Abstract: In recent years, there has been a considerable increase in the number of image-guided interventional procedures performed for the management of acute and chronic pain. Concomitantly, there has also been an increase in the complication rate related to these procedures. The aim of this narrative review is to summarize the primary complications associated with commonly performed image-guided (fluoroscopic- or ultrasound-guided) interventional procedures. We conclude that although complications from interventional pain procedures can be mitigated to a certain degree, they cannot be eliminated altogether. In order to avoid adverse events, patient safety should be given considerable attention and physicians should be constantly aware of the possibility of developing complications. Keywords: chronic pain, pain management, analgesics, opioid, epidural injection, facet joints
Summary Background Data: Surgery actually achieves the bestresults in the treatment of esophageal achalasia; the options varyfrom a short extramucosal esophagomyotomy to an extendedesophagogastromyotomy with an associated partial fundoplicationto restore the main antireflux barrier. A total 360° fundoplication isgenerally regarded as an obstacle to esophageal emptying. Matherials and Methods: Since 1992 to November 2003, a total of195 patients (91 males, 104 females), mean age 45.2 years (range,12–79 years), underwent laparoscopic treatment of esophageal acha-lasia. Intervention consisted of Heller myotomy and Nissen-Rossettifundoplication with intraoperative endoscopy and manometry. Results: In 3 patients (1.5%), a conversion to laparotomy wasnecessary. Mean operative time was 75 15 minutes. No mortalitywas observed. Overall major morbidity rate was 2.1%. Mean post-operative hospital stay was 3.6 1.1 days (range, 1–12 days). At amean clinical follow up of 83.2 7 months (range, 3–141 months)on182patients(93.3%),anexcellentorgoodoutcomewasobservedin 167 patients (91.8%) (dysphagia DeMeester score 0–1). Noimprovement of dysphagia was observed in 4 patients (2.2%).Gastroesophageal pathologic reflux was absent in all the patients.
In this review, we evaluate the role of liquid biopsy in managing lung cancer patients during the still ongoing coronavirus disease 2019 (COVID-19) healthcare emergency.The novel influenza coronavirus (severe acute respiratory syndrome coronavirus or SARS-CoV-2) has upended several aspects of our lives, including medical activities. In this setting, many routine cancer diagnostic and therapeutic procedures have been suspended, leading to delays in diagnosis, treatments, and, ultimately, increases in cancer mortality rates. Equally drastic has been the impact of COVID-19 on clinical trials, many of which have been stalled or have never begun. This has left many patients who were hoping to receive innovative treatments in a limbo. Although, as of today, the introduction of drastic security measures has been crucially important to contain the pandemic, one cannot ignore the need to continue providing chronically ill patients all the health care they need, in terms of detection, prevention, and treatment. In these unprecedented times, liquid biopsy, more than ever before, may play a relevant role in the adequate management of these frail patients.we performed a deep analysis of the recent international literature published in English on PUBMED in the last six months focused on the impact of SARS-CoV-2 on the management of lung cancer patients, focusing the attention on the role of liquid biopsy.COVID-19 pandemic has significantly modified our lives and overall medical practice. In these unprecedented times, liquid biopsy may represent a valid and less time-consuming diagnostic approach than conventional tissue and cytological specimens.
A high prevalence of cryoglobulins has been reported in patients with hepatitis C virus (HCV)-related liver disease. The aim of this study was to evaluate the prevalence and the incidence of cryoglobulins and their association with clinical symptoms in chronic hepatitis and cirrhosis patients.The prevalence of cryoglobulins and cryoglobulinemic syndrome was investigated at enrollment in 237 patients (213 with chronic hepatitis and 24 with cirrhosis). A 7-yr follow-up was conducted evaluating the occurrence of cryoglobulins and/or cryoglobulinemic syndrome every 6 months. Rheumatoid factor was also tested in all patients.Prevalence of rheumatoid factor, cryoglobulins, and cryoglobulinemic syndrome in chronic hepatitis patients were 2%, 0.8%, and 0%, respectively. In cirrhosis patients the prevalence was 4%, 8%, and 0%, respectively. No statistically significant differences were found between the two groups. During the follow-up only one patient for each group abruptly developed cryoglobulinemic syndrome, and none of the patients who showed signs of cryoglobulinemia developed the syndrome or showed signs of evolution of the disease.Our data demonstrate that the presence of cryoglobulins and/or cryoglobulinemic syndrome in HCV-related liver disease is unusual, as is the occurrence of cryoglobulinemia over time in these patients. This leads us to think that HCV-related cryoglobulinemic syndrome and HCV-related liver disease are independent diseases. This supports new and indirect evidence for an independent and direct role of HCV in liver and blood disorders.
