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Donatella MOSCA

Ricercatore Universitario
Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell'Adulto

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Pubblicazioni

2022 - Vaginal Evisceration of Small Bowel With Extraperitoneal Ileal Resection of the Herniated Loops: A Case Report [Articolo su rivista]
Missori, Giulia; Marchesini, Nicolò Luigi Arrigo; Mosca, Donatella; Ricciardolo, Andrea Aurelio; Serra, Francesco; Gelmini, Roberta
abstract

Introduction: Vaginal evisceration is an extremely rare surgical emergency that can be described as the extrusion of abdominal viscera through a defect or a rupture of the vaginal wall. We reported the case of an acute abdomen due to small bowel evisceration secondary to vaginal vault dehiscence that required combined vaginal-abdominal approach Case: We discuss the case of a 72-year-old female who presented to the emergency department for a large prolapse with visible extrusion of the small bowel per vagina. The eviscerated bowel was resected by external vaginal approach due to excessive swelling of the loops which made it impossible to reduce them through the vagina defect. A midline laparotomy was undertaken for further assessment, and the vault defect was closed by transabdominal repair Conclusion: From its first description in 1864, just a few cases of vaginal evisceration had been described in the medical literature; the most common organ to eviscerate is the distal ileum, although cases of omentum, colon, fallopian tube, and appendix evisceration have also been reported. We described a rare case of transvaginal evisceration of the small bowel in our emergency department; it is a rare surgical emergency that must be managed to prevent serious consequences, such as bowel ischemia and necrosis, sepsis, and death. We suggest that a multidisciplinary approach to prompt examination and management by gynecologists and general surgeons is recommended to reduce the risk of morbidity and mortality. With this paper the authors would like to share the surgical manage of this rare emergency with other surgeons all around the world.

2019 - A rare case of acute abdomen in the adult: The intestinal duplication cyst. case report and review of the literature [Articolo su rivista]
Ricciardolo, Andrea Aurelio; Iaquinta, Tommaso; Tarantini, Alessandro; Sforza, Nicola; Mosca, Donatella; Serra, Francesco; Cabry, Francesca; Gelmini, Roberta
abstract

Introduction: Duplications of the gastrointestinal tract are rare congenital anomalies that can occur anywhere throughout the gastrointestinal tract. The reported incidence is 1/4500, and more than 80% occurs before the age of two as an acute abdomen or bowel obstruction. The most common site is Ileum (60%), while the colonic localisation is reported between 4 and 18%. Presentation of the case: Herein we report the case of a 35-year-old man, presented at the Emergency Department with fever and localised abdominal pain in the right iliac fossa. Preoperative abdominal ultrasound and CT scan showed a cystic mass of 44 × 43 × 70 mm adjoining the posterior wall of the right colon. He underwent explorative laparoscopy, laparotomy conversion, right hemicolectomy with an intra-operative diagnosis of colonic duplication cyst, confirmed by histology. Discussion: The review of the literature showed as the intestinal duplication cysts are rare congenital anomalies. The clinical presentation is variable and depends on the site and the related complications. A surgical approach based on the resection of the involved bowel tract is the treatment associated with the best long-term outcomes. Conclusion: It is important to include intestinal duplication in the differential diagnosis of acute abdomen, to ensure the best therapeutic strategy.

2017 - Fibroadenoma of the perianal region: A case report and review of the literature [Articolo su rivista]
Campanelli, Michela; Cabry, Francesca; Segattini, Silvia; Amorotti, Claudio; Mosca, Donatella; Gelmini, Roberta
abstract

Ectopic breast tissue (EBT) is defined as glands located outside of the breast. EBT has been thought to arise from a remnant of the embryonic mammary ridge along the milk line from the axilla to the groin, including the anal region. Fibroadenomas of the perianal region are very uncommon, in literature has not been reported a complete review yet. We report a case of a 36-year-old woman presented to the surgical outpatient department with complaints of swelling and growing mass in the anal region. The lesion was completely excised as a day surgery case. histological examination showed a rare case of fibroadenoma. Additionally, a comprehensive review of the literature of the last 39 years was performed, collecting 12 cases of fibroadenomas of the perianal region. The population affected was young, the mean age at presentation was 39 years and no male was reported, 6 patients reported a tender painful mass and after a completely excision no recurrence was reported despite 10 of the 12 publications analyzed did not mentioned the follow-up. in conclusion, if a lesion is discovered along the milk line, the possibility of pathological ectopic breast tissue should always be considered, and excision should be the treatment of choice.

