In JoVE (1)

Other Publications (66)

Articles by Claudio Ricci in JoVE

 JoVE Bioengineering

Mesenchymal Stromal Cell Culture and Delivery in Autologous Conditions: A Smart Approach for Orthopedic Applications

1Dept. of Clinical and Experimental Medicine, University of Pisa, 2OtoLab, Azienda Ospedaliero-Universitaria Pisana (AOUP), 3Dept. of Civil and Industrial Engineering, University of Pisa, 4Immunohematology Operative Unit, Azienda Ospedaliero-Universitaria Pisana (AOUP), 5Dept. Of Surgical, Medical, Molecular Pathology and Emergency Medicine, University of Pisa, 6II Orthopedic and Traumatologic Clinic, Azienda Ospedaliero-Universitaria Pisana (AOUP)

JoVE 54845

Other articles by Claudio Ricci on PubMed

Inflammatory Pseudotumor of the Liver: About a Case Investigated by US and CT

La Radiologia Medica. Oct, 2002  |  Pubmed ID: 12569318

Neuromuscolar and Vascular Hamartoma of the Duodenum. A Clinical Case and Review of the Literature

Annali Italiani Di Chirurgia. Mar-Apr, 2005  |  Pubmed ID: 16302660

The NMVH of the intestine is a rare lesion, typical located in the small bowel. After the first 2 cases, reported in 1982, other 12 cases have been described, ten localized in the jejunual or ileal tract, only 1 in the cecum.

Thrombosed Splenic Artery Aneurysm Simulating a Pancreatic Body Mass: Can Two Entities Be Distinguished Preoperatively Thus Avoiding Diagnostic and Therapeutic Mistakes?

JOP : Journal of the Pancreas. Mar, 2007  |  Pubmed ID: 17356250

Splenic artery aneurysms are rare and they are usually easy to diagnose. Spiral computed tomography is the most sensitive diagnostic technique for this disease. Its primary treatment is interventional radiology; surgery is indicated in selected cases.

Laparoscopic Distal Pancreatectomy in Non-malignant Pancreatic Tumors

JOP : Journal of the Pancreas. Jan, 2008  |  Pubmed ID: 18182748

Solid Serous Microcystic Tumor of the Pancreas

JOP : Journal of the Pancreas. Jul, 2008  |  Pubmed ID: 18648150

Reconstruction After Pancreaticoduodenectomy: Isolated Roux Loop Pancreatic Anastomosis

Chirurgia Italiana. Sep-Oct, 2008  |  Pubmed ID: 19062486

Pancreatic fistula is the most frequent major complication after pancreaticoduodenectomy. Its rate may be related to several risk factors, among which pancreatic anastomotic reconstruction techniques. The study reported here was a prospective, non-randomized study of 38 consecutive patients who underwent pancreaticoduodenectomy from March 2006 to February 2007. Two groups were studied according to the type of treatment of the pancreatic remnant: group 1 (n = 18) in which an isolated Roux loop Wirsung-jejunal end-to-side anastomosis was performed; and group 2 (n = 20) in which a pancreaticojejunostomy was carried out in the same jejunal loop as the biliary and gastric anastomosis. The two groups of patients were compared regarding preoperative characteristics, surgical procedure and postoperative outcome. Postoperative mortality, morbidity and pancreatic fistula in all the patients in the two groups were evaluated in relation to several risk factors. The overall postoperative mortality and morbidity rates were 2.6% (1/38 cases) and 26.3% (10/38 cases), respectively. The pancreatic fistula rate was 13.1% (5 cases). There were no significant differences in postoperative outcome between the two groups. However, both mean and median postoperative postoperative hospital stay were shorter in group 1 than in group 2 (P < 0.001). Postoperative pancreatic fistula was not significantly more frequent in relation to any of the different risk factors. The isolated Roux loop Wirsung-jejunal end-to-side anastomosis after PD is safe, easy to perform and allows the same results of pancreaticojejunostomy in the same jejunal loop of the biliary and gastric anastomosis. Moreover the isolated Roux loop reconstruction allows a significant decrease of the length of postoperative hospital stay.

Sclerosing Cholangitis, Autoimmune Chronic Pancreatitis, and Situs Viscerum Inversus Totalis

Pancreas. Apr, 2009  |  Pubmed ID: 19307933

Total Pancreatectomy: Doing It with a Mini-invasive Approach

JOP : Journal of the Pancreas. May, 2009  |  Pubmed ID: 19454829

Pancreatic laparoscopic surgery represents one of the most discussed and demanding fields in surgery. Total pancreatectomy is considered to a viable option for treating both benign and malignant pathologies of the pancreas and, thanks to the introduction of laparoscopic techniques for pancreatic resections into clinical practice, it can be performed nowadays with a less invasive approach.

Managing Unsuspected Tumour Invasion of the Superior Mesenteric-portal Vein During Surgery for Pancreatic Head Cancer. A Case Report

JOP : Journal of the Pancreas. Jul, 2009  |  Pubmed ID: 19581755

In some cases, synchronous superior mesenteric-portal vein resection can be performed during pancreatic resection for cancer. The reconstruction technique is usually primary anastomosis; in only a few cases is an autologous vein graft needed.

Value of Both WHO and TNM Classification Systems for Patients with Pancreatic Endocrine Tumors: Results of a Single-center Series

World Journal of Surgery. Nov, 2009  |  Pubmed ID: 19655196

This study was designed to evaluate the clinical relevance of the World Health Organization (WHO) and tumor node metastasis (TNM) classifications in patients affected by pancreatic endocrine tumors.

Treatment of Advanced Gastric Cancer with Cetuximab Plus Chemotherapy Followed by Surgery. Report of a Case

Tumori. Nov-Dec, 2009  |  Pubmed ID: 20210249

The prognosis of patients affected by advanced gastric cancer who did not undergo non-curative resection is extremely poor. We report a case of a 26-year-old woman affected by gastric cancer with peritoneal carcinosis in whom surgical treatment was not considered. The patient was enrolled in the Italian phase II trial of cetuximab (Erbitux, Merck KGaA, Darmstadt, Germany), a monoclonal antibody, in combination with docetaxel and cisplatin chemotherapy. Restaging of the tumor showed progressive regression, so the patient underwent a total gastrectomy. The patient is alive, well and disease-free ten months after surgery. The good result achieved in this patient provides interesting prospects for chemotherapy combined with cetuximab, followed by surgery.

