1,721,091 research outputs found
En bloc resection of giant retroperitoneal liposarcoma involving the right colon – a video vignette
No full textWe present a video vignette illustrating an en bloc resection
of a giant retroperitoneal liposarcoma (RPLS)
involving the right kidney and colon in a 65-year-old
woman (Video S1).
She presented with a 2-month history of non-specific
abdominal pain. Abdominal CT scan showed a large
retroperitoneal tumour. A biopsy was performed and
the histopathological diagnosis was RPLS. At laparotomy,
a mass of 20 9 23 9 25 cm was removed en bloc
with the right kidney and right colon. A stapled sideto-
side ileocolic anastomosis was done. The histopathological
diagnosis was of well-differentiated RPLS (sclerosing
and adipocytic variety) with MDM2 gene
amplification. The patient was discharged on the eighth
postoperative day. After 5 years of follow-up, she is
alive and disease-free.
RPLS is usually associated with a high rate of recurrence.
In the absence of effective systemic therapies,
surgery represents the mainstay of treatment with curative
intent and complex multivisceral resections are frequently
required. Studies have demonstrated that the
prognosis of patients with RPLS is better when surgeons
adopt an aggressive surgical approach [1–5].
Contiguous organs need to be resected en bloc with the
tumour, even if they are not clearly infiltrated by RPLS.
Because the best chance of cure is at the time of primary
surgery, this rare and complex malignancy should
be managed by an experienced surgical team in a specialized
referral centre [2,4,5]. As the colon is one of
the organs more frequently involved, surgery for RPLS
should be carried out by sarcoma surgeons with experience
in colorectal surgery
Drains, Germs, or Steel: Multidisciplinary Management of Acute Colonic Diverticulitis
No full textThe medical and surgical management of uncomplicated diverticulitis has changed over the last several years. Although immunocompetent patients or those without comorbidities can be treated with antibiotics as an outpatient, the efficacy of high-fiber intake or drugs such as mesalamine or rifaximin is not yet clearly established in the treatment of acute episodes and in the prevention of recurrences. On the other hand, the choice between antibiotic treatment and percutaneous drainage is not always obvious in diverticulitis complicated by abscess formation, especially for larger abscesses; although the results of studies comparing the two approaches remain controversial, surgery must be pursued for abscesses > 8 cm. For emergency surgery, the debate is still ongoing regarding laparoscopic lavage and surgical resection followed by primary anastomosis, since for both approaches the published reports are not in agreement regarding possible benefits. Therefore, these approaches are recommended only for selected patients under the care of experienced surgeons. Also, the contribution of elective surgery toward the overall approach has been revised; currently, it is reserved primarily for patients with a high risk of recurrence and whenever more conservative treatments were not effective
Proteogenomic biomarkers in colorectal cancers: clinical applications
Full text linkIntroduction: Colorectal cancer (CRC) is one of the leading cancers in terms of incidence and mortality, rate requiring a multidisciplinary approach. The discovery of specific CRC biomarkers has caused a paradigm shift in its clinical management. Areas covered: The aim is to illustrate the possible clinical applications of CRC biomarkers through an updated literature review (from 2015 to 2020) based on the PubMed database. A relationship between cancer localization and genetic profile has been identified. Nowadays, the tumor markers are largely used to select patients that could really benefit from a specific type of adjuvant therapy, in order to optimize treatment programs, especially in metastatic patients. This review highlights both CRC biomarkers’ advantages and critical issues. Expert opinion: New biomarker discoveries allow to set noninvasive tests that could increase patient’s compliance with therapy. They also permit a cost-effective early diagnosis, as well as patient-tailored treatments, improving the overall survival. The CRC biomarkers could also have a prognostic value, and usually, they are included in follow-up programs. However, despite the continuous progression of new technologies, their clinical validation is still debated. In this context, additional clinical studies are still necessary to identify, among potential markers, the most effective ones
Emergency Endoscopy During the SARS-CoV-2 Pandemic in the North of Italy: Experience from St. Orsola University Hospital—Bologna
Full text linkThis is a report of the daily experience from February 28 to April 5, 2020, collected by our Emergency Endoscopy Service during the COVID-19 (coronavirus disease 2019) pandemic in the North of Italy, throughout the pre-peak and peak phases
Obstructing Left-Sided Colonic Cancer: Is Endoscopic Stenting a Bridge to Surgery or a Bridge to Nowhere?
No full textFor the 8–29% colorectal cancers that initially manifest with obstruction, emergency surgery (ES) was traditionally considered the only available therapy, despite high morbidity and mortality rates and the need for colostomy creation. More recently, malignant obstruction of the left colon can be temporized by endoscopic placement of a self-expanding metallic stent (SEMS), used as bridge to surgery (BTS), facilitating a laparoscopic approach and increasing the likelihood that a primary anastomosis instead of stoma would be used. Despite these attractive outcomes, the superiority of the BTS approach is not clearly established. Few authors have stressed the potential cancer risk associated with perforations that may occur during endoscopic stent placement, facilitating neoplastic spread and negatively impacting prognosis. For this reason, the current literature focuses on long-term oncologic outcomes such as disease-free survival, overall survival and recurrence rate that do seem not to differ between the ES and BTS approaches. This lack of consensus has spawned differing and sometimes discordant guidelines worldwide. In conclusion, 20 years after the first description of a colonic stent as BTS, the debate is still open, but the growing number of articles about the use of SEMS as a BTS signifies a great interest in the topic. We hope that these data will finally converge on a single set of recommendations supporting a management strategy with well-demonstrated superiority
INTERNATIONAL VARIATION IN USE OF IMAGING FOR PATIENTS PRESENTING WITH RIGHT ILIAC FOSSA PAIN
No full textAim: To investigate variation in utilisation of diagnostic imaging for patients
presenting with right iliac fossa (RIF) pain across five countries.
Method: Prospective observational cohort study of adult (16 years and
above) patients presenting with RIF pain. The primary endpoint was the
overall imaging rate, including computed tomography (CT), magnetic
resonance (MRI), and ultrasound imaging. The secondary endpoint was the
negative appendicectomy rate (NAR; removal of a histologically normal
appendix).
Results: Data were collected in Ireland/UK (n1⁄47665; 169 centres), Italy
(n1⁄4782; 50 centres), and Spain/Portugal (n1⁄41046; 55 centres). Imaging
rates were lower in Ireland/UK (women: 74%, men: 41%) than in Italy
(women: 87%, men: 84%) and Spain/Portugal (89% for both women and
men). Overall CT and MRI scans rates were similar across all countries, but
ultrasound was more commonly used in Italy (77%) and Spain/Portugal
(81%) than Ireland/UK (46%). The overall NAR was higher in Ireland/UK
(16%) than in Italy (3%) and Spain/Portugal (6%).
Conclusions: Whilst rates of CT and MRI imaging were similar across the
five countries, the NAR was lowest in Italy and Spain/Portugal. It may be
possible to decrease the NAR in Ireland/UK without increasing the rate of
CT scanning
Carbonic maceration and traditional wine making: a quality control procedure using gas chromatographic determination of fixed compounds
No full textEvaluating the timing of laparoscopic cholecistectomy for acute cholecystitis (AC) in two italian centers: early or delayed approach?
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