Publications by authors named "Mario Dente"

15 Publications

  • Page 1 of 1

Primary adenocarcinoma of the renal pelvis: histologic features of a stepwise process from intestinal hyperplasia to dysplasia in a patient with chronic renal abscess.

Int J Surg Pathol 2014 Apr 4;22(2):182-5. Epub 2013 Sep 4.

1Department of General Surgery, Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy.

Pure adenocarcinomas of the urothelium are very rare and their location in the pelvis is uncommon. Although their pathogenesis is not well defined, adenocarcinomas are likely to originate from neoplastic transformation of the glandular cells of the urothelial intestinal metaplasia usually arising in response to chronic irritating stimuli, such as long-duration inflammation, urolithiasis, and hydronephrosis. We report a case of an 81-year-old woman who underwent right nephrectomy for relapsing renal abscess due to a staghorn calculus. Histological examination disclosed an infiltrating adenocarcinoma arising from a tubulovillous adenoma with the surrounding pelvic mucosa showing a sequence of intestinal metaplasia, low- and high-grade villous adenoma, and invasive adenocarcinoma, supporting the hypothesis of cancer progression due to chronic inflammation from the urothelium through the metaplasia step.
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http://dx.doi.org/10.1177/1066896913502225DOI Listing
April 2014

Barbed unidirectional V-Loc 180 suture in laparoscopic Roux-en-Y gastric bypass: a study comparing unidirectional barbed monofilament and multifilament absorbable suture.

Surg Endosc 2013 Oct 31;27(10):3846-51. Epub 2013 May 31.

Hôpital Civil de Colmar, 39, Avenue de la Liberté, 68240, Colmar Cedex, France,

Background: This study aimed primarily to evaluate the safety of digestive running suture (in gastrojejunal and antecolic jejunojejunal anastomosis closure) using unidirectional absorbable barbed suture (V-Loc 180) in laparoscopic Roux-en-Y gastric bypass (LRYGB) and secondarily to assess the efficacy of V-Loc 180 in reducing operative time.

Methods: A prospective cohort study of 315 consecutive patients who underwent LRYGB was performed between October 2009 and October 2012 using an identical procedure technique. For the first 76 patients, a multifilament absorbable suture was used to assess the gastrojejunal anastomosis and the antecolic jejunal suture. For the following 239 patients, a unidirectional barbed monofilament suture was used. Data including operative time, time required for gastric pouch creation, time spent in both anastomoses constructions, conversion rate, and complications were prospectively recorded.

Results: The postoperative complications did not differ significantly between the two groups. Early complications were observed for 1 patient (1.3%) in the multifilament group and for 14 patients (5.8%) in the barbed procedure group (p > 0.05). Late complications were observed for 1 patient (1.3%) in the multifilament group and for 5 patients (2%) in the barbed procedure group (p > 0.05). A shortened operative time was achieved in the barbed suture group. The mean operative time was 74.3 ± 15.3 min in the Vicryl group versus 62.7 ± 15.5 min in the V-Loc group (p < 0.05). The mean operative time required to fashion the gastrojejunal anastomosis was 21.3 ± 6.3 min in the Vicryl group versus 17.4 ± 5.1 min in the V-Loc group (p < 0.05). The mean operative time required to fashion the jejunojejunal anastomosis was 21.4 ± 4.9 min in the Vicryl group versus 15.2 ± 5.5 min in the V-Loc group (p < 0.05).

Conclusions: The authors' experience has demonstrated that the use of interlocked V-Loc suture during LRYGB anastomosis appears to be safe and efficient. The findings show a shortened total operative time in terms of single gastrojejunal or jejunojejunal anastomosis time. No statistically significant differences in early or late postoperative complications were observed between the V-Loc and multifilament absorbable suture patients.
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http://dx.doi.org/10.1007/s00464-013-2993-5DOI Listing
October 2013

Complicated intra-abdominal infections in Europe: a comprehensive review of the CIAO study.

World J Emerg Surg 2012 Nov 29;7(1):36. Epub 2012 Nov 29.

Department of Surgery, Macerata Hospital, Macerata, Italy.