Hemangioma is the most frequent focal liver lesion. It affects mainly women and may cause symptoms such as abdominal pain, mass, and early satiety, or complications such as heart failure or coagulopathy (Kasabach-Merrit syndrome). Although, surgical resection is the only curative treatment for symptomatic giant hemangiomas, the best surgical technique (formal liver resection or enucleation) is still debated. Between January 2000 and April 2006 we treated 12 giant symptomatic hemangioma. Of these, 4 anterior and superficially located in the liver were treated by enucleation and they are discussed in this paper. The operative technique is described. Detailed pathologic examination has demonstrated an interface between hemangiomas and the normal liver tissue that allowed the enucleation. The dissection in the plane between the tumor and the adjacent normal liver tissue has been facilitated by the use of an ultrasonically activated device (USAD). Median operative blood loss was 90 ml (range, 50 to 190 ml), and no transfusion were used. The procedure described allowed a safe enucleation of giant hemangiomas with a reduced blood loss and the preservation of virtually all normal hepatic parenchyma.
Rearranged during transfection (RET) gene fusions are detected in 10-20% of thyroid cancer patients. Recently, RET fusion-positive metastatic thyroid cancers have attracted much attention owing to the FDA approval of two highly selective anti-RET tyrosine kinase inhibitors, namely, selpercatinib, and pralsetinib.This review summarizes the available evidence on the biological and predictive role of RET gene fusions in thyroid carcinoma patients and the latest screening assays currently used to detect these genomic alterations in histological and cytological specimens.Management of advanced thyroid carcinoma has significantly evolved over the last decade thanks to the approval of three multikinase inhibitors, i.e. sorafenib, lenvatinib, cabozantinib, and of two selective RET-tyrosine inhibitors, i.e. selpercatinib and pralsetinib. In this setting, the detection of RET-fusions in advanced thyroid cancer specimens through the use of next-generation sequencing has become a commonly used strategy in clinical practice to select the best treatment options.
Isolated hepatic splenosis is a rare but possible condition in abdominal surgery. At radiological imaging liver splenosis mimics malignant or pathological condition of the liver; obtaining a certain diagnosis prior to surgery is difficult. For this reason, the patients undergo to unnecessary operation, with a laparotomy access. We report a case of suspicious liver mass removed laparoscopically and revealed as hepatic splenosis.A 31 years old man patient was admitted to our Institution because of upper chronic abdominal pain. Thirteen years before the recovery the patient was operated of splenectomy with laparotomic incision. Computerized Tomography and Magnetic Resonance demonstrated the presence of suspicious hepatic mass in the III segment.The mass has been radically excised with laparoscopic approach. Postoperative stay was good and patient was discharged seven day after the operation. At histological examination ectopic splenic tissue on liver surface was found (socalled splenosis).Hepatic splenosis is not a rare condition and should be considered with the differential diagnosis especially in patients who had previous splenectomy and absence of liver cirrhosis. Laparoscopic exploration should always be preferred for the diagnosis of uncertain liver mass. Few works report laparoscopic excision for liver splenosis. For experience at our Institution laparoscopic procedure has an important role to get the diagnosis and it is also a feasible approach for minimally invasive resection.Laparoscopy, Liver, Splenosis.La splenosi epatica isolata è una condizione rara ma possibile in chirurgia addominale. All’ imaging radiologico la splenosi epatica mima una neoplasia o una condizione patologica del fegato; ottenere una diagnosi certa prima dell’intervento chirurgico è difficile. Per questo motivo, i pazienti possono essere sottoposti ad operazioni inutili, con accesso laparotomico.Un uomo di 31 anni è stato ricoverato presso il nostro Istituto a causa di un dolore cronico nel quadrante superiore dell’addome. La Tomografia Computerizzata e la Risonanza Magnetica hanno dimostrato la presenza di una massa epatica sospetta al III segmento.La massa è stata asportata radicalmente con approccio laparoscopico. La degenza postoperatoria è stata buona e il paziente è stato dimesso sette giorni dopo l’operazione. L’esame istologico ha rilevato la presenza di tessuto splenico ectopico sulla superficie epatica ( splenosi).La splenosi epatica non è una condizione rara e dovrebbe essere considerata in diagnosi differenziale specialmente in pazienti che hanno subito una splenectomia e in assenza di cirrosi epatica. L’esplorazione laparoscopica andrebbe sempre preferita per la diagnosi di una massa epatica sospetta. Pochi lavori riportano l’asportazione di splenosi epatica per via laparoscopica. Secondo l’esperienza del nostro Istituto la procedura laparoscopica ha un ruolo importante per ottenere la diagnosi ed risulta un approccio valido per eseguire resezioni epatiche.
