Publications by authors named "Giuseppinella Melita"

19 Publications

  • Page 1 of 1

Expression of VAChT and 5-HT in Ulcerative colitis dendritic cells.

Acta Histochem 2021 May 30;123(4):151715. Epub 2021 Apr 30.

Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Messina, Italy.

Ulcerative colitis is a chronic inflammatory condition of the gastrointestinal tract that can affect people of worldwide. In contrast with Crohn's disease, that can relate the entire thickness of the bowel wall, the inflammation of ulcerative colitis is limited to the colonic mucosa. Immune cells including activated T cells, plasma cells, mast cells, macrophages, and dendritic cells (DCs) trigger the inflammation. Furthermore, dendritic cells are antigen presenting cells involved in maintaining intestinal immune homeostasis. It has been described an increment of number in DCs colonic mucosa of patients with ulcerative colitis. The immune cells such as antigen-presenting cells can act as autocrine or paracrine modulators. Recent studies showed that dendritic cells synthetized and released classical neurotransmitters as glutamate, dopamine, acetylcholine, and serotonin. Paraformaldehyde-fixed intestinal tissues, obtained from the stricture sites of ten patients with ulcerative colitis were analyzed by immunostaining for Langerin/CD207, serotonin and vesicular acetylcholine transporter. As controls, unaffected (normal) portions of five patients were also investigated. Aim of this study was to characterize for the first time the human gut dendritic cells of ulcerative colitis patients, with Langerin/CD207 that is a c-type lectin expressed by different types of DCs and to colocalize in the same cells the expression of serotonin and vesicular acetylcholine transporter, showing the link between dendritic cells, gut enterochromaffin cells or autonomic nerves in immune activation and generation of intestinal inflammation.
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http://dx.doi.org/10.1016/j.acthis.2021.151715DOI Listing
May 2021

The management of colonic polyps in children: a 13-year retrospective study.

Eur J Pediatr 2021 Jul 16;180(7):2281-2286. Epub 2021 Mar 16.

Division of Digestive Endoscopy, University of Messina, Messina, Italy.

The aim of this study was to describe the frequency, major symptoms, and characteristics of colonic polyps in a cohort of children. A retrospective chart review of patients aged ≤ 18 years who were diagnosed with colonic polyp(s) from 2006 to 2019 in a tertiary hospital was included. Data collected included demographics, clinical presentation, interval of time between the onset of symptoms and the endoscopic diagnosis of colonic polyps, family history, characteristics of the polyp, and associated lesions. Over the study period, 35 Caucasian children were diagnosed with juvenile colonic polyps. Twenty-three patients (65.7%) were males. Lower gastrointestinal bleeding of a mean duration of 5.3 ± 4.9 months was the presenting symptom in nearly all cases (n = 34, 97%), and it was isolated in 17 patients. Clinical presentation did not significantly vary according to the age or the location or size of the polyp (p = 0.262, p = 1.000, and p = 0.149, respectively). The polyps were mainly located in the left colon (n = 29, 83%). Right colonic polyps were significantly larger than left colonic polyps (p = 0.037).Conclusion: Lower gastrointestinal bleeding represents the most common presentation of colonic polyps in children. Right-sided colonic polyps occur and may be even larger than left-sided ones. A total colonoscopy is therefore mandatory for all cases of suspected colonic polyps. This study represents a real-life contribution, and it can help improve the management strategies of this condition in childhood. What is Known: • Colonic polyps are quite common in children. • The majority of pediatric colonic polyps are solitary, benign, and located in the left colon. What is New: • Right-sided colonic polyps occur and may be even larger than left-sided ones. • A total colonoscopy is mandatory for all cases of suspected colonic polyps.
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http://dx.doi.org/10.1007/s00431-021-04017-yDOI Listing
July 2021

Managing Pediatric Foreign Body Ingestions: A 10-Year Experience.

Pediatr Emerg Care 2020 Sep 21. Epub 2020 Sep 21.

Division of Digestive Endoscopy, University of Messina, Messina.

Background: Foreign body (FB) ingestion is a common global issue in pediatrics. Most of the ingested FBs pass through the gastrointestinal tract, but up to 20% of cases require endoscopic removal. In this study, we retrospectively reviewed all pediatric cases of FB ingestion requiring endoscopic removal over a 10-year period in a tertiary hospital to compare the symptoms at presentation and outcomes with those reported in previous studies and to assess the association of the outcomes with patient and FB characteristics.

