63 research outputs found
PROGNOSTIC ROLE OF CAF-1 COMPLEX IN UVEAL MELANOMA
Uveal melanoma (UM) is the most common intraocular neoplasia in adults. Despite the recent advances in local therapy approaches, more than 50% of patients with UM still develop distant metastases, with a poor survival rate from the diagnosis of metastatic disease. Therefore, there is an urgent need to identify new reliable prognostic biomarkers and new therapeutic protocols for UM patients. Chromatin Assembly Factor-1 (CAF-1), a trimeric protein complex required for chromatin assembly after replication, which assembles histone octamers onto newly-replicated DNA, is an extremely promising new prognostic factor for solid malignancies of various histogenesis. We tested the immunohistochemical expression of CAF-1 p60 and p150 on paraffin-embedded tissue sections from 9 tissue microarrays (TMAs) made by cores, obtained from 133 UMs FFPE blocks. UMs included in this study were collected from 1990 to 2018, from the archives of the UOC of Surgical Pathology of the Federico II University of Naples and the Department G.F. Ingrassia, Section of Anatomic Pathology, University of Catania. We compared the immunohistochemical expression of CAF-1 subunits with BAP 1 expression, currently considered a relevant prognostic marker in UM.
CAF-1/p60 and CAF-1/ p150 proteins were found overexpressed in our series of UM cases, with a significant correlation with an unfavorable outcome. Moreover, Immunohistochemical evaluation of BAP1 resulted less effective in prognostic stratification of patients.
CAF-1/p60 and CAF-1/p150 resulted as reliable immunohistochemical markers, particularly in combination, to identify UM patients with a high risk of recurrence or metastasis. This finding opens up the chance of adding CAF-1 immunohistochemistry to the routine tissue prognostic algorithm for UM and provides new therapeutic insights
Post-pneumonectomy broncho-pleural fistula successfully closed by open-window thoracostomy associated with V.A.C. therapy
AbstractBroncho-pleural fistula (BPF), is a dramatic complication that may occur after lung resection. The treatment is challenging due to its high rate of morbidity and mortality. Herein, a case of BPF associated with empyema, occurred in an elderly patient who had undergone to left pneumonectomy for non-small cell lung cancer (NSCLC), is reported. After various treatments including chest drainage and endoscopic procedures, BPF was successfully closed by open-window thoracotomy associated with vacuum assisted closure (V.A.C.) device therapy. The authors conclude that V.A.C. is a convenient and safe measure in the management of empyema with BPF. Moreover, in similar clinical contexts, V.A.C. may be the only option available that may assure the survival of the patient and the avoiding any later-phases of residual cavity
Age as a risk factor in the occurrence of pneumothorax after transthoracic fine needle biopsy: Our experience
AbstractTransthoracic needle biopsy (TTNB) of the lung is a well-established technique for diagnosing many thoracic lesions, and is an important alternative to more invasive surgical procedures. Complications of TTNB include pneumothorax, hemoptysis, hemothorax, infection, and air embolism, with the most common complication as pneumothorax. From June 2011 to June 2014 we performed a prospective study of 188 patients who underwent TTNB with CT guidance at University Hospital of Salerno, Italy. Pneumothorax occurred in 14 of 188 biopsies (7.45%). With the respect of age of patients pneumothorax occurred more frequently in patients aged 60–70 years, while it was less frequent in younger (<60 years) and older patients (>70 years). In conclusion, data of our prospective study documented that CT-guided TTNB is a safe and reliable procedure in elderly patients with suspected chest malignancy and is well tolerated
Papillary thyroid carcinoma in paediatric age
In children, differentiated thyroid
carcinoma is a rare condition. Early diagnosis is not
always easy, because of the lack of clinical symptoms,
but it has a pivotal role in performing a correct
therapeutic process.
The study describes three cases of papillary
thyroid carcinoma. None of the three patients had a
positive familiarity or exposure to risk factors. In two
cases, the tumor occurred as a non-injurious swelling in
the anterior cervical region, in the other case it
occurred with a latero-cervical lymphadenopathy that
had been persistent for a year. In the first two patients
we made a certain diagnosis by the needle aspiration of
the thyroid nodule; in the other case the diagnosis was
made by surgical exeresis and histological analysis of
the lymph nodes. We also performed blood chemistry
and hormonal tests, neck ultrasound, chest x-ray.
