Role of Endoscopy in Tracheo-esophageal Prosthesis Phonation. Technical and Psychological Aspects. Our Institutional Experience

In our study, we have analyzed the use of flexible video endoscopy in patients undergoing total laryngectomy and candidates for the placement of a voice prosthesis, with the creation of a tracheo-esophageal fistula in which the prosthesis is positioned, which acts as a valve one-way, which allows the passage of air from the trachea to the oesophagus and prevents the passage of liquids in the opposite direction, allowing the pulmonary air to vibrate a segment of the cervical oesophagus. The use of flexible video endoscopy for the positioning of the prosthesis can be both primary and secondary to the intervention of total laryngectomy. Endoscopy has also been used in the ontological follow-up for the assessment of the hypo pharyngeal-oesophageal-gastric district in the search for relapses or secondary tumors, which may develop in this district in more than 10% of patients with pathological neoplasia. Higher aero-digestiv

Role of narrow band imaging (NBI), in the treatment of non-polypoid colorectal lesions, with endoscopic mucosal resection (EMR). A single-center experience

BACKGROUND: In this study, the authors evaluated the role of narrow band imaging endoscopy in the early detection of infiltration of the colon wall by flat and depressed lesions, highlighted during colonoscopy, to confirm the possibility of removal with Endoscopic Mucosal Resection (EMR). METHODS: 67 patients (37 males and 30 females) with non-polypoid colorectal lesions were included in this study. The location of the lesions, the size and possible infiltration of the colon wall were performed with a colonoscopy with NBI. Lesions without massive invasion were treated with an EMR. RESULTS: NBI was found to be a sensitive, specific, and accurate technique in assessing any infiltration of the colon wall. Endoscopic resection of the mucous membrane was successfully performed in 62 patients, it was not possible to perform it in 5 patients, due to the lack of dissection, and they underwent surgery. CONCLUSIONS: Non-polypoid colorectal lesions and early tumors can be treated with EMR. Certainly, early detection with Narrow Band Imaging endoscopy and subsequent endoscopic resection can reduce colorectal cancer mortality. Many studies have confirmed that these two methods have achieved important results comparable with surgical procedures. KEY WORDS: Endoscopic Mucosal Resection, Narrow Band Imaging, Therapy

Post-operative oncological and psychological evaluation of patients with colostomy for colorectal cancer.

BACKGROUND: The therapeutic arsenal for colorectal cancer is largely made up of surgery. In digestive tumors, ostomy devices induce loss of function and control. This medical device generates changes that affect all aspects of patients’ lives. This study evaluates the postoperative follow-up from the oncological point of view and the psychological impact of colosto- my on the quality of life of patients with colorectal cancer, analyzing any complications or relapses, and the high risk of self-concept disorder and social isolation. METHODS: The aim of the work was to identify all the surgeries for colorectal cancer performed in the Federico II University Hospital of Naples, from 2018 to 2021, and among them how many had been packaged a colostomy. We then analyzed how many patients had been evaluated 12 months after surgery, with a transanal endoscopy or transto- my, and the percentage of any complications or relapses. The same patients who underwent endoscopic control were also evaluated psychologically, to analyze how they lived the packaging of the ostomy and how it had affected the quality of life. READ-ONLY COP RESULTS: At endoscopic control, diversion colitis phenomena and few cases of stoma stenosis and stomatitis were detect- PRINTING PROHIBITED ed. No case of neoplastic recurrence. From the psychological point of view, the problems detected were in particular the alteration of body image, the loss of sphincter control, embarrassment and shame for the bad smell, impairment of sex- uality and difficulties in the couple relationship and social contacts, anxiety, depression and loneliness. CONCLUSIONS: The post-operative evaluation of the ostomy patient following colorectal cancer requires endoscopic control to suddenly detect recurrences and complications and psychological support that improves their quality of life

gender and quality of life in laryngectomized patients

Background: the aim of this study was to investigate possible correlations between the perception of postoperative quality of life and gender. Methods: the questionnaires “the Brief illness Perception Questionnaire” (B-iPQ) and “Voice handicap index” (Vhi) were administered to 94 patients divided into two groups according to gender group a: 73 men, group B: 21 women. RESULTS: The results showed that gender should be considered a factor influencing perceived quality of life in laryngectomized patients. Specifically, women showed greater concern towards the disease, its evolution, and the consequences on their lives, compared to men. CONCLUSIONS: the care of the laryngectomized woman should consider the impact that loss of voice has on the perception of her femininity, and the physical, functional, and above all emotional issues that such surgeries may lead to for women

Percutaneous endoscopic jejunostomy (PEJ) in patients with dumping syndrome: Evaluation of our center on a series of clinical cases

