenging procedure. The introduction of robotic surgery over the last ten years has implied a notable mutation of certain minimally invasive procedures, making it possible to overcome some limitations of the traditional laparoscopic technique. Robot-assisted gastric resection with D2 lymph node dissection has been shown to be safe and feasible in prospective and retrospective studies. However, to date there are no high quality comparative studies investigating the advantages of a robotic approach to GC over traditional laparoscopic and open gastrectomy. On the basis of the literature review here presented, robot-assisted surgery seems to fulfill oncologic criteria for D2 dissection and has a comparable oncologic outcome to traditional laparoscopic and open procedure. Robot-assisted gastrectomy was associated with the trend toward a shorter hospital stay with a comparable morbidity of conventional laparoscopic and open gastrectomy, but randomized clinical trials and longer follow-ups are needed to evaluate the possible influence of robot gastrectomy on GC patient survival.展开更多
AIM To evaluate the potential effectiveness of robot-assisted gastrectomy(RAG) in comparison to open gastrectomy(OG) for gastric cancer patients.METHODS A comprehensive systematic literature search using PubM ed,EMBAS...AIM To evaluate the potential effectiveness of robot-assisted gastrectomy(RAG) in comparison to open gastrectomy(OG) for gastric cancer patients.METHODS A comprehensive systematic literature search using PubM ed,EMBASE,and the Cochrane Library was carried out to identify studies comparing RAG and OG in gastric cancer.Participants of any age and sex were considered for inclusion in comparative studies of the two techniques independently from type of gastrectomy.A meta-analysis of short-term perioperative outcomes was performed to evaluate whether RAG is equivalent to OG.The primary outcome measures were set for estimated blood loss,operative time,conversion rate,morbidity,and hospital stay.Secondary among postoperative complications,wound infection,bleeding and anastomotic leakage were also analysed.RESULTS A total of 6 articles,5 retrospective and 1 randomized controlled study,involving 6123 patients overall,with 689(11.3%) cases submitted to RAG and 5434(88.7%) to OG,satisfied the eligibility criteria and were included in the meta-analysis.RAG was associated with longer operation time than OG(weighted mean difference 72.20 min;P < 0.001),but with reduction in blood loss and shorter hospital stay(weighted mean difference-166.83 mL and-1.97 d respectively;P < 0.001).No differences were found with respect to overall postoperative complications(P = 0.65),wound infection(P = 0.35),bleeding(P = 0.65),and anastomotic leakage(P = 0.06).The postoperative mortality rates were similar between the two groups.With respect to oncological outcomes,no statistical differences among the number of harvested lymph nodes were found(weighted mean difference-1.12;P = 0.10).CONCLUSION RAG seems to be a technically valid alternative to OG for performing radical gastrectomy in gastric cancer resulting in safe complications.展开更多
Esophageal gastrointestinal stromal tumors(GISTs) are extremely uncommon,representing approximately 5% of GISTs with the majority of esophageal GISTs occurring at the esophagogastric junction(EGJ).The treatment option...Esophageal gastrointestinal stromal tumors(GISTs) are extremely uncommon,representing approximately 5% of GISTs with the majority of esophageal GISTs occurring at the esophagogastric junction(EGJ).The treatment options available for these GISTs are fairly controversial.Many different options are nowadays at our disposal.From surgery to the target therapies we have the possibility to treat the majority of GISTs,including those which are defined as unresectable.The EGJ GISTs represent a stimulating challenge for the surgeon.The anatomical location increases the possibility of postoperative complications.As the role of negative margins in GIST surgery is still controversial and the eff icacy of target therapy has been demonstrated,why not treat EGJ GISTs with enucleation and,where indicated,adjuvant target therapy?展开更多
BACKGROUND: Gallbladder adenomyomatosis (GBA) is a hyperplastic disease affecting the wall of the gallbladder, with some typical features. It has historically been considered a benign condition, nevertheless recent re...BACKGROUND: Gallbladder adenomyomatosis (GBA) is a hyperplastic disease affecting the wall of the gallbladder, with some typical features. It has historically been considered a benign condition, nevertheless recent reports highlighted a potential role of GBA in predisposing to malignancies of the gallbladder. DATA SOURCES: We reviewed the literature concerning GBA from its identification until July 2012. Owing to the relative rarity of the disease, studies often are case reports or case series. Thus we herein report a summary of the key-points concerning diagnosis and treatment of GBA, easily applicable in everyday