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Piras A, D'Aviero A, Sanfratello A, Boldrini L, Pernice G, Spada M, Gaudio G, Pinelli M, Salamone G, Gebbia V, Dispensa N, Tulone G, Laudicella R, Comelli A, Di Raimondo D, Tuttolomondo A, Angileri T, Daidone A. Stereotactic Radiotherapy for penile metastasis: case report and systematic literature review. Oncol Res Treat 2024:000539275. [PMID: 38763125 DOI: 10.1159/000539275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/25/2024] [Indexed: 05/21/2024]
Abstract
Introduction Penile metastases (PM) are a rare clinical presentation mainly related to advanced stages of disease. Considering the low incidence, an optimal treatment approach has not yet been defined; surgery, chemotherapy, and radiotherapy are different options used in the vast majority with palliative intent. The advances in modern RT can represent an innovative tool in PM management and a curative option. This paper aims to report the case of a PM patient treated with Stereotactic Body Radiotherapy (SBRT) and perform a systematic literature review of current evidence on the RT approach to PM. Case report We reported the case of an 80-year-old patient with PM from primary bladder cancer. Following the surgical approach for the primary tumor, evidence of PM was shown, and the patient was admitted to SBRT treatment on PM after an adjuvant RT course on the pelvis. A 25 Gy in 5 fractions SBRT treatment was performed, and a complete clinical response was shown at the first follow-up. Methods A Pubmed/MEDLINE and Embase systematic review was carried out. The search strategy terms were [('penile metastasis'/exp OR 'penile metastasis' OR (penile AND ('metastasis'/exp OR metastasis))) AND ('radiotherapy'/exp OR radiotherapy)] and only original articles up to the 24.10.2023 were considered. Results A total of 174 studies were obtained using the previously mentioned search strategy, and the analysis was performed on 15 papers obtained following the complete selection process. All reported evidence was focused on the palliative approach of PM showing good results in terms of symptom control. Discussion The potential role of modern RT in the management of PM has yet to be defined. The reported case showed the feasibility and the clinical impact of SBRT in PM treatment.
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Scerrino G, Paladino NC, Orlando G, Salamone G, Richiusa P, Radellini S, Melfa G, Graceffa G. The Nexus of Hyperparathyroidism and Thyroid Carcinoma: Insights into Pathogenesis and Diagnostic Challenges-A Narrative Review. J Clin Med 2023; 13:147. [PMID: 38202152 PMCID: PMC10779506 DOI: 10.3390/jcm13010147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/13/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
This review investigates the intricate relationship between hyperparathyroidism (HPT) and thyroid carcinoma (TC), aiming to elucidate their coexistence, potential pathogenetic mechanisms, and clinical implications. A systematic search strategy, employing the MeSH terms 'Hyperparathyroidism' and 'Thyroid Carcinoma', spanned publications from 2013 to 2023 across the PubMed, Web of Science, and Scopus databases. Fifteen selected articles were analyzed. Studies unanimously confirm the notable association between primary hyperparathyroidism (PHPT) and thyroid nodules/cancer, with incidences ranging from 2.8% to 47.1%. Key findings reveal a predilection for papillary thyroid carcinoma (PTC) in this association, showcasing varying tumor characteristics and gender disparities. Lower preoperative serum parathyroid hormone (PTH) levels are a potential risk factor for thyroid cancer in PHPT patients. Diverse surgical approaches and tumor characteristics between PHPT and secondary hyperparathyroidism (SHPT) cases were noted. Moreover, this review underscores the scarcity of definitive guidelines in managing concurrent PHPT and thyroid conditions, advocating for comprehensive assessments to enhance diagnostic accuracy and refine therapeutic interventions. Rare coincidental associations, as highlighted by case reports, shed light on unique clinical scenarios. In essence, this review amalgamates evidence to deepen the understanding of the interplay between HPT and TC, emphasizing the need for further research to elucidate underlying mechanisms and guide clinical management.
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Affiliation(s)
- Gregorio Scerrino
- Unit of Endocrine Surgery, Department of Surgical Oncology and Oral Sciences, University of Palermo, 90127 Palermo, Italy
| | - Nunzia Cinzia Paladino
- Department of General Endocrine and Metabolic Surgery, Conception Hospital, Aix-Marseille University, 147, Boulevard Baille, 13005 Marseille, France;
| | - Giuseppina Orlando
- Unit of General and Emergency Surgery, Department of Surgical Oncology and Oral Sciences, University of Palermo, 90127 Palermo, Italy; (G.O.); (G.S.); (G.M.)
| | - Giuseppe Salamone
- Unit of General and Emergency Surgery, Department of Surgical Oncology and Oral Sciences, University of Palermo, 90127 Palermo, Italy; (G.O.); (G.S.); (G.M.)
| | - Pierina Richiusa
- Section of Endocrinology, Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy; (P.R.); (S.R.)
| | - Stefano Radellini
- Section of Endocrinology, Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy; (P.R.); (S.R.)
| | - Giuseppina Melfa
- Unit of General and Emergency Surgery, Department of Surgical Oncology and Oral Sciences, University of Palermo, 90127 Palermo, Italy; (G.O.); (G.S.); (G.M.)
| | - Giuseppa Graceffa
- Unit of General and Oncology Surgery, Department of Surgical Oncology and Oral Sciences, University of Palermo, 90127 Palermo, Italy;
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Scerrino G, Salamone G, Corigliano A, Richiusa P, Proclamà MP, Radellini S, Cocorullo G, Orlando G, Melfa G, Paladino NC. Weight Gain and Asthenia Following Thyroidectomy: Current Knowledge from Literature Review. J Clin Med 2022; 11:jcm11185486. [PMID: 36143133 PMCID: PMC9500853 DOI: 10.3390/jcm11185486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Thyroidectomy is a common procedure all over the world. Its complication rate is low, but some patients complain of weight gain and/or asthenia. The aim of this review is to investigate the correlation between thyroidectomy and weight change and asthenia. MATERIALS AND METHODS Seven papers concerning weight gain and four concerning asthenia were found. RESULTS Weight gain would seem to be more related to the change in habits after surgery. Asthenia seems to be more linked to endocrine mechanisms not yet clarified although a deficiency of triiodothyronine and its metabolites could explain some of its aspects. CONCLUSION Patients who are candidates for thyroidectomy should be adequately informed of the onset of both possible implications of the surgical act in terms of weight gain and chronic asthenia.
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Affiliation(s)
- Gregorio Scerrino
- Unit of General and Emergency Surgery, Department of Surgical Oncology and Oral Sciences, University of Palermo, Via L. Giuffré, 5, 90127 Palermo, Italy
| | - Giuseppe Salamone
- Unit of General and Emergency Surgery, Department of Surgical Oncology and Oral Sciences, University of Palermo, Via L. Giuffré, 5, 90127 Palermo, Italy
| | - Alessandro Corigliano
- Unit of General and Emergency Surgery, Department of Surgical Oncology and Oral Sciences, University of Palermo, Via L. Giuffré, 5, 90127 Palermo, Italy
| | - Pierina Richiusa
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), Section of Endocrinology, University of Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Maria Pia Proclamà
- Unit of General and Emergency Surgery, Department of Surgical Oncology and Oral Sciences, University of Palermo, Via L. Giuffré, 5, 90127 Palermo, Italy
| | - Stefano Radellini
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), Section of Endocrinology, University of Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Gianfranco Cocorullo
- Unit of General and Emergency Surgery, Department of Surgical Oncology and Oral Sciences, University of Palermo, Via L. Giuffré, 5, 90127 Palermo, Italy
| | - Giuseppina Orlando
- Unit of General and Emergency Surgery, Department of Surgical Oncology and Oral Sciences, University of Palermo, Via L. Giuffré, 5, 90127 Palermo, Italy
| | - Giuseppina Melfa
- Unit of General and Emergency Surgery, Department of Surgical Oncology and Oral Sciences, University of Palermo, Via L. Giuffré, 5, 90127 Palermo, Italy
| | - Nunzia Cinzia Paladino
- Department of General Endocrine and Metabolic Surgery, Conception University Hospital, Aix-Marseille University, 147 Boulevard Baille, 13005 Marseille, France
- Correspondence: ; Tel.: +33-04-9143-5511
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Graceffa G, Salamone G, Contino S, Saputo F, Corigliano A, Melfa G, Proclamà MP, Richiusa P, Mazzola S, Tutino R, Orlando G, Scerrino G. Risk Factors for Anaplastic Thyroid Carcinoma: A Case Series From a Tertiary Referral Center for Thyroid Surgery and Literature Analysis. Front Oncol 2022; 12:948033. [PMID: 35875085 PMCID: PMC9303013 DOI: 10.3389/fonc.2022.948033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 05/30/2022] [Indexed: 11/17/2022] Open
Abstract
Anaplastic thyroid carcinoma (ATC) is a very rare and extremely aggressive disease with a very poor prognosis. Several risk factors have been hypothesized, but there is no clear-cut literature data on it. We reviewed the literature concerning risk factors for ATC and analyzed the institutional database from 2005 to 2022. In total, 15 papers were suitable for review, while the retrospective data collection search, conducted on our institutional database, provided 13 results. In our experience, in agreement with literature data, ATC seems to be a neoplasm peculiar to old age (in our database, mean age is 72 years), with a higher prevalence in subjects with a low level of education and a long history of multinodular goiter (MNG). The role of cigarette smoking and blood group, hypothesized on some literature data, was more uncertain, although the small sample size evaluated probably had a great influence on these results. The higher incidence of the disease in individuals with a history of MNG could suggest more aggressive choices in the treatment of a benign disease, in contrast to current practice. However, this may be a highly questionable point considering that ATC accounts for no more than 2% of all thyroid neoplasms in surgical departments, even those dedicated to endocrine neck surgery. Further studies are therefore necessary for a step forward in this direction.
