25 results on '"Federici GF"'
Search Results
2. Evaluation of the Relationships Between Computed Tomography Features, Pathological Findings, and Prognostic Risk Assessment in Gastrointestinal Stromal Tumors.
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Iannicelli E, Carbonetti F, Federici GF, Martini I, Caterino S, Pilozzi E, Panzuto F, Briani C, and David V
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- Adult, Aged, Aged, 80 and over, Female, Gastrointestinal Tract diagnostic imaging, Gastrointestinal Tract pathology, Humans, Male, Middle Aged, Prognosis, Retrospective Studies, Risk Assessment, Gastrointestinal Neoplasms diagnostic imaging, Gastrointestinal Neoplasms pathology, Gastrointestinal Stromal Tumors diagnostic imaging, Gastrointestinal Stromal Tumors pathology, Tomography, X-Ray Computed methods
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Objectives: The aim of this study was to correlate computed tomography (CT) findings with pathology in gastrointestinal stromal tumors (GISTs)., Methods: A retrospective evaluation of CT images of 44 patients with GISTs was performed. Computed tomography findings analyzed were location, size, margins, degree and pattern of contrast enhancement, angiogenesis, necrosis, signs of invasion, peritoneal effusion, peritoneal implants, surface ulceration, and calcifications.Associations between CT features and mitotic rate, Miettinen classes of risk, lesions size, and among CT features were investigated. χ Test and Fisher test were performed., Results: Mitotic rate was associated with margins (P = 0.016) and with adjacent organ invasion (P = 0.043). Pattern of contrast enhancement (P = 0.002), angiogenesis (P = 0.006), necrosis (P = 0.006), invasion of adjacent organs (P = 0.011), and margins (P = 0.006) were associated with classes of risk. Several associations (P < 0.05) between lesion size and CT features and among all the investigated CT features were found., Conclusions: Computed tomography features could reflect GIST biology being associated with the mitotic rate and with classes of risk.
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- 2017
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3. Comparison of diffusion-weighted imaging and gadoxetic acid-enhanced MR images in the evaluation of hepatocellular carcinoma and hypovascular hepatocellular nodules.
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Di Pietropaolo M, Briani C, Federici GF, Marignani M, Begini P, Delle Fave G, and Iannicelli E
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- Aged, Aged, 80 and over, Disease Progression, Female, Humans, Image Enhancement, Male, Middle Aged, Retrospective Studies, Carcinoma, Hepatocellular diagnosis, Contrast Media, Diffusion Magnetic Resonance Imaging, Gadolinium DTPA, Liver pathology, Liver Neoplasms diagnosis, Magnetic Resonance Imaging methods
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Purpose: To compare diffusion-weighted imaging (DWI) and gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA) magnetic resonance imaging (MRI) in the evaluation of hepatocellular carcinoma (HCC) and nodules at high risk of HCC transformation., Materials and Methods: We evaluated nodules' size, vascular pattern, and signal intensity on hepatobiliary phase images and on DWI of 105 nodules (41 cirrhotic patients)., Results: A total of 35/66 HCCs identified on Gd-EOB-DTPA MRI showed hyperintensity on DWI. A total of 25/39 nodules (hypovascular and hypointense nodule on hepatobiliary phase images) progressed to HCC (higher risk for nodules ≥10mm in size and hyperintense on DWI, P<.05)., Conclusion: Gd-EOB-DTPA MRI demonstrated a significant role in the identification of nodule at higher risk of HCC transformation, and hyperintensity on DWI was associated with progression to HCC., (Copyright © 2015 Elsevier Inc. All rights reserved.)
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- 2015
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4. Gadoxetic acid-enhanced MRI for hepatocellular carcinoma and hypointense nodule observed in the hepatobiliary phase.
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Iannicelli E, Di Pietropaolo M, Marignani M, Briani C, Federici GF, Delle Fave G, and David V
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- Aged, Aged, 80 and over, Carcinoma, Hepatocellular pathology, Diagnosis, Differential, Female, Humans, Image Interpretation, Computer-Assisted, Liver Neoplasms pathology, Male, Middle Aged, Precancerous Conditions pathology, Retrospective Studies, Carcinoma, Hepatocellular diagnosis, Contrast Media, Gadolinium DTPA, Liver Neoplasms diagnosis, Magnetic Resonance Imaging methods, Precancerous Conditions diagnosis
- Abstract
Purpose: The aim of our study was to evaluate the diagnostic accuracy of gadoxetic acid-enhanced magnetic resonance (MR) imaging both in the detection of hepatocellular carcinoma (HCC) and precancerous lesions and in the assessment of their evolution., Materials and Methods: A retrospective study was undertaken on 56 patients with chronic liver disease and suspected liver lesions. We evaluated the number, size and signal intensity of the nodules on dynamic and hepatobiliary MR images. Follow-up studies were carried out every 3 months. Statistical analysis was performed using the Fisher's exact test., Results: A total of 120 nodules were identified in 41 patients. Of these, 92/120 nodules (76.6%; mean diameter 18.4 mm) showed the typical HCC vascular pattern: 90/92 nodules appeared hypointense and 2/92 were hyperintense on hepatobiliary phase images. An additional 28/120 hypointense, nonhypervascular nodules (23.3%; mean diameter 11 mm) were detected on hepatobiliary phase images, 15 of which showed hypointensity also on the equilibrium phase images. During the 3- to 12-month follow-up, 14/28 nodules (mean diameter 13.3 mm) developed the typical vascular pattern of HCC., Conclusions: Gadoxetic acid-enhanced MR imaging is useful for detecting HCC as well as hypovascular nodules with potential progression to HCC. Lesions measuring more than 10 mm in diameter are at higher risk of developing into HCC (p = 0.0128).
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- 2014
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5. Magnetic resonance cholangiopancreatography with secretin stimulation in the diagnosis of intraductal papillary mucinous neoplasm: a paradigmatic case report.