practice, rather than a systematic review. Also, results are integrated with our recent experience. RESULTS: In our experience, we observed a trend toward an increase of GBA during the last years, probably due to enhanced ultrasonographic technical advancements and physician’s expertise. GBA has distinctive imaging features. Several recent reports highlight the potential risk of cancer associated with GBA; however the disease is still classified as a benign condition. Although its correlation with malignancy has not been demonstrated, it is prudent to recommend cholecystectomy in some cases. However, in selected asymptomatic patients, a wait-and-see policy is a viable alternative. We propose an algorithm, based on GBA pathological pattern (diffuse, segmental, localized or fundal), suitable for decision-making.CONCLUSIONS: In symptomatic patients and if the diagnosis is doubtful, cholecystectomy is mandatory. Postponing surgery is an option to be offered to asymptomatic patients with low-risk GBA pattern who adhere to scheduled follow-ups.展开更多
文摘Therapy discontinuation in inflammatory bowel disease,particularly involving immunomodulators,biologics,and small molecules,remains a controversial and evolving topic.This letter reflects on developments following the publication by Meštrovićet al,emphasizing the complex balance between risks of relapse,antidrug antibody formation,and potential complications of long-term immunosuppression.Recent evidence underscores high relapse rates following withdrawal-especially of anti-tumor necrosis factor agents-and highlights the lack of robust data for newer biologics.Updated guidelines from European Crohn’s and Colitis Organization,British Society of Gastroenterology,and American College of Gastroenterology all support cautious and individualized approaches,with strict criteria and close follow-up,particularly in Crohn’s disease.For ulcerative colitis,therapeutic cycling remains insufficiently addressed.We proposed a flowchart to support clinical decision-making and stress the importance of shared decisionmaking in the era of personalized medicine since,despite new drug classes and evolving strategies,the therapeutic ceiling in inflammatory bowel disease has yet to be fully overcome.
基金Supported by Institutional NRSA,clinical oncology research training program,No.T32 CA079447(Bishehsari F)the Associazione Italiana per la Ricerca sul Cancro(AIRC),Milan to Mariani-Costantini R+3 种基金the Office for Internationalization,G.d’Annunzio University,Chietithe Carichieti Foundation,ChietiMinistero dell’Istruzione,dell’Universitàe della Ricerca(MIUR),Rome,Italythe Fondazione Umberto Veronesi,Milan,Italy and the MRC(5PT57)to Vacca M
文摘Colorectal cancer(CRC)is one of the leading causes of cancer and cancer-related mortality worldwide.The disease has been traditionally a major health problem in industrial countries,however the CRC rates are increasing in the developing countries that are undergoing economic growth.Several environmental risk factors,mainly changes in diet and life style,have been suggested to underlie the rise of CRC in these populations.Diet and lifestyle impinge on nuclear receptors,on the intestinal microbiota and on crucial molecular pathways that are implicated in intestinal carcinogenesis.In this respect,the epidemiological transition in several regions of the world offers a unique opportunity to better understand CRC carcinogenesis by studying the disease phenotypes and their environmental and molecular associations in different populations.The data from these studies may have important implications for the global prevention and treatment of CRC.
文摘This article aims to deepen the understanding of the role of Helicobacter pylori(H.pylori)infection in the development of cholelithiasis,initiated by the article by Yao et al,who investigated the potential link between H.pylori infection and the development of cholelithiasis through a multicenter retrospective study on an Asian population of over 70000 participants.They also performed a compre-hensive analysis of previously published studies on H.pylori and cholelithiasis,finding a positive association therein[odds ratio(OR)=1.103,P=0.049].Patients positive for H.pylori also had lower levels of total and direct bilirubin,but higher levels of total cholesterol and low-density lipoprotein cholesterol compared to uninfected patients(P<0.05).Cohort studies have confirmed that H.pylori is a risk factor for cholelithiasis(P<0.0001),and aggregate analyses of case-control and cross-sectional studies have shown a positive association between H.pylori and cholelithiasis in Asia(OR=1.599,P=0.034),but not in Europe(OR=1.277,P=0.246).Moreover,H.pylori appears to be related to a higher ratio of choledocho-lithiasis/cholecystolithiasis(OR=3.321,P=0.033).The authors conclude that H.pylori infection is positively correlated with cholelithiasis,particularly with the choledocholithiasis phenotype,especially in Asia,and it is potentially related to bilirubin and cholesterol metabolism.
