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  1. Article ; Online: Patient Selection Is a Key Factor to Evaluate Treatments of Hemorrhoids.

    Ratto, Carlo / Litta, Francesco / Orefice, Raffaele

    Diseases of the colon and rectum

    2020  Volume 63, Issue 9, Page(s) e516

    MeSH term(s) Hemorrhoidectomy ; Hemorrhoids/therapy ; Humans ; Ligation ; Patient Selection ; Rectum
    Language English
    Publishing date 2020-11-17
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 212581-x
    ISSN 1530-0358 ; 0012-3706
    ISSN (online) 1530-0358
    ISSN 0012-3706
    DOI 10.1097/DCR.0000000000001756
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Estimating the 18-Year Threshold with Third Molars Radiographs in the Southern Italy Population: Accuracy and Reproducibility of Demirjian Method.

    Caggiano, Mario / Scelza, Giuseppe / Amato, Alessandra / Orefice, Raffaele / Belli, Simona / Pagano, Stefano / Valenti, Chiara / Martina, Stefano

    International journal of environmental research and public health

    2022  Volume 19, Issue 16

    Abstract: The estimation of the age of the majority of living subjects is widely required nowadays due to the presence of unidentifiable individuals, without documents and general information, involved in migration or legal procedures. Dental age estimation (DAE) ... ...

    Abstract The estimation of the age of the majority of living subjects is widely required nowadays due to the presence of unidentifiable individuals, without documents and general information, involved in migration or legal procedures. Dental age estimation (DAE) is a valid method for investigating the age of subjects. The aim of this study was to evaluate the accuracy of the Demirjian method in a limited age group (16-24 years) in differentiating between older and younger than 18 years. From an initial sample of 17,594 radiographs, 460 were selected meeting the inclusion criteria. Two dentists provided the age estimate according to the Demirjian method, with a simplified approach based on the development of the third molars. The presence of a developmental stage of H for at least one third molar allowed to establish the major age if the other third molars, inferior or superior, have reached a stage equal or superior to F, with an accuracy of 90.2% and a predictive positive value of 91.6%. Thirty-three patients showed the development of at least one third molar (Stage H) before the age of 18 years while six patients showed the development of all four third molars with root completion (stage H) before the age of 18 years. When all third molars reached stage H an individual was over 18 years old in 97.4% of cases. In presence of one third molar on stage H and a stage equal or superior to F for the other third molars the probability of being of major age was 91.6%.
    MeSH term(s) Adolescent ; Adult ; Age Determination by Teeth/methods ; Humans ; Molar ; Molar, Third/diagnostic imaging ; Radiography, Panoramic ; Reproducibility of Results ; Young Adult
    Language English
    Publishing date 2022-08-22
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2175195-X
    ISSN 1660-4601 ; 1661-7827
    ISSN (online) 1660-4601
    ISSN 1661-7827
    DOI 10.3390/ijerph191610454
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: A Prospective Study on the Efficacy of Two Different Phlebotonic Therapies as a Bridge to Surgery in Patients with Advanced Hemorrhoidal Disease.

    Orefice, Raffaele / Litta, Francesco / Parello, Angelo / De Simone, Veronica / Campennì, Paola / Marra, Angelo Alessandro / Ratto, Carlo

    Journal of clinical medicine

    2021  Volume 10, Issue 8

    Abstract: The aims of this study were to evaluate the efficacy of two different phlebotonic therapies, preoperatively administered in advanced hemorrhoidal disease (HD) patients with recommendation for surgery, and to assess patient satisfaction after treatment. ... ...

    Abstract The aims of this study were to evaluate the efficacy of two different phlebotonic therapies, preoperatively administered in advanced hemorrhoidal disease (HD) patients with recommendation for surgery, and to assess patient satisfaction after treatment. In this prospective observational study, 100 patients were preoperatively treated either with micronized purified flavonoid fraction (group A) or sublingual nano-emulsion flavonoid (group B). HD symptoms, local inflammation signs and patients' satisfaction were evaluated at baseline visit (T0), after 4 weeks of therapy (T1) and 8 weeks after its discontinuation (T2). In group A, a significant improvement for all HD symptoms and inflammation signs was observed after therapy (T1), followed by a reduction of efficacy in T2, except for itching and edema. In group B, therapy had a significant benefit on symptoms and local inflammation at T1, which persisted after its discontinuation for all symptoms, and edematous hemorrhoids. In both groups, the satisfaction rate was "good" in 60% of patients and patients were statistically significant more satisfied at T1 compared with T2 (
    Language English
    Publishing date 2021-04-07
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2662592-1
    ISSN 2077-0383
    ISSN 2077-0383
    DOI 10.3390/jcm10081549
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article: Impact of COVID-19 Quarantine on Advanced Hemorrhoidal Disease and the Role of Telemedicine in Patient Management.

