Massimo Vecchiato

Polymyositis, dermatomyositis and malignancy: A further intriguing link

The association between malignancy and autoimmune myositis has been largely described and confirmed by numerous epidemiological studies. The temporal relationship between the two pathologic conditions can vary: malignancy may occur before, at the same time or following the diagnosis of myositis. Beside these observations, the molecular mechanisms underlying this association are still unknown, even though it has been demonstrated a possible antigenic similarity between regenerating myoblasts and some cancer cell populations. To better identify peculiar histopathologic features common to cancer and myositis, we screened muscle biopsies from patients affected with polymyositis, dermatomyositis, myositis in association to cancer, and from patients affected with newly diagnosed cancer, but without myositis. Similarly to the histopatologic features that were observed in the muscle from myositis patients, especially in those with cancer associated myositis, in patients affected with malignancy at the clinical onset of disease we observed early sign of myopathy, characterized by internally nucleated and regenerating myofibers, most of them expressing the neural cell adhesion molecule. The hypothesis that in a particular subset of individuals genetically predisposed to autoimmunity, an initial subclinical tumor-induced myopathy may result in an autoimmune myositis, represents a further intriguing link behind the association of these two conditions.

Risk factors for colorectal anastomotic stenoses and their impact on quality of life: what are the lessons to learn?

Aim  The aim of the study was to analyse the incidence of benign colorectal anastomotic stenoses in consecutive patients operated on in a single institution and to assess risk factors for their development. Their impact on quality of life was also evaluated.

Colpocystodefecography in obstructed defecation: is it really useful to the surgeon? Correlating clinical and radiological findings in surgery for obstructed defecation.

Objective  Colpocystodefecography images the pelvic floor with the dynamics of defecation, but various authors claim that it overestimates clinical findings. The aim of this study was to evaluate the pre‐ and postoperative consistency between clinical and colpocystodefecographic findings in patients undergoing surgery for obstructed defecation.

Extensive anal condylomatosis: prognosis in relation to viral and host factors

Objective  To evaluate the clinical course of extensive anal condylomatosis in relation to treatment modalities, patient comorbidity and immune function, and associated papillomavirus (HPV) sequences.

A new endoscopic technique for suspension of esophageal prosthesis for refractory caustic esophageal strictures.

There is no clear consensus concerning the best endoscopic treatment of benign refractory esophageal strictures due to caustic ingestion. Different procedures are currently used: frequent multiple dilations, retrievable self-expanding stent, nasogastric intubation and surgery. We describe a new technique to fix a suspended esophageal silicone prosthesis to the neck in benign esophageal strictures; this permits us to avoid the frequent risk of migration of the expandable metallic or plastic stents. Under general anesthesia a rigid esophagoscope was placed in the patients hypopharynx. Using transillumination from the optical device, the patients neck was pierced with a needle. A n.0 monofilament surgical wire was pushed into the needle, grasped by a standard foreign body forceps through the esophagoscope and pulled out of the mouth (as in percutaneous endoscopic gastrostomy procedure). After tying the proximal end of the silicone prosthesis with the wire, it was placed through the strictures under endoscopic view. This procedure was successfully utilized in four patients suffering from benign refractory esophageal strictures due to caustic ingestion. The prosthesis and its suspension from the neck were well-tolerated until removal (mean duration 4 months). A postoperative transitory myositis was diagnosed in only one patient. One of the most frequent complications of esophageal prostheses in refractory esophageal strictures due to caustic ingestion is distal migration. Different solutions were proposed. For example the suspension of a wire coming from the nose and then fixed behind the ear. This solution is not considered optimal because of patient complaints and moreover the aesthetic aspect is compromised. The procedure we utilized in four patients utilized the setting of a silicone tube hanging from the neck in a way similar to that of endoscopic pharyngostomy. This solution is a valid alternative both for quality of life and for functional results.

Malignant perivascular epithelioid cell tumor of the esophagus.