2017 - For a preoperative assessment of the colon vascular supply [Correspondence] [Articolo su rivista]
Mosca, Donatella; Farinetti, Alberto; Manenti, Antonio
abstract

N/A

2017 - Évaluation préopératoire de la vascularisation colique. For a preoperative assessment of the colon vascular supply [Articolo su rivista]
Mosca, D.; Farinetti, A.; Manenti, A.
abstract

2009 - Ricostruzione del sopracciglio con lembo a isola di cuoio capelluto basato sull'arteria temporale superficiale [Articolo su rivista]
Piccagliani, Leonardo; Francesco, Ferrara; Palmieri, Beniamino; Mosca, Donatella
abstract

The author described the reconstruction of a eyebrow, in a case of complete traumatic avulsion, using a scalp island flap based on the superficial temporal artery, in a young person of 32 years. Such lesion involved a serious aesthetic disablement to be able to causing turbe of the psychical equilibrium and individual relation, considered that the eyebrows exercises a determining function in the characterization of the face and the expressive gestures. The sagacity to cut the scalp island with a small advanced amplitude to that of the site in which it went inserted, has allowed during the sutura to obtain an optimal projection of the new-constructed eyebrow.

2006 - Cisti broncogena retroperitoneale. Caso clinico e revisione della letteratura [Articolo su rivista]
Mosca, Donatella; Piccagliani, Leonardo; DE BERNARDINIS, Giancarlo
abstract

Questo inusuale caso clinico va a sostenere le scarse segnalazioni di cisti broncogene retroperitoneali della letteratura internazionale, ne enfatizza le difficoltà di diagnosi preoperatoria poiché esse possono essere descritte come masse solide e cistiche. Un uomo di 69 anni viene sottoposto a intervento chirurgico per rimuovere una lesione espansiva definita surrenalica e scoperta in corso di accertamenti eseguiti per altre indicazioni. La lesione cistica viene individuata ed escissa soltanto dopo surrenectomia. Le cisti broncogene retroperitoneali, benché rare, dovrebbero essere prese in considerazione nella diagnosi differenziale delle lesioni espansive del retroperitoneo, particolarmente in presenza di tumori cistici della regione surrenalica di sinistra. E' il primo caso di cisti broncogena retroperitoneale dell'adulto segnalato in Italia.

2006 - Il diaframma mucoso.Una singolare complicanza della tecnica di Knight-Griffen associata a stomia protettiva [Articolo su rivista]
Amorotti, Claudio; Mosca, Donatella; U., Pintaudi
abstract

L'incidenza di diaframmi occlusivi su anastomosi meccaniche per resezioni anteriori del retto non è nota e la gestione di questa complicanza non è ben definita.Un uomo di 74 anni è stato sottoposto a resezione curativa di un adenocarcinoma del retto e a resezione segmentaria digiunale di un tumore stromale scoperto incidentalmente. L'anastomosi colorettale termino-terminale meccanica, secondo la tecnica di Knight-Griffen, e l'anastomosi digiuno-digiunale termino-terminale manuale sono state protette da un'ileostomia temporanea.Alcuni elementi rendono il caso del tutto singolare: il diaframma occlusivo anastomotico, sotteso a livello dell'anastomosi meccanica, non era costituito da tessuto di granulazione ma da un lembo di mucosa.Vari fattori hanno contribuito alla genesi e al mancato riconoscimento di questa complicanza.Vanificato l'approccio endoscopico, il trattamento è avvenuto nel corso di un intervento per perforazione intestinale.