Are There Prognostic Factors Related to Recurrence in Pancreatic Endocrine Tumors?

Pancreatology : Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]. 2010  |  Pubmed ID: 20299821

The aim of this study was to evaluate the rate, site, time of recurrence and prognostic factors related to the appearance of recurrences in patients affected by pancreatic endocrine tumors (PETs).

Clinical Outcome of Patients Who Underwent Total Pancreatectomy

Pancreas. May, 2010  |  Pubmed ID: 20418761

Pancreatic Endocrine Tumors Less Than 4 Cm in Diameter: Resect or Enucleate? a Single-center Experience

Pancreas. Aug, 2010  |  Pubmed ID: 20431423

Pancreatic endocrine tumors (PETs) are usually small, benign or low-grade malignant, and surgery should preserve the pancreatic parenchyma as much as possible. The aim of the study was to evaluate the postoperative and long-term survival of patients undergoing enucleation in small PETs.

A Prospective Study on Radiofrequency Ablation Locally Advanced Pancreatic Cancer

Hepatobiliary & Pancreatic Diseases International : HBPD INT. Jun, 2010  |  Pubmed ID: 20525559

Radiofrequency ablation (RFA) has been suggested as a new treatment option for patients with locally advanced cancer. This study aimed to prospectively evaluate the efficacy and safety of intraoperative RFA in patients with unresectable, locally advanced, non-metastatic carcinoma of the pancreatic head.

A Bizarre Abdominal Cystic Lesion

JOP : Journal of the Pancreas. Sep, 2010  |  Pubmed ID: 20818122

In spite of careful intraoperative precautions and gauze counts, mistakes can still occur during surgery. In the case reported, a retained gauze leaved during a surgical approach for removing a solid-cystic papillary tumor localized in the pancreatic tail, caused both persistent abdominal discomfort and the presence of an abdominal cystic lesion at imaging techniques. When a previous operative history is present, a foreign body should be taken into account in the differential diagnosis of a patient with an intra-abdominal cystic mass. Finally, radio-opaque marker should be routinely used by surgeons in order to reach a correct diagnosis in operated patients having retained gauze.

Total Pancreatectomy: Indications, Operative Technique, and Results: a Single Centre Experience and Review of Literature

Updates in Surgery. Aug, 2010  |  Pubmed ID: 20845100

The aims of this study were to identify the indications to perform a total pancreatectomy and to evaluate the outcome and quality of life of the patient who underwent this operation. A retrospective analysis of a prospective database, regarding all the patients who underwent total pancreatectomy from January 2006 to June 2009, was carried out. Perioperative and outcome data were analyzed in two different groups: ductal adenocarcinoma (group 1) and non-ductal adenocarcinoma (group 2). Twenty (16.9%) total pancreatectomies out of 118 pancreatic resections were performed. Seven (35.0%) patients were affected by ductal adenocarcinoma (group 1) and the remaining 13 (65.0%) by pancreatic diseases different from ductal adenocarcinoma (group 2) [8 (61.5%) intraductal pancreatic mucinous neoplasms, 2 (15.4%) well-differentiated neuroendocrine carcinomas, 2 (15.4%) pancreatic metastases from renal cell cancer and, finally, 1 (7.7%) chronic pancreatitis]. Eleven patients (55%) underwent primary elective total pancreatectomy; nine (45%) had a completion pancreatectomy previous pancreaticoduodenectomy. Primary elective total pancreatectomy was significantly more frequent in group 2 than in group 1. Early and long-term postoperative results were good without significant difference between the two groups except for the disease-free survival that was significantly better in group 2. The follow-up examinations showed a good control of the apancreatic diabetes and of the exocrine insufficiency without differences between the two groups. In conclusion, currently, total pancreatectomy is a standardized and safe procedure that allows good early and late results. Its indications are increasing because of the more frequent diagnose of pancreatic disease that involved the whole gland as well as intraductal pancreatic mucinous neoplasm, neuroendocrine tumors and pancreatic metastases from renal cell cancer.

Laparoscopic Versus Open Distal Pancreatectomy in Pancreatic Tumours: a Case-control Study

Updates in Surgery. Dec, 2010  |  Pubmed ID: 21052893

Laparoscopic distal pancreatectomy has become an increasingly used procedure in the surgical treatment of benign or borderline cystic and endocrine tumours. The feasibility and safety of this technique is well known but its results when compared with open distal pancreatectomy were rarely reported in literature. Data from 22 consecutive patients who underwent laparoscopic distal pancreatectomy were recorded in a prospective database from January 2006 to January 2010. These patients were matched with 22 patients who underwent open distal pancreatectomy from January 2000 to December 2005, regarding age, gender, American Society of Anesthesiologists score, pancreatic pathology. Intraoperative parameters and postoperative outcome were compared between the two groups. Blood loss, amount of analgesic drugs administered, postoperative mortality and morbidity and pancreatic fistula rate were similar in laparoscopic and open groups. Tumour size was significantly smaller in laparoscopic group (2.0 ± 3.3 vs. 5.0 ± 4.2 cm; P = 0.038). Operative time was significantly shorter in open group (145 ± 49 vs. 225 ± 83 min, P = 0.045). Time to adequate oral intake and length of postoperative hospital stay were significantly better in laparoscopic group than in open group (3.0 ± 0.8 vs. 4.0 ± 0.7 days; P = 0.030 and 8.0 ± 1.3 vs. 11.0 ± 3.0 days; P = 0.011, respectively). Laparoscopic distal pancreatectomy is a feasible and safe surgical approach as well as open distal pancreatectomy.

