Publications by authors named "Francesco Andreoli"

17 Publications

  • Page 1 of 1

Outcome of Endovascular Repair of Popliteal Artery Aneurysms using the Supera Stent.

J Vasc Interv Radiol 2021 02;32(2):173-180

Ospedale Civile S. Agostino-Estense, Azienda Ospedaliero- Universitaria di Modena, University of Modena and Reggio Emilia, Via Giardini, 1355, 41100 Baggiovara, Modena, Italy.

Purpose: To evaluate the efficacy of endovascular repair of popliteal artery aneurysms (PAAs) with a wire-interwoven nitinol stent.

Materials And Methods: This is a prospective, descriptive, and analytical study. From January 2016 to December 2018, 28 consecutive patients (29 lower limbs) were treated for a PAA with the deployment of the Supera stent (Abbott Vascular, Illinois). Twenty-three (79.3%) PAAs were asymptomatic; 6 (20.7%) presented with symptoms. The mean diameter and length of the aneurysm were 26.8 mm (20-40 mm) and 47.1 mm (23-145 mm) respectively. The primary endpoint was the prevention of embolic symptoms. The secondary endpoints were aneurysm exclusion, aneurysm diameter decrease, freedom from reintervention, and preservation of preoperative runoff vessels.

Results: Technical success was 100%, with a median of 2.4 run-off vessels at completion angiography, without any loss of run-off vessels. A double Supera stent was deployed in 10 cases. At completion angiography, a median of 2.4 runoff vessels were present, without any loss of runoff vessels. The mean follow-up time was 24.3 (12-35) months. Primary endpoints were reached in 100% of the cases and vessels run off was preserved in all cases. In 2 PAAs, complete sac thrombosis was witnessed at 6-month follow-up, while at 12-month follow-up, it was seen in 10 of 29 (34.4%) limbs. In all the other cases the diameter of the aneurysm remained stable, with a freedom from sac enlargement of 100%. No fractures or stent thromboses were detected.

Conclusions: For endovascular repair of PAAs, the use of a thick interwoven-wire stent, that could work like a multilayer flow modulator showed encouraging mid-term results with no cases of stent fracture, occlusion or aneurysm increase.
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http://dx.doi.org/10.1016/j.jvir.2020.11.003DOI Listing
February 2021

Unibody bifurcated aortic endograft: device description, review of the literature and future perspectives.

Future Cardiol 2020 Nov 23. Epub 2020 Nov 23.

Vascular & Endovascular Surgery Unit, Department of Surgery Paride Stefanini, Policlinico Umberto I of Rome, Sapienza University of Rome, Rome, Italy.

The unibody (Powerlink/AFX/AFX2) Endovascular AAA device (Endologix Inc., CA, USA) presents a unique design with its long main body and two innate limbs. The device is designed to be deployed and sits on the native aortoiliac bifurcation and represents the only one-piece bifurcated endograft designed to use anatomical fixation for endograft stabilization. According to published literature, the unibody device seems to represent a valid choice in the treatment of abdominal aortic aneurysms. This particular device would seem to satisfactorily perform even in the treatment of more compressed aneurysms (also in off-label association with parallel grafts) and in occlusive pathologies. Ongoing studies will provide new real-life data in a large and unselected patient population to better understand the device's advantages and limitations.
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http://dx.doi.org/10.2217/fca-2020-0119DOI Listing
November 2020

Unibody Endograft Using AFX 2 for Less Invasive and Faster Endovascular Aortic Repair: Protocol for a Multicenter Nonrandomized Study.

JMIR Res Protoc 2020 04 6;9(4):e16959. Epub 2020 Apr 6.

See Acknowledgments section for collaborators/group members.

Background: Since the introduction of endovascular aortic repair (EVAR) for treatment of abdominal aortic aneurysms (AAAs), progressive improvements in results have been achieved. However, conventional bifurcated stent grafts have been proven to have a nonnegligible risk of failure and secondary intervention, principally due to the lack of adequate proximal sealing. The unique AFX 2 Endovascular AAA System (Endologix, Irvine, CA) unibody device, which provides different sealing and fixation features compared with conventional devices, seems to overcome these limitations.

Objective: The aim of this study is to evaluate intraoperative, perioperative, and postoperative results in patients treated with the AFX 2 Endovascular AAA System endografts for elective AAA repair in a large cohort of consecutive patients.

