Quality of life after restorative proctocolectomy for ulcerative colitis: different questionnaires lead to different interpretations.

Background: According to some researchers, health-related quality-of-life scores for patients who undergo restorative proctocolectomy (RPC) for ulcerative colitis (UC) are comparable to those of healthy control subjects. Other studies show evidence that patients who undergo RPC experience a health-related quality of life similar to patients with mild UC or UC in remission.

Hypothesis: The discrepancy in health-related quality-of-life scores among studies may be due to different health-related quality-of-life analyses.

Health-related quality of life after ileocolonic resection for Crohn's disease: long-term results.

Background: Crohn's disease (CD) is a chronic illness that interferes with the daily life of those affected. The aim of the present study was to evaluate long-term health-related quality of life (HRQL) outcome and its clinical predictors in CD patients who have had ileocolonic resection.

Methods: Ninety-seven CD patients, with a mean follow-up of 47.

Rod in loop ileostomy: just an insignificant detail for ileostomy-related complications?

Background And Aims: The aim of this prospective study was to validate a variant in the loop ileostomy construction to reduce peristomal pressure ulcers and, subsequently, the need of stoma therapist assistance and the frequency of changing the stoma appliance.

Patients And Methods: We have enrolled 33 consecutive patients who underwent two stage restorative proctocolectomies. The first consecutive 13 patients operated on had their ileostomies constructed with a standard rod.

Urologic complications in Crohn's disease: suspicion criteria.

Background/aims: Genitourinary complications occur in 4 to 35% of Crohn's disease patients. The aim of this study was to assess the threshold to suspect urologic involvement in Crohn's disease in order to plan the correct surgical management.

Methodology: Medical records of 258 consecutive patients who have undergone bowel resection for Crohn's disease were reviewed.

Expression of costimulatory molecule CD80 in colonic dysplasia in ulcerative colitis: an immunosurveillance mechanism against colorectal cancer?

Background And Aims: Ulcerative colitis is an established risk factor for colorectal cancer but dysplasia reports are much more frequent than invasive neoplasm diagnosis. The effective activation of T lymphocytes that provide antitumor surveillance requires the presence of costimulation molecules such as CD80 and CD86 on the surface of antigen-presenting cells. The aim of our study was to verify the presence of an in vivo immunosurveillance mechanism in the early stages of colon tumorigenesis.

Prospective validation of the Barcelona Clinic Liver Cancer staging system.

Background/aims: The Barcelona Clinic Liver Cancer (BCLC) classification offers a prognostic stratification of patients with hepatocellular carcinoma (HCC). We recently demonstrated the BCLC's peculiar prognostic ability in a retrospective cohort of HCC patients. The aim of this study was to evaluate the BCLC system prospectively in a subsequent separate group of HCC patients enrolled at the same surgically oriented liver unit.

Role of blood AFP mRNA and tumor grade in the preoperative prognostic evaluation of patients with hepatocellular carcinoma.

Aim: To explore the potential prognostic role of preoperative tumor grade and blood AFP mRNA in a cohort of patients with hepatocellular carcinoma (HCC) eligible for radical therapies according to a well-defined treatment algorithm not including nodule size and number as absolute selection criteria.

Methods: Fifty patients with a diagnosis of HCC were prospectively enrolled in the study. Inclusion criteria were: (1) histological assessment of tumor grade by means of percutaneous biopsies; (2) determination of AFP mRNA status in the blood; (3) patient's eligibility for radical therapies.

Persistence of high CD40 and CD40L expression after restorative proctocolectomy for ulcerative colitis.

Aim: To focus on the role of CD40 and CD40L in their pathogenesis.

Methods: We analyzed by immunohistochemistry the CD40 and CD40L expression in the pouch mucosa of 28 patients who had undergone RPC for UC, in the terminal ileum of 6 patients with UC and 11 healthy subjects. We also examined by flow cytometry the expression of CD40 by B lymphocytes and monocytes in the peripheral blood of 20 pouch patients, 15 UC patients and 11 healthy controls.

Syngeneic living-donor liver transplantation for hemangioendothelioma: a clinical model for studying liver regeneration.

A 22-year-old Caucasian patient underwent living-donor liver transplantation (LDLT) for hepatic hemangioendothelioma in a healthy liver. The organ donor was his monozygotic twin brother. Surgery was uneventful in both donor and recipient, who received the same postoperative treatment (i.

[Definitive breast cancer surgery as an outpatient: rationale and our experience].

Introduction: The objective of this study was to evaluate the feasibility of outpatient breast definitive surgery.

Case And Methods: Between January 2001 and September 2003 181 definitive breast cancer surgical approaches were performed at Surgical Department of Genoa University on 173 patients. Mean age was 60 years (28-92).

Multimodal therapy before liver transplantation for hepatocellular carcinoma.

Background: : The use of orthotopic liver transplantation (OLT) for the treatment of patients with hepatocellular carcinoma (HCC) remains controversial because of the risk of both exclusion from the waiting list due to tumor progression and post OLT HCC recurrence. The aim of the present study was to evaluate the effect of an aggressive HCC treatment during the waiting list time on overall and recurrence-free survival of HCC transplanted patients in a single institutional study.

Methods: : Since 1991, 40 HCC patients joined the OLT-waiting list.

Local excision of rectal polyp: indications and techniques.

The local excision of a rectal polyp is often wrongly considered to be a minor surgical procedure. In reality, the malignant potential of adenomas and the not-infrequent presence of cancer in larger polyps, require, for their removal, an oncologically correct operation with strict indication and accurate execution. Despite an increasing inclination to extend the indications of endoscopic polypectomies to polyps of larger size and villous configuration, the local surgical approach remains the preferred treatment in most cases.

