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| 1 | Diagnosis and management of choledocholithiasis in the golden age of imaging, endoscopy and laparoscopy显示文摘Biliary lithiasis is an endemic condition in both Western and Eastern countries, in some studies affecting 20% of the general population. In up to 20% of cases, gallbladder stones are associated with common bile duct stones(CBDS), which are asymptomatic in up to one half of cases. Despite the wide variety of examinations and techniques available nowadays, two main open issues remain without a clear answer: how to cost-effectively diagnose CBDS and, when they are finally found, how to deal with them. CBDS diagnosis and management has radically changed over the last 30 years, following the dramatic diffusion of imaging, including endoscopic ultrasound(EUS) and magnetic resonance cholangiography(MRC), endoscopy and laparoscopy. Since accuracy, invasiveness, potential therapeutic use and costeffectiveness of imaging techniques used to identifyCBDS increase together in a parallel way, the concept of 'risk of carrying CBDS' has become pivotal to identifying the most appropriate management of a specific patient in order to avoid the risk of 'under-studying' by poor diagnostic work up or 'over-studying' by excessively invasive examinations. The risk of carrying CBDS is deduced by symptoms, liver/pancreas serology and ultrasound. 'Low risk' patients do not require further examination before laparoscopic cholecystectomy. Two main 'philosophical approaches' face each other for patients with an 'intermediate to high risk' of carrying CBDS: on one hand, the 'laparoscopy-first' approach, which mainly relies on intraoperative cholangiography for diagnosis and laparoscopic common bile duct exploration for treatment, and, on the other hand, the 'endoscopy-first' attitude, variously referring to MRC, EUS and/or endoscopic retrograde cholangiography for diagnosis and endoscopic sphincterotomy for management. Concerning CBDS diagnosis, intraoperative cholangiography, EUS and MRC are reported to have similar results. Regarding management, the recent literature seems to show better short and long term outcome of surgery in terms of retained stones and need for further procedures. Nevertheless, open surgery is invasive, whereas the laparoscopic common bile duct clearance is time consuming, technically demanding and involves dedicated instruments. Thus, although no consensus has been achieved and CBDS management seems more conditioned by the availability of instrumentation, personnel and skills than cost-effectiveness, endoscopic treatment is largely preferred worldwide. | Renato Costi Alessandro Gnocchi Francesco Di Mario Leopoldo Sarli | 2014 | World Journal of Gastroenterology2014，20，37： | 48 |
| 2 | palliative care and end-stage colorectal cancer management:The surgeon meets the oncologist显示文摘Colorectal cancer(CRC)is a common neoplasia in the Western countries,with considerable morbidity and mortality.Every fifth patient with CRC presents with metastatic disease,which is not curable with radical intent in roughly 80%of cases.Traditionally approached surgically,by resection of the primitive tumor or stoma,the management to incurable stageⅣCRC patients has significantly changed over the last three decades and is nowadays multidisciplinary,with a pivotal role played by chemotherapy(CHT).This latter have allowed for a dramatic increase in survival,whereas the role of colonic and liver surgery is nowadays matter of debate.Although any generalization is difficult,two main situations are considered,asymptomatic(or minimally symptomatic)and severely symptomatic patients needing aggressive management,including emergency cases.In asymptomatic patients,new CHT regimens allow today long survival in selected patients,also exceeding two years.The role of colonic resection in this group has been challenged in recent years,as it is not clear whether the resection of primary CRC may imply a further increase in survival,thus justifying surgeryrelated morbidity/mortality in such a class of shortliving patients.Secondary surgery of liver metastasis is gaining acceptance since,under new generation CHT regimens,an increasing amount of patients with distant