Methods: All eligible EVAR patients will be included in this observational, multicenter, prospective, nonrandomized study. The number of patients to be enrolled is 500.

Results: The primary endpoint of the study is to evaluate the technical and clinical success of EVAR with unibody endografts in short- (90-day), mid- (1-year), and long-term (5-year) follow-up periods. The following secondary endpoints will also be addressed: operative time, intraoperative radiation exposure, contrast medium usage, AAA sac shrinkage at 12-month and 5-year follow-up, and any potential role of patients' baseline characteristics and device configuration on primary endpoint. The actual start date of the investigation was November 2019. The final patient is expected to be treated by the end of December 2020, and the estimated study completion date is December 2025.

Conclusions: This study will provide verified real-world data on AAAs treated by AFX 2 endografts and followed for a long-term interval.

International Registered Report Identifier (irrid): PRR1-10.2196/16959.
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http://dx.doi.org/10.2196/16959DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7171559PMC
April 2020

Influence of Thoracic Endovascular Repair on Aortic Morphology in Patients Treated for Blunt Traumatic Aortic Injuries: Long Term Outcomes in a Multicentre Study.

Eur J Vasc Endovasc Surg 2020 Mar 3;59(3):428-436. Epub 2020 Jan 3.

Department of Vascular Surgery, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Modena, Italy.

Objective: The aim of this study was to evaluate aortic remodelling and associated complications in patients treated by thoracic endovascular aneurysm repair (TEVAR) for blunt traumatic aortic injuries (BTAI).

Methods: This was a retrospective, observational, multicentre study. Remodelling was considered as aortic diameter variations of >2 mm and distal graft and aortic axis angle modification measured by computed tomography angiography (CTA). The predefined levels of measurement were the proximal end of the graft (D1: landing in zone [LZ] 2; D2: LZ 3); distal end (D3); and control measurement (D4) 15 mm beyond D3. Survival, procedure, graft, and/or radiation exposure related complications were registered. CTA was required within three months and at one, six, and 10 years post-operatively.

Results: Between 2004 and 2017 52 patients were treated; 47 were included for remodelling analysis (five immediate deaths were excluded); median age was 47 years (range 20-80 years). Mean TEVAR oversizing was 19.6% ± 9.7% (range 5%-35%). Following a median follow up of 67.4 ± 56.1 months (range 14-153 months) survival at one, three, six, and 10 years was 90.4% (standard error [SE] 4.1%), 88.3% (SE 4.5%) 84.8% (SE 5.5%), and 84.8% (SE 5.5%), respectively. There were no procedure/graft related complications except for one late intramural haematoma that required re-intervention. Freedom from aortic remodelling at one, six, and 10 years was 85.1% (SE 5.2%), 30.9% (SE 8.6%), and 24.7% (SE 8.8%), respectively. The increase in D1/D2 and D3 diameters were influenced by time from intervention (both p < .001), age (p < .001 and p = .002, respectively) and sealing in zone 2 (p = .027 and p = .042, respectively). For every 10% increase in oversizing, proximal neck diameter remodelling was 3.4% (p = .05). The distal axis decreased over time (p < .001; significant between three and six years).

Conclusion: TEVAR is safe for BTAI in the mid to long term. This study reports a correlation between time, oversizing, and remodelling, but the level of adverse events was low.
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http://dx.doi.org/10.1016/j.ejvs.2019.05.008DOI Listing
March 2020

Twenty years outcomes in a single center experience after endovascular aneurysm repair with unibody endograft and anatomical fixation.

J Cardiovasc Surg (Torino) 2020 Dec 18;61(6):720-728. Epub 2019 Nov 18.

Department of Vascular Surgery, S. Agostino-Estense Civil Hospital, University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy.

Background: To assess the long-term safety and effectiveness of endovascular aneurysm repair (EVAR) treatment with unibody endograft deployed on aortic bifurcation (anatomical fixation).

Methods: A retrospective, observational, single-center study of patients treated from 1999 to 2002 with unibody bifurcated endograft. Follow-up protocol required clinical and doppler-ultrasound at 1 and 6 months and annually thereafter, computed tomography angiography at 1-, 6- and 12-months and then every year. Primary endpoints included technical and treatment success, survival and freedom from late EVAR failure; secondary endpoints were freedom from late open conversion (LOC), freedom from late re-interventions and endoleaks.