2004 - Angiomixoma aggressivo della pelvi e del perineo. Presentazione di un caso clinico e revisione della letteratura [Articolo su rivista]
Amorotti, Claudio; Mosca, Donatella; U., Pintaudi; Maiorana, Antonino
abstract

L'angiomixoma aggressivo è un raro tumore mesenchimale che origina dal tessuto connettivo della pelvi e del perineo. Si caratterizza per una sintomatologia aspecifica, per la tendenza ad infiltrare i tessuti circostanti e per la facilità con cui recidiva anche a notevole distanza di tempo. Viene presentato il caso di una paziente di sesso femminile di 57 anni che giunge alla nostra osservazione per la comparsa di una voluminosa tumefazione del perineo e già sottoposta più volte ad asportazione di neoformazioni della regione pelviperineale. Si descrive l'iter diagnostico che ha consentito il riconoscimento della neoplasia già in fase preoperatoria e l'iter terapeutico. L'intervento chirurgico di asportazione è stato condotto con un duplice accesso laparotomico e perineale a doppia equipe ed è stato reso particolarmente difficoltoso dall'imponente sclerosi retroperitoneale coinvolgente le basse vie urinarie, il moncone vaginale ed il mesoretto. L'asportazione radicale della neoplasia ha permesso la ricostituzione della normale anatomia pelvica, la regressione della sintomatologia preoperatoria e la ripresa della usuale attività lavorativa. Il trattamento di scelta dell'angiomixoma aggressivo è chirurgico. Questa neoplasia pur essendo benigna assume il comportamento di una malattia maligna per il coinvolgimento degli organi pelvici. Data l'aggressività locale tende a recidivare con un'elevata frequenza potendosi ripresentare anche dopo decenni dal primo intervento. Fondamentale risulta pertanto un follow up a lungo termine.

2003 - Rectal prolapse. Functional results after the Orr-Loygue's rectopexy technique [Articolo su rivista]
Amorotti, C.; Mosca, D.; Di Blasio, P.; Trenti, C.
abstract

The aims of surgery in rectal prolapse are various: reducing the prolapse, preventing relapse, clearing up incontinence and avoiding constipation. Among several technical options available, anterior rectopexy would appear to be the most suitable for achieving these aims. A retrospective clinical study was conducted in 32 patients operated on from January 1996 to June 1999. For patient recruitment, the preoperative examinations were clinical evaluation, barium enema, anorectal manometry, and urodynamic tests. Surgical procedures were Orr-Loygue rectopexy in 29 cases and Ripstein rectopexy in 3 cases. A sigmoidectomy was also performed in 9 cases and a Burch cystopexy in 4 cases. Early results are available for all patients; only 29 have been evaluated after a mean follow-up of 47 months (range: 30-72). Rectal tenesmus, faecal incontinence and urinary incontinence improved in all cases. Constipation cleared up in 9 cases after a complementary sigmoidectomy; in 15 of the remaining 20 patients constipation persisted or developed. Indications for surgery for rectal prolapse must be considered with caution. The good results of anterior rectopexy depend on correct surgical technique and prevention of septic and pelvic complications. Sigmoidectomy does not increase the morbility rate. A planned colic resection in patients with delayed transit would prevent postoperative constipation. The good results are stable even over long-term follow-up periods. This procedure is also effective for the treatment of genital prolapses.

2003 - Usefulness of lateral internal sphincterotomy combined with hemorrhoidectomy by the Milligan-Morgan's technique: results of a prospective randomized trial [Articolo su rivista]
Amorotti, C.; Mosca, D.; Trenti, C.; Pintaudi, U.
abstract

Pain is invariably experienced after haemorrhoidectomy. Internal anal spasm is considered to be a major factor in the genesis of such pain. This prospective randomized study was designed to compare the effectiveness of two manoeuvres (surgical sphincterotomy and chemical sphincterotomy) in reducing post-haemorrhoidectomy pain. Sixty patients (38 males, 22 females) with grade III and IV haemorrhoids were included in this study. In all cases resting anal pressure was reported in the range of 50-100 mm Hg. Group A patients underwent Milligan-Morgan haemorrhoidectomy plus chemical sphincterotomy; group B patients underwent Milligan-Morgan haemorrhoidectomy plus internal left lateral sphincterotomy (0.8-1 cm in length) and group C patients underwent Milligan-Morgan haemorrhoidectomy alone. The postoperative course was carefully evaluated and was found to be better in group B. None of the patients treated by surgical sphincterotomy developed incontinence. Two patients in group C developed anal strictures. When indicated, internal left lateral sphincterotomy (0.8-1 cm) is a safe procedure and reduces post-haemorrhoidectomy pain and stenosis.