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Iannicelli E, Carbonetti F, Di Pietropaolo M, Federici GF, Capurso G, and David V
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Context. One of the characteristic findings of intraductal papillary mucinous neoplasms (IPMN) is the presence of a direct communication between the lesion and the ductal pancreatic system and when magnetic resonance cholangiopancreatography (MRCP) shows uncertain findings, it is useful to perform a MRCP after secretin stimulation (MRCP-S) which provides a better visualization of the ductal system. Case Report. We present a case of 51-year-old man in whom, during a CT follow-up for a renal tumour, was found a cystic lesion of the pancreas. To better evaluate the lesion and its suspected communication with the pancreatic system, MR with gadolinium and MRCP and MRCP-S were performed. With the MRCP and MRI it was not possible to identify a clear communication between the cystic lesion and the ductal system. MRCP-S showed an increase in signal intensity of the lesion and its communication with the ductal system, allowing us to classify the cystic lesion as a main duct in intraductal papillary mucinous neoplasm. The patient underwent a surgical duodenal pancreatectomy. The histological result of the specimen confirmed the diagnosis of adenocarcinoma IPMN. Conclusion. In this case MRCP-S has allowed a clearer identification of the cystic lesion allowing a correct diagnosis and treatment.
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- 2014
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6. Does an isolated benign choledochal stricture hide a PSC?
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De Angelis P, Tambucci R, Romeo E, Rea F, Caloisi C, Caldaro T, di Abriola GF, Foschia F, Torroni F, Monti L, and Dall'Oglio L
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- Adolescent, Child, Cholangiopancreatography, Endoscopic Retrograde, Cholangitis, Sclerosing diagnostic imaging, Choledochal Cyst complications, Choledochal Cyst diagnostic imaging, Cholestasis, Extrahepatic complications, Colitis, Ulcerative complications, Colonoscopy, Common Bile Duct diagnostic imaging, Constriction, Pathologic diagnosis, Constriction, Pathologic diagnostic imaging, Constriction, Pathologic etiology, Constriction, Pathologic pathology, Dilatation, Endosonography, Female, Follow-Up Studies, Humans, Jaundice, Obstructive etiology, Male, Pancreatitis complications, Sphincterotomy, Endoscopic, Stents, Cholangitis, Sclerosing diagnosis, Common Bile Duct pathology, Magnetic Resonance Imaging
- Abstract
Background: Strictures of the extra-hepatic biliary tree are rare in children and have a benign non-traumatic inflammatory origin or are related to idiopathic fibrosing pancreatitis. Primary sclerosing cholangitis (PSC) can manifest as multiple biliary strictures or as a single dominant stricture. We describe the presentation, treatment, and outcome of six cases of isolated benign choledochal stricture (IBCS)., Methods: All patients underwent magnetic resonance cholangiography (MRC). Five patients underwent diagnostic and therapeutic ERCP, and 4 patients underwent intra-choledochal mini-probe EUS and biopsy. Colonoscopy was performed in suspected ulcerative colitis (UC)., Results: We report 6 patients (mean age at diagnosis: four males, 12.1 years; two females, 14.2 years) with IBCS. Clinical onset included 3 cases of acute biliary pancreatitis and obstructive jaundice, one obstructive jaundice, one cholestasis, and one pancreatitis. At diagnosis, MRC confirmed IBCS in all patients. Biliary sphincterotomy, stricture dilation, and stenting were performed in 4 patients. One child underwent hepaticojejunostomy for a type I choledocal cyst. During follow-up (mean: 21 months; range: 1-3 years), all patients were asymptomatic. Four patients developed UC (three pancolitis, one descending colitis). One child developed PSC., Conclusion: IBCS can be successfully treated by therapeutic ERCP. The occurrence of UC could suggest that IBCS is a form of PSC., (Copyright © 2013 Elsevier Inc. All rights reserved.)
- Published
- 2013
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7. Arterioesophageal fistula after stenting for esophageal atresia.
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Lo A, Baird R, De Angelis P, Lévesque D, Morinville V, di Abriola GF, Caldero T, Laberge JM, and Dall'Oglio L
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- Esophageal Atresia surgery, Esophagus pathology, Humans, Infant, Newborn, Postoperative Complications, Esophageal Atresia therapy, Esophageal Fistula etiology, Stents adverse effects, Subclavian Artery pathology, Vascular Fistula etiology
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- 2013
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8. Celiac disease and CFTR mutations in patients with chronic asymptomatic pancreatic hyperenzymemia.
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Valente R, Antonelli M, Piciucchi M, Federici GF, Signoretti M, Iannicelli E, Capurso G, and Delle Fave G
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- Female, Humans, Male, Cholangiopancreatography, Magnetic Resonance, Pancreatic Diseases enzymology
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- 2013
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9. Eosinophilic esophagitis: is it also a surgical disease?