The CIAO Study ("Complicated Intra-Abdominal infection Observational" Study) is a multicenter investigation performed in 68 medical institutions throughout Europe over the course of a 6-month observational period (January-June 2012).Patients with either community-acquired or healthcare-associated complicated intra-abdominal infections (IAIs) were included in the study.2,152 patients with a mean age of 53.8 years (range: 4-98 years) were enrolled in the study. 46.3% of the patients were women and 53.7% were men. Intraperitoneal specimens were collected from 62.2% of the enrolled patients, and from these samples, a variety of microorganisms were collectively identified.The overall mortality rate was 7.5% (163/2.152).According to multivariate analysis of the compiled data, several criteria were found to be independent variables predictive of patient mortality, including patient age, the presence of an intestinal non-appendicular source of infection (colonic non-diverticular perforation, complicated diverticulitis, small bowel perforation), a delayed initial intervention (a delay exceeding 24 hours), sepsis and septic shock in the immediate post-operative period, and ICU admission.Given the sweeping geographical distribution of the participating medical centers, the CIAO Study gives an accurate description of the epidemiological, clinical, microbiological, and treatment profiles of complicated intra-abdominal infections (IAIs) throughout Europe.
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http://dx.doi.org/10.1186/1749-7922-7-36DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3539964PMC
November 2012

Complicated intra-abdominal infections in Europe: preliminary data from the first three months of the CIAO Study.

World J Emerg Surg 2012 May 21;7(1):15. Epub 2012 May 21.

Department of Surgery, Macerata Hospital, Macerata, Italy.

The CIAO Study is a multicenter observational study currently underway in 66 European medical institutions over the course of a six-month study period (January-June 2012).This preliminary report overviews the findings of the first half of the study, which includes all data from the first three months of the six-month study period.Patients with either community-acquired or healthcare-associated complicated intra-abdominal infections (IAIs) were included in the study.912 patients with a mean age of 54.4 years (range 4-98) were enrolled in the study during the first three-month period. 47.7% of the patients were women and 52.3% were men. Among these patients, 83.3% were affected by community-acquired IAIs while the remaining 16.7% presented with healthcare-associated infections. Intraperitoneal specimens were collected from 64.2% of the enrolled patients, and from these samples, 825 microorganisms were collectively identified.The overall mortality rate was 6.4% (58/912). According to univariate statistical analysis of the data, critical clinical condition of the patient upon hospital admission (defined by severe sepsis and septic shock) as well as healthcare-associated infections, non-appendicular origin, generalized peritonitis, and serious comorbidities such as malignancy and severe cardiovascular disease were all significant risk factors for patient mortality.White Blood Cell counts (WBCs) greater than 12,000 or less than 4,000 and core body temperatures exceeding 38°C or less than 36°C by the third post-operative day were statistically significant indicators of patient mortality.
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http://dx.doi.org/10.1186/1749-7922-7-15DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3444376PMC
May 2012

[Experimental teaching program on cooperation between "Sapienza" University of Rome and the University Hospital "Le Bon Samaritain" in N'Djamena, Chad].

Ann Ital Chir 2012 May-Jun;83(3):273-6

Facoltà di Medicina e Psicologia, Università degli Studi di Roma La Sapienza, Italy.

Background: The shortage of essential surgical care in sub-Saharan Africa is a worldwide problem. Lack of healthcare workers, surgeons and very limited resources are the reason for this critical health crisis. Furthermore in Africa many physicians as soon as they get a degree emigrate in more attractive countries.

Methods: "Multidisciplinary teaching support to a new Faculty of Medicine in N'Djamena - Chad" is a teaching cooperation program between «Sapienza» University of Rome and the University Hospital "Le Bon Samaritain" in N'Djamena, Chad. The project started in 2010, with the aim of cooperating in teaching medical students of African origin and in training Italian residents in sub-Saharan surgical and internal pathologies. In Chad the greatest surgical burden (about 11% of the total global diseases) is created by injuries, cancers, congenital anomalies, appendicitis, bowel obstructions, hernias, abscesses (by amebiasis or others) and obstetric emergencies.

Conclusions: Up till now healthcare in Africa especially in rural areas has been provided by international organisations,we believe that academic collaborations between high-income and low-income Nations is necessary to meet the real needs of the african surgical workforce; at the same time it is very useful for store of knowledge of our residents.
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August 2013

Mentored trainees obtain comparable operative results to experts in complex laparoscopic colorectal surgery.

Int J Colorectal Dis 2012 Jan 23;27(1):65-9. Epub 2011 Aug 23.

IRCAD-EITS Institute, University Hospital of Strasbourg, 1 Place de l'Hôpital, 67091, Strasbourg Cedex, France.

Purpose: The aim of this study is to evaluate the impact of an expert monitoring on the quality and results of laparoscopic reversal of Hartmann's procedure (LRHP) performed by trainee surgeons by comparing their results to the expert's outcomes.

Methods: Forty-two LRHP were performed between 2000 and 2008 following a step-by-step, standardised, full laparoscopic procedure. Patients operated upon by a senior surgeon were compared to patients operated upon by trainee surgeons while being mentored by the senior surgeon. Operative time, conversion, complications and post-operative outcome were measured.

Results: Each group included 21 patients. All patients underwent LRHP successfully. Two procedures were converted. No significant difference was observed between the expert and the trainees: operative time, 132 min (SD ± 50) vs. 131 min (SD ± 47) and complications (2-14%), 4 vs. 2. Three complications required re-operation, and three other were treated medically, including one dilatation of an anastomosis. Post-operative outcomes were comparable (oral intake, 3 vs. 2 days; post-operative hospital stay, 6 vs. 7.5 days); no mortality occurred.

