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Mario Sianesi

Publications and source records attributed to Mario Sianesi.

At least 19 recordsLinked to original sources
PubMed2006

Dunbar's syndrome and superior mesenteric artery's syndrome: a rare association.

Celiac artery compression syndrome (CACS) and superior mesenteric artery syndrome (SMAS) are 2 rare diseases, widely described in literature. Their association has not been specifically investigated; in fact, few cases have been reported. For this reason we reviewed our experience from January 1974 to June 2004. We report 59 patients affected by CACS and 28 by SMAS. Coexistence of both syndromes in 8 patients was observed. These 8 patients were successfully treated with duodenojejunal bypass and decompression of the celiac trunk. In this paper, we analyze the pathogenesis, clinical presentation, diagnosis, and treatment of these syndromes, emphasizing their common aspects. The misdiagnosis of this association may justify in some cases the controversial results reported regarding the surgical treatment of these syndrome.

Adolescent↗
PubMed2006

The risk of developing metastatic disease in colorectal cancer is related to CD105-positive vessel count.

BACKGROUND AND OBJECTIVES: Angiogenesis is a complex multistep process that involves extracellular matrix remodeling, migration and proliferation of endothelial cells, and morphogenesis of microvessels. CD105 (endoglin), a co-receptor of the TGF-beta superfamily, was proposed as a marker of neovascularization in solid malignancies. The aim of this study was to evaluate retrospectively the effect of CD105-assessed angiogenesis on the risk of developing metastatic disease in colorectal cancer (CRC). METHODS: One hundred and twenty-five paraffin-embedded samples were analyzed by immunohistochemical methods using a CD105 monoclonal antibody. The median follow-up was 70.8 months. Survivals were calculated from actuarial estimates, and logistic regression predicted the risk of developing metastatic disease. RESULTS: The CD105-vessel count was strongly correlated with the occurrence of metastatic disease. The median CD105-positive vessels in patients with and without metastatic disease were 24.7 and 13.2 vessels/mm(2), respectively (P < 0.001). For each one microvessel increase in the vessels count per 400x field, there was a 1.42-fold increase in the risk of metastatic disease (P < 0.001). CONCLUSIONS: The assessment of tumor angiogenesis with anti-CD105 was not sufficient for its use as a surrogate end point for survival because of the amount of survival variability explained was only 8% in absence of metastatic disease. In contrast, multivariate logistic regression analysis revealed that CD105-vessels count can identify patients at high risk of metastatic disease.

Adenocarcinoma↗
PubMed2006

Videolaparoscopic cholecystectomy for acute cholecystitis: analyzing conversion risk factors.

We examined a series of 176 consecutive patients scheduled for videolaparoscopic cholecystectomy for acute cholecystitis to identify the independent parameters most likely to lead to conversion to laparotomy. This prospective study was conducted from June 2001 to December 2003 on 176 consecutive patients who were scheduled for videolaparoscopic cholecystectomy for acute cholecystitis. Of the 176 patients, 119 (group A) underwent videolaparoscopic chlecystectomy, and 57 (32.3%) were converted to laparotomy (group B). Patients were assessed for gender, age, time between onset of symptoms and surgery, previous surgery, ASA (American Society of Anesthesia) risk, leukocytosis, echotomographic findings, average operating time, intra- and post-operative complications, and conversion rate. Our study found that the parameters of age, ASA risk, duration of symptoms, leukocytosis, and operative time are independent conversion risk factors.

Aged↗
PubMed2006

Preliminary experience in minimally invasive videoassisted thyroidectomy (MIVAT).