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Rea F, Caldaro T, Tambucci R, Romeo EF, Caloisi C, Torroni F, di Abriola GF, Foschia F, Francalanci P, Dall'Oglio L, and De Angelis P
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- Adolescent, Child, Child, Preschool, Esophageal pH Monitoring, Female, Gastroesophageal Reflux diagnosis, Humans, Infant, Male, Eosinophilic Esophagitis complications, Eosinophilic Esophagitis drug therapy, Gastroesophageal Reflux complications, Gastroesophageal Reflux surgery, Proton Pump Inhibitors therapeutic use
- Abstract
Background: Eosinophilic esophagitis (EoE) is a chronic immune/antigen-mediated disease with esophageal dysfunction and eosinophil-predominant inflammation. An association between EoE and gastro-esophageal reflux disease (GERD) has not been well established., Aims: The aim was to evaluate patients with EoE who underwent pH-Multichannel Intraluminal Impedance (pH-MII), investigating proton-pump-inhibitors (PPI) therapy/anti-reflux surgery requirement., Methods: Twenty-five patients [mean age 7.6 (range 1-17 years)] with EoE underwent pH-MII. The children were then divided into Group 1 (pathological pH-MII) and Group 2 (normal pH-MII). PPI was administered for two months in Group 1 and in those children in Group 2 unresponsive to standard EoE therapy (diet and corticosteroids). All patients underwent endoscopy and clinical follow-up. Data are described as mean (range)., Results: Group 1 (n=16, M:F=14:2) had mean reflux index (RI) 13.9% (0.8%-53.4%) with a mean number of total reflux episodes (RE) of 65.8 (14-341). Group 2 (n=9, M:F=6:3) had a mean RI 1.2% (0.2%-2.7%) with a mean number of total RE of 27.4 (14-39). There was a histological response to repeated cycles of PPI in 11/16 (69%) children in Group 1 and 4/9 (44%) children in Group 2. Fundoplication, because of dependence on PPI, was required in 4/11 PPI-responders in Group 1, allowing discontinuation without relapse of EoE., Conclusions: The use of PPI is suggested in EoE at time of diagnosis in addition to standard treatment and may even have benefit in children who do not appear to have significant GERD but are unresponsive to standard therapy., (Copyright © 2013 Elsevier Inc. All rights reserved.)
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- 2013
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10. [Scrotal ultrasound: anatomy and pathological findings].
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Iannicelli E, Sessa B, Sapori A, Cappucci M, Briani C, Federici GF, Di Pietropaolo M, and Merola S
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- Humans, Male, Predictive Value of Tests, Scrotum pathology, Sensitivity and Specificity, Testicular Diseases pathology, Testicular Hydrocele pathology, Testicular Neoplasms diagnostic imaging, Varicocele pathology, Scrotum diagnostic imaging, Testicular Diseases diagnostic imaging, Testicular Hydrocele diagnostic imaging, Ultrasonography, Doppler, Color methods, Varicocele diagnostic imaging
- Abstract
Ultrasonography (US) is the imaging modality of choice for the evaluation of scrotal disease. It provides high anatomical detail and in most cases, it is essential to enable a correct diagnosis and to obtain the right management of the patient. Color Doppler ultrasonography is a non invasive technique that aids important information about testicular perfusion, necessary in reaching a specific diagnosis in many pathologic conditions; moreover contrast-enhanced ultrasonography (CEUS), recently introduced in the clinical practice, may be considered an additional tool in the classification and differentiation of testicular pathology. The purpose of this review, is to provide the state of the art on the role of ultrasonography in the evaluation of different scrotal pathologies including vaginal process' disorders, acute scrotum, varicocele, hydrocele, chronic inflammatory diseases and testicular tumours.
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- 2013
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11. Three-dimensional endoanal ultrasound and anorectal manometry in children with anorectal malformations: new discoveries.
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Caldaro T, Romeo E, De Angelis P, Gambitta RA, Rea F, Torroni F, Foschia F, di Abriola GF, and Dall'Oglio L
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- Adolescent, Anorectal Malformations, Anus, Imperforate physiopathology, Biofeedback, Psychology, Child, Child, Preschool, Constipation diagnostic imaging, Constipation physiopathology, Constipation therapy, Enema, Fecal Incontinence diagnostic imaging, Fecal Incontinence physiopathology, Fecal Incontinence therapy, Female, Follow-Up Studies, Humans, Male, Prospective Studies, Rectum surgery, Severity of Illness Index, Treatment Outcome, Anal Canal diagnostic imaging, Anal Canal physiopathology, Anal Canal surgery, Anus, Imperforate surgery, Constipation etiology, Endosonography, Fecal Incontinence etiology, Manometry, Postoperative Complications diagnostic imaging, Postoperative Complications physiopathology
- Abstract
Background/purpose: Fecal incontinence and constipation are common problems in follow-up of anorectal malformations (ARMs). We evaluated the anal sphincters using the 3-dimensional endoanal ultrasonography (3D-EAUS) and the anorectal manometry after ARMs repair., Methods: Seventeen patients, divided into 3 groups according to Wingspread classification, underwent anorectal manometry and 3D-EAUS. Clinical, manometric, and endosonographic scoring systems were used., Results: The average anal resting pressure (aARP) was significantly higher in low ARMs than in intermediate and high ARMs. The anal squeeze pressure was not statistically different between the 3 groups. Three-dimensional EAUS visualized internal anal sphincter (IAS) disruptions in 7 of 17 patients and absence of IAS in 6 of 17 children with high ARMs. Scars of the external anal sphincter were localized in low ARMs and generalized in the other groups. In the case of IAS disruption with aARP greater than 20 mm Hg, fecal incontinence and constipation improved with biofeedback and/or laxatives, whereas daily enemas were necessary in absence of IAS with aARP less than 20 mm Hg. Statistical correlation was observed between endosonographic and manometric findings and clinical outcomes., Conclusions: Lesions of the anal sphincter are common in ARMs. Three-dimensional EAUS and anorectal manometry ensure a complete assessment of the anal sphincter and could provide useful information to define the most appropriate treatments to improve the quality of life., (Copyright © 2012 Elsevier Inc. All rights reserved.)
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- 2012
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12. Strictureplasty and intestinal resection: different options in complicated pediatric-onset Crohn disease.