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Affiliation(s)
- Giuseppa Graceffa
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Giuseppe Salamone
- Department of Surgical Oncological and Oral Sciences, Unit of General and Emergency Surgery, University of Palermo, Palermo, Italy
| | - Silvia Contino
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Federica Saputo
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Alessandro Corigliano
- Department of Surgical Oncological and Oral Sciences, Unit of General and Emergency Surgery, University of Palermo, Palermo, Italy
| | - Giuseppina Melfa
- Department of Surgical Oncological and Oral Sciences, Unit of General and Emergency Surgery, University of Palermo, Palermo, Italy
| | - Maria Pia Proclamà
- Department of Surgical Oncological and Oral Sciences, Unit of General and Emergency Surgery, University of Palermo, Palermo, Italy
| | - Pierina Richiusa
- Section of Endocrinology-Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Sergio Mazzola
- Unit of Clinical Epidemiology and Tumor Registry, Department of Laboratory Diagnostics, Policlinico “P. Giaccone” University of Palermo, Palermo, Italy
| | - Roberta Tutino
- Department of General and Specialized Surgery, City of Health and Science Hospital of Turin, Turin, Italy
| | - Giuseppina Orlando
- Department of Surgical Oncological and Oral Sciences, Unit of General and Emergency Surgery, University of Palermo, Palermo, Italy
- *Correspondence: Giuseppina Orlando,
| | - Gregorio Scerrino
- Department of Surgical Oncological and Oral Sciences, Unit of General and Emergency Surgery, University of Palermo, Palermo, Italy
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Tutino R, Colli F, Rizzo G, Bonventre S, Scerrino G, Salamone G, Melfa G, Orlando G, Gallo G, Santarelli M, Massani M, Cocorullo G. Which Role for Hyperbaric Oxygen Therapy in the Treatment of Fournier's Gangrene? A Retrospective Study. Front Surg 2022; 9:850378. [PMID: 35465423 PMCID: PMC9018989 DOI: 10.3389/fsurg.2022.850378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/23/2022] [Indexed: 01/10/2023] Open
Abstract
Purpose In Fournier's gangrene, surgical debridement plus antimicrobial therapy is the mainstay of treatment but can cause a great loss of tissue. The disease needs long hospital stays and, despite all, has a high mortality rate. The aim of our study is to investigate if factors, such as hyperbaric therapy, can offer an improvement in prognosis. Methods We retrospectively evaluated data on 23 consecutive patients admitted for Fournier's gangrene at the University Hospital “P. Giaccone” of Palermo from 2011 to 2018. Factors related to length of hospital stay and mortality were examined. Results Mortality occurred in three patients (13.1%) and was correlated with the delay between admission and surgical operation [1.7 days (C.I. 0.9–3.5) in patients who survived vs. 6.8 days (C.I. 3.5–13.4) in patients who died (p = 0.001)]. Hospital stay was longer in patients treated with hyperbaric oxygen therapy [mean 11 (C.I. 0.50–21.89) vs. mean 25 (C.I. 18.02–31.97); p = 0.02] without an improvement in survival (p = 1.00). Conclusion Our study proves that a delay in the treatment of patients with Fournier's gangrene has a correlation with the mortality rate, while the use of hyperbaric oxygen therapy seems to not improve the survival rate, increasing the hospital stay instead.
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Affiliation(s)
- Roberta Tutino
- Chirurgia 3, Dipartimento di Chirurgia Generale e Specialistica, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
- *Correspondence: Roberta Tutino
| | - Francesco Colli
- Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy
| | - Giovanna Rizzo
- Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy
| | - Sebastiano Bonventre
- Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy
| | - Gregorio Scerrino
- Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy
| | - Giuseppe Salamone
- Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy
| | - Giuseppina Melfa
- Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy
| | - Giuseppina Orlando
- Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy
| | - Gaetano Gallo
- Department of General Surgery, University of Catanzaro, Catanzaro, Italy
| | - Mauro Santarelli
- Chirurgia 3, Dipartimento di Chirurgia Generale e Specialistica, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Marco Massani
- Chirurgia 1, Ospedale Regionale di Treviso, Azienda ULSS 2 Marca Trevigiana, Treviso, Italy
| | - Gianfranco Cocorullo
- Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy
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Licari L, Viola S, Salamone G. TAP Block Prior to Open Ventral Hernia Repair Improves Surgical Outcome. World J Surg 2022; 46:1383-1388. [PMID: 35352169 PMCID: PMC9054863 DOI: 10.1007/s00268-022-06508-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 11/26/2022]
Abstract
Background Ventral hernias commonly affect patients after major abdominal surgery. To reduce postoperative pain, the effects of the transversus abdominis plane (TAP) block, epidural analgesia and medication-only protocol have been investigated. The primary outcome was the cumulative dosage of opioids (morphine milligram equivalents MME), of acetaminophen and diclofenac for postoperative pain control on postoperative day (POD) 0, 1, and 2. Secondary outcomes were length of stay (LOS) and the pain scale rating using the numeric rating scale (NRS) on POD 0, 1, and 2. Methods The data were retrospectively extracted from the charts of the patients admitted for a surgical operation for OVHR from January 2015 to December 2019. Results Patients receiving medication-only analgesia had longer LOS (mean 6.1 days; p < 0.00001). Cumulative opioid consumption was significantly lower at 24 and 48 h after surgery in the TAP block group than in the other groups (mean MME 1.9 mg and 0.7 mg, respectively; p < 0.05). The cumulative consumption of diclofenac was significantly lower in the TAP block group than in the others (44.1 mg; p ≤ 0.00001 on POD 1; 4.4 mg; p = 0.03 on POD 2). TAP block is more effective in pain control in POD 0 (mean NRS 5.4; p < 0.00001), POD 1 (mean NRS 6.1; p = 0.006), and POD 2 (mean NRS 4.9; p = 0.001) if it is performed after adopting the retromuscular technique. Conclusions The comparison between the medication-only technique, epidural, and TAP block demonstrated the superiority of the last one for the aims considered in this study.
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Affiliation(s)
- Leo Licari
- Department of Surgical, Oncological and Oral Sciences (DICHIRONS), Policlinico P. Giaccone, University of Palermo, Via Liborio Giuffré 5, 90127, Palermo, Italy.
| | - Simona Viola
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies, University of Palermo, Palermo, Italy
| | - Giuseppe Salamone
- Department of Surgical, Oncological and Oral Sciences (DICHIRONS), Policlinico P. Giaccone, University of Palermo, Via Liborio Giuffré 5, 90127, Palermo, Italy
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Orlando G, Scerrino G, Corigliano A, Vitale I, Tutino R, Radellini S, Cupido F, Graceffa G, Cocorullo G, Salamone G, Melfa G. Papillary Thyroid Microcarcinoma: Active Surveillance Against Surgery. Considerations of an Italian Working Group From a Systematic Review. Front Oncol 2022; 12:859461. [PMID: 35402255 PMCID: PMC8984605 DOI: 10.3389/fonc.2022.859461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 02/15/2022] [Indexed: 12/19/2022] Open
Abstract
Introduction Active surveillance is considered a viable option for papillary thyroid microcarcinoma. Since the last decade of the 20th century, this method has spread from Japan to other countries, but has not yet been fully accepted and validated by the major Western Scientific Societies. In 2016, a systematic review on the results of active surveillance was published, based on two articles that showed encouraging results. Other reviews published subsequently, were mainly based on articles from the Far East. The aim of this review is to assess the most recent results published from 2017 to 2020 on this subject. Materials and Methods A systematic literature search was performed on MEDLINE via PUBMED, Web of Science, and Scopus according to PRISMA criteria. The MESH terms “papillary thyroid microcarcinoma” and “active surveillance” were adopted. Tumor progression, secondary localizations, and quality of life were the main benchmarks. Results Nine studies met the inclusion criteria. The increase in volume ranged from 2.7% and 23.2%; the occurrence of lymph node metastases from 1.3% to 29%; QoL was improved in both articles that addressed this topic. The level of evidence is considered low due to the retrospective and uncontrolled nature of most of the studies included in the review. Conclusion The evidence from the literature currently available on AS falls into two strands: a robust data set from the Japanese experience, and an initial experience from Western countries, whose data are still limited but which show a lack of substantial alerts against this practice. Further data is useful to validate the spread of Active Surveillance.