Methods: A retrospective chart review of children 16 years or younger who underwent upper endoscopy for FB ingestion from 2008 to 2018 in a tertiary hospital was included. Data on demographics, clinical presentation, characteristics of FBs, endoscopic findings, and outcomes were reviewed. The clinical data were further evaluated to determine the circumstances surrounding FB ingestion, FB management, and patient outcomes. Descriptive analysis of the data was performed using medians, frequencies, and percentage; χ or Fisher exact test was used to assess the dependence between categorical variables.

Results: Eighty-six patients (median age, 5.1 years; 67% males) underwent endoscopy for suspected FB ingestion, with a confirmation rate of 91%. Coins were the most commonly ingested FBs (n = 49, 57%). Most patients were symptomatic (84%); 97% of patients in whom the FB had an esophageal location and all patients in whom the FB was not detected by endoscopy were symptomatic (P = 0.007). The most frequent symptoms were drooling (70%) and unexplained crying (48%). Unexplained crying was more common in younger than in older patients (P < 0.001). The FB was more likely to be located in the esophagus in patients with drooling (P < 0.001) and dysphagia (P < 0.001). The distribution of FB location differed according to the FB type, with coins most frequently located in the esophagus and sharp and other FBs in the stomach (P = 0.023). Only 7 patients (8%) developed mild FB-related mucosal injury. No complications occurred during FB removal. All patients had an uneventful outcome.

Conclusions: Foreign body ingestion is common among younger children, and the clinical presentation can be variable. The presence or absence of symptoms, as well as the type of symptom, could aid clinicians in implementing diagnosis and proper management approaches in patients who ingest FBs requiring endoscopy.
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http://dx.doi.org/10.1097/PEC.0000000000002245DOI Listing
September 2020

Postoperative Bleeding after Thyroid Surgery: Care Instructions.

Sisli Etfal Hastan Tip Bul 2019 21;53(4):329-336. Epub 2019 Nov 21.

Department of Human Pathology in Adulthood and Childhood ''G. Barresi'', Division for Endocrine and Minimally Invasive Surgery, University Hospital G. Martino, University of Messina, Messina, Italy.

Prospective studies on the incidence, etiology, and prognosis of well-characterized patients with bleeding after thyroid surgery are lacking. Bleeding after thyroid surgery cannot be predicted or prevented even if risk factors are known in every single procedure, which enhances the im-portance of the following issues: (a) meticulous hemostasis and surgical technique; (b) coopera-tion with the anesthesiologist, i.e., controlling the Valsalva maneuver, adequate blood pressure at the end of the operation as well as at extubation phase and (c) in case of bleeding, a prompt management to guarantee a better outcome. This requires an intensive postoperative clinical monitoring of patients, ideally, in a recovery room with trained staff for at least 4-6 h. Early recognition of postoperative bleeding with immediate intervention is the key to the management of this complication.
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http://dx.doi.org/10.14744/SEMB.2019.95914DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7192296PMC
November 2019

Thyroidectomy in elderly patients aged ≥70 years.

Gland Surg 2017 Oct;6(5):587-590

Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood G. Barresi, University Hospital Policlinico G. Martino, University of Messina, Messina 98125, Italy.

Worldwide, the indications for thyroid surgery have been continuously extended among elderly patients in the last 20 years. The balance between treatment indication and surgical risk is certainly an interesting topic for every thyroid surgeon. This paper is a review of recent literature from January 2005 up to April 2017. We analyzed three principal subjects: indications for surgical treatment, medical complications and surgical complications. We can summarize the conclusions of our analysis, stating that age could not be considered as an absolute factor, but in relation to the comorbidities and the general clinical condition of the patient. Special risk indices dedicated to geriatric patients could be very useful in order to facilitate the decision-making process; however, relying on the current knowledge, we could state that there is value in providing surgery to geriatric patients in highly specialized and high-volume centers, where access to technology and its systematic use, coupled with surgeons' experience, could certainly avail the geriatric patient management.
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http://dx.doi.org/10.21037/gs.2017.10.01DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5676175PMC
October 2017

[Retroperitoneal giant schwannoma: a case report and review of the literature].

Chir Ital 2008 Jan-Feb;60(1):141-6

Dipartimento di Patologia Umana, Università degli Studi di Messina, Messina.

