G. Viviani

Catholic University of the Sacred Heart , Milano, Lombardy, Italy

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Publications (11)24.76 Total impact

  • Digestive and Liver Disease 03/2008; 40. DOI:10.1016/S1590-8658(08)60289-3 · 2.89 Impact Factor
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    ABSTRACT: Hepatocellular carcinoma is one of the leading causes of death for cirrhosis, and patients are often not eligible for surgery. To evaluate the effectiveness of radiofrequency ablation in single (less than 3.5cm in diameter) or multiple nodules (up to 3, sized less than 3cm) in respect of acceptability, applicability, primary ablation rate, local recurrence, complications, and long-term patients outcome. 184 hepatic nodules detected in 156 consecutive patients recruited from a local sonographic screening were treated. In 10.2% of patients under study, a laparoscopic or laparotomy guided technique was preferred to the percutaneous approach. Overall and tumor-free survivals were estimated by Kaplan-Meier method. For the multivariate analysis, the hazard ratios and their 95 percent confidence intervals were computed by Cox model regression analysis. No treatment-related deaths and a severe complication rate of 3.2% were recorded. Primary complete ablation was obtained in 83.7% of nodules (87.1% of patients), and in a significantly higher rate for nodules up to 2cm (91.3%; p<0.013). Acceptability was 100%, and eligibility was very high (156 out of 160 cases). Local recurrence rate at 1 and 3 years was 10% and 25% respectively. The overall 3- and 5-year survival rates after treatment were 69.3% and 34.6%. Higher survival rates were obtained in the Child A cirrhosis subgroup (p<0.03) after complete response (p<0.001) and in the absence of new lesions (p<0.023). Radiofrequency ablation has great acceptability and applicability, and is a safe and effective treatment to be used after sonographic screening for small hepatocellular carcinomas.
    Hepato-gastroenterology 01/2008; 55(81):191-6. · 0.91 Impact Factor
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    ABSTRACT: The present study reports on a prompt diagnosis of colonic amoebiasis with colonic spirochetosis by Brachyspira aalborgi and B. pilosicoli; such diagnosis allowed exclusion of other diseases and resolution of the case after specific treatment. A 37-year-old Italian man with a history of several months' mucosal diarrhea travelled to Greece, Romania and Tunisia. After his last trip he presented with an increase of up to 3-5 discharges daily, associated with bloody diarrhea, supporting the clinical suspect of inflammatory bowel disease. Colonoscopy revealed erosions from the cecum to the rectum, and ulcers both in the descending and sigmoid colon. Structures resembling amoebic trophozoites and sinusoidal microorganisms were observed in the colonic biopsies at histopathology and electron microscopy. Entamoeba histolytica DNA was detected by small-subunit rDNA polymerase chain reaction (PCR) from feces, rectal biopsies and isolated trophozoites. Spirochetes were identified from feces, colonic biopsies and cultures using a 16S rDNA restriction fragment length polymorphism-PCR specific for the detection of B. aalborgi and B. pilosicoli. After therapy, the patient was restored to health. The rapid identification of E. histolytica, B. aalborgi and B. pilosicoli using traditional and specific and sensitive molecular methods permitted an accurate diagnosis and a specific therapy. It is suggested that mixed infection by parasites and spirochetes might occur more frequently than expected: it would be of extreme interest and importance to intensify clinical findings, and one infection should not prompt the pathologist/clinician to stop looking.
    Journal of Gastroenterology and Hepatology 02/2007; 22(1):64-7. DOI:10.1111/j.1440-1746.2006.04396.x · 3.63 Impact Factor
  • Digestive and Liver Disease 04/2006; 38. DOI:10.1016/S1590-8658(06)80537-2 · 2.89 Impact Factor
  • Digestive and Liver Disease 04/2006; 38. DOI:10.1016/S1590-8658(06)80012-5 · 2.89 Impact Factor