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Romeo E, Jasonni V, Caldaro T, Barabino A, Mattioli G, Vignola S, di Abriola GF, De Angelis P, Pane A, Torroni F, Rea F, and Dall'Oglio L
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- Adolescent, Anastomosis, Surgical, Child, Child, Preschool, Colonic Diseases etiology, Constriction, Pathologic etiology, Constriction, Pathologic surgery, Crohn Disease complications, Female, Follow-Up Studies, Humans, Ileal Diseases etiology, Intestinal Obstruction etiology, Male, Postoperative Complications, Recurrence, Treatment Outcome, Young Adult, Colon surgery, Colonic Diseases surgery, Crohn Disease surgery, Ileal Diseases surgery, Ileum surgery, Intestinal Obstruction surgery, Jejunum surgery
- Abstract
Background/purpose: Surgical resection or strictureplasty (SP) are different options for intestinal Crohn disease (CD) strictures. The aim of this article is evaluation of long-term outcome of SP and resection., Methods: From 1996 to 2011, 39 patients (23 male, 16 female) with symptomatic ileal and ileocolonic CD strictures resistant to medical/nutritional therapy and treated with surgery in 2 different surgical units were reviewed. The mean age at diagnosis was 11.82 years (range, 4-17 years). Mean age at surgery was 15.94 years (range, 4-24 years). Mean follow-up was 6.88 years (range, 0.5-15 years). Patients underwent resection (group A) or different SP techniques (group B)., Results: Twenty patients underwent intestinal resection (ileal or ileocolonic resection), and 19 patients underwent SP (jejunal, ileal, or ileocolic). Early postsurgical complications were observed in 2 patients of group A. Follow-up of group A patients revealed that 1 patient needed emergency treatment after 8 months surgery because of adhesions and 1 patient developed recurrence treated with medical therapy. In the follow-up group B, 3 patients experienced disease recurrence, 2 of them at the site of previous surgery., Conclusions: At long-term follow-up, no significant difference in relapsing rate was observed between the 2 groups. Strictureplasty and resection represent an effective treatment of pediatric CD strictures. Strictureplasty could represent the first option for intestinal preservation., (Copyright © 2012 Elsevier Inc. All rights reserved.)
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- 2012
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13. Role of endoscopic retrograde cholangiopancreatography in diagnosis and management of congenital choledochal cysts: 28 pediatric cases.
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De Angelis P, Foschia F, Romeo E, Caldaro T, Rea F, di Abriola GF, Caccamo R, Santi MR, Torroni F, Monti L, and Dall'Oglio L
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- Adolescent, Anastomosis, Surgical, Bile Ducts, Extrahepatic surgery, Child, Child, Preschool, Cholangiopancreatography, Magnetic Resonance, Choledochal Cyst diagnosis, Choledochal Cyst surgery, Female, Follow-Up Studies, Humans, Jejunum surgery, Length of Stay statistics & numerical data, Liver surgery, Male, Postoperative Complications, Treatment Outcome, Cholangiopancreatography, Endoscopic Retrograde, Choledochal Cyst diagnostic imaging
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Background/purpose: Management of choledochal cysts consists of surgical excision and hepaticojejunal anastomosis. Endoscopic retrograde cholangiopancreatography (ERCP) can be used to resolve complications and to evaluate the biliary tract and pancreatobiliary duct junction. Our aim was to underline the importance of ERCP for optimal management., Methods: From 2005 to 2011, 28 patients were reviewed (21 female, 7 male; mean age, 5.71 years; range, 2-16 years). After imaging, all patients underwent elective ERCP and were referred for surgery., Results: Choledochal cyst was diagnosed at ultrasound and magnetic resonance cholangiopancreatography in all examined patients; common biliopancreatic duct was diagnosed in 3 (20%) of 15 patients at magnetic resonance cholangiopancreatography and in none at ultrasound. Endoscopic retrograde cholangiopancreatography showed choledochal cyst in all patients and common biliopancreatic duct in 19 (68%) of 28 patients. Twelve patients underwent sphincterotomy. All patients underwent surgical extrahepatic biliary tree resection and hepaticojejunal anastomosis. Mean period of hospitalization was 9.5 days (range, 6-13 days). No major complications related to ERCP were observed. Two patients needed postoperative ERCP for complications (pancreatitis during follow-up)., Conclusions: In our pediatric experience, ERCP is feasible and safe. It can rule out other possible biliary tract anomalies and help plan the timing and choice of the appropriate surgical procedure., (Copyright © 2012 Elsevier Inc. All rights reserved.)
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- 2012
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14. Simultaneous intraductal papillary neoplasms of the bile duct and pancreas treated with chemoradiotherapy.
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Valente R, Capurso G, Pierantognetti P, Iannicelli E, Piciucchi M, Romiti A, Mercantini P, Larghi A, Federici GF, Barucca V, Osti MF, Di Giulio E, Ziparo V, and Delle Fave G
- Abstract
Some authors have suggested that intraductal papillary mucinous neoplasms of the bile duct (IPMN-B) could be the the biliary counterpart of IPMN of the pancreas (IPMN-P) since they share several clinical-pathological features. These include prominent intraductal papillary proliferation pattern, a gastrointestinal phenotype, frequent mucin hyper-secretion and progression to mucinous carcinoma. To date there are just four reported cases of patients with synchronous IPMN-B and IPMN-P all of which were treated surgically. We hereby report the case of a 76-year-old woman who was incidentally diagnosed with both an asymptomatic 3 cm bulky fluid lesion obstructing the bile duct lumen, diagnosed as a malignant IPMN-B, and synchronous multiple pancreatic cystic lesions (10-13 mm) communicating with an irregular Wirsung, diagnosed as branch duct IPMN-P. Since surgery was ruled-out because of the patient's age and preferences, she underwent a conservative management regimen comprising both chemotherapy and radiotherapy. This was effective in decreasing the mass size and in resolving subsequent jaundice. This is also the first reported case of IPMN-B successfully treated with chemoradiotherapy. Clinicians should consider medical treatment as an option in this clinical scenario, in patients who may be unfit for surgery.
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- 2012
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15. Delayed gastric emptying and typical scintigraphic gastric curves in children with gastroesophageal reflux disease: could pyloromyotomy improve this condition?