    Campennì, Paola / Marra, Angelo A / Ferri, Lorenzo / Orefice, Raffaele / Parello, Angelo / Litta, Francesco / De Simone, Veronica / Goglia, Marta / Ratto, Carlo

    Journal of clinical medicine

    2020  Volume 9, Issue 11

    Abstract: The aims of this population study were to assess the lockdown impact on patients waiting for hemorrhoidal surgery, and the role of telemedicine in patient management. All patients on our waiting list for hemorrhoidal surgery were considered. Eligible ... ...

    Abstract The aims of this population study were to assess the lockdown impact on patients waiting for hemorrhoidal surgery, and the role of telemedicine in patient management. All patients on our waiting list for hemorrhoidal surgery were considered. Eligible patients were contacted by phone. Rørvik score was evaluated and compared to the baseline score. Univariate and multivariate analyses were performed. A numeric rating scale was used to estimate patient satisfaction regarding telemedicine. One-hundred and ten patients were found to be eligible. Finally, 103 patients were included in the study of whom 16 (15.3%) were already considered for priority surgery. Patients waiting for a longer time showed significantly worse scores (
    Keywords covid19
    Language English
    Publishing date 2020-10-25
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2662592-1
    ISSN 2077-0383
    ISSN 2077-0383
    DOI 10.3390/jcm9113416
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: The Management of Hemorrhoidal Disease by Dearterialization and Mucopexy.

    De Simone, Veronica / Litta, Francesco / Parello, Angelo / Campennì, Paola / Orefice, Raffaele / Marra, Angelo Alessandro / Goglia, Marta / Ratto, Carlo

    Reviews on recent clinical trials

    2020  Volume 16, Issue 1, Page(s) 60–66

    Abstract: Several minimally invasive surgical procedures have been recently developed to treat hemorrhoids without any excision. About 25 years ago, a non-excisional procedure providing doppler- guided ligation of the hemorrhoidal arteries has been proposed - ... ...

    Abstract Several minimally invasive surgical procedures have been recently developed to treat hemorrhoids without any excision. About 25 years ago, a non-excisional procedure providing doppler- guided ligation of the hemorrhoidal arteries has been proposed - named "hemorrhoidal dearterialization". The original technique has been modified over the years, and indications were expanded. In particular, a plication of the redundant and prolapsing mucosa/submucosa of the rectum (named "mucopexy") has been introduced to treat hemorrhoidal prolapse, without excision of the hemorrhoidal piles. At present, the THD® Doppler procedure is one of the most used techniques to treat hemorrhoids. Aim of this technique is to realize a target dearterialization, using a Doppler probe with the final purpose to reduce the arterial overflow to the hemorrhoidal piles. In the case of associated hemorrhoidal prolapse, a mucopexy is performed together with Doppler-guided dearterialization. The entity and circumferential extension of the hemorrhoidal prolapse guide the mucopexy, which can be considered tailored to a single patient; the dearterialization should be considered mandatory. Advantages of this surgical technique are the absence of serious and life-threatening postoperative events, chronic complications, and limited recurrence risks. The impact of the procedure on the anorectal physiology is negligible. However, careful postoperative management is mandatory to avoid complications and to guarantee an improved long-term outcome. Therefore, regular physiologic bowel movements, excessive strain at the defecation and strong physical activity are advisable.
    MeSH term(s) Hemorrhoids/diagnostic imaging ; Hemorrhoids/surgery ; Humans ; Ligation ; Rectum/diagnostic imaging ; Rectum/surgery ; Treatment Outcome ; Ultrasonography, Doppler
    Language English
    Publishing date 2020-05-22
    Publishing country United Arab Emirates
    Document type Journal Article
    ZDB-ID 2251879-4
    ISSN 1876-1038 ; 1574-8871
    ISSN (online) 1876-1038
    ISSN 1574-8871
    DOI 10.2174/1574887115666200506091306
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Implant of Self-Expandable Artificial Anal Sphincter in Patients With Fecal Incontinence Improves External Anal Sphincter Contractility.