  • Digestive and Liver Disease 04/2006; 38. DOI:10.1016/S1590-8658(06)80218-5 · 2.89 Impact Factor
  • 06/2003; 18(2). DOI:10.4081/mm.2003.4222
  • Digestive and Liver Disease 06/2002; 34. DOI:10.1016/S1590-8658(02)90286-0 · 2.89 Impact Factor
  • Digestive and Liver Disease 11/2001; 33. DOI:10.1016/S1590-8658(01)80444-8 · 2.89 Impact Factor
  • Digestive and Liver Disease 11/2000; 32. DOI:10.1016/S1590-8658(00)80527-7 · 2.89 Impact Factor
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    ABSTRACT: Effectiveness of radiofrequency ablation for HCCs measuring 3.5 cm or less Objective. To evaluate the therapeutic effectiveness, local recurrence and complication rates, and long-term outcomes of percutaneous radiofrequency ablation for hepatocellular carcinoma (HCC) (isolated nodules measuring ≤ 3.5 cm or < 3 lesions, each measuring ≤ 3 cm). Methods. Over a period of 7 years, we used radiofrequency ablation as the first-line treatment for 184 HCC nodules in 156 consecutive diagnosed patients who were ineligible for surgery. Percutaneous approaches were used in most cases, but laparoscopic approaches were preferred for safety reasons in 16/156 (10.2%) patients. Results. There were no treatment-related deaths. Severe complications occurred in 5/156 (3.2%) patients. Computed tomography (CT) performed one month after the procedure revealed complete ablation in 154/184 (83.7%) nodules and in 136/156 (87.1%) of the patients. Local recurrence rates at 1, 2, and 3 years were 10%, 20%, and 25%, respectively. Overall 3-and 6-year survival rates fol-lowing treatment were 69.3% and 34.6%, respectively. Higher rates (79% and 54%) were observed in the subset of patients with Child class A cirrhosis. Analysis based on Cox's proportional hazard model showed that the following factors significantly influenced survival: liver function (P<0.03), post-treatment appearance of distant metastases (p<0.023), and CT evidence of complete ablation (P<0.001). Conclusions. Radiofrequency ablation can be considered safe and effective for treatment for small HCCs in general practice settings although our results are not as good as those that have been reported in specialized referral centers. Scopo dello Studio. Valutare l'efficacia terapeutica, la ricorrenza di malattia, le complicanze e la sopravvivenza di pazienti sottoposti a trattamento ablativo percutaneo con radiofrequenze per epa-tocarcinoma singolo di diametro inferiore o uguale a 3.5 cm oppure multiplo fino a 3 lesioni con diametro inferiore a 3 cm. Metodi. In un periodo di 7 anni è stata eseguita terapia ablativa con radiofrequenze in 184 noduli di epatocarcinoma di 156 pazienti consecutivi non candidabili all'intervento chirurgico diagnosticati in un programma locale di screening. L'approccio percutaneo è stato evitato in quanto impossibile o rischioso nel 10.2% dei pazienti in cui è stata preferita la guida laparoscopica. Risultati. (1) Nessun paziente è deceduto a causa del trattamento; solo il 3.2% dei casi ha presen-tato complicanze maggiori; (2) il trattamento ha conseguito una risposta completa nell'83.7% dei noduli e nell'87.1% dei pazienti alla TC trifasica eseguita ad 1 mese dalla procedura con un tasso di recidiva locale ad 1, 2 e 3 anni del 10%, 20% e 25%; (3) la sopravvivenza a 3 e 6 anni è stata del 69.3% e 34.6%, ma più elevate 79% e 54% in cirrotici Child A; (4) variabili che hanno inciso signi-ficativamente sulla sopravvivenza sono state il grado di funzionalità epatica (p<0.03), (5) la com-parsa di nuove lesioni separate dalla prima trattata (p<0.023) e la risposta completa al trattamento in termini di necrosi (P<0.001) utilizzando la regressione di Cox e calcolando gli hazard ratio e i loro relativi intervalli di confidenza al 95%. Conclusioni. La termoablazione con radiofrequenze è un trattamento per piccoli epatocarcinomi affidabile in termini di sicurezza ed efficacia anche nella pratica clinica seppur in minore proporzio-ne rispetto a quanto descritto nei più recenti report di efficacia dei centri di riferimento.