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Caldaro T, Garganese MC, Torroni F, Ciofetta G, De Angelis P, di Abriola GF, Foschia F, Rea F, Romeo E, and Dall'Oglio L
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- Adolescent, Child, Child, Preschool, Esophageal Atresia diagnostic imaging, Esophageal Atresia surgery, Female, Follow-Up Studies, Fundoplication, Gastroesophageal Reflux diagnostic imaging, Gastroesophageal Reflux etiology, Gastroesophageal Reflux surgery, Gastroparesis complications, Gastroparesis diagnostic imaging, Humans, Infant, Male, Radionuclide Imaging, Treatment Outcome, Young Adult, Gastric Emptying, Gastroesophageal Reflux physiopathology, Gastroparesis surgery, Pylorus surgery, Stomach diagnostic imaging
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Background/purposes: Delayed gastric emptying (DGE) is a cofactor in the etiopathogenesis of gastroesophageal reflux disease (GERD). Scintigraphy is the criterion standard to evaluate gastric emptying (GE). This study aims to define typical scintigraphic activity-time curves (ATCs) related to DGE and esophageal atresia (EA) and to demonstrate the effectiveness of pyloromyotomy (P) in improving GE., Methods: Since 2002, 83 children underwent Nissen fundoplication. Patients were divided into 2 groups: group I, GERD-only patients; group II, patients with GERD owing to EA. Depending on preoperative scintigraphy, each group was subdivided into 2 subgroups. Before surgery and 1 year after, endoscopy and scintigraphy were performed. In the presence of DGE, P was associated with Nissen fundoplication. Gastric emptying differences at baseline and at follow-up were estimated by the Student t test. Pre- and post-ATCs were evaluated by the χ(2) test., Results: During follow-up, GE completely normalized in subgroups with DGE. Scintigraphic ATC analysis documented an association between DGE and a typical rectilinear fitting, with a higher rate in EA patients. After P, the scintigraphic pattern changed in an exponential manner related to a faster GE., Conclusions: Delayed gastric emptying is frequent in EA, and the scintigraphic ATCs are typical. Pyloromyotomy is a safe and effective technique to fully normalize GE., (Copyright © 2011 Elsevier Inc. All rights reserved.)
- Published
- 2011
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16. Surgery or endoscopy to treat duodenal duplications in children.
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Romeo E, Torroni F, Foschia F, De Angelis P, Caldaro T, Santi MR, di Abriola GF, Caccamo R, Monti L, and Dall'Oglio L
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- Acute Disease, Adolescent, Ampulla of Vater abnormalities, Ampulla of Vater surgery, Child, Child, Preschool, Duodenum diagnostic imaging, Duodenum surgery, Female, Follow-Up Studies, Gastrointestinal Hemorrhage etiology, Humans, Male, Pancreatitis etiology, Postoperative Hemorrhage etiology, Recurrence, Retrospective Studies, Treatment Outcome, Duodenoscopy statistics & numerical data, Duodenum abnormalities, Endosonography, Laparotomy statistics & numerical data, Ultrasonography, Interventional
- Abstract
Background/purpose: Gastrointestinal duplications (duodenal duplications [DDs]) are a rare congenital malformation generally located in or adjacent to the medial border of the duodenal wall. The goal of therapy is surgical excision. Conservative endoscopic management represents an alternative option., Aim: The aim of the study was to highlight the role of endoscopic ultrasound (EUS) in guiding the endoscopic or surgical treatment of DD., Methods: Between 2002 and 2010, 6 patients (2 male; mean age, 7.83 years; range, 2-18 years), all with recurrent acute pancreatitis, were diagnosed with DD by ultrasound and magnetic resonance imaging. Endoscopy was always performed together with EUS (Olympus UM-3R 20-MHz radial miniprobe, Tokyo, Japan). An endoscopic section of the common duodenal-DD wall, using a precut needle or sphincterotome, was chosen by EUS when the biliary tree was not involved in the DD. Otherwise, surgery with duodenotomy and complete opening of the common wall was used., Results: After EUS evaluation, endoscopic treatment was successfully performed in 4 patients, 2 of whom required surgical treatment. Bleeding occurred in 1 patient after endoscopic resection and in 1 patient after surgery. The mean follow-up time without pathologic signs was 3.3 years (range, 0.25-8)., Conclusions: Endoscopic ultrasound can effectively guide surgical or endoscopic therapies. Bleeding is a possible complication., (Copyright © 2011 Elsevier Inc. All rights reserved.)
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- 2011
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17. Custom dynamic stent for esophageal strictures in children.
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Foschia F, De Angelis P, Torroni F, Romeo E, Caldaro T, di Abriola GF, Pane A, Fiorenza MS, De Peppo F, and Dall'Oglio L
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- Antibiotic Prophylaxis, Burns, Chemical therapy, Caustics adverse effects, Child, Child, Preschool, Dexamethasone administration & dosage, Dexamethasone therapeutic use, Equipment Design, Esophageal Motility Disorders prevention & control, Esophageal Perforation etiology, Esophageal Stenosis chemically induced, Esophageal Stenosis etiology, Female, Humans, Infant, Intubation, Gastrointestinal, Male, Postoperative Complications therapy, Proton Pump Inhibitors administration & dosage, Proton Pump Inhibitors therapeutic use, Radiation Injuries therapy, Dilatation instrumentation, Esophageal Stenosis therapy, Stents adverse effects
- Abstract
Background: Esophageal stenting represents a new strategy to avoid multiple dilations owing to stenosis relapse. Our custom stent improves esophageal motility unlike the widespread self-expandable plastic esophageal stents. The aim of the study was to confirm the efficacy of treatment with silicone custom stents in esophageal stenosis (ES) in pediatric patients., Methods: A silicone stent of 7-, 9-, or 12.7-mm external diameter is built coaxially on a nasogastric tube that guarantees the correct position. The 2 ends are tailored to allow food passage between stent and esophageal wall. All patients received dexamethasone (2 mg/kg per day) for 3 days and ranitidine/proton-pump inhibitors. Study approval was obtained from our ethical board., Results: From 1988 to 2010, 79 patients with ES, mean age 35.4 months (3-125 months), underwent esophageal hydrostatic/Savary dilations and custom-stent placement, left in place for at least 40 days. Stenting was effective in 70 (88.6%) of 79 patients. Fifty percent of the patients with effective treatment received only one dilation for stent placement. Fourteen patients received more stents successfully. There was one stent-related major complication., Conclusion: Our custom stent improves treatment in ES. In caustic injuries, ES stenting represents the first option. In postsurgical ES, we stent after at least 5 dilations., (Copyright © 2011 Elsevier Inc. All rights reserved.)