Diverticulum of the Midthoracic Oesophagus and Left Diaphragmatic Relaxation

BMJ Case Reports. Nov, 2010  |  Pubmed ID: 22791853

The case of a 58-year-old man with a large midthoracic oesophageal diverticulum and a left diaphragmatic relaxation who presented with night regurgitations, abdominal bloating, epigastric burning and a sensation of fullness after meals is reported. The patient underwent a successful thoracotomic diverticulectomy with left diaphragmatic plicature. The postoperative course was uneventful. To our knowledge this is the first reported case of an association between midthoracic oesophageal diverticulum and left diaphragmatic relaxation. Moreover, we hypothesised that the diverticulum was caused by a pulsion mechanism due to obstruction of the distal oesophagus secondary to diaphragmatic relaxation.

The Problems of Radiofrequency Ablation As an Approach for Advanced Unresectable Ductal Pancreatic Carcinoma

Cancers. Jul, 2010  |  Pubmed ID: 24281165

Advanced ductal pancreatic carcinoma (PC) remains a challenge for current surgical and medical approaches. It has recently been claimed that radiofrequency ablation (RFA) may be beneficial for patients with locally advanced or metastatic PC. Using the MEDLINE database, we found seven studies involving 106 patients in which PC was treated using RFA. The PC was mainly located in the pancreatic head (66.9%) with a median size of 4.6 cm. RFA was carried out in 85 patients (80.1%) with locally advanced PC and in 21 (19.9%) with metastatic disease. Palliative surgical procedures were carried out in 41.5% of the patients. The average temperature used was 90 °C (with a temperature range of 30-105 °C) and the ratio between the number of passes of the probe and the size of the tumor in centimeters was 0.5 (range of 0.36-1). The median postoperative morbidity and mortality were 28.3% and 7.5%, respectively; the median survival was 6.5 months (range of 1-33 months). In conclusion, RFA is a feasible technique: however, its safety and long-term results are disappointing; Thus, the RFA procedure should not be recommended in clinical practice for a PC patient.

Radiofrequency Ablation for Advanced Ductal Pancreatic Carcinoma: is This Approach Beneficial for Our Patients? A Systematic Review

Pancreas. Jan, 2011  |  Pubmed ID: 21160378

Assessment of Complications According to the Clavien-Dindo Classification After Distal Pancreatectomy

JOP : Journal of the Pancreas. Mar, 2011  |  Pubmed ID: 21386637

The absence of a definition and a widely accepted ranking system to classify surgical complications has hampered proper interpretation of the surgical outcome.

The Usefulness of a Grading System for Complications Resulting from Pancreatic Resections: a Single Center Experience

Updates in Surgery. Jun, 2011  |  Pubmed ID: 21537973

The aim of this study was to test the usefulness of the Clavien-Dindo classification after pancreatic resection. In 183 patients who underwent pancreatic resections, complications were classified according to Clavien-Dindo classification and each grade was evaluated regarding the length of the postoperative stay and was compared to the most important complications. Sixty-four (35.0%) patients had no complications; out of the 119 (65.0%) patients with complications, grade I, was 9.3%; grade II, 35.5%; grade III, 9.3%; grade IV, 7.7% and grade V, 3.3%. The postoperative pancreatic fistula rate was 29.1%, postpancreatectomy hemorrhage, 35% and delayed gastric emptying, 11.5%. There was a progressive increase in the length of hospitalization from patients with no complications to those having grade IV (P < 0.001). Postoperative pancreatic fistula, postpancreatectomy hemorrhage and delayed gastric empty rates significantly increased from Clavien-Dindo grade I to grade IV; only postoperative pancreatic fistula and postpancreatectomy hemorrhage severity significantly increased from grade I to grade IV (both P < 0.001). The Clavien-Dindo classification is an objective, simple, and reliable way of reporting all complications following pancreatic resections and it allows to recognize appropriately all the most important complications after pancreatic resection, and the severity of postoperative pancreatic fistula and postpancreatectomy hemorrhage.

Cystic Dystrophy of the Duodenal Wall is Not Always Associated with Chronic Pancreatitis

World Journal of Gastroenterology. Oct, 2011  |  Pubmed ID: 22110260

Cystic dystrophy of the duodenal wall is a rare form of the disease which was described in 1970 by French authors who reported the presence of focal pancreatic disease localized in an area comprising the C-loop of the duodenum and the head of the pancreas. German authors have defined this area as a "groove". We report our recent experience on cystic dystrophy of the paraduodenal space and systematically review the data in the literature regarding the alterations of this space. A MEDLINE search of papers published between 1966 and 2010 was carried out and 59 papers were considered for the present study; there were 19 cohort studies and 40 case reports. The majority of patients having groove pancreatitis were middle aged. Mean age was significantly higher in patients having groove carcinoma. The diagnosis of cystic dystrophy of the duodenal wall can now be assessed by multidetector computer tomography, magnetic resonance imaging and endoscopic ultrasonography. These latter two techniques may also add more information on the involvement of the remaining pancreatic gland not involved by the duodenal malformation and they may help in differentiating "groove pancreatitis" from "groove adenocarcinoma". In conclusion, chronic pancreatitis involving the entire pancreatic gland was present in half of the patients with cystic dystrophy of the duodenal wall and, in the majority of them, the pancreatitis had calcifications.

Pancreatic Metastasis from Renal Cell Carcinoma

Urologia. Oct, 2011  |  Pubmed ID: 22139800

Pancreatic metastases from renal cell carcinoma are uncommon.

Usefulness of the Clavien–Dindo Classification After Pancreaticoduodenectomy

ANZ Journal of Surgery. Oct, 2011  |  Pubmed ID: 22295320

Late Postpancreatectomy Hemorrhage After Pancreaticoduodenectomy: is It Possible to Recognize Risk Factors?

JOP : Journal of the Pancreas. Mar, 2012  |  Pubmed ID: 22406600

Post-pancreatectomy hemorrhage is one of the most common complications after pancreaticoduodenectomy.