Results: Seventy-three patients, mean age of 73±6 years were enrolled. Median follow-up was 6±0.5 years. Technical success was 98.6% (N.=71/73; causes of failure: 1 open conversion and 1 type Ib endoleak). A treatment success of 96% (N.=69/72) was recorded due to endoleaks (N.=2; 1 type Ia and 1 type Ib) and limb occlusion (N.=1). Survival at 1, 5, 10, 15 and 18 years was 90%, 58%, 40%, 32% and 23% respectively. One aneurysm-related death for infection of the endograft was registered. EVAR failure was 14% (N.=10/71). Three LOC were recorded and freedom from reinterventions at 1, 5, 10 and 18 years was 99%, 91%, 86% and 86%. Fourteen endoleaks were recorded: Ia (N.=6; 42.8%), Ia+Ib (N.=1; 7.1%), Ib (N.=2; 14.2%) and II (N.=5; 35.6%). Four endoleaks were observed, 9 endovascular correction and 1 LOC were required. Endoleaks free survival of 90% at 1-year and 75% at the end of the study. Aneurysm sac shrinkage was observed in 79% (N.=56/71).

Conclusions: This small, retrospective cohort of anatomically fixed EVAR demonstrated long-term safety and effectiveness. The design of the unibody graft did not substantially change and newer generation should guarantee the same performance.
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http://dx.doi.org/10.23736/S0021-9509.19.11076-2DOI Listing
December 2020

Early Experience with the Covera Stent Graft as a Bridging Stent in Branched Thoraco-Abdominal Endovascular Aneurysm Repairs.

J Vasc Interv Radiol 2019 Dec 24;30(12):1949-1955. Epub 2019 Oct 24.

Department of Vascular Surgery Ospedale Civile S. Agostino-Estense, Azienda Ospedaliero- Universitaria di Modena, University of Modena and Reggio Emilia, Via Giardini, 1355, 41100 Baggiovara, Modena, Italy.

Purpose: To evaluate the Covera Plus (Bard, Tempe, Arizona) covered stent as a bridging stent in branched thoraco-abdominal endovascular aneurysm repair (BEVAR).

Materials And Methods: Retrospective analysis of 112 self-expandable stents was performed at 2 university centers between August 2017 and March 2019. Thirty-one consecutive BEVAR procedures were studied (21 males; mean age, 75 years; 29 American Society of Anesthesiologists grade III/IV) with 119 patent target vessels (7 did not receive the studied device). Primary endpoints were technical success, branch instability, and primary/secondary clinical success. Secondary endpoints included primary/secondary patency and any adverse events.

Results: Technical success was 100%. Median follow-up was 12 months (interquartile range, 6-14 months). Branch instability was registered twice (2/112), due to immediate renal occlusion and type Ic endoleak; no additional events occurred during the follow-up. Primary clinical success was 84%. There were 2 immediate deaths, 1 upper limb ischemia, 1 hemorrhage from splenic artery, and 1 type Ic endoleak; these last 3 events were successfully treated, with a secondary clinical success of 100% that was maintained during the follow-up. One late death occurred. Primary patency was 99% (111/112) and 100% (105/105) within 30 days and at the end of the study period,respectively. Adverse events included 4 acute kidney injuries and 2 spinal cord ischemia. No type I/III endoleaks, occlusion, fracture, or dislodging were diagnosed after 30 days.

Conclusions: The stent graft seems safe and effective for bridging in BEVAR with low branch instability and high patency rate. Longer follow-up is required to confirm these promising results.
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http://dx.doi.org/10.1016/j.jvir.2019.08.006DOI Listing
December 2019

Application of the EU-SILC 2011 data module "intergenerational transmission of disadvantage" to robust analysis of inequality of opportunity.

Data Brief 2019 Aug 23;25:104301. Epub 2019 Jul 23.

Luxembourg Institute of Socio-Economic Research - LISER, 10 Porte des Sciences, L-4366, Esch-sur-Alzette, Luxembourg.

This data article describes the original data, the sample selection process and the variables used in Andreoli and Fusco (Andreoli and Fusco, 2019) to estimate gap curves for a sample of European countries. Raw data are from 2011 roaster of EU-SILC, cross-sectional sample of module "intergenerational transmission of disadvantage". This article reports descriptive statistics of the using sample. It also discusses the algorithm adopted to estimate the main effects and details the content of additional Stata files stored on the online repository. These additional files contain raw estimates from bootstrapped samples, which form the basis for estimating gap curves and their variance-covariance matrices. The data article also reports representations of gap curves for all 16 selected countries.
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http://dx.doi.org/10.1016/j.dib.2019.104301DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6685694PMC
August 2019

Experimental Study of Nonclassical Teleportation Beyond Average Fidelity.