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- 2011
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18. Esophageal stenosis in epidermolysis bullosum: a challenge for the endoscopist.
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De Angelis P, Caldaro T, Torroni F, Romeo E, Foschia F, di Abriola GF, Rea F, El Hachem M, Genovese E, D'Alessandro S, and Dall'Oglio L
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- Adolescent, Adult, Antibiotic Prophylaxis, Catheterization adverse effects, Cefoxitin administration & dosage, Cefoxitin therapeutic use, Child, Child, Preschool, Contraindications, Deglutition Disorders etiology, Dexamethasone administration & dosage, Dexamethasone therapeutic use, Esophageal Perforation etiology, Esophageal Stenosis etiology, Esophageal Stenosis surgery, Female, Fluoroscopy, Gastrostomy, Humans, Male, Middle Aged, Preanesthetic Medication, Proton Pump Inhibitors administration & dosage, Proton Pump Inhibitors therapeutic use, Radiography, Interventional, Young Adult, Catheterization methods, Epidermolysis Bullosa complications, Esophageal Stenosis therapy, Esophagoscopy
- Abstract
Background/purpose: Esophageal stenosis is a severe complication in dystrophic epidermolysis bullosa (EB). Endoscopic dilations may cause mucosal injury with stricture recurrence. Our aim was to describe our referral EB-center experience on safety and long-term efficacy of fluoroscopically guided balloon dilation without endoscopy., Methods: Over 14 years, 34 patients with EB, previously evaluated with barium esophagogram for dysphagia, underwent balloon esophageal dilation. Under fluoroscopy, a guide wire was introduced via a nostril into the stomach. A 12-mm pneumatic balloon, which passed over the wire, was filled using radio-opaque contrast, dilating the stricture. Orotracheal intubation was avoided. Antibiotics, dexamethasone, and proton-pump inhibitors were administered. Study approval was obtained from our ethical board., Results: Ninety-three dilations were performed. Seventeen patients had a single stenosis. The mean age of onset was 18 years (range, 3-47 years). Thirteen patients underwent one dilation. In 6 cases, endoscopy was necessary to visualize the esophageal lumen. Complications included cervical esophageal perforation (2) and transitory dysphagia (10). Thirty patients were feeding within 24 hours. During the follow-up, 2 patients required a gastrostomy, and 2 patients underwent fundoplication for gastroesophageal reflux disease., Conclusions: Fluoroscopically guided balloon dilation in EB is a safe and well-tolerated procedure. An experienced endoscopy team is necessary in certain cases., (Copyright © 2011 Elsevier Inc. All rights reserved.)
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- 2011
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19. Eosinophilic esophagitis: management and pharmacotherapy.
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De Angelis P, Morino G, Pane A, Torroni F, Francalanci P, Sabbi T, Foschia F, Caldaro T, di Abriola GF, and Dall'Oglio L
- Subjects
- Adult, Anti-Inflammatory Agents therapeutic use, Biological Products pharmacology, Biological Products therapeutic use, Child, Eosinophilia diagnosis, Eosinophilia immunology, Esophagitis diagnosis, Esophagitis immunology, Food Hypersensitivity complications, Glucocorticoids pharmacology, Glucocorticoids therapeutic use, Humans, Anti-Inflammatory Agents pharmacology, Eosinophilia therapy, Esophagitis therapy
- Abstract
Eosinophilic esophagitis represents the most debated disease of the last 10 years, too often speculated or overestimated and certainly well known and examined. The aim of this study was to summarize the recent therapeutic trends in order to show persistent doubts regarding several debated therapies. The study combined the most recent international literature and the authors' daily experience to define the scope of the review, with limits caused by a lack of available randomized studies between dietetic and pharmacological treatment. It was concluded that eosinophilic esophagitis is an immunoallergic disease that is generally caused by identifiable food and environmental allergens although, in a minority of cases, the etiological trigger remains undetermined. Therapy usually fights the responsible agents, but sometimes they are not resolved. A need for more pathogenetically driven treatments is invoked.
- Published
- 2008
- Full Text
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20. Paediatric eosinophilic oesophagitis: towards early diagnosis and best treatment.
