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Antonello A.,Veneto Institute of Oncology IOV IRCSS | Ishaq S.,Birmingham City University | Ishaq S.,St. Georges University | Zanatta L.,Santa Maria del Prato Hospital | And 3 more authors.
Surgical Endoscopy and Other Interventional Techniques | Year: 2016

Background: Currently there are three main treatment options for Zenker’s diverticulum (ZD): surgery, rigid endoscopy and flexible endoscopy. After primary success, recurrence can be as high as 19 % for surgery, 12.8 % for rigid endoscopy and 20 % for flexible endoscopy. Flexible endoscopy may represent an ideal treatment option for recurring ZD. The aims of this paper are to evaluate the efficacy and safety of flexible endotherapy for recurring ZD after surgery and/or endoscopic stapling and to compare the treatment outcome between naive and recurring patients. Methods: Data on patients that underwent flexible endotherapy for ZD between January 2010 and January 2015 were collected. Patients were divided into those with recurrences after surgery and/or endoscopic stapling and those who did not have previous treatments. Dysphagia, regurgitation, and respiratory symptom severity before the procedure were graded. The outcome parameters were: complications, symptom improvement after the first treatment, number of treatment sessions, rate of complete remission and relapses. These parameters were then compared between patients groups. Results: Twenty-five recurring patients were included. Treatment was carried out successfully in all patients. Two adverse events occurred; they were successfully managed conservatively. After the first treatment, there was a significant reduction in dysphagia, regurgitation and respiratory symptoms scores. The median number of treatments was 1 (IQR 0.25, range 1–3): symptom remission was achieved in 84 % patients and partial improvement in 16 %. Relapsing symptoms occurred in 20 % patients; they were successfully managed with an additional treatment session. Results were compared with data on 34 consecutive naive patients treated within the same time span; no differences of the outcome parameters were revealed. Conclusions: Flexible endotherapy for ZD recurrences after surgery and endoscopic stapling appears to be safe and effective, and its efficacy and safety profile seems to be comparable between recurring and naive patients. © 2015, Springer Science+Business Media New York. Source

Caffo O.,Santa Chiara Hospital | Fratino L.,Italian National Cancer Institute | Barbieri R.,Carlo Poma Hospital | Perin A.,Civil Hospital | And 8 more authors.
Urologic Oncology: Seminars and Original Investigations | Year: 2013

Objective: Although there is no standard treatment after docetaxel failure in patients with castration-resistant prostate cancer (CRPC), second-line chemotherapy is increasingly required. Its mechanism of action and toxicity profile make pemetrexed suitable for testing in this setting. Methods and materials: Patients with docetaxel-resistant CRPC received pemetrexed 500 mg/m2 every 3 weeks for 6 courses. The usual premedication with vitamin supplementation and dexamethasone prophylaxis was regularly administered. The primary objective was to quantify the biochemical response rate. Results: The biochemical response rate was 10.5% (95% CI 1.3-33.1), with 2 patients showing a reduction in prostate specific antigen (PSA) of ≥50%. The null hypothesis that the PSA response rate would be less than 20% was therefore accepted, and patient accrual was stopped after the evaluation of the 19th patient. The 1-year overall survival rate was 61.5%, with a median survival of 14 months. A considerable proportion of the patients (36%) were withdrawn from the study because of hematologic and nonhematologic toxicity. Conclusions: Our experience with pemetrexed in CRPC patients appears discouraging in terms of activity and toxicity. No further studies of this drug should be performed in CRPC patients. © 2013 Elsevier Inc. Source

Battaglia G.,Veneto Institute of Oncology IOV | Antonello A.,Veneto Institute of Oncology IOV | Realdon S.,Veneto Institute of Oncology IOV | Cesarotto M.,Veneto Institute of Oncology IOV | And 3 more authors.
Digestive Endoscopy | Year: 2015

Background and Aim Flexible endoscopic septum division is becoming a prominent treatment option for Zenker's diverticulum (ZD). Over the years, various techniques have been developed and many cutting tools have been tested with varying results. We report our experience with a recently designed, monopolar, rotating, scissor-shaped device (SB Knife). Methods Data on 31 consecutive patients that underwent flexible endoscopic treatment for ZD with the use of the SB Knife were retrieved. Dysphagia, regurgitation, and respiratory symptom severity before the procedure were graded. Procedure duration, rate of complications, symptom changes after the procedure and rate of relapsing patients during follow up were recorded. Results The procedure was carried out successfully in all patients. Median procedure time was 14 min. One case of late-onset bleeding developed 1 week after the procedure, and was managed endoscopically. A significant symptom improvement was achieved (dysphagia: median score <3, median score >0, P < 0.001; regurgitation: median score <2, median score >0, P < 0.001; respiratory symptoms: median score <2, median score >0, P = 0.009). Two patients had mild relapsing symptoms, respectively, after 4 and 9 months from the procedure but refused further treatment. Conclusions Endoscopic treatment of ZD using this new device is safe and efficient at short term follow up. No perforations were observed and there was a substantial reduction of symptoms after the treatment. Larger studies are needed to fully assess advantages of this new device for endoscopic treatment of ZD. © 2015 The Authors. Digestive Endoscopy © 2015 Japan Gastroenterological Endoscopy Society. Source

Giglia G.,University of Palermo | Giglia G.,Maastricht University | Brighina F.,University of Palermo | Rizzo S.,Fondazione Istituto San Raffaele G. Giglio | And 6 more authors.
Functional Neurology | Year: 2014

Several studies have shown that transcranial direct current stimulation (tDCS) is able to enhance performances on verbal and visual working memory (WM) tasks. Available evidence points to the right dorsolateral prefrontal cortex (DLPFC) as a critical area in visual WM, but to date direct comparisons of the effects obtained by stimulating the left versus the right DLPFC in the same subject are lacking.Our aim was to determine whether tDCS over the right DLPFC can differently affect performance as compared with left DLPFC stimulation. Ten healthy subjects performed a memory-guided visuospatial task in three conditions: baseline, during anodal stimulation applied over the right and during anodal stimulation applied over the left DLPFC. All the subjects also underwent a sham stimulation as control. Our results show that only active stimulation over the right DLPFC is able to increase performance when compared to the other conditions. Our findings confirm the crucial role played by the right DLPFC in spatial WM tasks. © 2014, CIC Edizioni Internazionali s.r.l., Inc. All rights reserved. Source

Vigneri S.,University of Palermo | Bonventre S.,University of Palermo | Inviati A.,University of Palermo | Schifano D.,University of Palermo | And 6 more authors.
Clinical Neurophysiology | Year: 2014

These data strengthen the hypothesis of a different pathophysiology and progression into a chronic (i.e. unresponsive) form in patients with ERD. Objective: To evaluate the effects of transcranial direct current stimulation (tDCS) on esophageal peristalsis in patients with gastroesophageal reflux disease (GERD). Methods: Patients with GERD preliminary diagnosis were included in a randomized double-blind sham-controlled study. Esophageal manometry was performed before and during transcranial direct current stimulation (tDCS) of the right precentral cortex. Half of patients were randomly assigned to anodal, half to sham stimulation. Distal waves amplitude and pathological waves percentage were measured, after swallowing water boli, for ten subsequent times. Last, a 24. h pH-bilimetry was done to diagnose non-erosive reflux disease (NERD) or functional heartburn (FH). The values obtained before and during anodal or sham tDCS were compared. Results: Sixty-eight patients were enrolled in the study. Distal waves mean amplitude increased significantly only during anodal tDCS in NERD (p= 0.00002) and FH subgroups (p= 0.008) while percentage of pathological waves strongly decreased only in NERDs (p= 0.002). Conclusions: Transcranial stimulation can influence cortical control of esophageal motility and improve pathological motor pattern in NERD and FH but not in erosive reflux disease (ERD) patients. Significance: Pathophysiological processes in GERD are not only due to peripheral damage but to central neural control involvement as well. In ERD patients dysfunctions of the cortico-esophageal circuit seem to be more severe and may affect central nervous system physiology. © 2014 International Federation of Clinical Neurophysiology. Source

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