Vincenzo Tammaro

Radioimmunoguided surgery in colorectal cancer: A 6-year experience with four different technical solutions

Intraoperative radioimmunodetection is a new staging technique for epithelial neoplasms. After intravenous injection, a radioimmunoconjugate compound (monoclonal antibody and isotope) attaches itself to the antigens expressed on the surface of neoplastic cells, causing them to emit gamma rays. Radioactivity is detected at the presurgical stage by immunoscintigraphy and intraoperatively with a gamma-detecting probe (GDP). In our experience, intraoperative tumor-to-normal-tissue (T/NT) GDP ratio counts > or =3:1 were considered positive radioimmunoguided surgery (RIGS) findings. We studied 52 colorectal cancer patients, 48 with primary lesions and 7 with relapses. Positive RIGS findings were obtained in 33 patients whose lymph node assessments were characterised by eight false positive identifications. In 10 patients, RIGS data yielded a more accurate staging of the disease. Unreliable RIGS findings were recorded in 15 patients: four injected with monoclonal antibody (MAb) B72.3 labeled with Iodine-125; five with MAb anti-carcinoembryonic antigen (CEA) labeled with 99mTechnetium (Tc); two with MAb B72.3 labeled with Indium-111; and three with MAb B72.3 labeled with Iodine-131 plus interferon-beta. In analysis, our experience did not permit definitive evaluation of the methods diagnostic and staging accuracy.

Temperature profile of ex-vivo organs during radio frequency thermal ablation by fiber Bragg gratings

Abstract. We report on the integration of fiber optic sensors with commercial medical instrumentation for temperature monitoring during radio frequency ablation for tumor treatment. A suitable configuration with five fiber Bragg grating sensors bonded to a bipolar radio frequency (RF) probe has been developed to monitor the area under treatment. A series of experiments were conducted on ex-vivo animal kidney and liver and the results confirm that we were able to make a multipoint measurement and to develop a real-time temperature profile of the area, with a temperature resolution of 0.1°C and a spatial resolution of 5 mm during a series of different and consecutive RF discharges.

What indication, morbidity and mortality for central pancreatectomy in oncological surgery? A systematic review.

Conventional pancreatic resections for pancreatic neck and body diseases include pancreaticoduodenectomy, distal pancreatectomy with or without splenectomy, and total pancreatectomy. Recent studies have reported encouraging results of non-traditional pancreatic resections, including central pancreatectomy (CP), for central pancreatic disease. This surgical approach offers the potentials of low postoperative morbidity and preservation of metabolic functions. This study performs a systematic review on CP. A comprehensive literature search was conducted, for the period 1992-2015, on three worldwide databases: PubMed, Scopus, ISI-Web of Knowledge. We focused on indications, morbidity and mortality of this surgical procedure. The review shows that CP is particularly suitable for small-medium size diseases localized into the pancreatic body. This procedure is associated with an increased postoperative morbidity but an excellent postoperative pancreatic function. CP is a safe and effective procedure when performed following the right indications.

A multidisciplinary approach to an unusual medical case of locally advanced gastric cancer: a case report

IntroductionComplete abdominal wall infiltration with neoplastic gastrocutaneous fistula is an unexpected and out of the ordinary presentation of locally advanced gastric cancer. It is very rare to encounter case reports presenting diffuse abdominal wall invasion, but a complete parietal destruction is an exceptional event.Case presentationHere we describe the case of an 81-year-old Caucasian woman presenting a carcinoma perforating her anterior gastric wall and infiltrating all layers of her abdominal wall. The gastric tumor infiltrated her transverse mesocolon, the rectus abdominis muscles bilaterally and overran them anteriorly, causing a large parietal deficit and a complete external fistula. Treatment consisted of a complex surgical procedure requiring general and reconstructive surgery cooperation in order to perform an en bloc gastric resection including colon and abdominal wall, followed by a parietal reconstruction through positioning of prosthesis and reverse abdominoplasty.ConclusionsClinical presentation, histology and therapeutic options are discussed. The importance of a multidisciplinary approach when encountering extremely rare clinical presentations is emphasized.

Immunosuppression and Multiple Primary Malignancies in Kidney-Transplanted Patients: A Single-Institute Study

Immunodeficiency is associated with higher cancer incidence. However, it is unknown whether there is a link between immunodeficiency and development of multiple primary malignancies. In the present study we analyse this link focusing on kidney-transplanted patients, as they are at higher risk of developing cancer due to the chronic assumption of immunosuppressants. We followed up 1200 patients who underwent kidney transplantation between 1980 and 2012. A total of 77/1200 kidney-transplanted patients developed cancer and 24 of them developed multiple cancers. Most multiple cancers were synchronous with a nonsignificant association between cancer and rejection episodes. In the general cancer population, one-ninth of patients are at higher risk of developing a second tumor over a lifetime; hence it would be reasonable to conclude that, from a merely theoretical and statistical viewpoint, long-term transplanted patients potentially have a higher risk of developing MPMs. However, data did not confirm this assumption, probably because these patients die before a second primary malignancy appears. Despite many observations on the increased incidence of different tumor types in immunodeficient patients and despite immunosuppression certainly being a predisposing factor for the multicancer syndrome, data so far are not robust enough to justify a correlation between immunodeficiency and multiple primary malignancies in transplanted patients.