Schwannomas are rare tumours that originate in the neural sheath and account for only a small percentage of all retroperitoneal tumours. They are usually solitary, circumscribed and encapsulated lesions eccentrically located on proximal nerves or spinal nerve roots. Presentation is typically varied and non-specific, ranging from abdominal pain, an abdominal mass or an incidental finding. The preoperative diagnosis is difficult and laboratory tests are usually unremarkable. We report the case of a 66-year-old female presenting with abdominal pain in her left flank and with an ultrasonographic diagnosis of a left kidney mass. She was diagnosed as suffering from a giant retroperitoneal schwannoma after surgical exploration and complete excision. The role of CT scan and CT-guided needle biopsy is emphasised, in that ultrasonography and fine needle aspiration alone do not provide sufficient information regarding aetiology and malignancy. Radical surgical excision is curative but recurrences may occur. Careful follow-up is needed.
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May 2008

[Laparoscopy in traumatic abdominal emergencies].

Chir Ital 2006 Jul-Aug;58(4):485-91

Unità Operativa Complessa di Chirurgia Generale e Mininvasiva, Dipartimento di Scienze Chirurgiche, Azienda Ospedaliera Universitaria Policlinico G. Martino, Università degli Studi di Messina.

Over the past few years the laparoscopic technique has changed most of the concepts of traditional surgery and is today the standard approach in elective surgery for many pathologies requiring surgery. Unfortunately the same cannot be said for emergency surgery, though much progress has been made in this field, too. The Authors examine the most important abdominal diseases that can be diagnosed and, possibly, treated by the laparoscopic approach in the emergency setting, concluding that laparoscopic management of such conditions is a feasible proposition in many cases. Technological improvements and the development of new, more versatile surgical instruments will undoubtedly contribute to the increasingly widespread use of the laparoscopic approach also in emergency procedures.
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November 2006

Gallstone ileus: report of a case successfully treated by a laparoscopically-assisted enterolithotomy.

Ann Ital Chir 2005 Mar-Apr;76(2):203-5; discussion 205

Department of Human Pathology, University of Messina, Messina, Italy.

Gallstone ileus is an unusual cause of small bowel obstruction that occurs more frequently in elderly patients. The diagnosis is always very challenging and in most of cases this rare complication is misdiagnosed before surgery. The Authors report on a 81-year-old woman with small bowel obstruction who was laparoscopically diagnosed with gallstone ileus and successfully treated by a laparoscopically-assisted enterolithotomy.
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December 2005

[Role of ultrasonography in the non-operative management of liver traumas].

Chir Ital 2005 Sep-Oct;57(5):607-13

Dipartimento di Patologia Umana, Università degli Studi di Messina, Messina.

The technical progress in imaging methodology and intensive care over recent years has allowed a reduction in surgical operations for hepatic trauma. In the past, surgeons based their evaluations on clinical findings and patients in critical condition were submitted to surgery. The percentage of negative laparotomies was high (6% to 25%) due to non-haemorrhagic hepatic lesions at surgery. The introduction of ultrasonography and computed tomography offered two important tools for determining the origin and extent of traumatic lesions of the liver and other abdominal organs. These modern imaging techniques enable us to diagnose and monitor patients with hepatic trauma with a reduction in negative laparotomies and allow conservative treatment of numerous traumatic lesions of the liver. Despite the diagnostic superiority of computed tomography in the evaluation of patients with hepatic trauma, the risk of exposure to ionising radiation in several, consecutive examinations in patients undergoing conservative treatment has aroused considerable interest with regard to the use of ultrasonography for both the initial and later evaluation of such patients. We report on our experience with 28 patients with liver traumas, focusing on the role of ultrasonography in their non-operative management.
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November 2005

Duodenal perforation secondary to biliary stent dislocation: a case report and review of the literature.

Chir Ital 2005 May-Jun;57(3):385-8

Department of Human Pathology, University of Messina, Messina.

Gut perforation secondary to the insertion of a biliary stent is an uncommon but potentially life-threatening complication. Duodenal perforation has to be taken into consideration whenever the patient starts to suffer severe abdominal pain after the stenting procedure. An early diagnosis is fundamental in order to avoid further complications. Timely conservative treatment with nasogastric suction, nothing by mouth, antibiotics and stent replacement could prevent infection and consequent development of an abscess. We report a case of duodenal perforation secondary to biliary endoprosthesis dislocation in which, in spite of prompt diagnosis and treatment, a large retroperitoneal abscess developed and a CT-guided drainage proved necessary followed later by a surgical operation.
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December 2005

[Substernal goiter: pre-, intra- and postoperative problems].