Aims: To date, precision medicine has played a pivotal role in the clinical administration of solid-tumor patients. In this scenario, a rapidly increasing number of predictive biomarkers have been approved in diagnostic practice or are currently being investigated in clinical trials. A pitfall in molecular testing is the diagnostic routine sample available to analyze predictive biomarkers; a scant tissue sample often represents the only diagnostical source of nucleic acids with which to conduct molecular analysis. At the sight of these critical issues, next-generation sequencing (NGS) platforms emerged as referral testing strategies for the molecular analysis of predictive biomarkers in routine practice, but the need for highly skilled personnel and extensive working time drastically impacts the widespread diffusion of this technology in diagnostic settings. Here, we technically validate a fully integrated NGS platform on diagnostic routine tissue samples previously tested with an NGS-based diagnostic workflow by a referral institution. Methods: A retrospective series of n = 64 samples (n = 32 DNA, n = 32 RNA samples), previously tested using a customized NGS assay (SiRe™ and SiRe fusion), was retrieved from the internal archive of the University of Naples Federico II. Each sample was tested by adopting an Oncomine Precision Assay (OPA), which is able to detect 2769 molecular actionable alterations [hotspot mutations, copy number variations (CNV) and gene fusions] on fully integrated NGS platforms (Genexus, Thermo Fisher Scientific (Waltham, MA, USA). The concordance rate between these technical approaches was determined. Results: The Genexus system successfully carried out molecular analysis in all instances. A concordance rate of 96.9% (31 out of 32) was observed between the OPA and SiRe™ panels both for DNA- and RNA-based analysis. A negative predictive value of 100% and a positive predictive value of 96.9% (62 out of 64) were assessed. Conclusions: A fully automatized Genexus system combined with OPA (Thermo Fisher Scientific) may be considered a technically valuable, time-saving sequencing platform to test predictive biomarkers in diagnostic routine practice.
Background: Tracheal stenosis represents a fearsome complication that substantially impairs quality of life. The recent SARS-CoV-2 pandemic increased the number of patients requiring invasive ventilation through prolonged intubation or tracheostomy, increasing the risk of tracheal stenosis. Study design and methods: In this prospective, observational, multicenter study performed in Lombardy (Italy), we have exanimated 281 patients who underwent prolonged intubation (more than 7 days) or tracheostomy for severe COVID-19. Patients underwent CT scan and spirometry 2 months after hospital discharge and a subsequent clinical follow-up after an additional 6 months (overall 8 months of follow-up duration) to detect any tracheal lumen reduction above 1%. The last follow-up evaluation was completed on 31 August 2022. Results: In the study period, 24 patients (8.5%, CI 5.6–12.4) developed tracheal stenosis in a median time of 112 days and within a period of 200 days from intubation. Compared to patients without tracheal stenosis, tracheostomy was performed more frequently in patients that developed stenosis (75% vs 54%, p = 0.034). Tracheostomy and alcohol consumption (1 unit of alcohol per day) increased risk of developing tracheal stenosis of 2.6-fold (p = 0.047; IC 0.99–6.8) and 5.4-fold (p = 0.002; CI 1.9–16), respectively. Conclusions: In a large cohort of patients, the incidence of tracheal stenosis increased during pandemic, probably related to the increased use of prolonged intubation. Patients with histories of prolonged intubation should be monitored for at least 200 days from invasive ventilation in order to detect tracheal stenosis at early stage. Alcohol use and tracheostomy are risk factors for developing tracheal stenosis.
