Globozoospermia: A Case Report and Systematic Review of Literature

Crafa Andrea,Condorelli Rosita Angela,Vignera Sandro La,Calogero Aldo Eugenio,Cannarella Rossella 대한남성과학회 2023 The World Journal of Men's Health Vol.41 No.1

Purpose: Globozoospermia is a genetic syndrome characterized by the presence of round-headed spermatozoa and infertility due to the inability of these spermatozoa to fertilize the oocyte. In this article, we present the clinical case of a young globo-zoospermic patient with a new, not yet described mutation of the DPY19L2 gene. We also performed a systematic review of the literature on gene mutations, the outcome of assisted reproductive techniques, and the risk of transmission of abnormali-ties to the offspring in patients with globozoospermia and made recommendations to offer a more appropriate clinical man-agement of these patients. Materials and Methods: We performed a systematic search in the PubMed, Google Scholar, and Scopus databases from their inception to December 2021. The search strategy included the combination of the following Medical Subjects Headings (MeSH) terms and keywords: “globozoospermia”, “round-headed spermatozoa”, “round head spermatozoa”, “intracytoplas-mic sperm injection”, “ICSI”, “offspring”, “child health”, “assisted reproductive technique outcome”. All the eligible studies were selected following the PECOS (Population, Exposure, Comparison/Comparator, Outcomes, Study design) model. The quality of included studies was assessed by applying the “Cambridge Quality Checklists”. Results: The main genes involved in the pathogenesis of globozoospermia are DPY19L2, SPATA16, PICK1, GGN, SPACA1, ZPBP, CCDC62, and CCNB3 genes. Other genes could also play a role. These include C2CD6, C7orf61, CCIN, DNH17, DNH6, PIWIL4, and CHPT1. Globozoospermic patients should undergo ART to achieve fertility. In particular, intracytoplas-mic sperm injection with assisted oocyte activation or intracytoplasmic morphologically-selected sperm injection appears to be associated with a higher success rate. Patients with globozoospermia should also be evaluated for the high rate of sperm aneuploidy which appears to influence the success rate of ART but does not appear to be associated with an increased risk of transmission of genetic abnormalities to offspring. Conclusions: This systematic review summarizes the evidence on the gene panel to be evaluated, ICSI outcomes, and the health of the offspring in patients with globozoospermia. Evidence-based recommendations on the management of patients with globozoospermia are provided.

How to prevent the postoperative pancreatic fistula with an ethylene vinyl alcohol copolymer (Onyx<SUP>Ⓡ</SUP>)

Francesco Crafa,Francesco Esposito,Adele Noviello,Nicola Moles,Enrico Coppola Bottazzi,Carmelo Lombardi,Antonio Miro,Giulio Lombardi 한국간담췌외과학회 2018 Annals of hepato-biliary-pancreatic surgery Vol.22 No.3

Backgrounds/Aims: Despite the advances in identifying risk factors, improving operative technique, and postoperative patient care, pancreatic leakage after pancreatic resection remains a highly debated topic. The aim of this study is to describe our technique and our initial experience with the intraoperative embolization of the main pancreatic duct with an Ethylene Vinyl Alcohol Copolymer (Onyx<SUP>Ⓡ</SUP>). Methods: Two patients of 63 and 64 years underwent pancreaticoduodenectomy for a cholangiocarcinoma of the extrahepatic bile duct and a pancreatic adenocarcinoma, respectively. At the time of pancreatic parenchyma resection, a Wirsung duct was identified and catheterized. A wirsungography was done and then, embolization with Onyx<SUP>Ⓡ</SUP> was carried out under fluoroscopic control. Results: Neither of the patients developed a postoperative pancreatic fistula. They were discharged to home on the 17<SUP>th</SUP> and 18<SUP>th</SUP> postoperative day, respectively. At the last follow-up, no recurrence was found. The two patients became diabetics; both needed the support of supplementary pancreatic enzymes. Conclusions: To our knowledge, we are the first to describe this technique, which seems safe and reliable. Studies on this subject with more patients are needed to confirm the validity of this procedure.

The “reverse air leak test”: a new technique for the assessment of low colorectal anastomosis

Francesco Crafa,Augusto Striano,Francesco Esposito,Amalia Rosaria Rita Rossetti,Mario Baiamonte,Valeria Gianfreda,Antonio Longo 대한대장항문학회 2022 Annals of Coloproctolgy Vol.38 No.1