Phys Rev Lett 2018 Oct;121(14):140501

Dipartimento di Fisica-Sapienza Università di Roma, Piazzale Aldo Moro 5, I-00185 Roma, Italy.

Quantum teleportation establishes a correspondence between an entangled state shared by two separate parties that can communicate classically and the presence of a quantum channel connecting the two parties. The standard benchmark for quantum teleportation, based on the average fidelity between the input and output states, indicates that some entangled states do not lead to channels which can be certified to be quantum. It was recently shown that if one considers a finer-grained witness, then all entangled states can be certified to produce a nonclassical teleportation channel. Here we experimentally demonstrate a complete characterization of a new family of such witnesses, of the type proposed in Phys. Rev. Lett. 119, 110501 (2017)PRLTAO0031-900710.1103/PhysRevLett.119.110501 under different conditions of noise. We report nonclassical teleportation using quantum states that cannot achieve average fidelity of teleportation above the classical limit. We further use the violation of these witnesses to estimate the negativity of the shared state. Our results have fundamental implications in quantum information protocols and may also lead to new applications and quality certification of quantum technologies.
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http://dx.doi.org/10.1103/PhysRevLett.121.140501DOI Listing
October 2018

Endovascular aneurysm sealing with the Nellix endograft in hemodynamically-unstable ruptured abdominal aortic aneurysm with challenging anatomy.

J Cardiovasc Surg (Torino) 2019 Dec 28;60(6):708-717. Epub 2018 Aug 28.

Department of Vascular Surgery, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Modena, Italy.

Background: To assess immediate and midterm outcomes of hemodynamically-unstable patients with ruptured abdominal aortic aneurysm (rAAA) treated with the Nellix endovascular sealing system (EVAS).

Methods: From June 2014 to June 2017, 21 hemodynamically-unstable rAAA patients with challenging anatomies were treated with EVAS. The mean AAA diameter and neck length measured 73±15 mm and 14±10 mm, respectively. All the patients presented an advance trauma life support (ATLS) hemorrhage class ≥1 confirming a compromised hemodynamic status. Primary endpoints include technical success, treatment success, primary safety and 30-day survival. Secondary endpoints include re-intervention rate and time free-from-reintervention.

Results: Technical success was achieved in 95% (N.=20/21); one patient was converted intraoperatively to open surgery due to ongoing hemorrhage. Seven re-interventions were performed within 30-days and one during the follow-up; treatment success rate of 67% and re-intervention rate of 33%. Early endoleaks were diagnosed in 5 patients (24%). Primary safety was 52%. After a mean follow-up of 11±10 months, survival rates were 81%, 62% and 57% at 1, 6 and 12 months, respectively. Time free-from-reintervention was 15±11 months.

Conclusions: Emergency-EVAS (eEVAS) appeared feasible and useful, especially in hemodynamically-unstable patients with challenging anatomies. There are some limitations in this cohort study and larger, prospective and comparative studies are required to confirm eEVAS as part of an emergency treatment protocol for rAAA.
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http://dx.doi.org/10.23736/S0021-9509.18.10397-1DOI Listing
December 2019

Inequality in old age cognition across the world.

Econ Hum Biol 2018 05 22;29:179-188. Epub 2018 Mar 22.

University of Luxembourg, Institute for Socio-Economic Research (IRSEI), Belval, Luxembourg. Electronic address:

Although cohort and country differences in average cognitive levels are well established, identifying the degree and determinants of inequalities in old age cognitive functioning could guide public health and policymaking efforts. We use all publicly available and representative old age surveys with comparable information to assess inequalities of cognitive functioning for six distinctive age groups in 29 countries. We document that cognitive inequalities in old age are largely determined by earlier educational inequalities as well as gender differential survival rates. For example, a one percentage point increase in the Gini index of past education is associated with an increase of 0.45 percentage points in the Gini index of delayed recall and 0.23 percentage points in the Gini of immediate recall. Results are robust to a variety of alternative explanations and persist even after controlling for gender-related biases in survival rates. Furthermore, we find evidence that unequal opportunities for education -captured by differences in parental background and gender- also have significant effects on inequality of old age cognition.
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http://dx.doi.org/10.1016/j.ehb.2018.03.002DOI Listing
May 2018

Experimental violation of local causality in a quantum network.