文摘Objective:Since the introduction of the Da Vinci®robotic system,robot-assisted colon resection has gained popularity because of its the potential technical advantages.Recently,two new CE-marked platforms have become available in Europe:Hugo™RAS and Versius®.We present the firstprospective case series comparing these three robotic systems.Methods:This exploratory,prospective study enrolled 45 consecutive adult patients undergoing robotic colon resection between February and December 2024,as part of the COMPAR trial.Two experienced colorectal surgeons performed all procedures across two surgical units.Each robotic platform was used in 15 cases.The primary outcomes were conversion to laparoscopy or open surgery and intra-operative complications.The secondary outcomes included post-operative recovery,oncological results,and platform-specifictechnical parameters.Results:The mean age was 66.8 years and 68.9%of patients underwent surgery for colon cancer.No conversions occurred in the Da Vinci group,whereas 2 and 3 conversions to laparoscopy were recorded with Hugo™RAS and Versius®,respectively.One intra-operative instrument malfunction occurred with Hugo™RAS,and one surgical complication was reported in each group.No significantdifferences emerged in post-operative recovery or oncological outcomes.Versius®cases required more frequent use of laparoscopic energy devices(p<0.001).Hugo™RAS was associated with a longer total operating room time(p=0.022)and longer incision length(p=0.005).Conclusion:Robotic colorectal surgery with all three platforms is feasible when performed by expert surgeons.While early outcomes are encouraging,larger comparative trials are needed to confirmdifferences in recovery and oncological efficacy.
文摘AIMTo treated with electrochemotherapy (ECT) a prospective case series of patients with liver cirrhosis and Vp3-Vp4- portal vein tumor thrombus (PVTT) from hepatocellular carcinoma (HCC), in order to evaluate the feasibility, safety and efficacy of this new non thermal ablative technique in those patients.METHODSSix patients (5 males and 1 female), aged 61-85 years (mean age, 70 years), four in Child-Pugh A and two in Child-Pugh B class, entered our study series. All patients were studied with three-phase computed tomography (CT), contrast enhanced ultrasound (CEUS) and ultrasound-guided percutaneous biopsy of the thrombus before ECT. All patients underwent ECT treatment (Cliniporator Vitae<sup>®</sup>, IGEA SpA, Carpi, Modena, Italy) of Vp3-Vp4 PVTT in a single session. At the end of the procedure a post-treatment biopsy of the thrombus was performed. Scheduled follow-up in all patients entailed: CEUS within 24 h after treatment; triphasic contrast-enhanced CT and CEUS at 3 mo after treatment and every six months thereafter.RESULTSPost-treatment CEUS showed complete absence of enhancement of the treated thrombus in all cases. Post-treatment biopsy showed apoptosis and necrosis of tumor cells in all cases. The follow-up ranged from 9 to 20 mo (median, 14 mo). In 2 patients, the follow-up CT and CEUS demonstrated complete patency of the treated portal vein. Other 3 patients showed a persistent avascular non-tumoral shrinked thrombus at CEUS and CT during follow-up. No local recurrence was observed at follow-up CT and CEUS in 5/6 patients. One patient was lost to follow-up because of death from gastrointestinal hemorrage 5 wk after ECT.CONCLUSIONIn patients with cirrhosis, ECT seems effective and safe for curative treatment of Vp3-Vp4 PVTT from HCC.