Factors Related to Long-term Survival in Patients Affected by Well-differentiated Endocrine Tumors of the Pancreas

ISRN Surgery. 2012  |  Pubmed ID: 22811937

Aim. To identify factors related to survival in patients affected by well-differentiated PETs (benign, uncertain behavior, and carcinoma) who underwent R0 pancreatic resection. Methods. Retrospective study of 74 consecutive patients followed up from January 1980 to December 2011. Prognostic factors were sex, age, type of tumor, presence of symptoms, type of surgical procedure, size of tumor, lymph nodes status, WHO classification, and TNM stage. Overall survival was evaluated using the Kaplan-Meier method. Cox regression analyses were used to identify the factors associated with prognosis in univariate and multivariate analysis. Results. The mean follow-up of all the patients was 106 ± 89 months. The 5-10-year long-term survival was 90.9% and 79.1%, respectively. At univariate analysis, patient age <55 years was significantly related to a better long-term survival compared to patients age ≥55 years (307 ± 15 months versus 192 ± 25 months; P = 0.010). Multivariate analysis showed that female gender (P = 0.006), patients without comorbidities (P = 0.033), and patients affected by well-differentiated benign pancreatic endocrine tumors (P = 0.008 and P = 0.002 in relation to tumors with uncertain behavior and carcinomas, resp.) were factors significantly related to a better long-term survival. Conclusions. Patients factors were strongly related to a better long-term survival in patients observed. WHO classification is a very useful prognostic tool for well-differentiated PETs.

Preoperative Gemcitabine and Oxaliplatin in a Patient with Ovarian Metastasis from Pancreatic Cystadenocarcinoma

Case Reports in Gastroenterology. May, 2012  |  Pubmed ID: 22949893

We describe a case of clinical benefit and partial response with gemcitabine and oxaliplatin (GEMOX) in a young patient with ovarian metastasis from cystadenocarcinoma of the pancreas. A young woman complained of abdominal pain and constipation. Computed tomography (CT) and magnetic resonance imaging scans disclosed two bilateral ovarian masses with pancreatic extension. She underwent bilateral ovarian and womb resection. During surgery peritoneal carcinosis, a pancreatic mass and multiple abdominal lesions were found. The final diagnosis was mucinous pancreatic cystadenocarcinoma with ovarian and peritoneal metastases. She started chemotherapy with GEMOX (gemcitabine 1,000 mg/m(2)/d1 and oxaliplatin 100 mg/m(2)/d2 every 2 weeks). After 12 cycles of chemotherapy a CT scan showed reduction of the pancreatic mass. She underwent distal pancreatic resection, regional lymphadenectomy and splenectomy. Pathologic examination documented prominent fibrous tissue and few neoplastic cells with mucin-filled cytoplasm. Chemotherapy was continued with gemcitabine as adjuvant treatment for another 3 cycles. There is currently no evidence of disease. As reported in the literature, GEMOX is associated with an improvement in progression-free survival and clinical benefit in patients with advanced pancreatic cancer. This is an interesting case in whom GEMOX transformed inoperable pancreatic cancer into a resectable tumor.

Pancreatic Mucinous Cystic Neoplasm in a Male Patient

JOP : Journal of the Pancreas. Nov, 2012  |  Pubmed ID: 23183402

Mucinous cystic neoplasm (MCN) of the pancreas usually affects female patients and is characterized by an ovarian-type stroma. From literature review, only 9 cases of MCNs have been reported in male patients.

Asymptomatic Cholecystocolonic Fistula: a Diagnostic and Therapeutic Dilemma

Case Reports in Surgery. 2013  |  Pubmed ID: 23691423

Cholecystocolonic fistulas (CCF) are rare complications of gallstones with a variable clinical presentation. Despite modern diagnostic tools, cholecystocolonic fistulas are often asymptomatic and it is difficult to diagnose them preoperatively. Biliary-enteric fistulae have been found in 0.9% of patients undergoing biliary tract surgery. The most common site of communication of the fistula is the cholecystoduodenal (70%), followed by the cholecystocolic (10-20%), and the least common is the cholecystogastric fistula. Herein, we report a case of female patient with multiple episodes of acute recurrent cholangitis due to common bile duct and gallbladder stones in which preoperative imaging studies were negative for cholecystocolonic fistula that was incidentally discovered and treated during surgery and was appropriately treated. A review of the literature is reported too.

Peng's Binding Pancreaticojejunostomy After Pancreaticoduodenectomy. An Italian, Prospective, Dual-institution Study

Pancreatology : Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]. May-Jun, 2013  |  Pubmed ID: 23719605

To evaluate Peng's binding pancreaticojejunostomy as a safe technique which avoids anastomotic leakage after a pancreaticoduodenectomy.

A Bizarre Foreign Body in the Appendix: A Case Report

World Journal of Gastrointestinal Surgery. Jun, 2013  |  Pubmed ID: 23805364

Foreign bodies are rare causes of appendicitis and, in most cases, ingested foreign bodies pass through the alimentary tract asymptomatically. However, ingested foreign bodies may sometimes remain silent within the appendix for many years without an inflammatory response. Despite the fact that cases of foreign-body-induced appendicitis have been documented, sharp and pointed objects are more likely to cause perforations and abscesses, and present more rapidly after ingestion. Various materials, such as needles and drill bits, as well as organic matter, such as seeds, have been implicated as causes of acute appendicitis. Clinical presentation can vary from hours to years. Blunt foreign bodies are more likely to remain dormant for longer periods and cause appendicitis through obstruction of the appendiceal lumen. We herein describe a patient presenting with a foreign body in his appendix which had been swallowed 15 years previously. The contrast between the large size of the foreign body, the long clinical history without symptoms and the total absence of any histological inflammation was notable. We suggest that an elective laparoscopic appendectomy should be offered to such patients as a possible management option.

Is There a Proper Type of Management for Branch-duct Intraductal Papillary Mucinous Tumors of the Pancreas?

JOP : Journal of the Pancreas. Sep, 2013  |  Pubmed ID: 24018600

The Role of Lymph Node Ratio in Recurrence After Curative Surgery for Pancreatic Endocrine Tumours

Pancreatology : Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]. Nov-Dec, 2013  |  Pubmed ID: 24280574

The prognostic role of lymph nodes metastasis in pancreatic neuroendocrine tumours is unclear.