Chir Ital 2005 May-Jun;57(3):301-7

Cattedra di Chirurgia dell'Apparato Digerente, Università degli Studi di Messina.

The Authors report their experience with problems in treating substernal goiter. They then explain at length the complex haemodynamic or respiratory situations encountered and the therapeutic management of the condition. Also discussed are technical surgical problems, and the prevention and therapy of possible complications. They conclude by stating that thanks to all the technical means currently available complete patient control can be achieved before, during and after the operation, thus significantly contributing to the successful outcome of surgical treatment.
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December 2005

Incidental gall bladder carcinoma: does the surgical approach influence the outcome?

ANZ J Surg 2005 Sep;75(9):795-8

Department of Human Pathology, University of Messina, Messina, Italy.

Background: The aim of the study was to evaluate the outcome in patients with unsuspected gall bladder carcinoma diagnosed after cholecystectomy, comparing the laparoscopic approach with open surgery.

Methods: A retrospective study was done of 16 patients who were diagnosed with unsuspected gall bladder carcinoma out of the 2850 who had undergone cholecystectomy for symptomatic cholelithiasis at our institution between 1990 and 2004. Eight cases (seven women and one man, mean age 63 (range 49-75 years) ) were diagnosed after laparoscopic cholecystectomy (group A) and eight cases (six women and two men, mean age 63 (range 50-79 years) ) after open cholecystectomy (group B). We evaluated the outcome in the two groups correlating the cumulative survival rates with tumour stage and surgical technique.

Results: In group A, three patients had port-site recurrence (1 pT1a and 2 pT1b tumours) after 6, 7 and 9 months, one had intraperitoneal dissemination (pT2) after 3 months, and four had no recurrence (1 pTis, 2 pT1a and 1 pT1b). In group B, five patients had recurrences (4 pT1b and 1 pT2) after an average of 8 months (range 5-11) and three had no recurrence (1 pTis and 2 pT1a). Survival rate was statistically correlated with tumour stage but not with the surgical approach used to perform cholecystectomy.

Conclusions: The surgical approach used for cholecystectomy would seem not to influence the outcome in patients with unsuspected gall bladder carcinoma. The tumour stage is the most important prognostic factor.
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http://dx.doi.org/10.1111/j.1445-2197.2005.03528.xDOI Listing
September 2005

Laparoscopic cholecystectomy in Child-Pugh class C cirrhotic patients.

JSLS 2005 Jul-Sep;9(3):311-5

Department of Human Pathology, University of Messina, Messina, Italy.

Objectives: This study aimed to determine whether laparoscopic cholecystectomy is a safe and advisable procedure in Child-Pugh C cirrhotic patients with symptomatic cholelithiasis.

Methods: The records of 42 laparoscopic cholecystectomies performed between January 1995 and February 2004 in patients with Child-Pugh A, B, and C cirrhosis were retrospectively reviewed, focusing on the 4 patients with Child-Pugh C cirrhosis.

Results: Among the 38 Child-Pugh A and B patients, no deaths occurred. In this group, only 1 Child-Pugh B cirrhotic patient required blood transfusion, and postoperative morbidity occurred in 10 patients including hemorrhage, wound infection, intraabdominal collection, and cardiopulmonary complications (morbidity rate 26%). The mean postoperative stay was 5 days (range, 3 to 13). The indication for surgery in the 4 Child-Pugh C patients was acute cholecystitis. In this group, 2 deaths occurred for severe liver failure in 1 case and for sepsis in the other. One patient developed heavy gallbladder bed bleeding, and a second operation was necessary to control the hemorrhage. The morbidity rate was 75%. Only 1 patient had no complications. The mean postoperative stay was 10 days (range, 4 to 17).

Conclusions: Laparoscopic cholecystectomy is a safe procedure in well-selected Child-Pugh A and B cirrhotic patients indicated for surgery, but it is a very high-risk procedure in Child-Pugh C patients. Indications for surgery in Child-Pugh C patients should be evaluated very carefully and surgery should be avoided unless the patient needs an emergency cholecystectomy for acute cholecystitis. Child-Pugh C cirrhotic patients might better benefit from percutaneous drainage of the gallbladder.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3015601PMC
October 2005

Pleural effusion as a complication of intrathoracic goitre.

Chir Ital 2003 Nov-Dec;55(6):919-22

Cattedra di Chirurgia dell'Apparato Digerente, Università degli Studi di Messina.