BACKGROUND: We report our initial experience in the treatment of thyroid disease with Minimally Invasive Videoassisted Technique (MIVAT) introduced by Miccoli. METHODS: We have treated from July to September 2005, 5 patients, with MIVAT. The procedure is carried out through an incision of 15-20 mm 2 cm on sternal notch and the thyroidectomy is performed by dedicated instruments. RESULTS: We have surgically treated 3 follicular hyperplasias, one Hurthle adenoma and one papillary carcinoma. The mean time of thyroidectomy was 98 +/- 14 minutes; four cases were discharged after 24 hours and one case after 48 hours for a postoperative hypertension. No hypocalcemia, no nerve palsy. Cosmetic result and postoperative pain were excellent. CONCLUSION: MIVAT is a safe, reproducible technique with an indication in a minority of patients candidates to thyroidectomy and is characterized by a better postoperative discomfort.

Adult↗
PubMed2006

Role of gut microflora and probiotic effects in the irritable bowel syndrome.

BACKGROUND: Even though the cause of irritable bowel sindrome (IBS) is not yet known, alterations of the intestinal microflora may be important in its pathogenesis. AIM: To evaluate the efficacy of rifaximine alone or in association with the probiotic strain of Bifidobacterium longum W11 in reducing symptoms in patients with IBS. METHODS: We performed a monocentric, prospective, randomized open trial including 70 patients randomized in to two groups: Group A (41 patients) receiving rifaximin 200 (2 cp bid for ten days in a month) followed by a formulation of the probiotic strain of Bifidobacterium longum W11(one granulated suspension for 6 days on alternate weeks ) and Group B (29 patients) receiving only rifaximin 200 (2 cp bid for ten days in a month). The clinical evaluation was performed at admission and after 2-months, taking into account the method of visual analogous. RESULTS: At the 2-month follow-up, Group A patients reported a greater improvement of symptoms compared to patients in group B (p = 0.010) even if the physician's opinion at T1 did not confirm these results (p = 0.07). CONCLUSION: The increased colonisation by Bifi-dobacterium longum W11, after the cyclic administration of rifaximin, which eradicates the bacterial overgrowth of the small intestine, may reduce symptoms, especially those related to bowel habit and stool frequency in patients with IBS. The abnormalities observed in the colonic flora of IBS suggest, in fact, that a probiotic approach will ultimately be justified.

Adult↗
PubMed2005

The utility of serum PTH assessment 24 hours after total thyroidectomy.

BACKGROUND: Hypocalcemia is the most frequent complication following total thyroidectomy. This prospective study examines the predictive value of parathyroid hormone (PTH) levels measured 24 hours after surgery. MATERIAL AND METHODS: A total of 1006 consecutive patients (mean age, 54.8 years; female/male ratio, 4/1) underwent total thyroidectomy for benign or malignant thyroid from January 1995 to November 2003. Serum calcium, phosphorus, and PTH were measured preoperatively and at 24 hours after surgery. All patients underwent preoperative examination to assess cord motility. RESULTS: A total of 253 (25.1%) patients presented with hypocalcemia demonstrated by clinical and laboratory findings. In 101 cases the hypocalcemic syndrome manifested after 24 to 36 hours whereas in 5 of 101 cases, symptom onset was between 48 and 72 hours. Serum calcium levels lower than 7.5 mg/dL were recorded in all the 101 cases. In 239 of 253 cases serum calcium returned to normal values within 7 days following surgery. PTH at 24 hours was below normal levels in 49 of the 101 patients but was within normal limits in 52 cases. The incidence of hypocalcemia was higher in patients undergoing surgery for malignant thyroid ( P < 0.05). CONCLUSIONS: We do not consider PTH levels at 24 hours postoperatively as predictive of hypocalcemia.

Calcium↗
PubMed2005

Radiologic assessment of rectosigmoid cancer before and after neoadjuvant radiation therapy: comparison between quantitation techniques.