metastasis initially considered non resectable become resectable,with a significant increase in long term survival.The management of CRC emergency patients still represents a major issue in Western countries,and is associated to high morbidity/mortality.Obstruction is traditionally approached surgically by colonic resection,stoma or internal by-pass,although nowadays CRC stenting is a feasible option.Nevertheless,CRC stent has peculiar contraindications and complications,and its long-term cost-effectiveness is questionable,especially in the light of recently increased survival.Perforation is associated with the highest mortality and remains mostly matter for surgeons,by abdominal lavage/drainage,colonic resection and/or stoma.Bleeding and other CRC-related symptoms(pain,tenesmus,etc.)may be managed by several mini-invasive approaches,including radiotherapy,laser therapy and other transanal procedures. | Renato Costi Francesco Leonardi Daniele Zanoni Vincenzo Violi Luigi Roncoroni | 2014 | World Journal of Gastroenterology2014，20，24： | 6 |
| 3 | Metabolic syndrome and non-alcoholic fatty liver disease in liver surgery: The new scourges?显示文摘The aim of this topic highlight is to review relevant evidence regarding the influence of the metabolic syndrome(MS) and its associated liver manifestation, non-alcoholic fatty liver disease(NAFLD), on the development of liver cancer as well as their impact on the results of major liver surgery. MS and NAFLD, whose incidences are significantly increasing in Western countries, are leading to a changing profile of the patients undergoing liver surgery. A MEDLINE search was performed for relevant articles using the key words 'metabolic syndrome', 'liver resection', 'liver transplantation', 'non alcoholic fatty liver disease', 'non-alcoholic steatohepatitis' and 'liver cancer'. On one hand, the MS favors the development of primary liver malignancies(hepatocellular carcinoma and cholangiocarcinoma)either through NAFLD liver parenchymal alterations(steatosis, steatohepatitis, fibrosis) or in the absence of significant underlying liver parenchyma changes. Also, the existence of NAFLD may have a specific impact on colorectal liver metastases recurrence. On the other hand, the postoperative period following partial liver resection and liver transplantation is at increased risk of both postoperative complications and mortality. These deleterious effects seem to be related to the existence of liver specific complications but also higher cardio-vascular sensitivity in a setting of MS/NAFLD. Finally, the long-term prognosis after curative surgery joins that of patients operated on with other types of underlying liver diseases. An increased rate of patients with MS/NAFLD referred to hepatobiliary units has to be expected. The higher operative risk observed in this subset of patients will require specific improvements in their perioperative management. | Francois Cauchy David Fuks Alban Zarzavadjian Le Bian Jacques Belghiti Renato Costi | 2014 | World Journal of Hepatology2014，6，5： | 4 |
| 4 | Liver resection and metabolic disorders: An undescribed mechanism leading to postoperative mortality显示文摘AIM: To investigate the mechanism leading to perioperative mortality in patients undergoing major liver resection and presenting with metabolic disorders.METHODS: The link between Metabolic Syndrome and non-alcoholic fatty liver disease is currently demonstrated. Various metabolic disorders and the Metabolic Syndrome(the association of ≥ 3 metabolic disorders) have been recently described as a risk factor of perioperative mortality in major liver resection. Patients who passed away during perioperative course of major liver resection and presenting with the association of ≥ 2 metabolic disorders without any other known cause of liver disorders were reviewed.RESULTS: From January 2001 to May 2010 in a tertiary centre, ten patients presenting with ≥ 2 metabolic disorders without any other known cause of liver disorders died during perioperative course of major liver resection. The same four-consecutive-steps sequence of events occurred, including jaundice. The analysis of this series suggested a rapidly deteriorating congestive liver resulting in an increased portal hypertension leading to hepatorenal syndrome and lately to multiorgan failure(mimicking septic collapse) as the mechanism leading to exitus. The acute portal hypertension is mainly related to the surgical procedure. The chronic portal hypertension is indeterminate. Patients with ≥ 2 metabolic disorders should be considered as potentially presenting with portal hypertension possibly evolving towards hepatorenal syndrome; thus, they should be considered as having a high perioperative risk and should be carefully evaluated before undergoing major liver resection.CONCLUSION: As fibrosis was not present or marginal in liver specimens, the real cause of portal hypertension in patients with multiple metabolic disorders should be investigated with further studies. | Alban Zarzavadjian Le Bian Renato Costi Mohamed Said Sbai-Idrissi Claude Smadja | 2014 | World Journal of Gastroenterology2014，20，39： | 2 |
| 5 | Cholecystocolonic fistula: facts and myths. A review of the 231 published cases显示文摘 | Renato Costi Bruto Randone Vincenzo Violi Olivier Scatton Leopoldo Sarli Olivier Soubrane Bertrand Dousset Thierry Montariol | 2009 | Journal of Hepato - Biliary - Pancreatic Surgery2009，，1： | 2 |
| 6 | Expression of vascularendothelial growth factor(VEGF)and assessment of mi-crovascular density with CD34 as prognostic markers forendometrial carcinoma显示文摘 | Guset G Costi S Lazar E | 2010 | Rom J Morphol Embryol2010，51，4： | 1 |
| 7 | Operative treatment of periarnpullary retroperitoneal perforation complicating endo- scopic sphincterotomy 显示文摘 | SADI L PORRINI C COSTI R | 2007 | Surgery2007，142，1： | 1 |
| 8 | Arythiopyrrole (AThP) derivatives as non-nucleoside HIV-1 s: synthesis,structure-activity relationships, and doeking studies ( part 2 ) 显示文摘 | LAVECHIA A COSTI R ARTICO M | 2006 | Chem Med Chem2006，1，12： | 1 |
| 9 | Arythiopyrrole(AThP) derivatives as non-nucleoside HIV-1 reverse transcriptase inhibitots: synthesis, slruclure-activity relationships, and docking studies( part 1) 显示文摘 | SANTO RD COSTI R ARTICO M | 2006 | Chem Med Chem2006，1，12： | 1 |
| 10 | Laminar separation flow over a prolate spheroid 显示文摘 | Costis C E Hoang N T Telionis D P | 1989 | Journal of Aircraft1989，26，9： | 1 |
| 11 | Design,synthesis and biological activities of pyrrolylethanoneamine deriva-tives,a novel class of mono- amine oxidases inhibitors显示文摘 | Santo R D Costi R Roux A | 2005 | J Med Chem2005，48，13： | 1 |
| 12 | Prospective randomized trial of low-pressure pneumopefitoneum for reduction of shoulder-tip pain flowing laparoscopy显示文摘 | Sarli L Costi R Samsebastiano G | 2000 | Br J Surg2000，87，9： | 1 |
| 13 | Small gallstones, acute pancreatitis, and prophylactic cholecystectomy 显示文摘 | Costi R Violi V Roncoroni L | 2006 | Am J Gastroenterol2006，101，7： | 1 |
| 14 | Wind array power prediction for improved operating economics and reliability显示文摘 | Schlueter R A Sigari G Costi A | 1985 | IEEE Transactions on Power Apparatus and Systems1985，104，7： | 1 |
| 15 | Multiresidue analysis of sulfonamides in meat by supramolecular solvent microextraction, liquid chromatography and fluorescence detection and method validation according to the 2002/657/EC decision显示文摘 | COSTI E M SICILIA M D RUBIO S | 2010 | Journal of Chromatography A2010，1217，40： | 1 |
| 16 | Low rate of occult hepatitis B virus infection among Anti-HBc positive blood donors living in a low prevalence region in Brazil显示文摘 | Siva CM Costi C Michelon C | 2005 | J Infect2005，51，1： | 1 |
| 17 | Degenerative spondylolist hesis in patients with neurogenic claudication effects functional performance and self - reported quality of life 显示文摘 | Drury T Ames SE Costi K | 2009 | Spine2009，34，25： | 1 |
| 18 | Degenerative spondylolisthesis in patients with neurogenic claudication effects functional performance and self-reported quality of life显示文摘 | Drury T Ames S E Costi K | 2009 | Spine2009，34，25： | 1 |
| 19 | Implant retrieval studies of the wear and loosening of prosthetic joints : A review 显示文摘 | M A Mcgee D W Howie K Costi | 2000 | Wear2000，241，2： | 1 |
| 20 | Mechanical consequence of annular t ears and subsequent intervertebral disc degeneration显示文摘 | 5,Latham CW Peary MJ Costi JJ | | Clin Biomech, 19 940，9，11： | 1 |
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