基金Supported by the Science&Technology Department of Sichuan Province(2010FZ0098,2011HH0022)Chengdu Bureau of Science and Technology(10GGYB883SF)the Scientific Research Foundation of the Health Department of Sichuan Province(100487,100489)
文摘Objective To investigate the efficacy of hematopoietic stem cell （HSC） transplantation via the hepatic artery vs. the portal vein for end-stage liver disease （ESLD）. Methods Patients with hepatic decompensation were prospectively recruited from September 2010 to September 2012 to receive HSC transplantation via the hepatic artery or the portal vein. Liver function was examined at 3, 6, and 12 months after transplantation. Liver biopsy results were analyzed using the Knodell score. Results Eighty patients （58 males and 22 females） were enrolled in the study. The Child-Pugh score was grade B in 69 cases, and grade C in the remaining 11 cases. HSC transplantation was performed via the portal vein in 36 patients and via the hepatic artery in 44 patients. ALT levels decreased while serum albumin levels increased significantly in both groups at 6 and 12 months after HSC transplantation （P〈0.05 compared with pre-transplantation levels）. Total biliruhin levels decreased significandy in both groups at 3, 6, and 12 months after HSC transplantation （P〈0.05 compared with pre-transplantation levels）. Additionally, prothromhin time decreased in both groups at 12 months after HSC transplantation （P〈0.05 compared with pre-transplantation level）. There were no significant differences in ALT, total bilirubin and prothromhin time between the two groups either before or after transplantation. Moreover, Knodell score decreased significantly at 6 and 12 months. Histological examination showed that liver cell edema, degeneration, necrosis, and inflammation were significantly relieved at 3, 6, and 12 months after transplantation. The incidence of portal vein thrombosis, upper gastrointestinal bleeding, and hepatic encephalopathy were 1.25%, 3.75%, and 2.5% respectively. The one-year survival rate was 100%. Conclusions Autologous HSC transplantation improves liver function and histology in ESLD patients The administration route of HSC has no significant impact on the efficacy of transplantation.
文摘Gastrointestinal stromal tumors(GISTs) represent the most common mesenchymal tumors of the alimentary tract. These tumors may have different clinical and biological behaviors. Malignant forms usually spread via a hematogenous route, and lymph node metastases rarely occur. Herein, we report a patient with a jejunal GIST who developed supraclavicular lymph node metastasis. We conclude that lymphatic diffusion via the mediastinal lymphatic station to the supraclavicular lymph nodes can be a potential metastatic route for GISTs.
文摘The new coronavirus disease 2019 (COVID-19) pandemic has resulted in a globalhealth emergency that has also caused profound changes in the treatment ofcancer. The management of hepatocellular carcinoma (HCC) across the world hasbeen modified according to the scarcity of care resources that have been divertedmostly to face the surge of hospitalized COVID-19 patients. Oncological andhepatobiliary societies have drafted recommendations regarding the adaptation ofguidelines for the management of HCC to the current healthcare situation. Thisreview focuses on specific recommendations for the surgical treatment of HCC (i.e., hepatic resection and liver transplantation), which still represents the bestchance of cure for patients with very early and early HCC. While surgery shouldbe pursued for very selected patients in institutions where standards of care aremaintained, alternative or bridging methods, mostly thermoablation and transarterialtherapies, can be used until surgery can be performed. The prognosis ofpatients with HCC largely depends on both the characteristics of the tumour andthe stage of underlying liver disease. Risk stratification plays a pivotal role indetermining the most appropriate treatment for each case and needs to balancethe chance of cure and the risk of COVID-19 infection during hospitalization.Current recommendations have been critically reviewed to provide a reference forbest practices in the clinical setting, with adaptation based on pandemic trendsand categorization according to COVID-19 prevalence.