Nat Commun 2017 03 16;8:14775. Epub 2017 Mar 16.

Dipartimento di Fisica - Sapienza Università di Roma, P.le Aldo Moro 5, I-00185 Roma, Italy.

Bell's theorem plays a crucial role in quantum information processing and thus several experimental investigations of Bell inequalities violations have been carried out over the years. Despite their fundamental relevance, however, previous experiments did not consider an ingredient of relevance for quantum networks: the fact that correlations between distant parties are mediated by several, typically independent sources. Here, using a photonic setup, we investigate a quantum network consisting of three spatially separated nodes whose correlations are mediated by two distinct sources. This scenario allows for the emergence of the so-called non-bilocal correlations, incompatible with any local model involving two independent hidden variables. We experimentally witness the emergence of this kind of quantum correlations by violating a Bell-like inequality under the fair-sampling assumption. Our results provide a proof-of-principle experiment of generalizations of Bell's theorem for networks, which could represent a potential resource for quantum communication protocols.
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http://dx.doi.org/10.1038/ncomms14775DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5356073PMC
March 2017

Laparoscopic treatment of stone recurrence in a gallbladder remnant: report of an additional case and literature review.

J Gastrointest Surg 2009 Nov 5;13(11):2084-91. Epub 2009 May 5.

Department of Medical and Surgical Critical Care, Section Surgery, Florence University, Policlinico di Careggi, Viale Morgagni 85, Florence, Italy.

Cholecystectomy is an effective treatment of gallstones. Nevertheless, recurrence of biliary symptoms following cholecystectomy, either laparotomic or laparoscopic, is quite common. Causes are either biliary or extrabiliary. Symptoms of biliary origin chiefly depend on bile duct residual stones or strictures. Rarely, they depend on stone recurrence in a gallbladder remnant. Diagnosis of gallstone recurrence in gallbladder remnant is difficult, mainly arising from ultrasonography, computed tomography, magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography.Incomplete gallbladder removal may be either voluntary or inadvertent: in the first case, it is performed to remove gallstones without dissecting a difficult Calot's triangle or an excessively bleeding posterior wall of gallbladder caused by liver cirrhosis. Available data do not support the hypothesis that laparoscopic cholecystectomy entails an increased incidence of this condition, in spite of some opposite opinions. Treatment of lithiasis in gallbladder remnants is chiefly surgical. Although technically demanding, completion cholecystectomy can be safely performed in a laparoscopic way. We report a case of stone relapse in a gallbladder remnant, discovered 16 years following laparoscopic cholecystectomy and successfully treated by laparoscopic completion cholecystectomy. We furthermore review literature data in order to ascertain whether recent large diffusion of laparoscopic surgery causes an increase of such cases.
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http://dx.doi.org/10.1007/s11605-009-0913-8DOI Listing
November 2009

Failure of gastric bypass following several gastrointestinal hemorrhages.

Obes Surg 2010 Apr 19;20(4):523-5. Epub 2008 Jul 19.

Fondazione Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena IRCCS, Università di Milano, Milan, Italy.

Gastrointestinal hemorrhage is an infrequent major complication of gastric bypass. We present a 22-year-old morbidly obese man who underwent a laparoscopic Roux-en-Y gastric bypass and had several life-threatening hemorrhages from both the gastric pouch and gastric remnant, associated with an intra-abdominal hemorrhage. The patient underwent two subsequent reoperations, leading eventually to gastrectomy. The possibility to discover all the sources of bleeding after gastric bypass is discussed, and the adoption of a modification of the procedure that allows the investigation of the excluded stomach is suggested.
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http://dx.doi.org/10.1007/s11695-008-9629-1DOI Listing
April 2010

Multispectral imaging autofluorescence microscopy in colonic and gastric cancer metastatic lymph nodes.

Clin Gastroenterol Hepatol 2007 Feb;5(2):230-6

Department of Critical Medicine and Surgery, University of Florence, Florence, Italy.

Background & Aims: The lymphadenectomy and extended lymphadenectomy procedures have been points of controversy in surgical oncology. The methods available for the detection of metastatic lymph nodes are numerous. These include lymphoscintigraphy and radiolabeled antibody detection, but in most cancers the currently used technique is sentinel lymph node identification, performed primarily through the use of immunohistochemistry. We propose the application of autofluorescence (AF)-based techniques for lymph node evaluation in colorectal and gastric tumors.