The three children underwent total
thyroidectomy and two of them also underwent rightsided cervical lymph node exeresis because there was
the presence of metastasis.
In our experience, the best therapeutic strategy
for children with differentiated thyroid carcinoma is the
total thyroidectomy, followed or not by latero-cervical
lymph node exeresis and radioiodiotherapy. The
removal of the whole gland reduces the risk of relapse
Minimally invasive treatment of urolithiasis in children: evaluation of the use of flexible ureterorenoscopy and laser lithotripsy
Urolithiasis is a multifactorial disease; in recent years, its incidence has gradually increased in pediatric age. Among the factors involved in urolithiasis pathophysiology, urinary tract anomalies and metabolic diseases are the most relevant, although ethnicity and environmental factors may have an important role.
The advances in technology and miniaturization of endoscopic devices have permitted the use of Retrograde Intrarenal Surgery (RIRS) to treat kidney and ureteral stones.
Nowadays, flexible ureterorenoscopy and laser lithotripsy, which are techniques that have been applied in the management of adult upper urinary tract disorders, are also used in children as a minimally invasive treatment of urolithiasis with encouraging, effective and safe results.
The Authors report a retrospective review of their record of cases considering 21 pediatric urolithiasis treatment procedures performed between October 2017 and April 2019 in a total of 17 patients (10 males and 7 females).
Six procedures involved the use of the flexible ureterorenoscope (FURS) while in 15 procedures the application of the laser fiber was used (FURSL). A case of laser lithotripsy for bladder stone was included. The average age of patients was 10.5 years (2-18 years). The renal pelvis dilatation pretreatment was evaluated in post-operative follow-up.
From the evaluation of the sample in analysis, the use of RIRS has good results in the treatment of paediatric urolithiasis, emerging as a valid option in the management of the paediatric population in terms of efficacy and safety, with an improvement in patient outcomes
Complications of the “nuss procedure” in pectus excavatum
During the pediatric age range, one
the most frequent deformities of the chest wall are
Pectus Excavatum (PE). Currently the treatment of
choice for PE is surgical intervention following the
Nuss procedure.
In this study, we present a description of the
complications associated with surgical treatment of PE
with the Nuss technique, in patients with symmetrical or
asymmetrical deformity, in different stages of disease
severity.
The study was conducted in collaboration with
the Pediatric Hospital “Istituto G. Gaslini” of Genoa.
We analyzed a cohort of 402 patients (334 males and 68
females), who underwent corrective surgery between
2005 and 2018. Within this group of patients, we
observed 82 cases with complications (20.39%), 20 of
which were intraoperative (4.98%) and 62 postoperative (15.42%). For the evaluation of
complications, this group was arbitrarily divided into
patients with symmetric and asymmetric Pectus and in
patients with mild, moderate and severe Pectus using
Haller's index.
Although a small group of patients presented
complications, overall results from data analysis show
that the Nuss technique represents the preferred surgical
procedure for the treatment of PE, in agreement with
literature. Furthermore, in our results show no
correlation between asymmetry or severity of PE with
complication related to the surgery
Laparoscopic repair of paediatric indirect inguinal hernia: modified flip flap technique
In paediatric age, indirect inguinal
hernia represents more than 95% of the hernial disease.
It is a congenital type, in contrast with adulthood in
which acquired forms are more frequently found (1).
The laparoscopic correction of indirect inguinal hernia
is one of the most common surgeries performed in
paediatric age. In recent years, various techniques have
been introduced for the videolaparoscopic correction of
this disease.
The aim of this study is to provide an
assessment of the efficacy and safety of the execution
of a modified Flip-Flap technique, using tissue glue for
filling of Peritoneal-vaginal duct (DPV), performed in
order to ensure greater suture tightness and reduce the
incidence of postoperative hydrocele.
The Authors present a retrospective review of
their record of cases, considering a total of 187 patients
aged between 18 months and 14 years. For the
correction of the hernial defect, the modified VLS FlipFlap technique was carried out.