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Affiliation(s)
- Giuseppina Orlando
- Department of Surgical Oncology and Oral Sciences, Unit of General and Emergency Surgery, University of Palermo, Palermo, Italy
| | - Gregorio Scerrino
- Department of Surgical Oncology and Oral Sciences, Unit of General and Emergency Surgery, University of Palermo, Palermo, Italy
- *Correspondence: Gregorio Scerrino,
| | - Alessandro Corigliano
- Department of Surgical Oncology and Oral Sciences, Unit of General and Emergency Surgery, University of Palermo, Palermo, Italy
| | - Irene Vitale
- Department of Surgical Oncology and Oral Sciences, Unit of General and Emergency Surgery, University of Palermo, Palermo, Italy
| | - Roberta Tutino
- Department of Surgical Oncology and Oral Sciences, Unit of General and Emergency Surgery, University of Palermo, Palermo, Italy
| | - Stefano Radellini
- Section of Endocrinology - Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Francesco Cupido
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Giuseppa Graceffa
- Department of Surgical Oncology and Oral Sciences, Unit of General and Oncology Surgery, University of Palermo, Palermo, Italy
| | - Gianfranco Cocorullo
- Department of Surgical Oncology and Oral Sciences, Unit of General and Emergency Surgery, University of Palermo, Palermo, Italy
| | - Giuseppe Salamone
- Department of Surgical Oncology and Oral Sciences, Unit of General and Emergency Surgery, University of Palermo, Palermo, Italy
| | - Giuseppina Melfa
- Department of Surgical Oncology and Oral Sciences, Unit of General and Emergency Surgery, University of Palermo, Palermo, Italy
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Tutino R, Salamone G, De Marco P, Cocorullo G, Gulotta G. Outpatient Treatment of Hemorrhoidal Disease: The Alternative Way to Treat Hemorrhoidal Disease in a Simple, Safe and Effective Manner. Rev Recent Clin Trials 2021; 16:5-9. [PMID: 32133966 DOI: 10.2174/1574887115666200305150029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 01/08/2020] [Accepted: 02/12/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Hemorrhoidal disease is a widespread problem in healthy working patients. The traditional surgical approaches cause a loss of several working days related to the post-- operative course that is often painful. To avoid these problems while offering a symptoms resolution in patients with low degrees hemorrhoids, the non-surgical treatments are nowadays largely proposed in proctological clinics. METHODS We resume the recent literature on the issue to offer a practical and easy to use guide for clinicians. RESULTS Rubber band ligation, injection sclerotherapy and infrared coagulation are cost effective, safe and effective treatments for patients with II- and III-degree hemorrhoids. Relapses are commons even if the procedures can be repeated until symptoms resolution. IV-degree hemorrhoids are not suitable of these treatments. CONCLUSION The proctological clinics must evaluate the quality of life offered to patients and discuss with them the appropriate treatment in order to select the most appropriate one for symptoms resolution and disease cure. Less is not always the best but can be an alternative to be offered.
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Affiliation(s)
- Roberta Tutino
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Giuseppe Salamone
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Paolino De Marco
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Gianfranco Cocorullo
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Gaspare Gulotta
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
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Licari L, Campanella S, Carolla C, Viola S, Salamone G. De Garengeot Hernia: Case Report and Review of the Literature of a Rare Femoral Hernia. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02778-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
AbstractDe Garengeot hernia is a rare femoral hernia defined as the presence of the appendix within the femoral hernia sac. The incidence of appendicitis in this type of hernia is a rare condition that accounts for 0.08–0.13% of all De Garengeot hernias. We describe the case of a 61-year-old woman that presented at the emergency department with a tender mass (diameter 10 × 8 cm) in the right groin region for 5 days associated with pain in lower right abdomen and accompanied by fever (38 °C). Computed tomography (CT) of the abdomen revealed the presence of a complex fluid collection with small foci of air in the right inguinal region, measuring 9 × 7 × 10 cm in the 3 orthogonal dimensions and a blind ending tubular structure extending from the caecal base into the groin mass through a narrowed neck defect, medial to the common femoral vessels. The CT scan demonstrated the suspected diagnosis of De Garengeot hernia complicated by acute appendicitis. The intra-operative findings confirmed the diagnosis. The patient was successfully managed operatively. The surgical strategy took into account the need to significantly reduce the diffusion of the infection inside the abdominal cavity. The patient was discharged on the fifth postoperative day without peri-/postoperative complications.
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Licari L, Viola S, Carolla C, Campanella S, Salamone G. Evidence-Based Strategies to Promote Long-Term Cardiac Implant Site Health: Review of the Literature. Cureus 2021; 13:e13027. [PMID: 33665051 PMCID: PMC7924010 DOI: 10.7759/cureus.13027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2021] [Indexed: 11/09/2022] Open
Abstract
Cardiac implantable electronic devices (CIEDs) are commonly used nowadays. The association between CIED placement and infections is responsible for the high mortality and device explantation rate. Since CIED placement has increased in the past decade, CIED-related complications have risen. In order to reduce the CIED-related complications rate, the prevention of device infection represents the main goal. Over time, many different studies have proven the importance of the measures to prevent CIED-related infections. This review aims to collect the actual recommendations for CIED infection prevention, providing an overview of the main evidence-based strategies.
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Affiliation(s)
- Leo Licari
- Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, ITA
| | - Simona Viola
- Biological, Chemical and Pharmaceutical Sciences and Technologies, University of Palermo, Palermo, ITA
| | - Claudia Carolla
- Surgical, Oncological and Oral Sciences, Policlinico Universitario P. Giaccone, University of Palermo, Palermo, ITA
| | - Sofia Campanella
- Surgical, Oncological and Oral Sciences, Policlinico Universitario P. Giaccone, University of Palermo, Palermo, ITA
| | - Giuseppe Salamone
- Surgical, Oncological and Oral Sciences, Policlinico Universitario P. Giaccone, University of Palermo, Palermo, ITA
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Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries. Lancet 2021; 397:387-397. [PMID: 33485461 PMCID: PMC7846817 DOI: 10.1016/s0140-6736(21)00001-5] [Citation(s) in RCA: 104] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/02/2020] [Accepted: 12/17/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. METHODS This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. FINDINGS Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70-8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39-8·80) and upper-middle-income countries (2·06, 1·11-3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26-11·59) and upper-middle-income countries (3·89, 2·08-7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. INTERPRETATION Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. FUNDING National Institute for Health Research Global Health Research Unit.
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Soczewski E, Gori S, Paparini D, Grasso E, Fernández L, Gallino L, Schafir A, Irigoyen M, Lobo TF, Salamone G, Mattar R, Daher S, Pérez Leirós C, Ramhorst R. VIP conditions human endometrial receptivity by privileging endoplasmic reticulum stress through ATF6α pathway. Mol Cell Endocrinol 2020; 516:110948. [PMID: 32693008 DOI: 10.1016/j.mce.2020.110948] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/10/2020] [Accepted: 07/10/2020] [Indexed: 12/17/2022]
Abstract
Endometrial stromal cells undergo endoplasmic reticulum (ER) stress and unfolded protein response (UPR) during the decidualization linked with the inflammation and angiogenesis processes. Considering VIP (vasoactive intestinal peptide) induces the decidualization program, we studied whether modulates the ER/UPR pathways to condition both processes for embryo implantation. When Human Endometrial Stromal Cell line (HESC) were decidualized by VIP we observed an increased expression of ATF6α, an ER stress-sensor, and UPR markers, associated with an increase in IL-1β production. Moreover, AEBSF (ATF6α -inhibitor pathway) prevented this effect and decreased the expansion index in the in vitro model of implantation. VIP-decidualized cells also favor angiogenesis accompanied by a strong downregulation in thrombospondin-1. Finally, ATF6α, VIP and VPAC2-receptor expression were reduced in endometrial biopsies from women with recurrent implantation failures in comparison with fertile. In conclusion, VIP privileged ATF6α-pathway associated with a sterile inflammatory response and angiogenesis that might condition endometrial receptivity.
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Affiliation(s)
- E Soczewski
- CONICET, Universidad de Buenos Aires. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales IQUIBICEN, Buenos Aires, Argentina
| | - S Gori
- CONICET, Universidad de Buenos Aires. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales IQUIBICEN, Buenos Aires, Argentina
| | - D Paparini
- CONICET, Universidad de Buenos Aires. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales IQUIBICEN, Buenos Aires, Argentina
| | - E Grasso
- CONICET, Universidad de Buenos Aires. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales IQUIBICEN, Buenos Aires, Argentina
| | - L Fernández
- CONICET, Universidad de Buenos Aires. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales IQUIBICEN, Buenos Aires, Argentina
| | - L Gallino
- CONICET, Universidad de Buenos Aires. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales IQUIBICEN, Buenos Aires, Argentina
| | - A Schafir
- CONICET, Universidad de Buenos Aires. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales IQUIBICEN, Buenos Aires, Argentina
| | - M Irigoyen
- Fertilis Medicina Reproductiva, San Isidro, Buenos Aires, Argentina
| | - T F Lobo
- Departamento de Obstetrícia, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - G Salamone
- Instituto de Medicina Experimental, IMEX-CONICET, Academia Nacional de Medicina, Buenos Aires, Argentina
| | - R Mattar
- Departamento de Obstetrícia, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - S Daher
- Departamento de Obstetrícia, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - C Pérez Leirós
- CONICET, Universidad de Buenos Aires. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales IQUIBICEN, Buenos Aires, Argentina
| | - R Ramhorst
- CONICET, Universidad de Buenos Aires. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales IQUIBICEN, Buenos Aires, Argentina.
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Licari L, Campanella S, Carolla C, Madonia C, Canino B, Salamone G. Abdominal wall incisional hernia repair improves respiratory function: results after 3 years of follow-up. Hernia 2020; 25:999-1004. [PMID: 32929633 PMCID: PMC8370921 DOI: 10.1007/s10029-020-02302-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 09/02/2020] [Indexed: 11/28/2022]
Abstract
Purpose Hernias severely impact patient quality of life (QoL), and 80% of patients require a surgical operation. Moreover, hernias are responsible for respiratory function alterations. This study aims to investigate the postoperative alterations in respiratory function after open ventral hernia repair in patients with incisional hernia. Methods Patients operated on at the Policlinico “Paolo Giaccone” at Palermo University Hospital between January 2015 and December 2016 were identified in a prospective database. Fifty-one patients were enrolled in the study. The respiratory outcome measures used were forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC ratio, peak expiratory flow (PEF) and PEF percentage (%PEF). The timepoints at which the parameters listed were assessed were t0, 1 week before the surgical operation; t1, 12 months later; and t2, 3 years later. Results The difference between mean preoperative and postoperative PEF was significant [t0 4.32 (4.03–7.92), t1 6.7 (4.27–8.24) with p = 0.012 and t2 6.5 (4.25–8.21) with p = 0.026]. The %PEF increased from 75% preoperatively to 87% at t1 (p = 0.009) and to 85% at t2 (p = 0.03). No differences were found in the comparison of pre- and postoperative FVC, FEV1 or FEV1/FVC ratio. Conclusion The improvement in respiratory measures suggests the importance of abdominal wall restoration to recover functional activity of respiratory function.