2002 - Spontaneous and postoperative bile peritonitis. Surgical technique [Articolo su rivista]
Amorotti, C.; Mosca, D.; Di Blasio, P.
abstract

Background. Bile peritonitis has a diversified aetiology that can present in clinical pictures of variable gravity depending on whether the bile is uncontaminated or activated by other secretions (intestinal, pancreatic) or actually infected. The consequent treatment is therefore eclectic. In our opinion, however, the therapeutic strategy proves effective if modulated on the basis of certain priority elements that should be carefully considered. The type of treatment adopted in relation to immediate and long-term results has been evaluated. The investigation was carried out retrospectively on the series of bile peritonitis treated at the Surgical Clinic of the University of Modena from 1980 to 1998. 45 cases of bile peritonitis are reported of which: 32 postoperative, 2 post-traumatic, 2 following transparietohepatic injection, 7 during acute necrotic cholecystitis, 2 following spontaneous perforation of the biliary tree. As regards the type of treatment, in 13 cases (well-drained postoperative forms) a conservative solution was adopted; in another 13 cases (9 septic and 4 with mixed bile supply) surgery was resorted to again, in the remainder transparietohepatic drainage was carried out in association almost always with the application of a transpapillary endoprosthesis. Results. Morbility was 26.6% (12 cases); 4 patients (8.8%) were reoperated for late complications with mortality of 50%. Total mortality was 20% (9 patients). Conclusions. Treatment of bile peritonitis may be eclectic but the complex forms benefit from early surgical or parasurgical treatment for a definitive resolution of this feared complication.

2000 - A rare case of jejunal adenocarcinoma [Articolo su rivista]
Mosca, D.; Di Renzo, M.; Cartelli, C.; Loria, P.; De Bernardinis, G.
abstract

A case of jejunal adenocarcinoma is presented. The rarity of this pathology, poor specificity of clinical patterns, diagnostic procedures and therapy are also described.

1999 - Postoperative peritonitis. Policy for reoperation [Articolo su rivista]
Amorotti, C.; Mosca, D.; Palladino, L.; Spallanzani, A.; Rossi, A.
abstract

Background. Postoperative peritonitis is a pathologic condition with a sometime nuclear clinical occurence and therefore with an uncertain timing for reoperation. Aim of this paper is to identify the type and frequency of the digestive and systemic symptoms in relation to the anatomo-pathologic peroperative picture. Methods. Between 1980 and 1996, 119 patients were reoperated for a postoperative peritonitis (PPO) in the Surgical Department of Modena University. PPO was due to a lesion situated above the mesocolon in 33 patients, from the small bowel in 18, postappendicectomy in 25 and from the colon in 40. The first operation (for benign disease in 66.4%, for malignancy in 33.6%) was performed in emergency in 47 cases (39.5%) and as elective surgery in 72 (60.5%). Results. The global mortality was of 33.6% (40 patients). An attempt is made to identify, the earlier and the most important bioclinical parameters for a correct indication to surgery. Twenty symptoms have been identified that, with different frequency, are strictly related with the onset of a PPO (in average 5 symptoms were positive). A research of these parameters, each 4-6 hours, allow to identify a subclinic PPO. Conclusions. During the decisional timing, it is important to check these general and digestive symptoms, apparently not serious, in order to avoid the onset appearance of an abdominal tenderness or a multiorgan failure that make the prognosis more severe.

1998 - Male breast myofibroblastoma. Case report [Articolo su rivista]
Palladino, L.; Mosca, D.; Ganz, E.; Ficarra, G.; Buttazzi, A.; Speranza, M.
abstract

A case of male breast myofibroblastoma, personally observed, is described. Preoperative examinations have a limited diagnostic value. Only histological study, with immunohistochemical stain, allows to make a right diagnosis and to distinguish this tumor from other, benign or malignant mesenchymal neoplasms.