The evaluation of safety, efficacy, operating
time, relapse rate and development of short-term
complications (such as postoperative hydrocele, scrotal
hematoma or ecchymosis, atrophy or iatrogenic testicle
ascension) was considered in a mean follow-up of 6
months. The Authors suggest that this variant of the
peritoneal Flip-Flap technique is simple to perform; its
safety, reproducibility and effectiveness is proven and
has a percentage of relapses and complications
overlapping with the “open” approach and superior to
other laparoscopic techniques
Laparoscopic splenectomy: postero-lateral approach
In paediatric population, the
laparoscopic splenectomy has been preferred to the open
surgery during the last years. Due to the improvement of
the technique and the devices, the indications to the
laparoscopic splenectomy have been increased, even
though there is still a variety of conditions in which the
execution of this technique is arduous. During the
preoperative consult there is the need to carefully
evaluate the existence of cholecystic lithiasis, the
haemoglobin level in patients with SCA, platelet count in
children with ITP and the vaccination status. An anterior
and a lateral or hanging spleen approach are primarily
used for laparoscopic splenectomy. In the last four years,
near the Section of Pediatric Surgery of the Department
of Pediatrics, Obstetrics and Medicine of the
Reproduction of Siena University, 8 cases of
splenomegaly have been treated, 7 by lateral
videolaparoscopic splenectomy (5 males and 2 females,
with medium age of 10,5 years) and 1 by anterior
approach (10 years).
The advantages shown by these techniques
allow the laparoscopic splenectomy to be considered as
a valid alternative to the open surgery. In children’s
laparoscopic splenectomy, the rate of complications is
considerably low and the the major problem is the
intraoperative hemorrhage. With increasing surgical
experience, the minimally invasive approach appears to
be superior in terms of faster postoperative recovery,
shorter hospital stay, perioperative and postoperative
advantages. Therefore, the laparoscopic technique may
soon be accepted as the standard method in patients
requiring splenectomy
Congenital cystic adenomatoid malformation of the lung tipe II: three cases report
Congenital cystic adenomatoid
malformation (CCAM) is a rare congenital lung
lesion. It may appear since birth (30-35%) with
difficulty breathing or may have a late onset (60-
65%) with recurring pulmonary infections or
growth failure; in a small percentage of cases, the
lesion can be completely asymptomatic.
Fetal or post-natal surgery can be used as
surgical treatment of these lesions. Postnatal
surgery consists of a lobectomy, bilobectomy or
pneumonectomy, based on the size of the lesion.
The best age to undergo this surgery is around 2
years, but only if the injury is stable and the child
has no complications.
The study describes three cases of CCAM,
observed at the Pediatric Surgery Section of the
University of Siena. We analyzed those 3 cases
whose approach was defined by the onset of
symptoms, age and clinical condition of patients. In
the first case the surgery was performed a few hours
after birth due to the worsening of the clinical
conditions; in the other two cases it was delayed
because the patients were asymptomatic.
The purpose of this study is to review the
management of patients with CCAM in relation to
clinical onset and the type of injury
Pre and post-operative ph-metry in videolaparoscopic surgery for gastro oesophageal reflux disease
Gastro-oesophageal reflux is
common in children, especially in the first year of life,
and it may be regarded as physiological. Good
functioning of the lower oesophageal sphincter depends
largely on the anatomical relationships between
oesophagus, stomach and diaphragm hiatus. Relative
immaturity of these structures in newborn babies and
young children is a risk factor in reflux disease, which
may result in a wide variety of typical and/or atypical
symptoms and, sometimes, serious complications such as
oesophagitis and stenosis.
Reflux disease may be diagnosed and studied,
basing on morphological and functional aspects and,
since the advent of pH-metry, it is possible to personalise
the therapeutic approach to children with reflux.
Surgical treatment of reflux disease in children
has recently been improved due to a mini-invasive
surgical approach. Absolute indications are recurrent
pneumonia, intractable pain due to oesophagitis and
retarded growth, often in association with neurological
impairment.
In the last three years, 18 children with reflux
disease underwent videolaparoscopic surgery in our
department, 14 by the Nissen and 4 by the Toupet
technique.
Post-operative pH-metry always showed a
reduction in exposure of the distal oesophagus to acid
(integral of H+) and an improvement in oesophageal
clearance (short refluxes percentage) indicative of good
functioning of the gastro-oesophageal junction.
PH-metry proved to be an invaluable technique
for planning therapeutic strategy. In follow-up
evaluations, it enabled us to monitor functioning of the
gastro-oesophageal junction and to avoid other more
difficult and invasive tests in patients with severe
neurological impairment
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