Enzyme Kinetics Studies on 29-kDa Human Liver Cathepsin L

Chemical Biology & Drug Design. Dec, 2014  |  Pubmed ID: 24889867

Enzyme kinetics studies reported in the literature showed that human liver Cathepsin L is active only at lysosomal acidic pH values, while biochemical studies in living cells showed that the enzyme works even at neutral pH values (in a condition compatible with the extracellular compartment). Such an apparent ambiguity highlighted the need of analysing in depth the kinetics of ~29-kDa Cathepsin L, which is the form commonly used in experiments. The stability and catalytic activity of this enzyme were investigated at different pH values, reducing and non-reducing environments, presence of copper, iron and zinc ions, and presence of the natural modulator/inhibitor cystatin B. Our experiments showed that ~29-kDa human liver Cathepsin L is stable and catalytically functional even at neutral pH values and under non-reducing conditions, which simulate the extracellular compartment. Under these conditions, Cathepsin L was also proved to interact with cystatin B, being also modulated by physiological concentrations of Cu(++) , Fe(++) and Zn(++) . This paper suppose an advance in the comprehension of the catalytic properties of human liver Cathepsin L, its implications in different physiological processes and its potential use within a drug screening programme in which agents acting extracellularly are being considered.

Locally Advanced Pancreatic Cancer: Open Questions on Terminology, Diagnosis and Management

Updates in Surgery. Sep, 2014  |  Pubmed ID: 24965064

Interventional Radiology Procedures After Pancreatic Resections for Pancreatic and Periampullary Diseases

JOP : Journal of the Pancreas. Jul, 2014  |  Pubmed ID: 25076347

The use of interventional radiology has increased as the first-line management of complications after pancreatic resections.

Natural History of Branch-duct Intraductal Papillary Mucinous Neoplasms of the Pancreas: a Case Report

JOP : Journal of the Pancreas. Jul, 2014  |  Pubmed ID: 25076351

The natural history of incidental branch-duct intraductal papillary mucinous neoplasm of the pancreas is still unknown.

WHO 2010 Classification of Pancreatic Endocrine Tumors. is the New Always Better Than the Old?

Pancreatology : Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]. Nov-Dec, 2014  |  Pubmed ID: 25266640

In 2010, the World Health Organization released a new classification system for endocrine pancreatic tumors. The new categories replaced those in the old classification.

Laparoscopic Distal Pancreatectomy in Italy: a Systematic Review and Meta-analysis

Hepatobiliary & Pancreatic Diseases International : HBPD INT. Oct, 2014  |  Pubmed ID: 25308355

The use of laparoscopic distal pancreatectomy (LDP) increased in the past twenty years but the real diffusion of this technique is still unknown as well as the type of centers (high or low volume) in which this procedure is more frequently performed.

Systematic Review of Laparoscopic Versus Open Surgery in the Treatment of Non-parasitic Liver Cysts

Updates in Surgery. Dec, 2014  |  Pubmed ID: 25326850

We conducted a systematic review of the literature on the electronic databases Medline, Embase, Ovid and Cochrane to identify studies from 1990 to 2011 regarding the surgical management of non-parasitic liver cysts treated with laparoscopy (LT) and/or laparotomy (OT) to identify short-term and long-term outcomes of the relative treatments. Two reviewers independently extracted data regarding the following parameters: first author, year of publication, type of journal, study design, number of patients operated on, male/female ratio, mean age, mean size of the cysts treated, laparoscopic conversion rate, morbidity, mortality and recurrence in both groups (LT and OT). A qualitative analysis was carried out using the Pearson Chi square test and the Fischer's exact test where necessary. The data analysis was conducted by dividing the sample into three periods in relation to the development of laparoscopic surgery: period 1 (P1), 1990-1995 "pioneering" period of laparoscopy; period 2 (P2), 1996-2000 period of the "development of laparoscopy"; period 3 (P3), 2001-2011 period of "diffusion of laparoscopy." Thirty studies involving 948 patients comparing LT with OT were included in the final pooled analysis. Twenty-two studies were retrospective (73.3 %) and only 8 (26.7 %) were prospective. The number of publications increased during the three periods analysed. The correlation between the type of journal and the year of publication showed an increase (p = 0.048) in journals dedicated to LT during the three periods. In P1, the preferred approach was open surgery (66.3 %) with only 11 cases treated with LT. The conversion rate was 18.1 %. The overall complication rate was 33.3 % with a substantial equivalence between the two approaches (27.2 % for laparoscopic surgery and 36.6 % for laparotomic). The overall recurrence rate was 18.1 % with 36.3 % in the laparoscopic group and 9.2 % in the laparotomic group. In P2, the preferred approach was laparoscopic (56.7 %). The conversion rate was 2.3 %. The overall complication rate was 5.8 % but with some differences between the two approaches (10.3 % for the laparoscopic approach and 0 % for open surgery). The overall recurrence rate was 14.4 % with 17.4 % in the laparoscopic group and 10.4 % in the laparotomic group. In P3, the preferred approach was laparoscopic (69.9 %). The overall recurrence rate was 11.1 %; it was 6.1 % for the laparoscopic approach while it was 11.5 % for laparotomic. In all three periods analysed, the laparoscopic approach showed a statistically significant reduction in operative time (p = 0.009) and hospital stay (p = 0.001) and a significant (p < 0.05) reduction rate in symptomatic recurrences in patients with polycystic liver disease (25 %) as compared with simple liver cysts (7.5 %). The current data in the literature show that the laparoscopic approach may be the treatment of choice in patients with symptomatic non-parasitic cysts of the liver, providing the short-term advantages of minimally invasive surgery. Recurrence rates were acceptable and comparable to those of conventional surgery. Long-term outcomes should be verified by additional randomised controlled trials and long-term follow-ups.

Pancreatic Resection in Patients 80 Years or Older: a Meta-analysis and Systematic Review

Pancreas. Nov, 2014  |  Pubmed ID: 25333405

The aim of this study was to evaluate the safety of pancreatic resections in patients 80 years or older.

The Usefulness of a Multidisciplinary Team Approach in Decision Making for Pancreatic Serous Cystic Neoplasms

JOP : Journal of the Pancreas. Nov, 2014  |  Pubmed ID: 25435573

Serous cystic neoplasms of the pancreas are regarded as benign entities with rare malignant potential and are frequently resected.