Background: The Dumping syndrome occurs in a variable percentage of subjects undergoing surgery involving the esophageal and gastric district. The treatment makes use of the introduction of dietary measures and arti!cial nutrition, especially the internal one. This study evaluates the experience of a single center regarding the use of percutaneous endoscopic jejunostomy (PEJ) in patients developing the dumping syndrome. Methods: We evaluated the case history of our department, of all patients operated on at the level of the upper gastrointestinal tract, who had manifested symptoms referable to the Dumping syndrome in the postoperative period.We have identi!ed 3, which we have carried out further investigations to con!rm the presence of an accelerated gastric emptying, and given the poor results obtained with dietary modi!cations and drug therapy, we have implemented a feeding through enteral nutrition, through a jejunal probe. PEG/J positioned by Pull technique, and subsequently replaced after 8 months. Results: Clinically, patients did not develop short- or long-term complications, symptoms were signi!cantly reduced, and they gained weight. Psychologically, the anxiety disorders related to nutrition have improved. Conclusions: By means of percutaneous endoscopic jejunostomy, the symptoms related to hypoglycemic crises following the hyperinsulinemic response to the ingestion of carbohydrates in patients with Dumping were attenuated and the anxiety of eating was lessened. Although limited to a few cases, we believe this form of nutrition is the best for patients with dumping

Management of pheochromocytoma during pregnancy from diagnosis to laparoscopic adrenalectomy. A case report and review of literature

INTRODUCTION: Pheochromocytoma is an endocrine tumour of chromaffin cells. It can be diagnosed either sporadically or in the context of hereditary syndromes (e.g. Von Hippel Lindau, Neurofibromatosis type 1 and multiple neuroendocrine neoplasia type 2). During pregnancy, its frequency is very low (about 0,007%). This tumour causes paroxysmal hypertension in 0,1-0,6% pregnant women, because of an overproduction of catecholamines. If undiagnosed and nontreated, it's associated with high maternal and fetal mortality (40-50%). We report the case of a 30-year-old female diagnosed with pheochromocytoma during pregnancy at week 31 of gestation. In a multidisciplinary team made of surgeons, gynaecologists, anaesthetists, geneticists and endocrinologists we evaluated the case and according to literature, we choose a surgical approach after childbirth: performing a laparoscopic right adrenalectomy. DISCUSSION: In pregnancy, pheochromocytoma is a rare clinical condition. Gold standard treatment is laparoscopic adrenalectomy. However, the optimum timing of surgery is a challenge. CONCLUSION: Timely diagnosis of pheochromocytoma in pregnant women with hypertension and appropriate therapeutic management can lead to improve maternal, fetal and neonatal outcomes. The multidisciplinary team is necessary to recognize the symptoms and to adopt the right pre - and post - operative treatment. Laparoscopic adrenalectomy after delivery is safe and feasible even though the surgical procedure should be performed by an experienced surgeon. KEY WORDS: Pheochromocytoma, Pregnancy, Laparoscopic adrenalectomy and pregnancy, Management of pheochromocytoma, Laparoscopic adrenalectomy, Adrenalectomy, Pregnancy and pheochromocytoma

Role of Endoscopy in Trache-esophageal Prosthesis Phonation. Technical and Psychological Aspects. Our Institutional Experience.

Background and Aims: In our study, we have analyzed the use of flexible video endoscopy in patients undergoing total laryngectomy and candidates for the placement of a voice prosthesis, with the creation of a tracheo-esophageal fistula in which the prosthesis is positioned, which acts as a valve one-way, which allows the passage of air from the trachea to the oesophagus and prevents the passage of liquids in the opposite direction, allowing the pulmonary air to vibrate a segment of the cervical oesophagus. The use of flexible video endoscopy for the positioning of the prosthesis can be both primary and secondary to the intervention of total laryngectomy. Endoscopy has also been used in the ontological follow-up for the assessment of the hypo pharyngeal-oesophageal-gastric district in the search for relapses or secondary tumors, which may develop in this district in more than 10% of patients with pathological neoplasia. Higher aero-digestive. Methods: We performed a complete esophagogastroduodenoscopy on 36 patients who had total laryngectomy divided into two groups of 18 patients, in group A there were patients who hadalready been prosthetic for at least one year, and in the B group the patients underwent for the first time creation of a tracheo-esophageal fistula. Results: At endoscopy we found three neoplastic recurrences in group A that did not allow the placement of a new prosthesis, in group B we excluded 3 patients who had a grade B esophagitis according to the classification of Los Angeles, in the remaining 15 patients there were minor complications, in particular two patients presented intense inflammatory reaction after the creation of the fistula, one patient had phonatory difficulties, one patient had a progressive deterioration of the phonatory function, which endoscopic control showed was determined by a too short prosthesis. Conclusions: Without a doubt the flexible video endoscopy in recent years has been very widespread, we believe that our experience has confirmed the interesting and beneficial use in patients undergoing total laryngectomy and candidates for the placement of a tracheo-esophageal voice prosthesis, in the evaluation contraindications such as recurrences or secondary neoplasm’s of the oesophagus, and in the presence of reflux esophagitis in patients with hiatal hernia and / or cardiac incontinence

Morbid Obesity: treatment with Bioenterics Intragastric Balloon (BIB), psychological and nursing care: our experience

Obesity is considered a chronic disease, difficult to treat, and is the first cause of death in the world that is predictable. The surgical approach is limited to patients with severe obesity but there is an intermediate group who are not candidates for immediate surgery. The BioEnterics Intragastric Balloon (BIB) is recommended for weight reduction as a bridge to bariatric surgery. All patients in the study underwent a psychological evaluation prior to placement of the BIB