1998 - Management of postoperative peritonitis due to gastric and duodenal fistulas [Articolo su rivista]
Amorotti, C.; Mosca, D.; Palladino, L.; Broccardo, M.
abstract

Background. A leak from the anastomosis or gastroduodenal suture or the duodenal fistula after endoscopic sphincterotomy are a very serious complication of supramesocolonic surgery and at this regard multifocal or disseminated peritonitis is a much more serious situation than a possible gastroduodenocutaneous fistula. Methods. The treatment of 21 cases of postoperative supramesocolonic peritonitis is discussed. It is proposed a procedure of diluition, neutralization and aspiration of digestive secretions with an intraluminal three routes drainage associated to a system of perivisceral drainage. A Witzel jejunostomy is performed in order to provide continous high energy enteral support. Results. Mortality rate has been 28.6% (6 patients: 1 case of pulmonary embolism, 1 case of massive haemorrhage and 4 cases of MOF). The external fistula created by this technique healed spontaneously in an average time of 32 days (range 16-46); in two cases a late surgical procedure was required. The late complications involve only the abdominal wall (13 patients out of 21). Conclusions. This procedure prevents the recurrence of intrabdominal sepsis and local complications due to enzymatic action of digestive secretions.

1998 - The role of surgery in severe acute pancreatitis. Indications and timing from a prospective study [Articolo su rivista]
Amorotti, C.; Mosca, D.; Palladino, L.; Rossi, A.; Cioni, G.
abstract

Background. From January 1991 to December 1995 in the General Surgery Unit of the University of Modena, 119 consecutive patients with acute pancreatitis have been included in a prospective study; postoperative pancreatitis has been excluded. Methods. The severity of the disease has been evaluated by means of Ranson's and Imrie's scores, by contrast enhanced computed tomography and by a computer-assisted method elaborated on the bases of a retrospective series which considers 11 parameters taken into account no later than 8-12 hours from hospitalization. Results. The computer-assisted classification failed only in 8 cases (6.7%) with an attitudinal understaging in comparison with the pathological pictures. The computer-assisted method may be actually considered reliable for the assessment of therapeutical policy Conclusions. In severe acute pancreatitis with extensive necrosis and early lethal outcome despite intensive care, surgical treatment (long active drainage according to Levy) in the acute phase, represents the only hope to reduce early mortality rate. In severe acute pancreatitis with a milder clinical pattern, in the early stage of the disease, 30-40% shows late infectious contamination of necrotic collections. In these cases the computer-assisted method has been particularly useful in picking up, in an early phase, the cases with septic complications with a formal indication to surgery in order to avoid a condition of septic shock. This policy has reduced the mortality rate of acute pancreatitis to 19.4%.

1997 - Lateral ventral hernias of the abdominal wall. Anatomo-pathological, clinical and therapeutical considerations [Articolo su rivista]
Tazzioli, G; Mosca, Donatella
abstract

Ventral lateral hernias of the abdominal wall are rare. On the basis of their location we can classify them as follows: hernias of the aponeurosis of the transversus muscle, hernias of the rectal sheath and transmuscular hernias of the iliac region. In a group of 3134 hernias of the abdominal wall observed in a period of 16 years, 11 ventral lateral hernias have been encountered (0.3%). The diagnosis often presents great difficulties as the symptoms and the clinical findings are not typical. They must be differentiated from hematomas of the rectus sheath, abscess or intrabdominal processes. Echography and Computed Tomography have an important role in their detection. Nevertheless in some patients the true diagnosis is reached only intraoperatively. The treatment generally consists in surgical correction by layer closure of the fascial or muscular defect. In selected cases the use of prosthetic material and videolaparoscopic repair are indicated.

1997 - Liposarcoma of the spermatic cord [Articolo su rivista]
Ganz, E.; Mosca, D.; Tazzioli, G.; Zunarelli, E.
abstract

A case of well differentiated, liposarcoma of the spermatic cord in a 80 year old man is presented. The preoperative diagnosis of spermatic cord liposarcoma is not easy; however, a careful comparison between clinical and ultrasonographic findings can lead to diagnostic suspicion. The treatment of choice is the excision of the liposarcoma associated with orchiectomy and high ligation of the spermatic cord to reduce the risk of recurrence. Postoperative radiotherapy may be indicated for poor differentiated liposarcomas.