Interfacing Polymeric Scaffolds with Primary Pancreatic Ductal Adenocarcinoma Cells to Develop 3D Cancer Models

Biomatter. 2014  |  Pubmed ID: 25482337

We analyzed the interactions between human primary cells from pancreatic ductal adenocarcinoma (PDAC) and polymeric scaffolds to develop 3D cancer models useful for mimicking the biology of this tumor. Three scaffold types based on two biocompatible polymeric formulations, such as poly(vinyl alcohol)/gelatin (PVA/G) mixture and poly(ethylene oxide terephthalate)/poly(butylene terephthalate) (PEOT/PBT) copolymer, were obtained via different techniques, namely, emulsion and freeze-drying, compression molding followed by salt leaching, and electrospinning. In this way, primary PDAC cells interfaced with different pore topographies, such as sponge-like pores of different shape and size or nanofiber interspaces. The aim of this study was to investigate the influence played by the scaffold architecture over cancerous cell growth and function. In all scaffolds, primary PDAC cells showed good viability and synthesized tumor-specific metalloproteinases (MMPs) such as MMP-2, and MMP-9. However, only sponge-like pores, obtained via emulsion-based and salt leaching-based techniques allowed for an organized cellular aggregation very similar to the native PDAC morphological structure. Differently, these cell clusters were not observed on PEOT/PBT electrospun scaffolds. MMP-2 and MMP-9, as active enzymes, resulted to be increased in PVA/G and PEOT/PBT sponges, respectively. These findings suggested that spongy scaffolds supported the generation of pancreatic tumor models with enhanced aggressiveness. In conclusion, primary PDAC cells showed diverse behaviors while interacting with different scaffold types that can be potentially exploited to create stage-specific pancreatic cancer models likely to provide new knowledge on the modulation and drug susceptibility of MMPs.

Laparoscopic Distal Pancreatectomy: What Factors Are Related to the Learning Curve?

Surgery Today. Jan, 2015  |  Pubmed ID: 24610347

The factors related to the learning curve for laparoscopic distal pancreatectomy have rarely been evaluated.

Efficacy and Cost-effectiveness of Immediate Surgery Versus a Wait-and-see Strategy for Sporadic Nonfunctioning T1 Pancreatic Endocrine Neoplasms

Neuroendocrinology. 2015  |  Pubmed ID: 25228538

Whether patients with small (<2 cm), sporadic nonfunctioning pancreatic endocrine tumors (NF-PETs) should directly undergo pancreatic surgery or should be followed longitudinally to detect growth and malignancy still has to be defined.

Are There Preoperative Factors Related to a "soft Pancreas" and Are They Predictive of Pancreatic Fistulas After Pancreatic Resection?

Surgery Today. Jun, 2015  |  Pubmed ID: 25331230

Soft pancreatic parenchyma is the most widely recognized risk factor for pancreatic fistula. We conducted this study to clarify if there are preoperative factors related to a soft pancreatic remnant and to establish if they are useful for predicting pancreatic fistula.

Laparoscopic Versus Open Distal Pancreatectomy for Ductal Adenocarcinoma: a Systematic Review and Meta-analysis

Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract. Apr, 2015  |  Pubmed ID: 25560180

Laparoscopic distal pancreatectomy was proposed as an oncologically safe approach for pancreatic ductal adenocarcinoma.

Multiscale Fabrication of Biomimetic Scaffolds for Tympanic Membrane Tissue Engineering

Biofabrication. May, 2015  |  Pubmed ID: 25947357

The tympanic membrane (TM) is a thin tissue able to efficiently collect and transmit sound vibrations across the middle ear thanks to the particular orientation of its collagen fibers, radiate on one side and circular on the opposite side. Through the combination of advanced scaffolds and autologous cells, tissue engineering (TE) could offer valuable alternatives to autografting in major TM lesions. In this study, a multiscale approach based on electrospinning (ES) and additive manufacturing (AM) was investigated to fabricate scaffolds, based on FDA approved copolymers, resembling the anatomic features and collagen fiber arrangement of the human TM. A single scale TM scaffold was manufactured using a custom-made collector designed to confer a radial macro-arrangement to poly(lactic-co-glycolic acid) electrospun fibers during their deposition. Dual and triple scale scaffolds were fabricated combining conventional ES with AM to produce poly(ethylene oxide terephthalate)/poly(butylene terephthalate) block copolymer scaffolds with anatomic-like architecture. The processing parameters were optimized for each manufacturing method and copolymer. TM scaffolds were cultured in vitro with human mesenchymal stromal cells, which were viable, metabolically active and organized following the anisotropic character of the scaffolds. The highest viability, cell density and protein content were detected in dual and triple scale scaffolds. Our findings showed that these biomimetic micro-patterned substrates enabled cell disposal along architectural directions, thus appearing as promising substrates for developing functional TM replacements via TE.

Laparoscopic Distal Pancreatectomy in Benign or Premalignant Pancreatic Lesions: Is It Really More Cost-Effective Than Open Approach?

Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract. Aug, 2015  |  Pubmed ID: 26001367

Data regarding the quality of life in patients undergoing laparoscopic distal pancreatectomy are lacking and no studies have reported a real cost-effectiveness analysis of this surgical procedure. The aim of this study was to evaluate and compare the quality of life and the cost-effectiveness of a laparoscopic distal pancreatectomy with respect to an open distal pancreatectomy.

Portal/Superior Mesenteric Vein Reconstruction During Pancreatic Resection Using a Cryopreserved Arterial Homograft

Digestive Surgery. 2015  |  Pubmed ID: 26113314

Portal-superior mesenteric vein (PV/SMV) resection during pancreatic resection has been widely applied in clinical practice.

Neoadjuvant Chemoradiotherapy and Surgery Versus Surgery Alone in Resectable Pancreatic Cancer: A Single-Center Prospective, Randomized, Controlled Trial Which Failed to Achieve Accrual Targets

Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract. Oct, 2015  |  Pubmed ID: 26224039

The objective of the study is to evaluate the usefulness of neoadjuvant chemoradiotherapy in resectable pancreatic cancer.