The role of costimulatory molecules CD80 and CD86 and IFNgamma in the pathogenesis of ulcerative colitis.

Several studies showed that costimulatory signals on antigen presenting cells are up-regulated in inflammatory bowel disease. We quantified the expression of CD80, CD86, and IFNgamma in colonic mucosa of patients affected by ulcerative colitis and correlated it with clinical and biochemical parameters to identify the context of this up regulation. We enrolled 21 patients affected by ulcerative colitis and 6 healthy subjects.

Minimally invasive management of Crohn's disease complicated by ureteral stenosis.

Ureteral involvement due to Crohn's disease occurs in 3% to 6% of cases. Herein, we present a case of a 22-year-old woman with ileocolic Crohn's disease with right hydronephrosis due to compression of the ureter that was resolved with a 3-stage, minimally invasive procedure (preoperative percutaneous nephrostomy, ureteral stent placement, and sequential laparoscopically assisted ileocolectomy). Percutaneous right nephrostomy drainage permitted us to prevent renal damage before surgery, and successive ureteral double-J catheter placement minimized the risk of ureteral damage during the laparoscopic procedure.

Clinical significance of alpha-fetoprotein mRNA in blood of patients with hepatocellular carcinoma.

Background: Alpha-fetoprotein (AFP) messenger RNA (mRNA) in the blood reflects the presence of circulating hepatocellular carcinoma (HCC) cells and is a sensitive marker of HCC extrahepatic metastases. The specificity of this molecular marker and its correlation with the main HCC clinical-pathological parameters remains controversial, however.

Methods: AFPmRNA was determined in 50 HCC patients and in 50 patients with diagnosis of cirrhosis (6), or colon (24) or, pancreatic (20) carcinoma.

Role of stapled and hand-sewn anastomoses in recurrence of Crohn's disease.

Background/aims: Anastomotic recurrence after bowel resection is a major problem in Crohn's disease surgery. The aim of this study is to compare recurrence rate after stapled side-to-side ileo-colonic anastomosis to those after stapled end-to-side or hand-sewn side-to-side anastomosis to distinguish the role of suture technique and anastomotic configuration in the prevention of Crohn's disease recurrence.

Methodology: Eighty-four consecutive patients who had undergone ileo-colonic resection for Crohn's disease were enrolled: 12 of them had stapled side-to-side anastomosis, 36 stapled end-to-side anastomosis and 36 hand-sewn side-to-side anastomosis.

Cost-effective therapy in patients with idiopathic hirsutism.

Hirsutism affects 10% of women. Hirsute women with normal circulating androgen levels and normal ovarian function (i.e.

Growth hormone/insulin-like growth factor 1 axis recovery after liver transplantation: a preliminary prospective study.

Many studies on cirrhotic patients have shown that insulin-like growth factor 1 (IGF-1) plasma levels are related to the severity of liver dysfunction. This result suggests that IGF-1 is probably useful for monitoring liver function in the perioperative course of orthotopic liver transplantation (OLT). Growth hormone (GH), IGF-1 plasma levels, and routine liver function tests were measured in 15 adult cirrhotic patients undergoing OLT.

Risk factors for recurrence of stenosis in Crohn's disease.

A major problem in Crohn's disease (CD) surgery is the high frequency of recurrence after bowel resection. Several factors are thought to influence this phenomenon. CD "phenotype" was identified as one of this factors and obstructing CD seems to be a low risk.

Role of CD40 and B7 costimulators in inflammatory bowel diseases.

We analyse the costimulating role of CD40/CD40 ligand and B7/CD28 in inflammatory bowel diseases (IBD) as a potential target of antibody therapy. CD40, expressed by lamina propria B lymphocytes in gut mucosa, interacts with CD40 ligand on T cell. This interaction is implicated in the pathogenesis of IBD.

Liver transplantation for the treatment of moderately or well-differentiated hepatocellular carcinoma.

Objective: To determine the long-term results of liver transplantation for well- or moderately differentiated hepatocellular carcinoma (HCC).

Summary Background Data: HCC patient selection for liver transplantation remains controversial, and deciding exclusively on the strength of criteria such as number and size of nodules appears prognostically inaccurate.

Methods: Since 1991, preoperative tumor grading has been used at our center to establish whether a patient with HCC is fit for transplantation.

Health-related quality of life after restorative proctocolectomy for ulcerative colitis: long-term results.

Restorative proctocolectomy (RPC) is the favorite operation for ulcerative colitis, but it may influence health-related quality of life (HRQL). Our aims were to determine the long-term HRQL of patients and its modifications after a 5-year follow-up and to identify any risk factor for a worse outcome. We enrolled 36 patients submitted to RPC (mean follow-up 8.

The critical issue of hepatocellular carcinoma prognostic classification: which is the best tool available?

Background/aims: Prognosis assessment in patients with hepatocellular carcinoma (HCC) remains controversial. The most widely used HCC prognostic tool is the Okuda classification, but new staging systems (Cancer of the Liver Italian Program score, Chinese University Prognostic Index, French classification and Barcelona Clinic Liver Cancer, BCLC, staging) have been recently described. We investigated the value of known prognostic systems in the particular setting of a surgically oriented Liver Unit where 187 HCC Italian patients were mainly treated with radical therapies (resection and percutaneous ablation).

Pursestring placement before transsection of the rectum for facilitating the stapled low colorectal anastomosis.

We propose a simple, easy technique to perform a stapled colorectal anastomosis close to the anal sphincter that may help to lower leak rates. This is the same technique used by us for successful performance of intrathoracic and abdominal esophagoenteric mechanical anastomoses. The technique consists of hand sewing a double pursestring suture before sectioning the rectum.