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Affiliation(s)
- L Licari
- Department of Surgical, Oncological and Oral Sciences, Policlinico P. Giaccone, University of Palermo, Via Liborio Giuffré 5, 90127, Palermo, Italy.
| | - S Campanella
- Department of Surgical, Oncological and Oral Sciences, Policlinico P. Giaccone, University of Palermo, Via Liborio Giuffré 5, 90127, Palermo, Italy
| | - C Carolla
- Department of Surgical, Oncological and Oral Sciences, Policlinico P. Giaccone, University of Palermo, Via Liborio Giuffré 5, 90127, Palermo, Italy
| | - C Madonia
- Department of Surgical, Oncological and Oral Sciences, Policlinico P. Giaccone, University of Palermo, Via Liborio Giuffré 5, 90127, Palermo, Italy
| | - B Canino
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Policlinico P. Giaccone, University of Palermo, 90127, Palermo, Italy
| | - G Salamone
- Department of Surgical, Oncological and Oral Sciences, Policlinico P. Giaccone, University of Palermo, Via Liborio Giuffré 5, 90127, Palermo, Italy
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Licari L, Salamone G, Ciolino G, Campanella S, Parinisi Z, Sabatino C, Carfì F, Bonventre S, Gulotta G. The abdominal wall incisional hernia repair in cirrhotic patients. G Chir 2019; 39:20-23. [PMID: 29549677 DOI: 10.11138/gchir/2018.39.1.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND The incidence of abdominal wall hernia in cirrhotic patients with ascites is between 20 and 40%. Controversies regarding the treatment modality and surgical timing of abdominal wall incisional hernia repair in cirrhotic patients remain. The study proposed wants to analyze the abdominal incisional hernia repair in cirrhotic patients with ascites performed in a single center to determine post-operative morbidity, mortality and complication rate. PATIENTS AND METHODS Cirrhotic patients with abdominal incisional hernia that underwent surgical operation for abdominal wall hernia repair at the "Policlinico Paolo Giaccone" at Palermo University Hospital between January 2015 and December 2016 were identified and the data collected were retrospectively reviewed; patients' medical and surgical records were collected from charts and the surgical and ICU registries. The degree of hepatic dysfunction was classified using Child-Pugh classification. Post-operative mortality was considered up to 30-days after surgery. A follow-up period of 6 months at least was performed to evaluate hernia recurrence and complications. RESULTS Mortality rate is of 18.5% (p 0.002). Recurrence rate (p 0.004) and seroma formation rate (p 0.001) are most frequent in urgency group. The elevated ASA score and the prediction of a complicated post-operative course is higher in urgency group (p 0.004) as higher is the in-hospital stay (p 0.001) and the ICU stay (p 0.001). CONCLUSIONS Elective surgery for abdominal wall hernia repair in cirrhotic patients seems to be successful and associated with lower mortality/morbidity rate and recurrence rate than urgency.
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Scerrino G, Melfa G, Raspanti C, Attard A, Mazzola S, Porrello C, Tutino R, Fontana T, Paladino NC, Gulotta E, Salamone G, Cocorullo G. Mapping the centers performing endocrine neck surgery in Italy. G Chir 2019; 40:389-397. [PMID: 32003717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Quality of care and provider's experience seem to be strictly connected in any field of surgery. Aim of this study is to identify a method to classify the centers on the basis of the number of thyroidectomies and parathyroidectomies performed. METHODS We listed 666 centers performing endocrine neck surgery in 2015, from the database of the Italian Health Ministry. We performed a descriptive statistic analysis with a dedicated software. We identified the outliers, according to a previous literature review, in those centers performing >1000 and < 10 thyroidectomies, >100 and < 3 parathyroidectomies and we excluded them to our analysis. The remaining centers were grouped in a box-plot. Third quartile, median, procedures performed/3rd quartile value ratio (Standardized Hospitalization Ratio, SHR, superior cut-off), Romamedian/3rd quartile values ratio (inferior cut-off) were calculated. These centers were charted in a bar graph and three zones were identified: "excellence" (SHR>1.1), "SHR", "alert" (between the two cut-offs) and "risk" (under the lower cut-off). RESULTS 35743 thyroidectomies and 2306 parathyroidectomies were performed in Italy in 2015. After the outliers' exclusion, 407 and 157 centers performing respectively thyroidectomies and parathyroidectomies were analysed. A median value of respectively 37 thyroidectomies and 6 parathyroidectomies, and a 3rd quartile cut-off of respectively 85 and 12 were calculated. Concerning all the 666 centers, we found: 95 excellence centers for thyroidectomy and 33 for parathyroidectomy, respectively 18 and 17 falling into superior cut-off line, 100 and 29 in the alert zone, 453 and 587 in the risk zone. CONCLUSIONS Our method, according to the literature data, highlighted a number of thyroidectomies and parathyroidectomies performed in low volume centers. Looking for an optimization in health organization, we can consider some measures such as a net of tutorship of the "alert" hospitals by the excellence ones and a discouragement of the "risk" hospitals in performing endocrine neck surgery.
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Salamone G, Licari L, Augello G, Campanella S, Falco N, Tutino R, Cocorullo G, Gullo R, Raspanti C, De Marco P, Porrello C, Profita G, Gulotta G. Deep SSI after mesh-mediated groin hernia repair: management and outcome in an Emergency Surgery Department. G Chir 2019; 38:41-45. [PMID: 28460203 DOI: 10.11138/gchir/2017.38.1.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AIM Mesh-mediated groin hernia repair is considered the goldstandard procedure. It has low recurrence rate. Rarely a deep Surgical Site Infection (SSI) is seen when a synthetic prosthesis is used. CASE REPORT We describe a rare case of bilateral deep SSI after mesh-mediated groin hernia repair. Diagnosis was performed through the physical examination and radiological exams. Microbiological samples identified a methicillin-resistant Staphylococcus aureus responsible of the infection. Target therapy was performed and re-operation performed in order to remove the infected prosthesis and to apply a biological one to create the fibrous scaffold. During follow-up time, right side recurrence was observed. Tru-cut biopsy of fascia was obtained in order to identify the responsible of the recurrence. CONCLUSION Combination of antibiotic therapy and surgical reoperation seems to be the correct way to approach the deep SSI after mesh-mediated groin hernia repair. The use of biological mesh after synthetic removal seems to improve the final outcome.
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Cocorullo G, Tutino R, Falco N, Licari L, Orlando G, Fontana T, Raspanti C, Salamone G, Scerrino G, Gallo G, Trompetto M, Gulotta G. The non-surgical management for hemorrhoidal disease. A systematic review. G Chir 2019; 38:5-14. [PMID: 28460197 DOI: 10.11138/gchir/2017.38.1.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The non-surgical treatments for hemorrhoids are cost and time-saving techniques usually performed in patients suffering early hemorrhoidal disease. The most used are rubber band ligation (RBL), injection sclerotherapy (IS), and infrared coagulation (IRC). We performed a systematic review in order to evaluate: do these procedures really help to avoid further more aggressive treatments? What are the common harms? What are the rare harms? How many recurrences there are? A total of 21 RCTs were included in this review: 12 on RBL, 4 on IRC and 5 on IS. In RBL bleeding stops in up to 90% and III degree hemorrhoids improves in 78%-83.8%. IV degree prolapse should have a more invasive treatment. The commonest complications are bleeding and pain (8-80%). IRC related improvement is 78%, 51% and 22% for I, II and III degree. Post-operative pain occurs in 15-100% and post-operative bleeding ranges from 15% to 44%. Recurrence rate is 13% at a three months follow-up. IS brings to the resolution of prolapse in 90%-100% of II degree and allows good results for III degree even if reported only by case series. The post-procedural pain is 36%-49%. Bleeding is a very rare harm. Even if not definitive, these treatments could be an alternative for mild symptomatic patients after a clear explanation of recurrence rates and possible complications.
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Licari L, Salamone G, Parinisi Z, Campanella S, Sabatino C, Ciolino G, De Marco P, Falco N, Boventre S, Gulotta G. Multiparametric evaluation of risk factors associated to seroma formation in abdominal wall surgery. G Chir 2019; 38:280-284. [PMID: 29442058 DOI: 10.11138/gchir/2017.38.6.280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Incisional hernia is one of the main topics in the general surgery since there is not a unanimous consensus concerning to the best surgical methodology to adopt. It seems that prosthetic surgery is the best technique, even if responsible for the development of periprosthetic seroma. The aim of this study is to assess whether the preoperative abnormalities of the bio-humoral parameters may be considered as risk factors for seroma. PATIENTS AND METHODS From July 2016 to July 2017 at the "Policlinico Paolo Giaccone", Palermo, Department of Emergency Surgery, 56 patients included in this study, underwent laparotomic mesh repair. The inclusion criteria were: age > 18 years, incisional hernia W2R0 according to the Chevrel classification and a monoperator technique. The main variables were: sex, age, BMI, smoke, ASA score, and co-morbidities. Among the main serum-blood variables: natraemia, kalaemia, chloraemia, calcaemia, PCR, level of glucose, creatinine, albumin and proteins in the blood. The data were analyzed using SPSS software. RESULTS Univariate analysis highlighted hypo- and hyper-natraemia, hyper-kalaemia, hypo-chloraemia, high levels of PCR, hyper-glycemia, low level of serum-blood albumin and proteins, as statistically significant variables. Multivariate analysis revealed a p<0.05 for PCR, hypo-albuminemia and total serum-blood-protein level. CONCLUSIONS Alterations of pre-operative bio-humoral parameters could be associated to a greater risk of seroma development. A better understanding of such alterations may lead to more efficient risk stratification methods. This could be essential to better address the medical resources, reducing the post-operative complications and the outpatient controls as well as the risk associated to seroma.