Prevention of Fluid Effusion in Kidney Transplantation With the Use of Hemostatic Biomaterials

BACKGROUND Fluid effusion (blood, lymph, or urine) in kidney transplantation may give rise to several complications, directly, such as hematoma, seroma, lymphocele, and/or urinoma, or consequently, such as increased infection risk, longer hospital stay, graft compression--with or without functional impairment--and necessity of further hospitalizations. The aim of this study was to evaluate effectiveness of hemostatic biomaterials in prevention of fluid effusions, especially lymphocele in kidney transplant patients. METHODS We selected 40 patients who underwent kidney transplantation from 2009 to 2012 in which we used hemostatic biomaterials, and compared their results with those of other transplant patients from our center in which we did not used these biomaterials. Evaluated parameters were: fluid effusion, graft function, quality and quantity of drainage, blood count, and operative time. RESULTS There was no difference in operative time. The incidence of complications on which biomaterials can have a role decreased; particularly, we observed a reduction from 24.21% to 7.5% of fluid effusions (lymphocele). There was no evidence of complications due to biomaterials. CONCLUSIONS Hemostasis is important in surgery, and in kidney transplantations lymphostasis also has a significant role. In addition to the traditional hemostatic methods, recently some biomaterials, with the purpose of providing atraumatic hemostasis, were added. In our experience they are easy to use, and their use has proved to be effective for both hemostasis and lymphostasis with consequent reduction of fluid effusions.

Current Tissue Molecular Markers in Colorectal Cancer: A Literature Review

Background Colorectal cancer (CRC) is one of the most spread neoplasia types all around the world, especially in western areas. It evolves from precancerous lesions and adenomatous polyps, through successive genetic and epigenetic mutations. Numerous risk factors intervene in its development and they are either environmental or genetic. Aim of the Review Alongside common screening techniques, such as fecal screening tests, endoscopic evaluation, and CT-colonography, we have identified the most important and useful biomarkers and we have analyzed their role in the diagnosis, prevention, and prognosis of CRC. Conclusion Biomarkers can become an important tool in the diagnostic and therapeutic process for CRC. But further studies are needed to identify a noninvasive, cost-effective, and highly sensible and specific screening test for their detection and to standardize their use in clinical practice.

Temperature monitoring during thermal ablation on ex-vivo organs by Fiber Bragg gratings

In this paper we report on the application of Fiber Bragg gratings (FBGs) for temperature monitoring during radiofrequency ablation (RFA) for tumor treatment. A proper configuration with several FBG sensors deployed close to the region reached by RF discharges has been developed to monitor the necrotized area. Our ex-vivo experiments on animal kidney and liver confirm that we were able to monitor the temperature with a resolution of 0.1 °C during a series of different and consecutive RF discharges with the laparoscopic bipolar radiofrequency device Habib 4x.

Measurements of temperature during thermal ablation treatments on ex vivo liver tissue using fiber Bragg grating sensors

In this work, we propose the use of fiber Bragg grating (FBG) sensor arrays for real-time temperature monitoring during RadioFrequency Thermal Ablation (RFTA) tumor treatment. Real-time temperature monitoring of RF-treatment to the tumors lesion of an organ could prove to be highly beneficial for intra-operative surgical planning and subsequently ensure a successful outcome of a thermo-ablation procedure. An adequate configuration was designed in order to create a thermal multipoint map. In particular, the RF probe of a commercial medical device was properly packaged with FBG sensors. In order to discern the treatment areas as accurately as possible, a second 3.5 cm long array, consisting of several FBGs was also employed. The experiments were conducted on ex vivo animal liver tissues and results confirm that we were successfully able to conduct a multipoint measurement and to distinguish between different and consecutive RF discharges with a temperature resolution of 0.1 °C and a minimum spatial resolution of 5mm.

Real-time temperature monitoring during radiofrequency treatments on ex-vivo animal model by fiber Bragg grating sensors

Fiber Bragg Grating (FBG) sensors applied to bio-medical procedures such as surgery and rehabilitation are a valid alternative to traditional sensing techniques due to their unique characteristics. Herein we propose the use of FBG sensor arrays for accurate real-time temperature measurements during multi-step RadioFrequency Ablation (RFA) based thermal tumor treatment. Real-time temperature monitoring in the RF-applied region represents a valid feedback for the success of the thermo-ablation procedure. In order to create a thermal multi-point map around the tumor area to be treated, a proper sensing configuration was developed. In particular, the RF probe of a commercial medical instrumentation, has been equipped with properly packaged FBGs sensors. Moreover, in order to discriminate the treatment areas to be ablated as precisely as possible, a second array 3.5 cm long, made by several FBGs was used. The results of the temperature measurements during the RFA experiments conducted on ex-vivo animal liver and kidney tissues are presented herein. The proposed FBGs based solution has proven to be capable of distinguish different and consecutive discharges and for each of them, to measure the temperature profile with a resolution of 0.1 °C and a minimum spatial resolution of 5mm. Based upon our experiments, it is possible to confirm that the temperature decreases with distance from a RF peak ablation, in accordance with RF theory. The proposed solution promises to be very useful for the surgeon because a real-time temperature feedback allows for the adaptation of RFA parameters during surgery and better delineates the area under treatment.