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Distal migration of a partially covered duodenal stent requiring emergency surgical extraction
Luca Giovanni Campana,Rebecca Fish,Owen Thomas Dickinson,Mairéad Geraldine McNamara,Sarah Theresa O’Dwyer,Hans-Ulrich Laasch 소화기인터벤션의학회 2022 Gastrointestinal Intervention Vol.11 No.2
Duodenal stenting is an established alternative for the palliation of malignant gastric outlet obstruction (MGOO). Despite being relatively rare, stent migration remains an issue of concern. We present a case of duodenal stent displacement in a 71-year-old female with biliary and duodenal strictures secondary to pancreatic cancer. She presented with acute abdominal pain 10 days following the insertion of a 24-mm partially covered double-layer knitted device, which migrated to the ileocaecal junction. Since the priority was to minimise hospitalisation, we performed a laparotomy with extraction through an enterotomy combined with gastrojejunostomy to bypass the duodenum. The patient resumed oral intake on postoperative day 9 and tolerated a semi-solid diet for 3 months, until death. Despite continuous advances in enteral stent design, patient surveillance remains paramount. This report illustrates the complex decision-making around MGOO, addresses the management of stent migration, and highlights the role of surgery in simultaneously treating stent complications and palliating duodenal obstruction.
Distal migration of a partially covered duodenal stent requiring emergency surgical extraction
Luca Giovanni Campana,Rebecca Fish,Owen Thomas Dickinson,Mairéad Geraldine McNamara,Sarah Theresa O’Dwyer,Hans-Ulrich Laasch 소화기인터벤션의학회 2022 International journal of gastrointestinal interven Vol.11 No.2
Duodenal stenting is an established alternative for the palliation of malignant gastric outlet obstruction (MGOO). Despite being relatively rare, stent migration remains an issue of concern. We present a case of duodenal stent displacement in a 71-year-old female with biliary and duodenal strictures secondary to pancreatic cancer. She presented with acute abdominal pain 10 days following the insertion of a 24-mm partially covered double-layer knitted device, which migrated to the ileocaecal junction. Since the priority was to minimise hospitalisation, we performed a laparotomy with extraction through an enterotomy combined with gastrojejunostomy to bypass the duodenum. The patient resumed oral intake on postoperative day 9 and tolerated a semi-solid diet for 3 months, until death. Despite continuous advances in enteral stent design, patient surveillance remains paramount. This report illustrates the complex decision-making around MGOO, addresses the management of stent migration, and highlights the role of surgery in simultaneously treating stent complications and palliating duodenal obstruction.
Luca Ambrosio,Gianluca Vadalà,Javad Tavakoli,Laura Scaramuzzo,Giovanni Barbanti Brodano,Stephen J. Lewis,So Kato,Samuel K. Cho,S. Tim Yoon,김호중,Matthew F. Gary,Vincenzo Denaro 대한척추신경외과학회 2024 Neurospine Vol.21 No.1
Objective: To evaluate the global practice pattern of wound dressing use after lumbar fusion for degenerative conditions. Methods: A survey issued by AO Spine Knowledge Forums Deformity and Degenerative was sent out to AO Spine members. The type of postoperative dressing employed, timing of initial dressing removal, and type of subsequent dressing applied were investigated. Differences in the type of surgery and regional distribution of surgeons’ preferences were analyzed. Results: Right following surgery, 60.6% utilized a dry dressing, 23.2% a plastic occlusive dressing, 5.7% glue, 6% a combination of glue and polyester mesh, 2.6% a wound vacuum, and 1.2% other dressings. The initial dressing was removed on postoperative day 1 (11.6%), 2 (39.2%), 3 (20.3%), 4 (1.7%), 5 (4.3%), 6 (0.4%), 7 or later (12.5%), or depending on drain removal (9.9%). Following initial dressing removal, 75.9% applied a dry dressing, 17.7% a plastic occlusive dressing, and 1.3% glue, while 12.1% used no dressing. The use of no additional coverage after initial dressing removal was significantly associated with a later dressing change (p < 0.001). Significant differences emerged after comparing dressing management among different AO Spine regions (p < 0.001). Conclusion: Most spine surgeons utilized a dry or plastic occlusive dressing initially applied after surgery. The first dressing was more frequently changed during the first 3 postoperative days and replaced with the same type of dressing. While dressing policies tended not to vary according to the type of surgery, regional differences suggest that actual practice may be based on personal experience rather than available evidence.