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Falco N, Tutino R, Fontana T, Gullo R, Licari L, Raspanti C, De Marco P, Colli F, Venturelli P, Salamone G, Cocorullo G. Outpatient management of proctologic disease. Which techniques for local anesthesia? The experience of a single center. G Chir 2019; 40:182-187. [PMID: 31484006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Since 1899 outpatient management of surgical patients had been increasing, becoming the best option when possible. In 1988 was described the first experience of outpatient management of proctologic disease. Advances in local anesthesia techniques have improved the outpatient approach to surgical disease, particularly in patients with proctological diseases. METHODS From 2010 to 2016, 1160 patients who needed surgery for proctologic disease have been recruited: 239 hemorrhoidectomies using the variant of Milligan Morgan technique described by Phillips, 45 trans-anal hemorrhoidal DE-arterialization (THD), 315 sphincterotomies, 12 anal polypectomies, 230 loop seton positions, 65 cone-like fistulectomies and 254 fistulotomies for perianal fistulas. In 329 cases, we used the posterior perineal block, 603 local perineal blocks, and 228 tumescent anesthesia. RESULTS On a total of 1160 procedure failure rate was of 4.7% (55 cases). Urinary retention (69% 38 cases); bleeding 18% (10 cases), uncontrolled pain 12% of cases (7 cases). The chi-square test demonstrates (p<0.01) that the failure rate of the three types of anesthesia is very different with high statistical significance. The failure rate in patient underwent Posterior Perineal Block was 27/329 cases (8.2%), 8/228 (3.5%) in patients who underwent Tumescent Anesthesia and 20/603 (3.3%) in who underwent Local Perineal Block. CONCLUSIONS Outpatient protocols represent the most common approach to minor proctologic disease that needs a good local block, with a good analgesic and sedative assistance, the different local block seems to be the same concerning the pain control, but presents some little, not relevant difference concerning urinary retention rate.
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Attard A, Paladino NC, Lo Monte AI, Falco N, Melfa G, Rotolo G, Rizzuto S, Gulotta E, Salamone G, Bonventre S, Scerrino G, Cocorullo G. Skip metastases to lateral cervical lymph nodes in differentiated thyroid cancer: a systematic review. BMC Surg 2019; 18:112. [PMID: 31074393 PMCID: PMC7402576 DOI: 10.1186/s12893-018-0435-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 10/29/2018] [Indexed: 12/27/2022] Open
Abstract
Papillary thyroid carcinoma is a slow-growing cancer with a generally good prognosis that sometimes have an aggressive behaviour. Metastases to neck lymph nodes is the first step of the diffusion. The central neck compartment is involved most commonly. The ipsilateral lateral neck compartments are usually involved afterwards, and the involvement of the contralateral one is considered a quite rare occurrence. In more rare cases, metastases to lateral neck compartment without central lymph node metastasis (so called “skip metastases”) could be observed. Aim of this literature review study is to analyse the average incidence, pattern and risk factors of this occurrence. This study was performed according to PRISMA criteria. A final selection of 13 articles published in English language from 1997 to 2017 was performed. Any research article, review or meta-analysis was taken into consideration. Research was expanded considering the related references of articles. The incidence of skip metastases ranged from 1.6 to 21.8%. Risk factors such as age > 45 years, size < 5 mm and tumor located in the upper pole or isthmus of thyroid gland were found. Due to the frequency of skip metastases in thyroid cancer, a careful preoperative examination of lateral lymph nodes should be necessary.
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Affiliation(s)
- Andrea Attard
- Policlinico "P. Giaccone", Department of general emergency and transplant surgery, Unit of general and emergency surgery, Palermo, Italy
| | - Nunzia Cinzia Paladino
- Unit of General, Endocrine and Metabolic Surgery, CHU AP-HM Hôpital de la Conception (Marseille), 147 Boulevard Baille, 13385, Marseille cedex, France
| | - Attilio Ignazio Lo Monte
- Policlinico "P. Giaccone", Department of general emergency and transplant surgery, Unit of general and emergency surgery, Palermo, Italy
| | - Nicola Falco
- Policlinico "P. Giaccone", Department of general emergency and transplant surgery, Unit of general and emergency surgery, Palermo, Italy
| | - Giuseppina Melfa
- Policlinico "P. Giaccone", Department of general emergency and transplant surgery, Unit of general and emergency surgery, Palermo, Italy
| | - Giulia Rotolo
- Policlinico "P. Giaccone", Department of general emergency and transplant surgery, Unit of general and emergency surgery, Palermo, Italy
| | - Stefano Rizzuto
- Policlinico "P. Giaccone", Department of general emergency and transplant surgery, Unit of general and emergency surgery, Palermo, Italy
| | - Eliana Gulotta
- Policlinico "P. Giaccone", Department of general emergency and transplant surgery, Unit of general and emergency surgery, Palermo, Italy
| | - Giuseppe Salamone
- Policlinico "P. Giaccone", Department of general emergency and transplant surgery, Unit of general and emergency surgery, Palermo, Italy
| | - Sebastiano Bonventre
- Policlinico "P. Giaccone", Department of general emergency and transplant surgery, Unit of general and emergency surgery, Palermo, Italy
| | - Gregorio Scerrino
- Policlinico "P. Giaccone", Department of general emergency and transplant surgery, Unit of general and emergency surgery, Palermo, Italy.
| | - Gianfranco Cocorullo
- Policlinico "P. Giaccone", Department of general emergency and transplant surgery, Unit of general and emergency surgery, Palermo, Italy
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Falco N, Colli F, Tutino R, Fontana T, Licari L, Rotolo G, Scerrino G, Salamone G, Gulotta G. Benign multicystic mesothelioma: a case report of recurrent disease in a young adult with familiarity for renal cell carcinoma. G Chir 2019; 40:145-148. [PMID: 31131816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Benign multi-cystic peritoneal mesothelioma (BMCM) is a very rare disease (about 150 cases observed). The aetiology is currently little-known, and the data collected, without having achieved conclusive re sults, identify two possible causes: neoplastic and reactive inflammatory. This case report refers to a recidivism of BCMC in a patient whose brother, few months before, underwent a left nephrectomy and right renal Radio Frequency Termo Ablation (RFTA) for bilateral papillary renal cell carcinoma. For the recurring trend, the onset in a male young patient without chronic inflammatory diseases evidence, the presence of a first degree relative with a rare carcinoma we supposed a neoplastic aetiology. The available literature suggests that both tumours (BCMC and renal cell carcinoma) are susceptible to oestrogens. This biomolecular mechanism could represent a valid antipathogenic hypothesis.
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Scerrino G, Melfa G, Raspanti C, Rotolo G, Salamone G, Licari L, Fontana T, Tutino R, Porrello C, Gulotta G, Cocorullo G. Minimally Invasive Video-Assisted Thyroidectomy: Analysis of Complications From a Systematic Review. Surg Innov 2019; 26:381-387. [PMID: 30632464 DOI: 10.1177/1553350618823425] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Nowadays, minimally invasive video-assisted thyroidectomy (MIVAT) is considered a safe and effective option. However, its complication rate has not been specifically discussed yet. The aim of this systematic review was enrolling a large number of studies to estimate early and late complications (transient and definitive, uni- and bilateral laryngeal nerve palsy; transient and definitive hypocalcemia; cervical hematoma; hypertrophic or keloid scar) of MIVAT compared with conventional technique. METHODS The review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria in PubMed and Embase. Search terms were "minimally invasive," "video-assisted," and "thyroidectomy." We enrolled randomized clinical trials, nonrandomized trials, and noncontrolled trials. RESULTS Thirty-two articles were considered suitable. Complication rate of MIVAT was quite similar to conventional technique: only one randomized trial found a significant difference concerning overall skin complication, and a single trial highlighted hypocalcemia significantly increased in MIVAT, concerning serologic value only. No difference concerning symptomatic nor definitive hypocalcemia was found. CONCLUSIONS We can confirm that MIVAT is a safe technique. It should be adopted in mean-high-volume surgery centers for thyroidectomy, if a strict compliance with indication was applied.
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Licari L, Salamone G, Campanella S, Carfì F, Fontana T, Falco N, Tutino R, De Marco P, Comelli A, Cerniglia D, Petrucci G, Vitabile S, Gulotta G. Use of the KSVM-based system for the definition, validation and identification of the incisional hernia recurrence risk factors. G Chir 2019; 40:32-38. [PMID: 30771796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Incisional hernia is one of the most common complications after abdominal surgery with an incidence rate of 11 to 20% post laparotomy. Many different factors can be considered as risk factors of incisional hernia recurrence. The aim of this study is to confirm and to validate the incisional hernia recurrence risk factors and to identify and to validate new ones. METHODS In the period from July 2007 to July 2017, 154 patients were selected and subjected to incisional hernia repair. The surgical operations were conducted under general anaesthesia. Patients received antibiotic prophylaxis when indicated, according to the hospital prophylaxis scheme. Inclusion criteria of the study were single operator case studies and open laparotomy for incisional hernia repair. The statistical analysis proposed to identify and to verify the risk factors for recurrence of incisional hernia is the Support Vector Machine (SVM). The analysis was conducted verifying 34 risk factors. RESULTS The data analysis confirmed the known correlations showed in the international literature with a greater incidence of comorbidities such as diabetes 37%, dyslipidaemia and hypercholesterolemia with a cumulative incidence of 16%; tobacco smoke - by combining categories smokers and ex-smokers - reach 46%, COPD 16% and hypertension 51%. CONCLUSIONS The analysis of the data therefore confirmed the correlations showed in the international literature. A KSVM-based system to classify incisional hernia recurrence has been presented. The type of prosthesis and the site of its implant also play a significant role in the development of the recurrence. Sensitivity (86,25%), Specificity (87,14%), Negative Predictive Value (84,72%), Precision (88,46%), Accuracy (86,67%), and Error (13,33%) scores obtained using the proposed technique highlight the validity for the relapse's classification methodology.