    Litta, Francesco / Marra, Angelo A / Ortega Torrecilla, Nuria / Orefice, Raffaele / Parello, Angelo / De Simone, Veronica / Campennì, Paola / Goglia, Marta / Ratto, Carlo

    Diseases of the colon and rectum

    2021  Volume 64, Issue 6, Page(s) 706–713

    Abstract: Background: External anal sphincter contractility significantly contributes to control the passage of stool. An artificial anal sphincter placed into the intersphincteric space is a safe and effective procedure to treat fecal incontinence, even if its ... ...

    Abstract Background: External anal sphincter contractility significantly contributes to control the passage of stool. An artificial anal sphincter placed into the intersphincteric space is a safe and effective procedure to treat fecal incontinence, even if its mechanism of action has not been fully elucidated.
    Objective: The aim of this study was to evaluate external anal sphincter contractility changes after a self-expandable hyexpan prostheses was implanted into the intersphincteric space of the anal canal and clinical outcomes compared.
    Design: This was a prospective clinical study.
    Settings: The study was conducted at a university teaching hospital.
    Patients: Consecutive patients affected by fecal incontinence for at least 6 months after failure of conservative treatment were included.
    Interventions: All of the patients underwent 10-prostheses implantation and were examined preoperatively and postoperatively by endoanal ultrasound and anorectal manometry.
    Main outcome measures: Fecal incontinence symptoms were assessed by severity scores. The external anal sphincter muscle tension was calculated using a specific equation.
    Results: Thirty-nine patients (34 women; median age = 68 y) were included in the study; no morbidity was registered. After a median follow-up period of 14 months, both the median maximum voluntary squeeze pressure and the median inner radius of the external anal sphincter significantly increased. A statistically significant increase of external anal sphincter muscle tension was detected. A decrease of any fecal incontinence symptom and an improvement in severity scores were observed at the last follow-up examination. The external anal sphincter contractility was significantly higher in patients reducing incontinence episodes to solid stool by >50% and improving their ability to defer defecation for >15 minutes.
    Limitations: This was a single-center experience with a relatively small and heterogeneous sample size, patients with a potentially more severe disease because our institution is a referral center, and an absence of quality-of-life evaluation.
    Conclusions: Artificial anal sphincter implantation improved the external anal sphincter muscle tension; there was a positive correlation between its increase and the clinical outcome. See Video Abstract at http://links.lww.com/DCR/B468.
    Implante de esfnter anal artificial autoexpandible en pacientes con incontinencia fecal mejora la contractilidad del esfnter anal externo: ANTECEDENTES:La contractilidad del esfínter anal externo contribuye significativamente al control del paso de las heces. Un esfínter anal artificial colocado en el espacio interesfinteriano es un procedimiento seguro y eficaz para tratar la incontinencia fecal, incluso si su mecanismo de acción no se ha definido por completo.OBJETIVO:El objetivo de este estudio fue evaluar los cambios en la contractilidad del esfínter anal externo después de la implantación de una prótesis de hyexpan autoexpandible en el espacio interesfinteriano del canal anal y comparar los resultados clínicos.DISEÑO:Estudio clínico prospectivo.ENTORNO CLINICO:El estudio se realizó en un hospital universitario.PACIENTES:Pacientes consecutivos afectados por incontinencia fecal durante al menos 6 meses, tras fracaso de tratamiento conservador.INTERVENCIONES:Todos los pacientes fueron sometidos a la implantación de 10 prótesis, y fueron examinados pre y postoperatoriamente mediante ecografía endoanal y manometría anorrectal.PRINCIPALES MEDIDAS DE VALORACION:Los síntomas de incontinencia fecal se evaluaron mediante puntuaciones de gravedad. La tensión del músculo del esfínter anal externo se calculó mediante una formula específica.RESULTADOS:Treinta y nueve pacientes (34 mujeres; mediana de edad 68 años) fueron incluidos en el estudio; no se registró morbilidad. Después de un período de seguimiento medio de 14 meses, tanto la presión de compresión voluntaria máxima media como el radio interior medio del esfínter anal externo aumentaron significativamente. Se detectó un aumento estadísticamente significativo de la tensión del músculo del esfínter anal externo. En el último examen de seguimiento se observó una disminución de cualquier síntoma de incontinencia fecal y una mejora en las puntuaciones de gravedad. La contractilidad del esfínter anal externo fue significativamente mayor en los pacientes que redujeron los episodios de incontinencia a heces sólidas en más del 50% y mejoraron la capacidad para diferir la defecación durante más de 15 minutos.LIMITACIONES:Experiencia de un solo centro; tamaño de muestra relativamente pequeño y heterogéneo; pacientes con una enfermedad potencialmente más grave porque nuestra institución es un centro de referencia; ausencia de evaluación de la calidad de vida.CONCLUSIONES:La implantación del esfínter anal artificial mejoró la tensión muscular del esfínter anal externo; hubo una correlación positiva entre su aumento y el resultado clínico. Consulte Video Resumen en http://links.lww.com/DCR/B468.
    MeSH term(s) Aged ; Anal Canal/physiopathology ; Anal Canal/surgery ; Defecation/physiology ; Endosonography/methods ; Fecal Incontinence/physiopathology ; Fecal Incontinence/prevention & control ; Female ; Follow-Up Studies ; Humans ; Male ; Manometry/methods ; Middle Aged ; Muscle Tonus/physiology ; Prospective Studies ; Prostheses and Implants/adverse effects ; Prosthesis Design/trends ; Prosthesis Implantation/instrumentation ; Prosthesis Implantation/methods ; Safety ; Severity of Illness Index ; Treatment Outcome
    Language English
    Publishing date 2021-01-11
    Publishing country United States
    Document type Journal Article ; Observational Study ; Video-Audio Media
    ZDB-ID 212581-x
    ISSN 1530-0358 ; 0012-3706
    ISSN (online) 1530-0358
    ISSN 0012-3706
    DOI 10.1097/DCR.0000000000001857
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: One-year evaluation of anorectal functionality and quality of life in patients affected by mid-to-low rectal cancer treated with transanal total mesorectal excision.