文摘BACKGROUND： The necessity to obtain a tissue diagnosis of cancer prior to pancreatic surgery still remains an open debate. In fact, a non-negligible percentage of patients under- going pancreaticoduodenectomy （PD） for suspected cancer has a benign lesion at final histology. We describe an approach for patients with diagnostic uncertainty between cancer and chronic pancreatitis, with the aim of minimizing the incidence of PD for suspicious malignancy finally diagnosed as benign disease. METHODS： Eighty-eight patients （85.4%） with a clinicoradio- logical picture highly suggestive for malignancy received for- mal PD （group 1）. Fifteen patients （14.6%） in whom preopera- tive diagnosis was uncertain between pancreatic cancer and chronic pancreatitis underwent pancreatic head excavation （PHEX） for intraoperative tissue diagnosis （group 2）： those diagnosed as having cancer received PD, whereas those with chronic pancreatitis received pancreaticojejunostomy （P]）. RESULTS： No patient received PD for benign disease. All pa- tients in group I had adenocarcinoma on final histology. Eight patients of group 2 （53.3%） received PD after intraoperative diagnosis of cancer, whereas 7 （46.7%） received PJ because no malignancy was found at introperative frozen sections. No signs of cancer were encountered in patients receiving PHEX and PJ after a median follow-up of 42 months. Overall survival did not differ between patients receiving PD for cancer in the group 1 and those receiving PD for cancer after PHEX in the group 2 （P=0.509）. CONCLUSION： Although the described technique has been used in a very selected group of patients, our results suggest that PHEX for tissue diagnosis may reduce rates of unnecessary PD, when the preoperative diagnosis is uncertain between cancer and chronic pancreatitis.
文摘BACKGROUND Liver resection and radiofrequency ablation are considered curative options for hepatocellular carcinoma.The choice between these techniques is still controversial especially in cases of hepatocellular carcinoma affecting posterosuperior segments in elderly patients.AIM To compare post-operative outcomes between liver resection and radiofrequency ablation in elderly with single hepatocellular carcinoma located in posterosuperior segments.METHODS A retrospective multicentric study was performed enrolling 77 patients age≥70-years-old with single hepatocellular carcinoma(≤30 mm),located in posterosuperior segments(4a,7,8).Patients were divided into liver resection and radiofrequency ablation groups and preoperative,peri-operative and long-term outcomes were retrospectively analyzed and compared using a 1:1 propensity score matching.RESULTS After propensity score matching,twenty-six patients were included in each group.Operative time and overall postoperative complications were higher in the resection group compared to the ablation group(165 min vs 20 min,P<0.01;54%vs 19%P=0.02 respectively).A median hospital stay was significantly longer in the resection group than in the ablation group(7.5 d vs 3 d,P<0.01).Ninety-day mortality was comparable between the two groups.There were no significant differences between resection and ablation group in terms of overall survival and disease free survival at 1,3,and 5 years.CONCLUSION Radiofrequency ablation in posterosuperior segments in elderly is safe and feasible and ensures a short hospital stay,better quality of life and does not modify the overall and disease-free survival.
文摘In this editorial,we have analyzed the historical evolution of rectal and breast cancer surgery,focusing on the progressive reduction of demolitive approaches and the increasing use of more conservative strategies,accompanied by a growing emphasis on perioperative treatments aimed at enhancing surgical outcomes.All of these changes have been made possible due to an increased awareness and understanding of oncological diseases and improved perioperative treatments.
文摘Total pancreatectomy(TP) is a surgical procedure which includes the complete removal of the pancreatic gland, the spleen, the duodenum, the gallbladder, and the distal part of the stomach. TP represents the curative treatment of pancreatic cancer which simultaneously involves the head and the body/tail of the pancreas. Other possible indications for TP comprise multifocal parenchymal diseases, such as intraductal papillary mucinous neoplasms, pancreatic neuroendocrine tumors, multiple endocrine neoplasms, and chronic pancreatitis. Sometimes, TP is carried out in patients scheduled for pancreaticoduodenectomy(where only the head of the pancreas is removed) when a cancer located in the pancreatic head is intraoperatively found to also extend to the pancreatic body [1].
基金supported by the FAR19 grant of the University of Sassari,Italy.
文摘To the Editor:Extrahepatic cholangiocarcinoma(ECC)is an uncommon neoplasm associated with a poor prognosis[1-3].Surgical resection represents the only curative approach,since systemic treatments have scarce efficacy in achieving disease control.However,only 10%-40%of patients with ECC are resectable at diagnosis[1].Ma-jor hepatectomy and portal lymphadenectomy are usually required for hilar ECC,while pancreatoduodenectomy is the standard operation for distal ECC[3-5].However,ECC may spread horizon-tally along the biliary tree,causing tumor involvement of the entire extrahepatic biliary system.In these circumstances,hep-atopancreatoduodenectomy(HPD)has been proposed as a pro-cedure with curative intent[2,6,7].