1997 - Natural history of breast carcinoma: Our experience in lobular versus ductal carcinoma [Articolo su rivista]
Casolo, P.; Raspadori, A.; Drei, B.; Amuso, D.; Mosca, D.; Amorotti, C.; Di Blasio, P.; De Maria, R.; De Luca, G.; Colli, G.; Ganz, E.
abstract

Aim of the study is to evaluate the biology, the clinical evolution and the prognosis of lobular carcinoma of the breast. We retrospectively evaluated the patients treated in our institution during the last 13 years. 117 patients with lobular carcinoma of the breast and 117 patients, randomized out of 397 patients with 'classical' pattern of ductal carcinoma were compared. Age distribution, type of surgery, tumor size, TNM stage, axillary lymph node involvment, multifocality, multiple breast cancers, local and distant recurrences, overall survival and disease-free survival have been evaluated. There was not a significant difference in tumor size, lymph node involvment, stage distrihtuion, estrogens and progesteron receptors status, local and distant recurrences. The only significant differences were found in multifocality and multiple breast cancers. The said difference does not seem to modify the overall survival and the disease-free survival that are the same in the two groups. Our research shows that tumor size and axillary lymph node status are the only elements that have to be considered in the choice of the surgical treatment and prognosis. It seems that the difference in distant metastatic pattern between lobular and ductal carcinoma is the distinctive feature in the follow-up of these patients. © 1997 GEM s.r.l.

1997 - Primary lymphoma of the breast. Three cases of non-hodgkin lymphoma [Articolo su rivista]
Casolo, P.; Mosca, D.; Amorotti, C.; Drei, B.; Raspadori, A.; Di Blasio, P.; Ganz, E.; De Luca, G.; Colli, G.; De Maria, R.; Amuso, D.
abstract

Primary and sole breast lymphoma is a very rare disease. With the review of our series of 616 cases operated on for breast cancer, only 3 cases (0.48%) of primary breast non-Hodgkin lymphoma (LNH) have been observed. The authors outline the problems concerning diagnosis and therapy of this rare disease: pathological and immunoistoche-mical aspects are discussed. They stress the importance of staging in order to plan a correct multidisciplinar approach.

1997 - Recurrent CBD stones: Evolution from open to laparoscopic surgery [Articolo su rivista]
Amorotti, C.; Mosca, D.; Gibertini, G.; Mortilla, M. G.; De Maria, R.; Casolo, P.
abstract

Therapeutic policy and results of 25 years' experience in the management of CBD stones have been analyzed. The whole experience has been divided into three periods: open surgery of CBD stones (1969-1983), 636 cases of CBD lithiasis; endoscopic management of CBD stones (1984-1990), 149 cases of CBD lithiasis; era of laparoscopic cholecystectomy (1991-1994), 501 laparoscopic cholecystectomies with 37 cases of CBD stones (7.4%). The main peculiar issues characterizing the three periods are represented by the following points: a) progressive drop of percentage of CBD lithiasis (from 14.6% to 7.4%) as a consequence of under-utilization of diagnostic means (i.v. cholangiography, ERCP, intraoperative cholangiography) and, also, as a consequence of a total confidence in postoperative endoscopic management of recurrent CBD stones (85-90%); b) increased percentage of deliberately abandoned CBD stones when an endoscopic management is available (from 5.2% to 8.7%). For the same reason we have recorded a decrease of 'tactical' bilio-enteric anastomoses and sphincterotomies (from 9.5% to 2.7%). The well documented early morbility (2%) but mainly the late complications of endoscopic sphincterotomies suggest a great caution to avoid abusive indications in young patients. In our opinion the endoscopic approach is indicated in case of infected obstruction, in critically ill patients with biliary severe acute pancreatitis and in case of high surgical risk.

1997 - The surgical treatment of early breast cancer. Results of a prospective study on 204 cases [Articolo su rivista]
Casolo, P.; Mosca, D.; Amorotti, C.; Raspadori, A.; Drei, B.; Di Blasio, P.; Colli, G.; De Maria, R.; De Luca, G.; Ganz, E.; Amuso, D.
abstract