Laparoscopic Appendectomy: Which Factors Are Predictors of Conversion? A High-volume Prospective Cohort Study

International Journal of Surgery (London, England). Sep, 2015  |  Pubmed ID: 26231996

Appendicitis represents one of the most frequent condition requiring surgery. In Italy almost 0.2% of the population will be affected by acute appendicitis every year. Laparoscopic appendectomy (LA) has gained acceptance over the past years and despite several meta-analyses, randomized studies and retrospective studies have been conducted, the indications and results are still conflicting especially in cases of complicated appendicitis. The aim of our study is to evaluate which factors are related to conversion to open appendectomy (OA) during laparoscopic appendectomy (LA).

Characterization of Pancreatic Ductal Adenocarcinoma Using Whole Transcriptome Sequencing and Copy Number Analysis by Single-nucleotide Polymorphism Array

Molecular Medicine Reports. Nov, 2015  |  Pubmed ID: 26397140

The aim of the current study was to implement whole transcriptome massively parallel sequencing (RNASeq) and copy number analysis to investigate the molecular biology of pancreatic ductal adenocarcinoma (PDAC). Samples from 16 patients with PDAC were collected by ultrasound‑guided biopsy or from surgical specimens for DNA and RNA extraction. All samples were analyzed by RNASeq performed at 75x2 base pairs on a HiScanSQ Illumina platform. Single‑nucleotide variants (SNVs) were detected with SNVMix and filtered on dbSNP, 1000 Genomes and Cosmic. Non‑synonymous SNVs were analyzed with SNPs&GO and PROVEAN. A total of 13 samples were analyzed by high resolution copy number analysis on an Affymetrix SNP array 6.0. RNAseq resulted in an average of 264 coding non‑synonymous novel SNVs (ranging from 146‑374) and 16 novel insertions or deletions (In/Dels) (ranging from 6‑24) for each sample, of which a mean of 11.2% were disease‑associated and somatic events, while 34.7% were frameshift somatic In/Dels. From this analysis, alterations in the known oncogenes associated with PDAC were observed, including Kirsten rat sarcoma viral oncogene homolog (KRAS) mutations (93.7%) and inactivation of cyclin‑dependent kinase inhibitor 2A (CDKN2A) (50%), mothers against decapentaplegic homolog 4 (SMAD4) (50%), and tumor protein 53 (TP53) (56%). One case that was negative for KRAS exhibited a G13D neuroblastoma RAS viral oncogene homolog mutation. In addition, gene fusions were detected in 10 samples for a total of 23 different intra‑ or inter‑chromosomal rearrangements, however, a recurrent fusion transcript remains to be identified. SNP arrays identified macroscopic and cryptic cytogenetic alterations in 85% of patients. Gains were observed in the chromosome arms 6p, 12p, 18q and 19q which contain KRAS, GATA binding protein 6, protein kinase B and cyclin D3. Deletions were identified on chromosome arms 1p, 9p, 6p, 18q, 10q, 15q, 17p, 21q and 19q which involve TP53, CDKN2A/B, SMAD4, runt‑related transcription factor 2, AT‑rich interactive domain‑containing protein 1A, phosphatase and tensin homolog and serine/threonine kinase 11. In conclusion, genetic alterations in PDCA were observed to involve numerous pathways including cell migration, transforming growth factor‑β signaling, apoptosis, cell proliferation and DNA damage repair. However, signaling alterations were not observed in all tumors and key mutations appeared to differ between PDAC cases.

Prognostic Value of 68Ga-DOTANOC PET/CT SUVmax in Patients with Neuroendocrine Tumors of the Pancreas

Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine. Dec, 2015  |  Pubmed ID: 26405169

This study was performed to investigate the role of (68)Ga-DOTANOC SUVmax as a potential prognostic factor in patients with pancreatic neuroendocrine tumor (pNET).

Is Age a Barrier to Pancreaticoduodenectomy? An Italian Dual-institution Study

Updates in Surgery. Dec, 2015  |  Pubmed ID: 26614575

The aim of this study is to evaluate the role of age after pancreaticoduodenectomy. This is a retrospective study of 223 patients who underwent pancreaticoduodenectomy for periampullary diseases. Three age groups of patients were compared: ≤70 years of age (group A); between 71 and 79 years of age (group B) and 80 years of age or older (group C). The primary endpoint was the postoperative mortality rate. Secondary endpoints were the overall postoperative morbidity, postoperative pancreatic fistula, postoperative pancreatic haemorrhage, bile leakage, delayed gastric emptying rates, the length of hospital stay, intensive care unit stay, the type of discharge from hospital, reoperation rate and overall survival. Uni-multivariate analyses and Kaplan-Meier curve were carried out. At univariate analysis, only the type of discharge from hospital showed that group B and C patients required a period of rehabilitation more frequently than group A (P = 0.047 and P < 0.001, respectively). Multivariate analysis confirmed that age was not related to postoperative mortality (P = 0.258), morbidity (P = 0.912) and overall survival (P = 0.658), but it was related to type of discharge (P < 0.001). The present study seems to suggest that a pancreaticoduodenectomy is a feasible and safe procedure, even in elderly and very elderly patients even if the latter require a longer period of rehabilitation.

State of the Art Biological Therapies in Pancreatic Cancer

World Journal of Gastrointestinal Oncology. Jan, 2016  |  Pubmed ID: 26798437

Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal malignancies with a five-year survival rate of approximately 5%. Several target agents have been tested in PDAC, but almost all have failed to demonstrate efficacy in late phase clinical trials, despite the better understanding of PDAC molecular biology generated by large cancer sequencing initiatives in the past decade. Eroltinib (a small-molecule tyrosine-kinase inhibitor of epidermal growth factor receptor) plus gemcitabine is the only schedule with a biological agent approved for advanced pancreatic cancer, but it has resulted in a very modest survival benefit in unselected patients. In our work, we report a summary of the main clinical trials (closed and ongoing) that refer to biological therapy evaluation in pancreatic cancer treatment.

Validation of the 2010 WHO Classification and a New Prognostic Proposal: A Single Centre Retrospective Study of Well-differentiated Pancreatic Neuroendocrine Tumours

Pancreatology : Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]. May-Jun, 2016  |  Pubmed ID: 26924664

In 2010, the World Health Organization (WHO) modified the classification for pancreatic neuroendocrine tumours (NETs). Recently, some modifications were proposed to improve its prognostic value. The aim of this study was to test the prognostic value of both the original and the modified 2010 WHO grading systems.