Purpose: Anastomotic leakage is a fearsome complication in rectal surgery. Surgeons perform the classic air leak test, although its real effectiveness is still debated. The aim of this study was to describe a personal technique of reverse air leak test in which low colorectal anastomosis was assessed transanally through the intrarectal irrigation of a few mL of saline solution. Methods: From October 2014 to November 2019, 11 patients with low rectal cancer (type 1 in Roullier classification) were included in this study. At the beginning of the procedure, a circular anal dilator was inserted into the anus. A side-to-end colorectal anastomosis was performed. A few mL of saline solution were injected into the rectum and the entire anastomotic line was directly explored. The appearance of bubbles was considered as an anastomotic defect and repaired with an interrupted suture. A fluorescence angiography after intravenous injection of indocyanine green was performed in order to evaluate the perfusion of the anastomosis. Results: The reverse air leak test was positive in 4 cases (36.4%). The defect was repaired and a confirmation test was performed. In all patients, near-infrared evaluation showed no perfusion defect (grade 0) in low colorectal anastomosis. No postoperative fistula was detected in cohort study. A protective stoma was performed in 10 patients. On day 90, there were no complications and stoma closure was performed as planned. Conclusion: The reverse air leak test is a simple, feasible, and effective procedure to identify anastomotic leaks in low colorectal anastomoses.

Partial splenectomy

Francesco Esposito,Adele Noviello,Nicola Moles,Nicola Cantore,Mario Baiamonte,Enrico Coppola Bottazzi,Antonio Miro,Francesco Crafa 한국간담췌외과학회 2018 Annals of hepato-biliary-pancreatic surgery Vol.22 No.2

Backgrounds/Aims: Partial splenectomy (PS) is a surgical option for splenic mass, in order to reduce postoperative complications and preserve the splenic function. Despite this, data in literature is still scarce. The present study aimed to reveal our recent experience and provide a comprehensive overview of the feasibility and complications related to various surgical approaches. Methods: Data of patients who underwent PS, between 2014 and 2017 were retrospectively reviewed. Literature was searched for studies reporting all types of PS in adult or adolescent patients. Results: Five PS were performed in our department: two (40%) by laparoscopy and three (60%) by laparotomy. Two (40%) postoperative complications were detected, and in one of them, total splenectomy (TS) by laparotomy was finally required. There were no deaths or complications at last follow-up. Twenty studies including 213 patients were identified in the literature search. The rate of conversion from laparoscopic to open surgery was 3% (range, 5-50%) and in 3% of cases (range, 7-10%) PS was converted into total TS and the overall morbidity rate was 8% (range, 5-25%). In comparison to laparotomy, the conversion rate of laparoscopic approach to TS was 3.5% (vs. 1.4%) and a morbidity rate of 9.8% (vs. 4.3%). Conclusions: The present review shows that PS is a viable procedure in selected cases. The mini-invasive approach seemed to be feasible despite the presence of higher rate of complications than the open technique. In future, further studies on this topic are needed by involving more patients. Furthermore, it is proposed that the development of robotic surgery could make this approach the new gold-standard technique for spleen-preserving surgery.

Sentinel Lymph Node Analysis in Colorectal Cancer Patients Using One-Step Nucleic Acid Amplification in Combination With Fluorescence and Indocyanine Green

Francesco Esposito,Adele Noviello,Nicola Moles,Enrico Coppola Bottazzi,Mario Baiamonte,Ina Macaione,Umberto Ferbo,Maria Lepore,Antonio Miro,Francesco Crafa 대한대장항문학회 2019 Annals of Coloproctolgy Vol.35 No.4

Purpose: Analysis of the sentinel lymph node (SLN) in colorectal cancer (CRC) patients was proposed for more accurate staging and tailored lymphadenectomy. The aim of this study was to assess the ability to predict lymph node (LN) involvement through analysis of the SLN with a one-step nucleic acid (OSNA) technique in combination with peritumoral injection of indocyanine green (ICG) and near-infrared (NIR) lymphangiography in CRC patients. Methods: A total of 34 patients were enrolled. Overall, 51 LNs were analyzed with OSNA. LNs of 17 patients (50%) were examined simultaneously with hematoxylin and eosin (H&E) and OSNA. Results: SLN analysis of 17 patients examined with H&E and OSNA revealed that OSNA had a higher sensitivity (1 vs. 0.55), higher negative predictive value (1 vs. 0.66) and higher accuracy (100% vs. 76.4%) in predicting LN involvement. Overall, OSNA showed a sensitivity of 0.69, specificity of 1, accuracy of 88.2%, and stage migration of 8.8%. Compared to those who were OSNA (−), OSNA (+) patients had a greater number of LN metastases (4.8 vs. 0.16, P = 0.04), higher G3 rate (44.4% vs. 4%, P = 0.01), more advanced stage of disease (stage III: 77.8% vs. 16%; P = 0.00) and were more rapidly subjected to adjuvant chemotherapy (39.1 days vs. 50.2 days, P = 0.01). Conclusion: SLN analysis with OSNA in combination with ICG-NIR lymphangiography is feasible and can detect LN involvement in CRC patients. Furthermore, it allows for more accurate staging reducing the delay between surgery and adjuvant chemotherapy.