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De Angelis P, Markowitz JE, Torroni F, Caldaro T, Pane A, Morino G, Wietrzykowska RS, di Abriola GF, Ponticelli A, and Dall'Oglio L
- Subjects
- Administration, Inhalation, Administration, Oral, Adolescent, Aerosols, Androstadienes therapeutic use, Anti-Inflammatory Agents therapeutic use, Biopsy, Catheterization, Child, Child, Preschool, Endoscopy, Digestive System, Eosinophilia etiology, Esophageal pH Monitoring, Esophagitis etiology, Female, Fluticasone, Food Hypersensitivity diagnosis, Food Hypersensitivity therapy, Humans, Immunoglobulin E blood, Infant, Male, Prednisone therapeutic use, Prospective Studies, Retrospective Studies, Skin Tests, Upper Gastrointestinal Tract pathology, Eosinophilia diagnosis, Eosinophilia therapy, Esophagitis diagnosis, Esophagitis therapy, Food Hypersensitivity complications
- Abstract
Unlabelled: Eosinophilic oesophagitis is an emerging disease, well known also in paediatric age, probably caused by both IgE and non-IgE mediated food allergies, diagnosed by upper endoscopy with biopsy. The most severe complication is oesophageal stenosis. The identification of the offending allergens is often difficult; therapy is focused to eliminate the supposed antigenic stimulus, to control the acute symptoms and to induce long-term remission., Aim: We report the clinical outcome and the typical endoscopic findings of children and adolescents affected by eosinophilic oesophagitis, referring a proposal of diagnostic and treatment protocol., Patients and Methods: Twelve patients, affected by eosinophilic oesophagitis with a histological diagnosis, underwent radiographic upper gastro-intestinal series, 24 h pH-probe and standardised allergic testing; they were treated with steroids (oral prednisone and swallowed aerosolised fluticasone) and elimination diet. Dilations were performed when eosinophilic oesophagitis was not yet diagnosed, or in patients resistant to conventional treatment., Results: Two patients were lost to follow up (mean follow up: 1 year 11 months); seven patients have no symptoms and normal histology, five of them on restricted diet (without cow's milk protein) and two patients on elemental diet (amino acid formula). In two patients (no allergens identified), mild dysphagia and eosinophilic infiltration persist; one patients underwent Nissen fundoplication for Barrett's oesophagus: he has no symptoms and normal oesophagus, on restricted diet (without cow's milk/eggs protein and wheat)., Conclusion: The recognition of typical endoscopic picture with careful biopsies extended to the whole oesophagus, even in emergency, could more quickly lead to the correct diagnosis and avoid severe complications of eosinophilic oesophagitis in children, as stricture and failure to growth. Elimination diet is the key of resolution when the allergens are identified. A great challenge remains the relation between gastro-oesophageal reflux disease and eosinophilic oesophagitis, which should however be explained.
- Published
- 2006
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21. Endoscopic membranectomy of duodenal diaphragm: pediatric experience.
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Torroni F, De Angelis P, Caldaro T, di Abriola GF, Ponticelli A, Bergami G, and Dall'Oglio L
- Subjects
- Child, Preschool, Duodenal Obstruction diagnostic imaging, Duodenal Obstruction pathology, Humans, Infant, Infant, Newborn, Radiography, Duodenal Obstruction surgery, Duodenoscopy, Duodenum abnormalities, Duodenum surgery
- Published
- 2006
- Full Text
- View/download PDF
22. Efficacy of noninvasive tests in the diagnosis of Helicobacter pylori infection in pediatric patients.
- Author
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Sabbi T, De Angelis P, Colistro F, Dall'Oglio L, di Abriola GF, and Castro M
- Subjects
- Adolescent, Antigens, Bacterial analysis, Bacterial Proteins blood, Biopsy, Child, Child, Preschool, Endoscopy, Digestive System, Feces microbiology, Female, Gastritis pathology, Helicobacter Infections immunology, Humans, Hyperemia pathology, Immunoenzyme Techniques, Immunoglobulin G analysis, Male, Predictive Value of Tests, Prospective Studies, Pyloric Antrum pathology, Saliva immunology, Sensitivity and Specificity, Urease, Helicobacter Infections diagnosis, Helicobacter pylori isolation & purification
- Abstract
Background: Helicobacter pylori infection is likely acquired in childhood. Helicobacter pylori is recognized as a cause of gastritis and peptic ulcer., Objective: To investigate some noninvasive tests, particularly H pylori fecal antigen, for the diagnosis of H pylori infection in comparison with the gold-standard invasive test, esophagogastroduodenoscopy with biopsy., Methods: We studied 250 patients (102 male; age range, 3-18 years) who underwent esophagogastroduodenoscopy with biopsy (histologic examination and rapid urease test) for a suspicious upper gastrointestinal disease; in all of them, fecal H pylori antigen, serum H pylori immunoglobulin G, and cytotoxin-associated gene product A immunoglobulin G were measured. Sensitivity and specificity of noninvasive tests were compared with those of the gold-standard esophagogastroduodenoscopy with biopsy., Results: Ninety-three patients (37%) had positive histopathologic (Giemsa staining) and rapid urease test results. The H pylori fecal antigen revealed a sensitivity of 97%, a specificity of 98%, a positive predictive value of 97%, and a negative predictive value of 98%; serum H pylori immunoglobulin G had a sensitivity of 86%, a specificity of 80%, a positive predictive value of 72%, and a negative predictive value of 90%; and serum cytotoxin-associated gene product A immunoglobulin G had a sensitivity of 83%, a specificity of 80%, a positive predictive value of 71%, and a negative predictive value of 89%., Conclusions: Our study demonstrates that among noninvasive and easily applicable tests, particularly in small children, H pylori fecal test is simple, suitable, and has high accuracy for the screening of H pylori-positive patients.
- Published
- 2005
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23. Long gap esophageal atresia and esophageal replacement: moving toward a separation?