OBJECTIVE: Volumetric analysis was compared with conventional unidimensional measurements for follow-up of rectosigmoid cancer before and after radiation therapy. SUBJECTS AND METHODS: Fifteen patients with rectosigmoid cancer underwent helical CT before and after neoadjuvant radiation therapy. The helical CT examination was performed after colon distention with air and IV administration of an antiperistaltic drug. Two scans were obtained: one with the patient in the supine position and the other with the patient in the prone position after contrast medium injection. The maximal wall thickness and the volumetric analysis of the tumor were obtained through manual segmentation. RESULTS: The mean of the differences between the volumetric analysis of the scans obtained before and after radiation therapy was 8.3 +/- 10.3 (SD) mL (-22.7%) (p <0.05). The mean of the differences between the maximal wall thickness of the pre- and post-radiation therapy scans was 3.4 +/- 2.6 mm (-19.1%) (p <0.05). A significant difference was observed between the variation of the maximal wall thickness and the variation of volumetric analysis in pre- and post-radiation therapy scans (p <0.05). The patients could be classified in different response categories depending on the measurement method and on the response criteria. CONCLUSION: Volumetric analysis of rectosigmoid cancer is feasible. A long-term study is needed to correlate volumetric assessment with patient outcome.

Aged↗
PubMed2005

Technical analysis of volume-rendering algorithms: application in low-contrast structures using liver vascularisation as a model.

AIM: To assess the influence of pre-set volume-rendering opacity curves (OC) on image quality and to identify which absolute parameters (density of aorta, hepatic parenchyma and portal vein) affect visualization of portal vascular structures (low-contrast structures). MATERIALS AND METHODS: Twenty-two patients underwent a dual-phase spiral CT with the following parameters: collimation 3 mm, pitch 2, increment 1 mm. Three scans were performed: one without contrast medium and the latter two after the injection of contrast material (conventionally identified as ''arterial'' and ''portal''). The images were sent to a workstation running on an NT platform equipped with post-processing software allowing three-dimensional (3D) reconstructions to generate volume-rendered images of the vascular supply to the liver. Correlation between the absolute values of aorta, liver and portal vein density, OC parameters, and image quality were assessed. RESULTS: 3D images generated using pre-set OC obtained a much lower overall quality score than those produced with OC set by the operator. High contrast between the liver and the portal vein, for example during the portal vascular phase, allows wider windows, thus improving image quality. Conversely, the OC in the parenchymal phase scans must have a high gradient in order to better differentiate between the vascular structures and the surrounding hepatic parenchyma. CONCLUSIONS: Image features considered to be of interest by the operator cannot be simplified by the mean of pre-set OC. Due to their strong individual variability automatic 3D algorithms cannot be universally applied: they should be adapted to both image and patient characteristics.

Aged↗
PubMed2005

Pitfalls and feasibility of a protocol of virtual colonography designed for the screening of colo-rectal pre-cancerous lesions.

PURPOSE: To evaluate the pitfalls occurring during the virtual colonoscopy examination performed with a protocol designed for screening purposes. MATERIALS AND METHODS: 40 patients underwent a spiral CT for virtual colonoscopic evaluation with the following parameters: collimation 3 mm, feed 6 mm.rot(-1), pitch 2 and increment 1 mm in supine position. Virtual colonography examination was carried out using a dedicated workstation equipped with a software which allows to generate 3D images and virtual endoscopic views. Colon distension, fluid and fecal material were assessed on a 3 point scale. RESULTS: Distension score was 0.50. Left colon and cecum score was 0.32 while in the sigmoid and rectum the score was worse with 0.86. Fluid and fecal residues scores were 0.31 and 0.19 respectively. On almost half of the patients additional scans would be necessary. The main cause of additional scans is suboptimal intestinal preparation and colon distension. CONCLUSION: The use of virtual colonoscopy for screening purposes will be possible through the further technical development and with the optimisation of the protocols, particularly by the improvement of colon cleansing and distension.

Adult↗
PubMed2005

Endoscopic treatment of esophageal and colo-rectal fistulas with fibrin glue.

So far, the use of fibrin glue has been limited to the treatment of anal, recto-vaginal and enterocutaneous fistulae. Between 1991 and 2003 we performed the treatment of anastomotic leaks of the upper and lower gastro-intestinal tract with fibrin glue in 13 selected patients. In our experience the treatment with fibrin glue has been proved to be effective in the selected cases. If the fistulae clinically occured 7 days after surgery a higher number of endoscopic sessions were necessary than in patients with earlier appearance of anastomotic leakage. The utilization of fibrin glue for the endoscopic management of anastomotic leakages after surgery can be successful and safe if applied in selected patients.