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Geraci G, D'Orazio B, Chiarenza S, Agrusa A, Salamone G, Buscemi S, Di Buono G, Gulotta G. Efficacy of fibrin sealant in thyroid surgery. Is drainage still necessary? Ann Ital Chir 2019; 90:100-105. [PMID: 31182696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION The routinely use of drains in thyroid surgery is a traditional and well-defined method, even if there is no clear evidence of significant improvement in patients outcomes. Aim of our study is to define the feasibility, safety and cost- effectiveness of fibrin sealant in total thyroidectomy in order to overcome the use of drains. MATERIALS AND METHODS We enrolled 262 patients (45 men and 217 women, mean age 54.7 yrs) undergone total thyroidectomy in University Hospital of Palermo (Italy), between July 2015 and October 2017. We randomized patients into group A (drain) and group B (no drain, fibrin sealant application). RESULTS We registered statistical difference between the two groups in mean operative time, visual analogue scale of pain, post-operative stay, incidence of seromas and/or deep and superficial hematomas, re-operation and wound infection (reduced in the fibrin sealant group). No significant difference have been found in intraoperative blood loss, postoperative cough, post-operative use of analgesic and in incidence of hypoparathyroidism or recurrent palsy. CONCLUSIONS Our study demonstrates that there is no evidence that the use of suction drains improves patients outcome and that routinely use of fibrin sealant can be advocated in thyroid surgery as an adjunct to a good surgical procedure. KEY WORDS Complication, Drainage, Fibrin Sealant, Thyroidectomy.
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Salamone G, Licari L, Guercio G, Comelli A, Mangiapane M, Falco N, Tutino R, Bagarella N, Campanella S, Porrello C, Gullo R, Cocorullo G, Gulotta G. Vacuum-Assisted Wound Closure with Mesh-Mediated Fascial Traction Achieves Better Outcomes than Vacuum-Assisted Wound Closure Alone: A Comparative Study. World J Surg 2018; 42:1679-1686. [PMID: 29147897 PMCID: PMC5934457 DOI: 10.1007/s00268-017-4354-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Background Open abdomen (OA) permits the application of damage control surgery principles when abdominal trauma, sepsis, severe acute peritonitis and abdominal compartmental syndrome (ACS) occur. Methods Non-traumatic patients treated with OA between January 2010 and December 2015 were identified in a prospective database, and the data collected were retrospectively reviewed. Patients’ records were collected from charts and the surgical and intensive care unit (ICU) registries. The Acosta “modified” technique was used to achieve fascial closure in vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) patients. Sex, age, simplified acute physiology score II (SAPS II), abdominal compartmental syndrome (ACS), cardiovascular disease (CVD) and surgical technique performed were evaluated in a multivariate analysis for mortality and fascial closure prediction. Results Ninety-six patients with a median age of 69 (40–78) years were included in the study. Sixty-nine patients (72%) underwent VAWCM. Forty-one patients (68%) achieved primary fascia closure: two patients (5%) were treated with VAWC (37 median days) versus 39 patients (95%) who were treated with VAWCM (10 median days) (p = 0.0003). Forty-eight patients underwent OA treatment due to ACS, and 24 patients (50%) survived compared to 36 patients (75%) from the “other reasons” group (p = 0.01). The ACS group required longer mechanical ventilator support (p = 0.006), length of stay in hospital (p = 0.005) and in ICU (p = 0.04) and had higher SAPS II scores (p = 0.0002). Conclusions The survival rate was 62%. ACS (p = 0.01), SAPS II (p = 0.004), sex (p = 0.01), pre-existing CVD (p = 0.0007) and surgical technique (VAWC vs VAWCM) (p = 0.0009) were determined to be predictors of mortality. Primary fascial closure was obtained in 68% of cases. VAWCM was found to grant higher survival and primary fascial closure rate.
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Affiliation(s)
- Giuseppe Salamone
- General and Emergency Surgery - Policlinico P. Giaccone, University of Palermo, Via Liborio Giuffré 5, 90127, Palermo, Italy
| | - Leo Licari
- General and Emergency Surgery - Policlinico P. Giaccone, University of Palermo, Via Liborio Giuffré 5, 90127, Palermo, Italy.
| | - Giovanni Guercio
- General and Emergency Surgery - Policlinico P. Giaccone, University of Palermo, Via Liborio Giuffré 5, 90127, Palermo, Italy
| | - Albert Comelli
- Department of Industrial and Digital Innovation, Policlinico P. Giaccone, University of Palermo, Via Liborio Giuffré 5, 90127, Palermo, Italy
| | - Mirko Mangiapane
- General and Emergency Surgery - Policlinico P. Giaccone, University of Palermo, Via Liborio Giuffré 5, 90127, Palermo, Italy
| | - Nicolò Falco
- General and Emergency Surgery - Policlinico P. Giaccone, University of Palermo, Via Liborio Giuffré 5, 90127, Palermo, Italy
| | - Roberta Tutino
- General and Emergency Surgery - Policlinico P. Giaccone, University of Palermo, Via Liborio Giuffré 5, 90127, Palermo, Italy
| | - Noemi Bagarella
- General and Emergency Surgery - Policlinico P. Giaccone, University of Palermo, Via Liborio Giuffré 5, 90127, Palermo, Italy
| | - Sofia Campanella
- General and Emergency Surgery - Policlinico P. Giaccone, University of Palermo, Via Liborio Giuffré 5, 90127, Palermo, Italy
| | - Calogero Porrello
- General and Emergency Surgery - Policlinico P. Giaccone, University of Palermo, Via Liborio Giuffré 5, 90127, Palermo, Italy
| | - Roberto Gullo
- General and Emergency Surgery - Policlinico P. Giaccone, University of Palermo, Via Liborio Giuffré 5, 90127, Palermo, Italy
| | - Gianfranco Cocorullo
- General and Emergency Surgery - Policlinico P. Giaccone, University of Palermo, Via Liborio Giuffré 5, 90127, Palermo, Italy
| | - Gaspare Gulotta
- General and Emergency Surgery - Policlinico P. Giaccone, University of Palermo, Via Liborio Giuffré 5, 90127, Palermo, Italy
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Mirabella A, Fiorentini T, Tutino R, Falco N, Fontana T, De Marco P, Gulotta E, Gulotta L, Licari L, Salamone G, Melfa I, Scerrino G, Lupo M, Speciale A, Cocorullo G. Laparoscopy is an available alternative to open surgery in the treatment of perforated peptic ulcers: a retrospective multicenter study. BMC Surg 2018; 18:78. [PMID: 30253756 PMCID: PMC6156951 DOI: 10.1186/s12893-018-0413-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 09/17/2018] [Indexed: 02/07/2023] Open
Abstract
Background Perforated peptic ulcers (PPU) remain one of the most frequent causes of death. Their incidence are largely unchanged accounting for 2–4% of peptic ulcers and remain the second most frequent abdominal cause of perforation and of indication for gastric emergency surgery. The minimally invasive approach has been proposed to treat PPU however some concerns on the offered advantages remain. Methods Data on 184 consecutive patients undergoing surgery for PPU were collected. Likewise, perioperative data including shock at admission and interval between admission and surgery to evaluate the Boey’s score. It was recorded the laparoscopic or open treatments, the type of surgical procedure, the length of the operation, the intensive care needed, and the length of hospital stay. Post-operative morbidity and mortality relation with patient’s age, surgical technique and Boey’s score were evaluated. Results The relationship between laparoscopic or open treatment and the Boey’s score was statistically significant (p = 0.000) being the open technique used for the low-mid group in 41.1% and high score group in 100% and laparoscopy in 58.6% and 0%, respectively. Postoperative complications occurred in 9.7% of patients which were related to the patients’ Boey’s score, 4.7% in the low-mid score group and 21.4% in the high risk score group (p = 0.000). In contrast morbidity was not related to the chosen technique being 12.8% in open technique and 5.3% in laparoscopic one (p = 0.092, p > 0.05). 30-day post-operative mortality was 3.8% and occurred in the 0.8% of low-mid Boey’s score group and in the 10.7% of the high Boey’s score group (p = 0.001). In respect to the surgical technique it occurred in 6.4% of open procedures and in any case in the Lap one (p = 0.043). Finally, there was a statistically significant difference in morbidity and mortality between patients < 70 and > 70 years old (p = 0.000; p = 0.002). Conclusions Laparoscopy tends to be an alternative method to open surgery in the treatment of perforated peptic ulcer. Morbidity and mortality were essentially related to Boey’s score. In our series laparoscopy was not used in high risk Boey’s score patients and it will be interesting to evaluate its usefulness in high risk patients in large randomized controlled trials.