Methods: We studied 30 clinical cases: 15 colorectal cancers and 15 gastric cancers. All of the patients were in the advanced stages of the disease and were candidates for adjuvant therapy. Autofluorescence microspectroscopy and multispectral imaging autofluorescence microscopy have been used to analyze the AF emission of metastatic lymph node sections, excited with 365-nm wavelength radiation. The AF spectra were recorded in the range of 400-700 nm. Monochrome AF images were acquired sequentially through interference filters peaked at 450, 550, and 650 nm, and then combined together in a single red-green-blue image. The AF pattern and the emission spectrum of metastatic lymph nodes have unique characteristics that can be used to distinguish them from the normal ones.

Results: The results, compared with standard histopathologic procedures and with specific staining methods, supplied a satisfactory validation of the proposed technique, revealing the possibility of improving the actual diagnostic procedures for malignant lymph node alterations.

Conclusions: With the development of appropriate instrumentation, the proposed technique could be particularly suitable in intrasurgical diagnosis of metastatic lymph nodes.
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http://dx.doi.org/10.1016/j.cgh.2006.11.013DOI Listing
February 2007

["Tension-free" hernioplasty with prosthesis: comparison of 2 techniques].

Chir Ital 2002 Nov-Dec;54(6):819-27

Clinica Chirurgica II Dipartimento di Area Critica Medico Chirurgica Università degli Studi di Firenze.

The paper evaluates the results of the surgical therapy of primary inguinal hernia in adult subjects performed in our Institution from 1994 to 2000. The Trabucco and Lichtenstein procedures were compared. Two hundred and fifteen patients--123 Trabucco and 92 Lichtenstein--were enrolled in the study. A file was created for each patient with details of personal data, procedures, anaesthesia and postoperative course. A form regarding the present state of each patient was filled in, mainly by phone, but sometimes by physical examination, if patients complained of problems. The results were evaluated statistically using the Fisher f and X2 tests. Only four parameters showed significant differences: wound swelling, constipation and days off work were less frequent with the Trabucco procedure, while there was less loss of the foreign body sensation in the Lichtenstein patients (6.7% vs. 18.3%). No recurrences were detected. The results of the two procedures can be considered comparable.
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September 2003

Peripheral paraneoplastic neuropathy, an uncommon clinical onset of sigmoid cancer. Case report and review of the literature.

Tumori 2002 Jul-Aug;88(4):347-9

Department of Critical Medicine and Surgery, University of Florence, Italy.

A case of a 76-year-old man presenting with weakness of the lower legs and bilateral steppage gait is described. Neurological examination revealed a sensorimotor neuropathy with axonopathy and myelinic aspects. At the time of the diagnostic workup an episode of rectal bleeding occurred. Colonoscopy demonstrated an exophytic cancer of the sigmoid colon at 40 cm from the anal verge. At surgery the tumor adhered to the ileum, so a left hemicolectomy and ileo-ileal resection were performed. Tumor stage was Dukes' B, Jass III, Astler-Coller B2, T3N0M0. The patient underwent postoperative chemotherapy and was followed for the past three years. At present he is free of disease and the neuropathy has completely regressed without any dedicated therapy. As reported in the literature the appearance of a paraneoplastic neurological syndrome (PNS) may be the first sign of a malignancy that is occult at the time of clinical presentation. The most widely supported theory about its etiology is that of an autoimmune origin. The paraneoplastic neurological syndrome is considered to be at a point of intersection between tumor immunology, autoimmune neurological disease, and basic neurobiology. Previous experience has resulted in a pathogenic model and in a definition of a group of autoantibodies related to the disease. Small cell lung cancer (SCLC) is the neoplasm most frequently associated with PNS; other malignancies include lymphomas and various hematological malignancies. Some authors reported also that the percentage of patients with a high titer of neuronal autoantibodies is small and several of the autoantibodies are present at low levels without any accompanying clinical manifestation. In a clinical retrospective study of the Mayo Clinic Group 115,081 patients were examined over the period 1984-1993 and only 58 patients (0.05%) could be defined as being affected by a paraneoplastic neurological syndrome. Only five of these patients had colon tumors. The number of patients is so small and so widely scattered among publications that no statistical analysis is possible. Probably the only possibility for early identification of such a syndrome is a high degree of suspicion. In fact, these patients are usually first admitted and studied in a neurological unit, and the diagnosis of a tumor-associated disease is a delayed event.
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November 2002