    De Simone, Veronica / Persiani, Roberto / Biondi, Alberto / Litta, Francesco / Parello, Angelo / Campennì, Paola / Orefice, Raffaele / Marra, Angelo / Costa, Alessandra / D'Ugo, Domenico / Ratto, Carlo

    Updates in surgery

    2020  Volume 73, Issue 1, Page(s) 157–164

    Abstract: Surgery of mid-to-low rectal cancer is still considered challenging. Transanal total mesorectal excision has been proposed to facilitate the mesorectal dissection, gain sphincter-saving procedures, and reduce functional sequelae. Few studies have ... ...

    Abstract Surgery of mid-to-low rectal cancer is still considered challenging. Transanal total mesorectal excision has been proposed to facilitate the mesorectal dissection, gain sphincter-saving procedures, and reduce functional sequelae. Few studies have investigated long-term functional outcomes and patients' quality of life. The aim of this study was to compare functional outcomes and quality of life before and after transanal total mesorectal excision in 1-year follow-up. Between February 2016 and April 2019, 51 patients with mid- or low rectal cancer undergoing transanal total mesorectal excision at Fondazione Policlinico Universitario "A. Gemelli" were enrolled. Neoadjuvant radiochemotherapy was administered to locally advanced cancers. Before and after the surgical procedure, patients were examined collecting clinical data, LARS score, CCFIS, SF36 and FIQL, performing anorectal manometry and endoanal ultrasonography. Thirty-three patients were eligible and completed the 12 months follow-up. After treatment, six patients (18.2%) had minor or major LARS. A mild but significant increase of CCFIS was documented. Only the mean resting pressure significantly decreased at follow-up. No sphincter lesions were documented. FIQL assessment showed significant reduction of lifestyle, coping/behaviour, and embarrassment, while an increase of general health was assessed by SF36. At both uni- and multivariate analyses the neoadjuvant radiochemotherapy had a not negligible impact. Transanal total mesorectal excision represents a safe approach to patients treated for mid- or low rectal cancer. The functional sequelae can be limited in severity, with a low incidence of minor/major LARS, particularly faecal incontinence. These results are comparable to those obtained by the conventional total mesorectal excision.
    MeSH term(s) Aged ; Anal Canal/physiopathology ; Digestive System Surgical Procedures/adverse effects ; Digestive System Surgical Procedures/methods ; Fecal Incontinence/etiology ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Neoadjuvant Therapy ; Organ Sparing Treatments/methods ; Postoperative Complications/etiology ; Quality of Life ; Recovery of Function ; Rectal Neoplasms/physiopathology ; Rectal Neoplasms/surgery ; Rectum/physiopathology ; Time Factors ; Treatment Outcome
    Language English
    Publishing date 2020-11-07
    Publishing country Italy
    Document type Journal Article ; Observational Study
    ZDB-ID 2572692-4
    ISSN 2038-3312 ; 2038-131X
    ISSN (online) 2038-3312
    ISSN 2038-131X
    DOI 10.1007/s13304-020-00919-y
    Database MEDical Literature Analysis and Retrieval System OnLINE

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