Colonic Diseases↗
PubMed2004

Pancreatic pseudocysts following acute pancreatitis: risk factors influencing therapeutic outcomes.

CONTEXT: The natural history of pancreatic pseudocysts has become well known in recent years, but the choice of a proper treatment still remains controversial. OBJECTIVE: This study aims at establishing whether predictive factors influencing therapeutic outcomes exist. SETTING: Patients with pancreatic pseudocysts following an episode of acute pancreatitis treated from January 1980 to December 2001 at the Department of General Surgery and Organ Transplantation of the University of Parma, Italy. PATIENTS: Seventy-four patients were studied: 12 had a spontaneous resolution, 37 patients were treated surgically, 15 were treated endoscopically and in 10, percutaneous drainage was used. MAIN OUTCOME MEASURES: Epidemiological, clinical and pathological characteristics of patients with pancreatic pseudocysts were related to morbidity, recurrence rates and hospital stay. RESULTS: At univariate logistic regression, our data reveal a significant increase in morbidity related to age (P=0.013), etiology (alcoholic vs. biliary, P=0.024), Ranson score of previous pancreatitis (P=0.006), nutritional assessment (P=0.001), residual necrosis (P<0.001) and modality of treatment (P=0.009), whereas none of these parameters has been shown to be significantly correlated to recurrence. At multivariate logistic regression, only residual necrosis was significantly related to morbidity. CONCLUSIONS: Some factors, such as epidemiological (age, etiology), clinical (severity of previous pancreatitis, malnourishment), pathological (residual necrosis), and therapeutical factors (emergency/urgency treatment) are predictive of worse outcomes for invasive treatment of pseudocysts. In particular residual necrosis appeared to be the most important factor influencing invasive treatment outcomes, confirming that this pathological aspect deserves particular attention from surgeons. No risk factors predicting pancreatic pseudocyst recurrence emerged.

Acute Disease↗
PubMed2004

Prognostic significance of nm23 gene product expression in patients with colorectal carcinoma treated with radical intent.

Reports of the relationship between the putative metastasis suppressor NM23 and metastasis and/or survival in colorectal cancer patients are conflicting. This study aimed to investigate whether nm23 immunostaining is correlated with established prognostic variables (Dukes' stage, degree of tumour differentiation, T stage and nodal involvement) in colorectal carcinomas for the patients treated with radical intent using Kruskal chi(2) analysis. The rates of survival at five years were estimated with the use of the Kaplan-Meier product-limit method with 95% confidence intervals derived by Greenwood's formula and the curves were compared with the use of the log-rank test. Cox proportional-hazard regression model was used to identify multivariate predictors and the corresponding outcome. The staining was performed on 112 paraffin-embedded surgical specimens collected between 1989-1992 using a monoclonal anti-nm23 antibody. Follow-up of patients was until time of death or for at least 5 years. There was not a significant correlation between tumour staging, degree of tumour differentiation, nodal involvement and nm23 status. Furthermore, there was no significant association with overall 5-year survival, disease recurrence, tumour site, age or sex. Although nm23 may be involved in suppressing tumour metastasis, nm23 immunohistochemistry has no prognostic value in colorectal cancer. For these reasons nm23 does not contribute further to the prognostic information provided by established prognostic variables.

Adenocarcinoma↗
PubMed2004

Spontaneous renal allograft rupture without acute rejection.

Renal allograft rupture (RAR) is a rare but potentially serious complication in the transplanted recipients. The most common cause is acute rejection. We report four cases (0.5%) of RAR occurred in a series of 778 consecutive kidney transplantations due to severe acute tubular necrosis and renal vein thrombosis with no evidence of acute rejection. Transplant nephrectomy was performed in three patients, whereas graft repair was achieved in one patient. These data suggest that RAR may be associated with renal vein thrombosis or severe acute tubular necrosis in absence of acute rejection. Frequently nephrectomy is necessary, but conservative surgical treatment should be attempted to preserve the allograft in selected cases.