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Affiliation(s)
- Antonino Mirabella
- O.U. of Emergency and General Surgery of "Villa Sofia" Hospital, Palermo, Italy
| | - Tiziana Fiorentini
- O.U. of Emergency and General Surgery of "Cervello" Hospital, Palermo, Italy
| | - Roberta Tutino
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy.
| | - Nicolò Falco
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Tommaso Fontana
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Paolino De Marco
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Eliana Gulotta
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Leonardo Gulotta
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Leo Licari
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Giuseppe Salamone
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Irene Melfa
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Gregorio Scerrino
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Massimo Lupo
- O.U. of Emergency and General Surgery of "Villa Sofia" Hospital, Palermo, Italy
| | - Armando Speciale
- O.U. of Emergency and General Surgery of "Cervello" Hospital, Palermo, Italy
| | - Gianfranco Cocorullo
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
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De Marco P, Militello G, Tutino R, Trapani A, Rizzo G, Kabhuli K, Falco N, Licari L, Salamone G, Gulotta G. The management of the slow transit constipation in the laparoscopic era. G Chir 2018; 34:297-302. [PMID: 30444478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The slow transit constipation (STC) is a functional bowel pathology with slow total gut transit time with normal calibre colon in addition to a variety of other systemic symptoms. Patients with an abnormal colonic motility refractory to conservative treatment are regarded as appropriate candidates for surgery. Laparoscopic total colectomy with ileum-rectum anastomosis represents the commonest surgical operation in the treatment of STC, in well selected patients, after failure of conservative treatment. From 2012 to 2016, 8 patients suffering constipation according to Roma III criteria and diagnosed as STC were submitted to a total colectomy in our O.U. We evaluated the long-term post-operative quality of life and the bowel function, specifically the persistence of constipation and the number of daily bowel movements. Based on our results, we consider that the use of minimally invasive total colectomy with an ileum-rectal anastomosis is the procedure of choice in patients with colonic inertia, and should be performed by experts in laparoscopic colorectal surgery offering a satisfying post-operative quality of life with low morbidity and mortality rates.
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Grasso E, Gori S, Soczewski E, Fernández L, Gallino L, Vota D, Martínez G, Irigoyen M, Ruhlmann C, Lobo TF, Salamone G, Mattar R, Daher S, Leirós CP, Ramhorst R. Impact of the Reticular Stress and Unfolded Protein Response on the inflammatory response in endometrial stromal cells. Sci Rep 2018; 8:12274. [PMID: 30116009 PMCID: PMC6095878 DOI: 10.1038/s41598-018-29779-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 07/18/2018] [Indexed: 11/15/2022] Open
Abstract
During decidualization, endometrial stromal cells undergo reticular stress (RS) and unfolded protein response (UPR), allowing the endoplasmic reticulum-expansion and immunomodulators production. Physiological RS generates the activation of sensing proteins, inflammasome activation and mature-IL-1β secretion, associated with pro-implantatory effects. We focus on the impact of RS and UPR on decidualized cells and whether they induce a physiological sterile inflammatory response through IL-1β production. Human endometrial stromal cell line (HESC) after decidualization treatment with MPA + dibutyryl-cAMP (Dec) increased the expression of RS-sensors (ATF6, PERK and IRE1α) and UPR markers (sXBP1 and CHOP) in comparison with Non-dec cells. Then we found increased NLRP3 expression in Dec cells compared with Non-dec cells. In fact STF-083010 (an IRE1α inhibitor) prevented this increase. Downstream, increased levels of active caspase-1 on Dec cells were detected by FAM-Flica Caspase-1 associated with an increase in IL-1β production. Moreover, the treatment with STF-083010 decreased the invasion index observed in Dec cells, evaluated by an in vitro model of implantation. In endometrial biopsies from recurrent spontaneous abortion patients an increased expression of IRE1α was found in comparison with fertile women; while recurrent implantation failure samples showed a lower expression of sXBP1, TXNIP and NLRP3 than fertile women, suggesting that RS/UPR tenors might condition endometrial receptivity.
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Grants
- PICT 2013-1632 Ministry of Science, Technology and Productive Innovation, Argentina | Agencia Nacional de Promoción Científica y Tecnológica (National Agency for Science and Technology, Argentina)
- PICT 2014-0657 Ministry of Science, Technology and Productive Innovation, Argentina | Agencia Nacional de Promoción Científica y Tecnológica (National Agency for Science and Technology, Argentina)
- PICT 2016-464 Ministry of Science, Technology and Productive Innovation, Argentina | Agencia Nacional de Promoción Científica y Tecnológica (National Agency for Science and Technology, Argentina)
- 20020130100040 and 20020090200034 Universidad de Buenos Aires (University of Buenos Aires)
- Ministry of Science, Technology and Productive Innovation, Argentina | Agencia Nacional de Promoci&#x00F3;n Cient&#x00ED;fica y Tecnol&#x00F3;gica (National Agency for Science and Technology, Argentina)
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Affiliation(s)
- E Grasso
- CONICET, Universidad de Buenos Aires. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales IQUIBICEN, Buenos Aires, Argentina
| | - S Gori
- CONICET, Universidad de Buenos Aires. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales IQUIBICEN, Buenos Aires, Argentina
- Institute of Experimental Medicine IMEX-CONICET, National Academy of Sciences, Buenos Aires, Argentina
| | - E Soczewski
- CONICET, Universidad de Buenos Aires. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales IQUIBICEN, Buenos Aires, Argentina
| | - L Fernández
- CONICET, Universidad de Buenos Aires. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales IQUIBICEN, Buenos Aires, Argentina
| | - L Gallino
- CONICET, Universidad de Buenos Aires. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales IQUIBICEN, Buenos Aires, Argentina
| | - D Vota
- CONICET, Universidad de Buenos Aires. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales IQUIBICEN, Buenos Aires, Argentina
| | - G Martínez
- Instituto de Fertilidad San Isidro, Buenos Aires, Argentina
| | - M Irigoyen
- Instituto de Fertilidad San Isidro, Buenos Aires, Argentina
| | - C Ruhlmann
- Instituto de Fertilidad San Isidro, Buenos Aires, Argentina
| | - T F Lobo
- Department of Obstetrics, Universidade Federal de São Paulo, São Paulo, Brazil
| | - G Salamone
- Institute of Experimental Medicine IMEX-CONICET, National Academy of Sciences, Buenos Aires, Argentina
| | - R Mattar
- Department of Obstetrics, Universidade Federal de São Paulo, São Paulo, Brazil
| | - S Daher
- Department of Obstetrics, Universidade Federal de São Paulo, São Paulo, Brazil
| | - C Pérez Leirós
- CONICET, Universidad de Buenos Aires. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales IQUIBICEN, Buenos Aires, Argentina
| | - R Ramhorst
- CONICET, Universidad de Buenos Aires. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales IQUIBICEN, Buenos Aires, Argentina.
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Salamone G, Licari L, Guercio G, Campanella S, Falco N, Scerrino G, Bonventre S, Geraci G, Cocorullo G, Gulotta G. The abdominal wall hernia in cirrhotic patients: a historical challenge. World J Emerg Surg 2018; 13:35. [PMID: 30065783 PMCID: PMC6064098 DOI: 10.1186/s13017-018-0196-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 07/18/2018] [Indexed: 12/20/2022] Open
Abstract
Background The incidence rate of abdominal wall hernia is 20–40% in cirrhotic patients. A surgical approach was originally performed only if complication signs and symptoms occurred. Several recent studies have demonstrated the usefulness of elective surgery. During recent decades, the indications for surgical timing have changed. Methods Cirrhotic patients with abdominal hernia who underwent surgical operation for abdominal wall hernia repair at the Policlinico “Paolo Giaccone” at Palermo University Hospital between January 2010 and September 2016 were identified in a prospective database, and the data collected were retrospectively reviewed; patients’ medical and surgical records were collected from charts and surgical and intensive care unit (ICU) registries. Postoperative morbidity was determined through the Clavien-Dindo classification. Cirrhosis severity was estimated by the Child-Pugh-Turcotte (CPT) score and MELD (model of end-stage liver disease) score. Postoperative mortality was considered up to 30 days after surgery. A follow-up period of at least 1 year was used to evaluate hernia recurrence. Results The univariate and multivariate analyses demonstrated the unique independent risk factors for the development of postsurgical morbidity (emergency surgery (OR 6.42; p 0.023), CPT class C (OR 3.72; p 0.041), American Society of Anesthesiologists (ASA) score ≥ 3 (OR 4.72; p 0.012) and MELD ≥ 20 (OR 5.64; p 0.009)) and postsurgical mortality (emergency surgery (OR 10.32; p 0.021), CPT class C (OR 5.52; p 0.014), ASA score ≥ 3 (OR 8.65; p 0.018), MELD ≥ 20 (OR 2.15; p 0.02)). Conclusions Concerning abdominal wall hernia repair in cirrhotic patients, the worst outcome is associated with emergency surgery and with uncontrolled disease. The correct timing of the surgical operation is elective surgery after ascites drainage and albumin/electrolyte serum level and coagulation alteration correction.