文摘Otitis media is a frequent problem in preschool children and one of the most common reasons for treatment with antibiotics in children. The exact diagnosis is important for proper management. The diagnosis of otitis media is often difficult. Pneumatic otoscopy, otomicroscopy, and tympanometry can improve the diagnostic quality by indicating fluid or no fluid in the middle ear and thus improve the quality of treatment. The aim of this review is to explain why and how tympanometry can improve the diagnostic quality in otitis media, and to identify some barriers and difficulties encountered when using tympanometry in daily practice. The current literature on tympanometry and own experiences during 38 years are used to elucidate the aim. Tympanometry is difficult to understand and use, when the procedure is not properly trained. The problems are both of a technical nature, and it is difficult to understand and use the information from the curve and the figures on the display. If the use of tympanometry in general practice is increased, the diagnostic quality will improve and hopefully antibiotics will be prescribed on more appropriate indications and less frequently. More demand on tympanometry will hopefully reduce the price of the tympanometer, making it more accessible for GPs. First in that situation the use will be nearly as common as the use of the otoscope.
文摘This study describes a glucocapparin determination method. Based on rapeseed determination of glucosinolate (GSL), the equation of the average straight regression line is Y = 100.42X – 0.03 (R2 = 0.9998). Enzymatic hydrolysis of glucocapparin extracted from leaves and fruits of B. senegalensis, analyzed by SPME-GC-MS confirmed the presence of methylisothiocyanate as the main hydrolysis glucocapparin product. Monitoring glucocapparin contents in B. senegalensis leaves and fruits collected in 4 localities in Senegal showed differences between organs according localities and periods of harvest. Glucocapparin content was very high in dry season particularly in January and the lowest rates were recorded during the rainy period between August and November.
文摘Background: Tympanic paragangliomas are common middle ear benign neoplasias that develop from endocrines cells situated along the great blood vessels of the head and neck, as well as those of the thoracic and lumbar spine. Primary symptoms of tympanic locations include hearing loss and pulsatile tinnitus. Otoscopy often shows a retrotympanic reddish mass, causing tympanic bulging. Computerized tomography scan findings include a tissue density regular mass located at the promontory and limited within the middle ear cavity. Surgical management comprises tumour excision with control of bleeding, with or without prior embolization. Aim: The aim of this presentation is to report an unusual case of tympanic paraganglioma. Case Presentation: We report the case of a 56-year-old patient whose clinical and paraclinical presentations were consistent with cholesteatoma, though a tympanic paraganglioma was discovered per-operatively. Conclusion: In some rare cases, tympanic paraganglioma can be present like a cholesteatoma.
文摘Radical gastrectomy with an adequate lymphadenectomy is the main procedure which makes it possible to cure patients with resectable gastric cancer (GC). A number of randomized controlled trials and meta-analysis provide phase III evidence that laparoscopic gastrectomy is technically safe and that it yields better short-term outcomes than conventional open gastrectomy for early-stage GC. While laparoscopic gastrectomy has become standard therapy for early-stage GC, especially in Asian countries such as Japan and South Korea, the use of minimally invasive techniques is still controversial for the treatment of more advanced tumours, principally due to existing concerns about its oncological adequacy and capacity to carry out an adequately extended lymphadenectomy. Some intrinsic drawbacks of the conventional laparoscopic technique have prevented the worldwide spread of laparoscopic gastrectomy for cancer and, despite technological advances in recent year, it remains a technically challenging procedure. The introduction of robotic surgery over the last ten years has implied a notable mutation of certain minimally invasive procedures, making it possible to overcome some limitations of the traditional laparoscopic technique. Robot-assisted gastric resection with D2 lymph node dissection has been shown to be safe and feasible in prospective and retrospective studies. However, to date there are no high quality comparative studies investigating the advantages of a robotic approach to GC over traditional laparoscopic and open gastrectomy. On the basis of the literature review here presented, robot-assisted surgery seems to fulfill oncologic criteria for D2 dissection and has a comparable oncologic outcome to traditional laparoscopic and open procedure. Robot-assisted gastrectomy was associated with the trend toward a shorter hospital stay with a comparable morbidity of conventional laparoscopic and open gastrectomy, but randomized clinical trials and longer follow-ups are needed to evaluate the possible influence of robot gastrectomy on GC patient survival.
文摘AIM To evaluate the potential effectiveness of robot-assisted gastrectomy(RAG) in comparison to open gastrectomy(OG) for gastric cancer patients.METHODS A comprehensive systematic literature search using PubM ed,EMBASE,and the Cochrane Library was carried out to identify studies comparing RAG and OG in gastric cancer.Participants of any age and sex were considered for inclusion in comparative studies of the two techniques independently from type of gastrectomy.A meta-analysis of short-term perioperative outcomes was performed to evaluate whether RAG is equivalent to OG.The primary outcome measures were set for estimated blood loss,operative time,conversion rate,morbidity,and hospital stay.Secondary among postoperative complications,wound infection,bleeding and anastomotic leakage were also analysed.RESULTS A total of 6 articles,5 retrospective and 1 randomized controlled study,involving 6123 patients overall,with 689(11.3%) cases submitted to RAG and 5434(88.7%) to OG,satisfied the eligibility criteria and were included in the meta-analysis.RAG was associated with longer operation time than OG(weighted mean difference 72.20 min;P < 0.001),but with reduction in blood loss and shorter hospital stay(weighted mean difference-166.83 mL and-1.97 d respectively;P < 0.001).No differences were found with respect to overall postoperative complications(P = 0.65),wound infection(P = 0.35),bleeding(P = 0.65),and anastomotic leakage(P = 0.06).The postoperative mortality rates were similar between the two groups.With respect to oncological outcomes,no statistical differences among the number of harvested lymph nodes were found(weighted mean difference-1.12;P = 0.10).CONCLUSION RAG seems to be a technically valid alternative to OG for performing radical gastrectomy in gastric cancer resulting in safe complications.
文摘Esophageal gastrointestinal stromal tumors(GISTs) are extremely uncommon,representing approximately 5% of GISTs with the majority of esophageal GISTs occurring at the esophagogastric junction(EGJ).The treatment options available for these GISTs are fairly controversial.Many different options are nowadays at our disposal.From surgery to the target therapies we have the possibility to treat the majority of GISTs,including those which are defined as unresectable.The EGJ GISTs represent a stimulating challenge for the surgeon.The anatomical location increases the possibility of postoperative complications.As the role of negative margins in GIST surgery is still controversial and the eff icacy of target therapy has been demonstrated,why not treat EGJ GISTs with enucleation and,where indicated,adjuvant target therapy?
基金presented by Professor Silvestro Canonico as a short oral communication concerning the topic at the 3rd edition of the "Miniinvasive Surgery Congress" held in Naples on 23-24 March 2012
文摘BACKGROUND: Gallbladder adenomyomatosis (GBA) is a hyperplastic disease affecting the wall of the gallbladder, with some typical features. It has historically been considered a benign condition, nevertheless recent reports highlighted a potential role of GBA in predisposing to malignancies of the gallbladder. DATA SOURCES: We reviewed the literature concerning GBA from its identification until July 2012. Owing to the relative rarity of the disease, studies often are case reports or case series. Thus we herein report a summary of the key-points concerning diagnosis and treatment of GBA, easily applicable in everyday practice, rather than a systematic review. Also, results are integrated with our recent experience. RESULTS: In our experience, we observed a trend toward an increase of GBA during the last years, probably due to enhanced ultrasonographic technical advancements and physician’s expertise. GBA has distinctive imaging features. Several recent reports highlight the potential risk of cancer associated with GBA; however the disease is still classified as a benign condition. Although its correlation with malignancy has not been demonstrated, it is prudent to recommend cholecystectomy in some cases. However, in selected asymptomatic patients, a wait-and-see policy is a viable alternative. We propose an algorithm, based on GBA pathological pattern (diffuse, segmental, localized or fundal), suitable for decision-making.CONCLUSIONS: In symptomatic patients and if the diagnosis is doubtful, cholecystectomy is mandatory. Postponing surgery is an option to be offered to asymptomatic patients with low-risk GBA pattern who adhere to scheduled follow-ups.