Adult↗
PubMed2003

Old and new TNM in carcinoma of the gastric antrum: analysis of our personal experience.

Various tumor node metastasis (TNM) classifications have been proposed for staging of gastric carcinoma, including the fourth edition of the TNM classification and the Japanese Research Society for Gastric Cancer (JRSGC) system. In 1997 the fifth edition of TNM classification introduced the concept of the number of metastatic lymph nodes. We review our experience with staging gastric cancer in light of both the fourth and fifth editions of the TNM classification system. From January 1986 to December 1997, we performed subtotal resection in 193 patients with carcinoma of the gastric antrum. A total of 147 patients presented with criteria from the fifth TNM edition. We compared data from these patients with data from the fourth TNM edition. We analyzed 84 females and 63 males whose average age was 68.9 years. The average number of lymph nodes removed was 16.7. We used the Kaplan-Meier method to analyze survival. In accordance with the fourth TNM edition, we recorded 82 patients who were pN0, 36 who were pN1, and 29 who were pN2; according to the fifth edition, 82 patients were pN0, 33 were pN1, 17 were pN2, and 15 were pN3. Average follow-up was 26.7 months, and average survival was 56.9 months for N0 patients, 38.7 months for N1 patients, and 24.5 months for N2 patients staged according to the fourth edition. According to the fifth edition, survival was 39.3 months for N1 patients, 33.6 months for N2 patients, and 10.3 months for N3 patients. The survival curve was statistically different (P<0.001) between N0 and N1 patients according to the fourth edition; there was no significant difference between N1 and N2 patients. According to the fifth edition, the difference in survival probability was P<0.001 between N0 and N1 patients and N2 and N3 patients. The fifth TNM edition presents a greater ease of stratification in bringing together and mediating diverse cultural experiences between West and East. This staging lays the basis for a more accurate comparison between the groups.

Adenocarcinoma↗
PubMed2003

Hyperparathyroidism associated with thyroid pathology.

BACKGROUND: The pathological association between thyroid and parathyroid gland disease is here discussed. The multiphase analyzer has revealed a new type of subclinical primary hyperparathyroidism (HPP) and the role of surgery in these cases is not clear. METHODS: This is a prospective study of all cases of thyroid disease in association with parathyroid disease treated surgically in our Institute from July 1999 to June 2001. RESULTS: Of the 221 thyroidectomies carried out, 29 patients had an elevated preoperative serum level of parathyroid hormone (PTH). An ultrasonography examination was performed on all patients and a preoperative scanning with 99Tc-MIBI on 11 of 29 patients. We examined intraoperatively 19 cases of HPP (14 parathyroid adenoma, 5 hyperplasia). In 10 cases we observed a normal size of the parathyroid gland and we did not perform a parathyroidectomy. CONCLUSIONS: All patients with elevated serum parathyroid hormone and serum calcium levels before thyroidectomy should be considered candidates also for surgery to the parathyroid glands. The pathological association between thyroid and parathyroid gland diseases is not rare. We must conduct an accurate neck exploration in all these cases.

Adult↗
PubMed2003

Solitary facial metastasis of an ileal carcinoid.

We report an unusual case of solitary facial metastasis as first clinical manifestation of an ileal carcinoid. Only one similar case has been reported in the literature. The patient, a 79 years old man, was referred for the excision of a right facial subcutaneous nodule. Pathology showed a soft tissue metastasis of mid-gut carcinoid. After a complete radiological investigation, a small carcinoid of the terminal ileum was found and the patient underwent a right emicolectomy. Pathology confirmed a typical EC cells carcinoid identical to that of the facial tumor. At 2 years of follow-up no clinical or radiological signs of others metastases were found.

Aged↗