Is Total Pancreatectomy As Feasible, Safe, Efficacious, and Cost-effective As Pancreaticoduodenectomy? A Single Center, Prospective, Observational Study

Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract. Sep, 2016  |  Pubmed ID: 27418262

Total pancreatectomy is actually considered a viable option in selected patients even if large comparative studies between partial versus total pancreatectomy are not currently available. Our aim was to evaluate whether total pancreatectomy can be considered as feasible, safe, efficacious, and cost-effective as pancreaticoduodenectomy.

Copy Number Gain of Chromosome 3q is a Recurrent Event in Patients with Intraductal Papillary Mucinous Neoplasm (IPMN) Associated with Disease Progression

Oncotarget. Aug, 2016  |  Pubmed ID: 27566563

Intraductal papillary mucinous neoplasm (IPMN) is the most common cystic preneoplastic lesion of pancreatic cancer. We used an approach coupling high resolution cytogenetic analysis (Affymetrix Oncoscan FFPE Array) with clinically-oriented bioinformatic interpretation of data to understand the most relevant alterations of precursor lesions at different stages to identify new diagnostic markers.

Risk Factors of Type 1 Gastric Neuroendocrine Neoplasia in Patients with Chronic Atrophic Gastritis. A Retrospective, Multicentre Study

Endocrine. Sep, 2016  |  Pubmed ID: 27592118

The aim of this retrospective study was to evaluate the presence of risk factors for a type 1 gastric neuroendocrine neoplasia in a large cohort of patients with chronic atrophic gastritis. The study design consisted of an Italian multicentre, retrospective analysis. The study included all consecutive patients with chronic atrophic gastritis with or without type 1 gastric neuroendocrine neoplasias followed at the participating centres. Two hundred and twenty-nine patients with chronic atrophic gastritis were enroled at the participating centres. A total of 207 patients (154 female, 53 males, median age: 56.0 years) were included in the final analysis. One hundred and twenty-six patients had chronic atrophic gastritis without a gastric neuroendocrine neoplasia and 81 had a chronic atrophic gastritis with type 1 gastric neuroendocrine neoplasia. The median Chromogranin A level, evaluated in 141 patients, was 52.0 U/L. At upper gastrointestinal endoscopy, atrophy of the gastric mucosa was mild/moderate in 137 patients and severe in 68. Intestinal metaplasia of the corpus was present in 168 patients. At histological examination, 81 patients had a gastric neuroendocrine neoplasia (42 patients had a NET G1 and 33 a NET G2). The median Ki67 index was 2.0 %. At univariate and multivariate analysis, the risk factors for a gastric neuroendocrine neoplasia were: male gender, chromogranin A greater than 61 U/L, presence of intestinal metaplasia and age equal to or greater than 59 years. Chromogranin A greater than 61 U/L, the presence of intestinal metaplasia and male gender were independent risk factors for a type 1 gastric neuroendocrine neoplasia in patients with chronic atrophic gastritis.

A Critical and Comprehensive Systematic Review and Meta-analysis of Studies Comparing Intracorporeal and Extracorporeal Anastomosis in Laparoscopic Right Hemicolectomy

Langenbeck's Archives of Surgery. Sep, 2016  |  Pubmed ID: 27595589

Two main techniques are commonly used during laparoscopic right hemicolectomy in order to perform the ileocolic anastomosis: intracorporeal (IA) and extracorporeal (EA). The aim of this study was to evaluate the safety of the two techniques.

Laparoscopic Distal Pancreatectomy: Many Meta-analyses, Few Certainties

Updates in Surgery. Sep, 2016  |  Pubmed ID: 27605207

In recent years, an increasing of the level of evidence occurred with a significant number of meta-analyses. A question remains open: can LDP be considered the "new gold standard" for benign and malignant body-tail pancreatic disease? A systematic literature search was conducted to identify all meta-analyses published up to 2016. The primary endpoint was to evaluate the clinical safety of LDP. The secondary endpoints were to evaluate: the length of hospital stay (LOS), readmission rate, postoperative pancreatic fistula (POPF), overall postoperative morbidity and oncologic safety. Nine studies were found to be suitable for the analysis. Data regarding clinical safety were extractable in all meta-analyses but a "between study" homogeneity was available only in 7. The safety of LDP was sustained by six meta-analyses in benign/low grade of malignancy body-tail pancreatic lesions, by one in ductal adenocarcinoma (PDAC). LDP has a shorter LOS compared to open distal pancreatectomy (ODP), demonstrated by three meta-analyses. Readmission rate in LDP procedures was lower than in ODP; these data are sustained by one meta-analysis. LDP is not inferior to ODP regarding the occurrence of POPF (seven meta-analyses); overall morbidity rate was lower in LDP than ODP for benign or low-grade malignant tumor. The use of the LDP in PDAC is sustained from one study. In conclusion, LDP can be considered a safe alternative to ODP. LDP could have some advantages but the data do not permit to define this procedure as the first choice or as the new gold standard.

Pre-operative Diagnosis of Pancreatic Neuroendocrine Tumors with Endoscopic Ultrasonography and Computed Tomography in a Large Series

Journal of Gastrointestinal and Liver Diseases : JGLD. Sep, 2016  |  Pubmed ID: 27689195

Diagnosis of pancreatic neuroendocrine tumors (p-NETs) is frequently challenging. We describe a large series of patients with p-NETs in whom both pre-operative Computed Tomography (CT) and Endoscopic Ultrasonography (EUS) were performed.

Risk Factors for Malignancy of Branch-Duct Intraductal Papillary Mucinous Neoplasms: A Critical Evaluation of the Fukuoka Guidelines With a Systematic Review and Meta-analysis

Pancreas. Oct, 2016  |  Pubmed ID: 27776043

This study aimed to evaluate the accuracy of the risk factors proposed by Fukuoka guidelines in detecting malignancy of branch-duct intraductal papillary mucinous neoplasms.

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