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Bagolan P, Iacobelli Bd Bd, De Angelis P, di Abriola GF, Laviani R, Trucchi A, Orzalesi M, and Dall'Oglio L
- Subjects
- Abnormalities, Multiple mortality, Anastomosis, Surgical adverse effects, Anastomosis, Surgical methods, Bone and Bones abnormalities, Cardiovascular Abnormalities surgery, Cause of Death, Deglutition Disorders etiology, Esophageal Atresia mortality, Esophagitis, Peptic etiology, Feasibility Studies, Female, Gastrostomy, Humans, Infant, Newborn, Male, Preoperative Care, Surgical Flaps, Survival Rate, Urogenital Abnormalities surgery, Abnormalities, Multiple surgery, Esophageal Atresia surgery
- Abstract
Background/purpose: Treatment of long gap esophageal atresia (EA) is still a major challenge. Gastric transposition and colon interposition are the 2 most popular choices for esophageal replacement, but there is general agreement that the child's own esophagus is the best. The aim of the study was to critically evaluate the feasibility and outcome of primary repair of long gap EA with or without tracheoesophageal fistula (TEF) by direct esophago-esophageal anastomosis as the only technique., Methods: Seventy-one neonates with EA+/-TEF were considered. Nineteen cases were classified as long gap (> or =3 cm). All infants underwent either primary or shortly delayed repair. In the latter group, a gastrostomy was performed along with an x-ray evaluation of the gap a few days before surgery (mean age, 46.4 days). To avoid disruptive anastomotic force, all infants were kept paralyzed and mechanically ventilated for an additional 6 days after esophageal anastomosis. Before starting feeding, postoperative esophagogram was done on day 7. Endoscopy was done routinely, starting 1 month after surgery; pH monitoring was conventionally performed at 1 year of age or even earlier, should gastroesophageal reflux disease (GERD) be suspected. Follow-up ranged from 11 months to 7 years., Results: In all 19 long gap EA infants an esophago-esophageal anastomosis was performed. Six of them (31%) required an anterior esophageal flap to bridge residual gap. Complications included minor anastomotic leak in 2 cases and anastomotic stricture (<5mm) in 12 (80%) cases, which were treated with an average of 5 dilatations (1 of which with resection of the stricture). GERD occurred in 8 cases (53.3%), of which, 3 required fundoplication. None of the patients had esophageal swallowing difficulties or persistent dysphagia. Two children experienced food aversion. Mean hospital stay was 66.2 (22 to 230) days. There were 4 deaths (very low birth weight, 1; associated anomalies, 1; and late sepsis, 2)., Conclusions: Considering heat gap determination remains imprecise, it seems possible to conclude that in a well-established tertiary care level referral center: (1) long gap EA could be treated successfully with primary repair and anastomosis; (2) strictures and GER represent the most frequent postoperative problem, but additional procedures required seem "acceptable" to maintain the patient's own esophagus and avoid replacement; (3) esophageal substitution in long gap EA should be reserved for cases in which a previous attempt of esophageal reconstruction failed.
- Published
- 2004
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24. Strictureplasty: An alternative approach in long segment bowel stenosis Crohn's disease.
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Di Abriola GF, De Angelis P, Dall'oglio L, and Di Lorenzo M
- Subjects
- Adolescent, Adult, Colon surgery, Colonic Diseases etiology, Colonic Diseases surgery, Crohn Disease complications, Digestive System Surgical Procedures methods, Female, Humans, Ileal Diseases etiology, Ileal Diseases surgery, Ileum diagnostic imaging, Ileum surgery, Intestinal Obstruction etiology, Male, Radiography, Retrospective Studies, Crohn Disease surgery, Intestinal Obstruction surgery
- Abstract
Background/purpose: Intestinal resection is the most frequent surgical procedure for bowel stenoses in Crohn's disease (CD). Recurrence of strictures, particularly with ileocolonic disease, often requires resection of lengthy segments of bowel, potentially resulting in short bowel syndrome. Different techniques of strictureplasty, such as those described by Mikulicz, Finney and Michelassi, are used in adults. However, these procedures are uncommon in pediatric surgery. The authors report their experience with different techniques of strictureplasty and with their modified Michelassi technique for the surgical treatment of long intestinal strictures caused by CD., Methods: Five adolescents (2 boys; 3 girls; mean age, 16 age; range, 14 to 20 years) with severe ileocolonic stenoses and intestinal obstruction, not responsive to medical and nutritional therapy, were treated with different strictureplasty techniques. In 3 of them the modified side-to-side Michelassi technique was used., Results: No postoperative complications occurred. After a mean follow-up of 20.5 months (range, 6 to 28 months), patients are free of symptoms with good nutritional status and off steroid therapy., Conclusions: Strictureplasty is a good and effective surgical option for sparing bowel length in CD patients with extensive intestinal strictures., (Copyright 2003 Elsevier Inc. All rights reserved.)
- Published
- 2003
- Full Text
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25. Combined approach to functional constipation in children.
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Amendola S, De Angelis P, Dall'oglio L, Di Abriola GF, and Di Lorenzo M
- Subjects
- Cathartics therapeutic use, Child, Child, Preschool, Constipation etiology, Constipation psychology, Encopresis etiology, Female, Humans, Male, Parent-Child Relations, Parenting, Psychotherapy, Secondary Prevention, Surveys and Questionnaires, Constipation therapy
- Abstract
Background/purpose: The authors' 15-year experience with children shows a high percentage of recurrence of functional constipation (FC) with conventional treatment. These data, confirmed in the international literature, led them to develop a new therapeutic approach. The aim of this study was to achieve intestinal control and avoid recurrence of FC in children through use of medical-psychological treatment., Methods: The authors studied 25 children (18 boys; mean age, 4.7 years; range, 2.10 to 7), 20% of whom had anal fissure, 30% retentive soiling, 52% pain on defecation, and 88% fecal retention owing to FC. Children and parents were questioned about eating and sleeping habits, school, toilet training, and daily routine. Treatment included increasing water and fiber intake, laxatives, and family therapy including making rules and working on autonomy and paternal role., Results: Mean onset of FC was 3.5 years, after "stressful events" in 88%. The questionnaire shows that 68% lacked parental autonomy and authority; 84% of children decided on their own about eating habits and sleeping; 68% had a "peripheral" father with a mother-child symbiotic relationship. After one month of therapy, 92% of children showed a modification of at least 2 behavioral patterns; after 3 months, 88% had regular bowel movements. During follow-up (range, 6 to 28 months), 48% had 2 or 3 recurrent episodes. After one year, 68% had reinforced the new behavioral patterns with resolution of the pathologic aspects., Conclusions: A multidisciplinary approach in the treatment of childhood functional constipation showed consistent therapeutic results by making rules and by equalizing family roles., (Copyright 2003 Elsevier Inc. All rights reserved.)
- Published
- 2003
- Full Text
- View/download PDF
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