Malignant perivascular epithelioid cell tumor (PEComa) is a rare tumor composed of hybrid tumor cells characterized by immunoreactivity for both melanocytic and smooth muscle markers. This paper describes the uncommon esophageal location of an 8 cm PEComa in a 75-year-old Caucasian man who was presented with ingravescent dysphagia. Although PEComas arising within the gastrointestinal tract are exceptional findings, clinicians should not exclude this class of tumors in the diagnostic investigation of a bulky lesion of the esophageal wall.

Natural history of recurrent varices undergoing reintervention: a retrospective study.

BACKGROUND Recurrent varices after surgery are a complex problem. Many studies regarding the causes of recurrence and the best procedures that can be used to study them have been conducted but few studies on the natural history of the operations performed for recurrence. OBJECTIVES To evaluate the efficiency of reintervention in controlling the varicose disease, its symptoms, and patient satisfaction. MATERIALS AND METHODS Of 71 patients operated on for surgical recurrence related to an inguinal cavernoma between 1996 and 2004, 51 were reassessed in May 2006 with a clinical and Duplex examination. Surgical and anesthesiological data were collected. RESULTS The average follow-up after reintervention for the 51 of the 71 treated patients who came to the examination was 5.8 years; 38 (74.5%) of the patients were very satisfied, and one patient (2%) was dissatisfied. Thirty-five (68.6%) of the patients still had varices, but only 17 of these had real varices at the original site; 18 patients showed persistent or residual varices (3 patients, 5.8%) or a progression (15 patients, 29.9%) of the varicose disease. CONCLUSIONS Surgical intervention on an outpatient basis may have a significant role in controlling the varicose disease with few complications.

Quality of life after laparoscopic sigmoid resection for uncomplicated diverticular disease

PurposeThe study aimed to evaluate the QoL in patients who underwent elective surgery for uncomplicated diverticulitis using a recently developed diverticulitis quality of life questionnaire (DV-QoL).MethodsAll consecutive patients who underwent surgery for uncomplicated diverticulitis or who were hospitalized and treated conservatively for acute uncomplicated diverticulitis episodes in three referral centers, in a 5-year period, were included in the study. The 36-Item Short Form Survey and the DV-QoL were administered to the patients to assess their QoL before and after treatment of diverticular disease.ResultsNinety-seven patients who underwent surgery, 44 patients who were treated conservatively, and 44 healthy volunteers were included in the study. DV-QoL scores correlated with SF-36 scores (p < 0.0001). The surgically treated patients reported a worse quality of life before treatment with respect to the patients treated conservatively (mean 21.12 surgical vs 15.41 conservative, p = 0.0048). The surgically treated patients presented better post-treatment global scores with respect to the conservatively treated patients (mean: 6.90 surgical vs 10.61 conservative, p = 0.0186). Covariance analysis confirmed that the differences between the pre- and post-treatment DV-QoL scores were significantly higher in the surgical (p = 0.0002) with respect to the non-surgical patients. As far as single items were concerned, differences between the two groups were found in the pre- and post-treatment “concerns” and “behavioral changes” DV-QoL items.ConclusionsSigmoidectomy reduces concerns about diverticulitis and behavioral changes due to the disease. Quality of life should be considered when referring patients with uncomplicated diverticulitis to surgery. Prospective studies are required to confirm this result.

Surgery for obstructed defecation in over 65 year old patients

Materials and methods 32 over 65-years old patients underwent surgery for obstructed defecation syndrome and then observed prospectively by the Coloproctological Unit of Surgical Clinic III, S. Antonio Hospital, Padova, from 2001 to 2007. All patients were evaluated with a dedicated questionnaire: Knowles-Eccerseley-Scott score (KESS) for all patients and Obstructed Defecation score (ODS) for two groups, proctological and gynecological examination, colpocystodefecography before surgery and 6 months afterwards.

Anterior laparoscopic rectal resection for cancer in the elderly: long-term outcome, risk factors and health related quality of life

Background Elderly population in Western countries is rapidly increasing. Literature suggests that radical colorectal resection in the elderly can be safely undertaken with good short and long term results; however results of specific rectal laparoscopic resections are not well defined and so quality of life. The aim of this study was to assess long-term outcome; risk factors and health related quality of life (HRQoL) in elective rectal cancer laparoscopic resection in patients older than 65 years.