Monitoring the activities of Italian colposcopy clinics before and during the COVID-19 pandemic
Giovanni Delli Carpini,Paolo Giorgi Rossi,Luca Giannella,Jacopo Di Giuseppe,Nicolò Clemente,Francesco Sopracordevole,Maggiorino Barbero,Giorgio Bogani,Rosa De Vincenzo,Massimo Origoni,Francesco Cantat 대한부인종양학회 2023 Journal of Gynecologic Oncology Vol.34 No.1
Objective: To evaluate the impact of healthcare reorganization during the severe acute respiratory syndrome coronavirus 2 pandemic on Italian colposcopy clinic activities, focusing on cervical excision procedures, follow-ups for conservative management of low-grade lesions, and follow-ups post cervical excision. Methods: Retrospective study conducted in 14 Italian colposcopy clinics. The number and clinical characteristics of cervical excisions, follow-ups for conservative management of low-grade lesions, and follow-ups after cervical excision were compared between the period March 1, 2019 to February 29, 2020 (pre-pandemic) and March 1, 2020 to February 28, 2021 (pandemic) with a Poisson regression analysis. Results: In the pandemic period, the number of cervical excisions was reduced by 8.8% (95% confidence interval [CI]=−15.6% to −2%; p=0.011). Excisions were less frequently performed in the operating room (−35.1%; 95% CI=−47.6% to −22.6%; p<0.001), the number of patients from spontaneous screening was reduced by −14.0% (95% CI=−23.4% to −4.6%; p=0.003), and the CO2-laser technique was used less frequently (−30%; 95% CI=−45.1% to −15.0%; p<0.001). As compared to the pre-pandemic period, the number of follow-ups for conservative management of low-grade lesions was reduced by −26.7% (95% CI=−39.0% to −14.4%; p<0.001), and the follow-up appointments after cervical excision were reduced by −51.0% (95% CI=−58.1% to −43.9%; p<0.001). Conclusion: The most significant impact of the healthcare reorganization during the coronavirus disease 2019 pandemic was on follow-ups after cervical excision. The resumption of disrupted activities should follow a risk-based prioritization, starting from women in follow-up after cervical excision. It is advisable that the trend of performing cervical excision as an outpatient procedure is maintained in the post-pandemic period.
Acellular Dermal Matrices and Paraffinoma: A Modern Tool for a Nearly Obsolete Disease
Luca Grassetti,Matteo Torresetti,Alessandro Scalise,Davide Lazzeri,Giovanni Di Benedetto 대한성형외과학회 2017 Archives of Plastic Surgery Vol.44 No.3
Paraffinoma is a destructive complication of paraffin oil injection, usually associated with massive tissue destruction, thus requiring radical surgery and subsequent complex reconstruction. Although breast and penile paraffinomas have been widely described and their management is quite standardized, paraffinomas of the knee are still rare and only few case reports or small case series are available in the current literature. We describe the case of a 77-year-old man with a large paraffinoma of the right knee that occurred after self-injection of paraffin oil, 58 years before. He underwent wide surgical resection of the soft tissues overlying the knee and subsequent two-stage reconstruction by using acellular dermal matrix and, after 20 days, split-thickness skin grafts. Follow-up after 16 months showed no signs of skin ulcerations or inflammation, with an overall improvement in function. Even though conventional flap reconstructions may be still useful, the authors believe that acellular dermal matrices represent a safe, reliable, and less invasive alternative for challenging soft tissue reconstructions even in elderly patients with multiple medical problems.
Protective Effects of Probiotic Lactobacillus rhamnosus IMC501 in Mice Treated with PhIP
( Luca Dominici ),( Milena Villarini ),( Francesca Trotta ),( Ermanno Federici ),( Giovanni Cenci ),( Massimo Moretti ) 한국미생물 · 생명공학회 2014 Journal of microbiology and biotechnology Vol.24 No.3
The aim of the present study was to investigate the antigenotoxic properties of the probiotic Lactobacillus rhamnosus IMC501; DNA damage was induced by one representative food mutagen, 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP). Mice were treated orally with suspensions of lactobacilli for 10 days before administration of food mutagen. During the treatment, the abundance of lactobacilli in feces, as assessed by qPCR analysis, increased, whereas β-glucuronidase and N-acetyl-β-glucosaminidase activities decreased. The extent of DNA damage was measured in colon and liver cells by comet assay. In colonocytes, diet supplementation with IMC501 resulted in a significant inhibition of DNA damage induced by PhIP. The results obtained in this in vitro study suggest that Lactobacillus rhamnosus IMC501 used as a dietary supplement can provide a useful integration of antimutagen food components of the normal diet, which are generally lower than the protective level.
Luca Urso,Giovanni Christian Rocca,Grazia Maria Conti,Alessandro Colella,Alberto Nieri,Corrado Cittanti,Carmelo Ippolito,Mirco Bartolomei 대한핵의학회 2023 핵의학 분자영상 Vol.57 No.6
Recent studies have outlined the emerging role of 68Ga-PSMA-11 PET/CT in the diagnostic algorithm of clear cell renal cellcarcinoma (ccRCC). We report a unique intra-patient comparison of bilateral primary ccRCC imaged with 68Ga-PSMA-11PET/CT. Although both tumors resulted 68Ga-PSMA-11 avid, we found a remarkable discrepancy in uptake intensity betweenthe high grade and the low grade ccRCC. This case confirms previous evidence reporting that SUVmax on 68Ga-PSMA-11PET/CT could be used to discriminate aggressive high grade from more indolent low grade ccRCC, due to their differentendothelial expression of PSMA.