The authors report the results of a prospective study on 204 patients (1980-1993) affected by early infiltrating breast cancer (size £ 2 cm) as a part of a surgical series of 608 cases. 53 cases who underwent QUART (25.9%) and 151 cases (74.1 %) who underwent mastectomy modified according to Patey have been collected. 10 years actuarial survival has been respectively 79% after extensive surgery and 78% after conservative treatment. Local recurrences have been observed in 9 cases after meticolous follow-up (median 74.8 months, range 12-178): 3 (5,66%) patients after QUART and 6 (3.97%) after mastectomy; furthermore 1 patient after a conservative treatment (1.88%) has developed a second tumor at the same side probably dependent on the presence in the primary tumor of an extensive intraductal component. No correlations between histological features, grading, positive nodes, receptor status and local recurrences have been found. Only the age of patients looks significantly correlated with frequency of recurrences: 44.45% of local recurrences have been observed in patients less than 45 years old. Local recurrences after QUART have obliged, in all cases, to a radical mastectomy. Furthermore, frequency of distant metastases has been considered: after QUART percentage is lower (9.43%) than after radical mastectomy (13.9%). This consideration looks correlated with the longer follow-up of the later group. A multidisciplinar approach is adviced but the most important role is plaied by surgery. In conclusion it is outlined that conservative surgery is addressed to selectioned and consenting patients.

1996 - The functional results of low anterior resections: Colorectal anastomosis vs J-pouch coloanal anastomosis [Articolo su rivista]
Amorotti, C.; Mosca, D.; Ganz, E.; Di Blasio, P.; Casolo, P.
abstract

Forty-nine patients have undergone low anterior resection in the period January 1992-December 1993; they have been attributed to four groups according to the level of anastomosis and length of follow-up: - group 1: 13 patients with colorectal anastomosis - CRA - > 6 cm from anal verge; - group 2: 10 patients with low colorectal anastomosis - LCRA - (follow-up < 6 months); - group 3: 12 patients with low colorectal anastomosis - LCRA - (follow-up > 6 months); - group 4: 14 patients with J-pouch coloanal anastomosis - J-CAA. The clinical results (frequency of evacuations/24 hours, degree of fecal continence) show main differences in every group. In group 2, 80% of patients refers more than 5 evacuations/24 hours and 60% complains of incontinence for liquid stools; 70% of patients reports an unsatisfactory result. In group 3, a 6 months delay from surgery is enough to produce an improved clinical result in about 2/3 of patients. The clinical results and personal judgment of groups 1 and 4 are positive since the postoperative period in all cases. Postoperative manometric measurements reveal a very low value of anal data (MBP and MSP) in relation with the clinical result; on the contrary an important significance is attributed to rectal manometric data (VIS, MVT and rectal compliance). So preoperative anal manometric parameters don't allow the selection of surgical indication. The level of anastomosis (> or < 6 cm) influences the functional results: The rise of compliance with the pelvic J-pouch improves early functional results. Loop colostomy is a prudential attitude for anastomosis done low in the pelvis at less than 6 cm from the anal verge: functional results would get worse definitively in case of anastomotic leakage.

1994 - The treatment of iatrogenic injuries of CBD: Surgery vs endoprostheses [Articolo su rivista]
Amorotti, C.; Mosca, D.; De Maria, R.; Mortilla, M. G.
abstract

Analysis of the long-term results of 83 Roux-en-Y bilio-enteric anastomosis and 25 endoscopic stentings for iatrogenic biliary strictures, has allowed, in spite of drawbacks of a retrospective study, the identification of good indications for treatment. The good long-term results of surgical treatment (84.3%) after a mean follow-up of 8.5 years, have a favorable relationship with an intrahepatic preexisting dilatation of the biliary tree in the absence of chronic rough inflammation of the biliary wall. Otherwise, endoscopic stenting can be a good indication both as definitive treatment and complementary to surgery. On the contrary, the Hutson-Russell loop cutaneous choledochojejunostomy can represent a viable access to intrahepatic biliary tree for endoscopic instrumentation in case of recurrent anastomotic stricture. The long-term results are roughly similar after endoscopic (mean follow-up 23.6 months) and surgical treatment. The cases with unsatisfactory evolution after endoscopic management are the long strictures with late treatment with long-standing biliary infections. Nevertheless follow-ups of endoscopic series are too short to say that long-term results are really definitive. Short and incomplete strictures with bilio-cutaneous fistula have to be thought a good indication to endoscopic treatment. In our opinion self-expanding metallic stents have not to be used in benign strictures.

1991 - Regarding a case of non-Hodgkin's primary lymphoma of the adrenal gland [Articolo su rivista]
Casolo, P.; Frassoldati, A.; Giaco, M.; Lazzaretti, M. G.; Mosca, D.; Piccinni, L.
abstract