The authors report their experience with a case of bilateral pleural effusions as a complication of intrathoracic goitre. They then go on to examine all the possible causes of this phenomenon. After discussing the anatomy of the superior mediastinum, they conclude that hydrothorax related to intrathoracic goitre could be the result of pressure of the mass on venous structures, especially on the superior vena cava, or on the intramediastinal lymphatic vessles, or, as in the case reported, on both.
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February 2004

Warthin's tumour of the parotid gland.

Chir Ital 2002 Nov-Dec;54(6):869-72

Cattedra di Chirurgia dell'Apparato Digerente, Cattedra di Chirurgia Generale, Università degli Studi di Messina.

The authors, after examining two recent cases, explain a number of basic concepts regarding the diagnosis and therapy of Warthin's tumour of the parotid gland. Despite their low frequency, such tumours are very important because of their aetiopathogenesis, which is still controversial, and the recent increase in their incidence in females. Today, the diagnostic protocol, undertaken after the necessary clinical examination, relies mainly on ultrasonography and CT, but only a postoperative histological examination is capable of yielding a sure diagnosis and establishing the main histomorphological characteristics of the tumour. The therapeutic approach can be limited to conservative treatment, sparing the parotid gland and its vascularization and innervation.
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September 2003

[Intrabiliary rupture of hepatic hydatid cyst].

Chir Ital 2002 Mar-Apr;54(2):249-52

Cattedra di Chirurgia Generale, Università degli Studi di Messina.

Spontaneous hepatic hydatid cyst rupture into the biliary tract is unusual. The authors describe a case of a 62-year-old man with a hepatic hydatid cyst, showing that it is possible to confirm rupture into the biliary system with cholangiography-MRI. Surgical treatment remains the best form of management. Endoscopic management is a therapeutic possibility in all cases in which surgery is contraindicated. In the case observed endoscopic sphinctererotomy resolved the biliary obstruction, while the hydatid cyst was treated by transbiliary irrigation with scolicidal solutions and pharmacological therapy. The treatment permitted complete clinical resolution of the hepatic hydatosis.
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June 2002

[Diagnostic problems of choledochal cysts in the adult].

Chir Ital 2002 Mar-Apr;54(2):245-8

Cattedra di Chirurgia Generale, Università degli Studi di Messina.

Choledochal cysts are rare malformations of the biliary tree, the precise pathogenesis of which remains unclear. The authors present the case of a 21-year-old man with a choledochal cyst and discuss the main issues regarding the diagnosis and treatment of this uncommon lesion. In particular, of all the diagnostic techniques available, magnetic resonance cholangiopancreatography (MRCP) could become the imaging technique of choice for defining the pancreatobiliary ductal anatomy with at least the same degree of accuracy as that of diagnostic ERCP, while avoiding the potential complications associated with the latter. The patient was treated by surgical operation and, after a 12 month follow-up, is disease-free. Surgical treatment is necessary owing to the possibility of malignant transformation.
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June 2002

[Conservative treatment of hepatic trauma].

Chir Ital 2002 Mar-Apr;54(2):227-31

Cattedra di Chirurgia Generale, Università degli Studi di Messina.

Liver trauma has increased over the past few years. In haemodynamically stable patients with hepatic injuries a conservative approach is possible, mainly as a result of the reliability of the diagnostic tools available which allow accurate monitoring of the patients. Computed tomography (CT) of the abdomen is extremely useful for documenting the extent of the damage. Of 16 patients treated for blunt hepatic injury, 10 were managed non-operatively. In this group of patients there were no deaths or delayed laparotomies. Total hospital stay and transfusion requirements were lower. The advantages of non-operative therapy include a lower incidence of abdominal septic complications. All patients managed non-operatively were monitored until their CT scans showed complete resolution. The authors conclude that non-operative management of hepatic injury is a safe technique applicable to haemodynamically stable patients.
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June 2002

[Appendiceal mucocele].

Chir Ital 2002 Jan-Feb;54(1):107-10

Cattedra di Chirurgia Generale, Università degli Studi di Messina.

Mucocele of the appendix is a rare lesion, characterised by distension of the lumen due to accumulation of mucoid substance. Mucocele is often asymptomatic and is found incidentally during surgical explorations or ultrasonography studies. This report illustrates the clinicopathologic features of a case of appendiceal mucocele observed during an emergency laparotomy. The surgical treatment consisted in appendicectomy. Colonscopic examination subsequently revealed a left colonic precancerous lesion that was treated with endoscopic polypectomy. The case described underlines the importance of colonic surveillance in patients with mucocele.
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May 2002