Conclusions: Standardisation simplifies this difficult laparoscopic procedure and offers the same outcome whether it is performed by an expert or by mentored trainees. The complications were comparable to those occurring at experienced centres (anastomotic leak or stricture, ureteral injury, re-operation). The expert mentoring does not prevent all complications but can solve intra-operative technical problems, thus improving the trainee's confidence. Mentoring should be promoted as it can be performed locally or remotely using modern interactive technology.
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http://dx.doi.org/10.1007/s00384-011-1290-9DOI Listing
January 2012

Giant inframuscular lipoma disclosed 14 years after a blunt trauma: a case report.

J Med Case Rep 2008 Sep 30;2:318. Epub 2008 Sep 30.

Department of Surgery, Sapienza University of Rome, School of Medicine, St. Andrea Hospital, Rome, Italy.

Introduction: Lipoma is the most frequent benign tumor of the soft tissue. This lesion is often asymptomatic except in cases of enormous masses compressing nervous-vascular structures. Although the diagnosis is mostly clinical, imaging tools are useful to confirm the adipose nature of the lesion and to define its anatomic border. Sometimes, lipomas may be the result of a previous trauma, such as in this patient.

Case Presentation: A 45-year-old man presented at our institution with a giant hard firm mass in the upper external quadrant of the right buttock disclosed after a weight loss diet. Subsequent magnetic resonance imaging showed a giant adipose mass developed beneath the large gluteal muscle and among the fibers of the medium and small gluteal muscles. When questioned on his medical history, the patient reported a blunt trauma of the lower back 14 years earlier. He underwent surgery and histological examination confirmed a giant lipoma.

Conclusion: Lipomas might result from a previous trauma. It is hypothesized that the trigger mechanism is activated by cytokine and growth factors released after the trauma. We herein present an exceptional case of a giant post-traumatic lipoma which caused a painful compression on the right sciatic nerve.
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http://dx.doi.org/10.1186/1752-1947-2-318DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2569952PMC
September 2008

Multiple giant diverticula of the foregut causing upper gastrointestinal obstruction.

World J Gastroenterol 2008 May;14(20):3259-61

Departments of Surgery II School of Medicine, University of Rome La Sapienza, Sant'Andrea Hospital, Via di Grottarossa 1035-39, Rome 00189, Italy.

Small bowel diverticulosis represents an uncommon disorder (except for Meckel diverticulum) often misdiagnosed since it causes non-specific gastrointestinal symptoms. Most of times the diagnosis is carried out in case of related complications, such as diverticulitis, hemorrhage, perforation or obstruction. Intestinal obstruction can be caused by inflammatory stenosis due to repeated episodes of diverticulitis, volvulus, intussusception or jejunal stones. Herein we report a case of multiple jejunal diverticula causing chronic gastrointestinal obstruction.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2712863PMC
http://dx.doi.org/10.3748/wjg.14.3259DOI Listing
May 2008

Gastrointestinal stromal tumor of the anal canal: an unusual presentation.

World J Surg Oncol 2007 Feb 16;5:20. Epub 2007 Feb 16.

Department of Surgery, University of Rome La Sapienza, 2nd School of Medicine, Sant'Andrea Hospital, Rome, Italy.

Background: Gastrointestinal stromal tumors (GIST) of the stomach are the most frequent followed by those of the intestinal tract, while colon and rectum represent rare sites. GIST of the anal canal are extremely rare. They have been studied along with GIST of the rectum, as a single entity, and along with them they represent 5% of GIST. GIST arising from the anal canal account for only 2%-8% of the anorectal GIST. Thus anal GIST must be considered an exceptional case.

Case Presentation: A 78-year-old man was referred to our Institution for an anal mass, in absence of any symptom. The patient was treated by local excision. An histological diagnosis of a low grade GIST was made. No further treatment was necessary. No local recurrence of distant metastases were found at follow-up.

Conclusion: At the moment, only ten cases of c-kit positive anal GIST are reported in the literature. These few data are not sufficient to establish a widely accepted approach for this neoplasia. We recommend to perform an initial local excision, to define the risk of aggressive behavior and the resection margins and proceed to a more aggressive treatment, if the GIST belongs to high or very high risk group. The role of adjuvant therapy is still uncertain. Although inhibitors of tyrosine-kinase receptor needs further studies before their routine use, their role in case of distant or local recurrence has been accepted. Patients' close follow up is mandatory to disclose as soon as possible local recurrences or metastases.
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http://dx.doi.org/10.1186/1477-7819-5-20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1821025PMC
February 2007
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