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Affiliation(s)
- Giuseppe Salamone
- Department of Surgical, Oncological and Oral Science, University of Palermo, Policlinico P. Giaccone. Via Liborio Giuffré 5, 90127 Palermo, Italy
| | - Leo Licari
- Department of Surgical, Oncological and Oral Science, University of Palermo, Policlinico P. Giaccone. Via Liborio Giuffré 5, 90127 Palermo, Italy
| | - Giovanni Guercio
- Department of Surgical, Oncological and Oral Science, University of Palermo, Policlinico P. Giaccone. Via Liborio Giuffré 5, 90127 Palermo, Italy
| | - Sofia Campanella
- Department of Surgical, Oncological and Oral Science, University of Palermo, Policlinico P. Giaccone. Via Liborio Giuffré 5, 90127 Palermo, Italy
| | - Nicolò Falco
- Department of Surgical, Oncological and Oral Science, University of Palermo, Policlinico P. Giaccone. Via Liborio Giuffré 5, 90127 Palermo, Italy
| | - Gregorio Scerrino
- Department of Surgical, Oncological and Oral Science, University of Palermo, Policlinico P. Giaccone. Via Liborio Giuffré 5, 90127 Palermo, Italy
| | - Sebastiano Bonventre
- Department of Surgical, Oncological and Oral Science, University of Palermo, Policlinico P. Giaccone. Via Liborio Giuffré 5, 90127 Palermo, Italy
| | - Girolamo Geraci
- Department of Surgical, Oncological and Oral Science, University of Palermo, Policlinico P. Giaccone. Via Liborio Giuffré 5, 90127 Palermo, Italy
| | - Gianfranco Cocorullo
- Department of Surgical, Oncological and Oral Science, University of Palermo, Policlinico P. Giaccone. Via Liborio Giuffré 5, 90127 Palermo, Italy
| | - Gaspare Gulotta
- Department of Surgical, Oncological and Oral Science, University of Palermo, Policlinico P. Giaccone. Via Liborio Giuffré 5, 90127 Palermo, Italy
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Licari L, Salamone G, Campanella S, Sabatino C, Ciolino G, Parinisi Z, Carfì F, De Marco P, Gulotta G. Preliminary results about a novel technique of mesh positioning in the abdominal wall hernia repair. G Chir 2018; 39:223-226. [PMID: 30039789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION The surgical techniques described to approach the incisional hernia repair are various and there is not consensus about which of them to use. The Intra-Peritoneal Onlay Technique (IPOM) with classic mesh positioning is burdened by high post-operative complication rate. The study shows the preliminary results of a novel technique of open IPOM mesh positioning with "percutaneous" approach. PATIENTS AND METHODS From January 2010 to December 2016 patients with abdominal wall incisional hernia that underwent surgical operation via open mesh technique for abdominal wall hernia repair at the "Policlinico Paolo Giaccone" at Palermo University Hospital were identified and the data collected were retrospectively reviewed; patients' medical and surgical records were collected from charts and the surgical registries. One hundred thirty-five patients with open IPOM percutaneous mesh positioning were selected. DISCUSSION AND CONCLUSIONS The observational study proposed showed that the technique described for the abdominal wall incisional hernia repair seems to be hopeful in order to set a post-operative course not burdened by elevated rate of post-operative complications, estimated to be near 37% vs 13% reported by our series.
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Salamone G, Licari L, Guercio G, Comelli A, Mangiapane M, Falco N, Tutino R, Bagarella N, Campanella S, Porrello C, Gullo R, Cocorullo G, Gulotta G. Correction to: Vacuum-Assisted Wound Closure with Mesh-Mediated Fascial Traction Achieves Better Outcomes than Vacuum-Assisted Wound Closure Alone: A Comparative Study. World J Surg 2018; 42:3823. [PMID: 29789858 DOI: 10.1007/s00268-018-4685-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
In the original article the credit line for the reuse of Fig. 1 from an article published in the open access journal, World Journal of Emergency Surgery is missing.
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Affiliation(s)
- Giuseppe Salamone
- General and Emergency Surgery - Policlinico P. Giaccone, University of Palermo, Via Liborio Giuffré 5, 90127, Palermo, Italy
| | - Leo Licari
- General and Emergency Surgery - Policlinico P. Giaccone, University of Palermo, Via Liborio Giuffré 5, 90127, Palermo, Italy.
| | - Giovanni Guercio
- General and Emergency Surgery - Policlinico P. Giaccone, University of Palermo, Via Liborio Giuffré 5, 90127, Palermo, Italy
| | - Albert Comelli
- Department of Industrial and Digital Innovation, Policlinico P. Giaccone, University of Palermo, Via Liborio Giuffré 5, 90127, Palermo, Italy
| | - Mirko Mangiapane
- General and Emergency Surgery - Policlinico P. Giaccone, University of Palermo, Via Liborio Giuffré 5, 90127, Palermo, Italy
| | - Nicolò Falco
- General and Emergency Surgery - Policlinico P. Giaccone, University of Palermo, Via Liborio Giuffré 5, 90127, Palermo, Italy
| | - Roberta Tutino
- General and Emergency Surgery - Policlinico P. Giaccone, University of Palermo, Via Liborio Giuffré 5, 90127, Palermo, Italy
| | - Noemi Bagarella
- General and Emergency Surgery - Policlinico P. Giaccone, University of Palermo, Via Liborio Giuffré 5, 90127, Palermo, Italy
| | - Sofia Campanella
- General and Emergency Surgery - Policlinico P. Giaccone, University of Palermo, Via Liborio Giuffré 5, 90127, Palermo, Italy
| | - Calogero Porrello
- General and Emergency Surgery - Policlinico P. Giaccone, University of Palermo, Via Liborio Giuffré 5, 90127, Palermo, Italy
| | - Roberto Gullo
- General and Emergency Surgery - Policlinico P. Giaccone, University of Palermo, Via Liborio Giuffré 5, 90127, Palermo, Italy
| | - Gianfranco Cocorullo
- General and Emergency Surgery - Policlinico P. Giaccone, University of Palermo, Via Liborio Giuffré 5, 90127, Palermo, Italy
| | - Gaspare Gulotta
- General and Emergency Surgery - Policlinico P. Giaccone, University of Palermo, Via Liborio Giuffré 5, 90127, Palermo, Italy
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Bougard H, Noor F, Dell A, Van Straten S, Khamajeet A, Tshisola SK, Kabongo K, Kong V, Moodley Y, Anderson F, Madiba T, du Plooy F, Hartford L, Chilton G, Karjiker P, Mabitsela ME, Ndlovu SR, Badicel M, Jaich R, Ruiz-Tovar J, Garcia-Florez L, Otero-Díez JL, Ramos Pérez V, Aguado Suárez N, Minguez García J, Corral Moreno S, Collado MV, Jiménez Carneros V, García Septiem J, Gonzalez M, Picardo A, Esteban E, Ferrero E, Espin-Basany E, Blanco-Colino R, Andriola V, Solar García L, Contreras E, García Bernardo C, Pagnozzi J, Sanz S, Miyar de León A, Dorismé A, Rodicio J, Suarez A, Stuva J, Diaz Vico T, Fernandez-Vega L, Soldevila-Verdeguer C, Sena-Ruiz F, Pujol-Cano N, Diaz-Jover P, Garcia-Perez JM, Segura-Sampedro JJ, Pineño-Flores C, Ambrona-Zafra D, Craus-Miguel A, Jimenez-Morillas P, Mazzella A, Jayathilake AB, Thalgaspitiya SPB, Wijayarathna LS, Wimalge PMSN, Sanni HA, Okenabirhie O, Homeida A, Younis A, Omer OA, Abdulaziz M, Mussad A, Adam A, Björklund I, Ahlqvist S, Thorell A, Wogensen F, Sokratous A, Breistrand M, Thorarinsdottir H, Sigurdadottir J, Nikberg M, Chabok A, Hjertberg M, Elbe P, Saraste D, Rutkowski W, Forlin L, Niska K, Sund M, Oswald D, Peros G, Bluelle R, Reinisch K, Frey D, Palma A, Raptis DA, Zumbühl L, Zuber M, Schmid R, Werder G, Nocito A, Gerosa A, Mahanty S, Widmer LW, Müller J, Gübeli A, Zuk G, Gulcicek OB, Vartanoglu T, Kose E, Karahan SR, Aydin MC, Sahbaz NA, Halicioglu I, Alis H, Sapci I, Adiyaman C, Pektaş AM, Cengiz TB, Tansoker I, Işler V, Cevik M, Mutlu D, Ozben V, Ozmen BB, Bayram S, Yolcu S, Kobal BB, Toto ÖF, Çakaloğlu HC, Karabulut K, Mutlu V, Ozkan BB, Celik S, Semiz A, Bodur S, Gül E, Murutoglu B, Yildirim R, Baki BE, Arslan E, Ulusahin M, Guner A, Tomas K, Walker N, Shrimanker N, Cole S, Breslin R, Srinivasan R, Elshaer M, Hunter K, Al-Bahrani A, Liew I, Mairs NG, Rocke A, Dick L, Qureshi M, Chowdhury D, Wright N, Skerritt C, Kufeji D, Ho A, Dissanayake T, Tennakoon A, Ali W, Lim SJ, Tan C, O'Neill S, Jones C, Knight S, Nassif D, Sharma A, Warren O, White R, Mehdi A, Post N, Kalakouti E, Dashnyam E, Stourton F, Mykoniatis I, Currow C, Wong F, Gupta A, Shatkar V, Luck J, Kadiwar S, Smedley A, Wakefield R, Herrod P, Blackwell J, Lund J, Cohen F, Bandi A, Giuliani S, Bond-Smith G, Pezas T, Farhangmehr N, Urbonas T, Perenyei M, Ireland P, Blencowe N, Bowling K, Bunting D, Longstaff L, Keogh K, Jeon H, Iqbal MR, Khosla S, Jeffery A, Perera J, Ibrahem AA, Alhammali T, Salama Y, Oram S, Kidd T, Cullen F, Owen C, Wilson M, Chiu S, Sarafilovic H, Ploski J, Evans E, Abbas A, Kamya S, Ishak N, Bisset C, Andress C, Chin YR, Patel P, Evans D, Haslegrave A, Boggon A, Laurie K, Connor K, Mann T, Mansuri A, Davies R, Griffiths E, Shahbaz AR, Eng C, Din F, L'Heveder A, Park EHG, Ravishankar R, McIntosh K, Yau JD, Chan L, McGarvie S, Tang L, Lim H, Yap S, Park J, Ng ZH, Mirza S, Ang YL, Walls L, Roy C, Paterson-Brown S, Camilleri-Brennan J, Mclean K, D'Souza MS, Pronin S, Henshall DE, Ter EZ, Fouad D, Minocha A, English W, Morgan C, Townsend D, Maciejec L, Mahdi S, