Papers by Pierfilippo Crucitti
The Annals of Thoracic Surgery, 2022
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PubMed, 1994
Since the first years of the century, the improvement in surgical techniques has drastically redu... more Since the first years of the century, the improvement in surgical techniques has drastically reduced the main postoperative complication, profuse bleeding. More experience in thyroidectomy has highlighted other specific problems of the procedure, which has received substantial benefits by the adoption of targeted surgical techniques. The Authors describe the most important topics reported for each complication, on the basis of the latest literature and their own experience, with particular reference to the oncologic surgery of the thyroid.
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Journal of Clinical Anesthesia, Oct 1, 2020
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British Journal of Surgery, 1998
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Medical Sciences, Sep 23, 2022
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The Annals of Thoracic Surgery, Aug 1, 2022
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European Journal of Cardio-Thoracic Surgery, May 5, 2019
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Frontiers in Surgery, Jun 15, 2023
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PubMed, Jul 1, 1996
In patients affected by aortoiliac aneurysm the concurrent presence of a gastrointestinal tumor i... more In patients affected by aortoiliac aneurysm the concurrent presence of a gastrointestinal tumor is a not infrequent occurrence which poses problems of therapeutic approach (one step operation or prior treatment of one of the two diseases; in the latter case definition of timing and sequence of the surgical treatment). Three cases are reported where an eclectic therapeutic approach has enabled satisfactory results. A patient with an isolated aneurysm of right hypogastric artery associated with rectal cancer was treated with percutaneous embolization of the aneurysm and subsequent excision of the tumor. In a patient with a neoplasm of the left colon and aortic aneurysm, the aneurysm was treated first and after about a month the tumor was resected. In a patient with gastric cancer and aortic aneurysm subtotal gastrectomy was first performed and subsequently, after about 3 months, the aneurysm was treated by extraperitoneal route. Even if an unidirectional approach cannot be defined, it is thought that the two-step treatment of the associated diseases is preferable. In the presence of non stenosed non bleeding colorectal tumors it seems more suitable to treat the aneurysm first (increased postoperative risk for rupture of the aneurysm; more difficult preparation of subrenal aorta in the presence of cicatricial outcomes of colonic surgery; persistence of perianastomotic infections after colonic resection). Gastric tumors should be treated first for their higher biological aggressiveness and unfeasible correct preoperative staging. In particular cases (single unilateral aneurysm of a hypogastric artery associated with gastrointestinal cancer), non surgical treatment of the vascular lesion (embolization during angiography) is the treatment of choice.
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PubMed, Jul 1, 1996
In the last 20 years within the clinical research on venous thromboembolism a major objective was... more In the last 20 years within the clinical research on venous thromboembolism a major objective was to identify and develop increasingly effective and safe methods of prevention. This trend is justified by the high incidence of thromboembolism as well as by the relevant mortality for acute pulmonary embolism and postphlebitic sequels of difficult treatment. A significant contribution to the rational application of methods of prevention was given by the knowledge of risk factors. Together with acquired risks, as surgery, age, malignant tumors, in the last 30 years some conditions of thrombophilia were identified. They are caused by deficiencies in coagulation inhibitors (antithrombin III, protein C, protein S) or other alteration of the anticoagulation system as resistance to activated protein C or antiphospholipid antibodies. The primary prophylaxis of venous thromboembolism is aimed at the prevention of thrombosis by pharmacologic methods able to oppose the procoagulant alterations while avoiding hemorrhagic complications. The physical methods tend to reduce the stasis in the veins of the lower extremities. Subcutaneous calcium heparin at the dose of 5000 U twice or three times a day is the most common pharmacologic method used. It was shown to be safe and effective especially in postoperative prophylaxis of venous thromboembolism in general surgery. More recently, low molecular weight heparin fractions have been introduced. As compared to standard heparin they have the advantage of a single daily dose and a better efficacy in some groups of patients, as those undergoing hip replacement. Among the substances under clinical experimentation, dermatan sulfate seems promising. Most common physical prevention methods consist in the use of elastic graduated compression stockings and systems of intermittent pneumatic calf compression. The former can be used also in presence of a hemorrhagic risk as in neurosurgery. The latter have shown a good efficacy in increasing flow velocity and probably also in enhancing the fibrinolytic activity. The combination of physical and pharmacologic methods seems to be able of enhancing the efficacy of prophylaxis.
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Thyroid surgery has undergone an enormous evolution in recent years, resulting in a significant r... more Thyroid surgery has undergone an enormous evolution in recent years, resulting in a significant reduction in postoperative complications,most of which can be avoided by close attention to anatomical detail and meticulous surgical technique. There remain, however, certain forms of disease (i.e. thyroid cancer) and conditions (reoperative surgery) which determine a higher incidence of postoperative complications even in the most experienced hands. The authors describe postoperative complications, defining the etiopathogenetic mechanisms involved and suggesting techniques to avoid them
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PubMed, Apr 1, 1995
Colorectal cancer (CRC) is a neoplasm with a steadily growing incidence in Western countries. Mor... more Colorectal cancer (CRC) is a neoplasm with a steadily growing incidence in Western countries. Moreover the age of 50 and over is a critical risk factor. The relationship between dietary, environmental factors and CRC has been evaluated. At present, a number of genetic risk factors such as the genetic susceptibility, tumor suppressor genes and oncogenes are thought to play a major role. The correlation of CRC with adenomatous polyps and chronic inflammatory disease, ulcerative colitis in particular, has been evaluated. Prevention of CRC is mainly based on a rational diet and in the adoption of mass screening programmes.
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International journal of cancer medicine, 2023
Objectives: Non-small cell lung cancer can spread into lobe specific stations and non-lobe-specif... more Objectives: Non-small cell lung cancer can spread into lobe specific stations and non-lobe-specific mediastinal lymph nodes. We evaluated frequency and features of non-lobe specific nodal metastases, focusing especially on the prognostic value of only non-lobe specific N2-metastases after lobectomy. Methods: We performed a retrospective review of 550 patients with non-small cell lung cancer with clinical N0, undergoing lobectomy and systematic or lobe specific node dissection. We evaluated disease free and overall survival rates using Kaplan-Meier method and significance was tested by log-rank test. Result: Occult N2 disease was detected in 68 patients (8.1%), 26 of them (38.2%) had metastases in non-lobe specific stations. Comparing patients with lobe and non-lobe specific lymph node metastases, 3-years DFS rate was 44.4% vs. 20.0% (p-value = 0.009), while 3-years OS rate was 87.3% vs. 26.7% (p-value <0.001). Among patients with non-lobe specific metastases 16 of them (61.5%) had only non-lobe specific metastases, the remaining 10 patients (38.5%) had metastatic lymph node at the same time in non-lobe specific station but also in lobe-specific stations. Comparing post-operative survival between patients with only non-lobe specific metastases and synchronous lobe and non-lobe specific metastases, 3-years DFS rate was 12.5% vs. 41.3% respectively (p-value = 0.03), and 3-years OS rate was 12.5% vs 76.7% (p-value = 0.002). Conclusion: In patients with occult N2 disease, the finding of a metastatic lymph node in a non-lobe specific station relates with significant lower survival rate. The subset of patients who presented only non-lobe specific node metastases showed a significant lower survival rate compared to the remaining occult N2.
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Journal of Thoracic Disease
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The Journal of Clinical Endocrinology & Metabolism
Background and Objective Molecular analysis of thyroid fine-needle aspiration (FNA) specimens is ... more Background and Objective Molecular analysis of thyroid fine-needle aspiration (FNA) specimens is believed to improve the management of indeterminate nodules. Raman spectroscopy (RS) can differentiate benign and malignant thyroid lesions in surgically removed tissues, generating distinctive structural profiles. Herein, the diagnostic performance of RS was tested on FNA biopsies of thyroid gland. Design Prospective, blinded, and single-center study. Methods We enrolled 123 patients with indeterminate or more ominous cytologic diagnoses (TIR3A-low-risk indeterminate lesion, TIR3B-high-risk indeterminate lesion, TIR4-suspicious of malignancy, TIR5-malignant). All subjects were surgical candidates (defined by international guidelines) and submitted to FNA procedures for RS analysis. We compared RS data, cytologic findings, and final histologic assessments (as reference standard) using various statistical techniques. Results The distribution of our study population was as follows: TIR3A:3...
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Background: Thoracic surgery is a constantly evolving field that require innovative solutions. In... more Background: Thoracic surgery is a constantly evolving field that require innovative solutions. Invisible near-infrared fluorescence imaging with indocyanine green is an intraoperative technology that could be help for surgeons. Indocyanine green is a nontoxic dye with low rate of adverse reaction. Indocyanine green binds with plasma proteins and lipoprotein that allow a deep tissue penetration, and also the amphiphilic proprieties allow indocyanine green to migrate within lymphatics. Methods: We selected forty-nine previous studies from the literature searching terms “lung cancer”, “indocyanine green”, “thoracic surgery”, “fluorescent images”. The topics of the paper were: sentinel lymph node mapping, pulmonary nodes identification, intersegmental plane identification, and other application (pulmonary bullous lesions, bronchopleural fistula, bronchoplasty, pulmonary sequestration, chyle leak, hyperidrosis). Results: In the different applications indocyanine green showed a high ident...
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Scientific Reports, 2020
Over the last 50 years, the incidence of human thyroid cancer disease has seen a significative in... more Over the last 50 years, the incidence of human thyroid cancer disease has seen a significative increment. This comes along with an even higher increment of surgery, since, according to the international guidelines, patients are sometimes addressed to surgery also when the fine needle aspiration gives undetermined cytological diagnosis. As a matter of fact, only 30% of the thyroid glands removed for diagnostic purpose have a post surgical histological report of malignancy: this implies that about 70% of the patients have suffered an unnecessary thyroid removal. Here we show that Raman spectroscopy investigation of thyroid tissues provides reliable cancer diagnosis. Healthy tissues are consistently distinguished from cancerous ones with an accuracy of $$\sim $$ ∼ 90%, and the three cancer typology with highest incidence are clearly identified. More importantly, Raman investigation has evidenced alterations suggesting an early stage of transition of adenoma tissues into cancerous ones....
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International Journal of Surgery Case Reports, 2020
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Endocrine, 2019
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Minerva chirurgica, Jan 12, 2015
The main purpose of our project was to evaluate the prevalence of lung cancer in high risk, asymp... more The main purpose of our project was to evaluate the prevalence of lung cancer in high risk, asymptomatic individuals in addition to quantifying the rate of surgically resectable tumors, and evaluating the role of LDCT as a tool for lung cancer screening. Between June 2011 and March 2014, 1500 volunteers at high risk for lung cancer were enrolled in our study and underwent LDCT in our institution. The subsequent diagnostic and therapeutic steps were planned in relation to the results emerging from LDCT. To evaluate speed and type of growth, solid nodules ≤4 mm were reassessed with annual LDCT, those >46mm or >68 mm were reassessed with LDCT in 6 or 3 months while nodules suspicious for malignancy were investigated with PETCT or biopsy according to NCCN guidelines. Non calcified nodules were detected in 525 subjects (35 % of population): among these 42% had a diameter ≤ 4 mm, 43 % had a diameter > 5mm but <10mm, 3% appeared as "ground glass" lesions, and 63 (12% ...
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Papers by Pierfilippo Crucitti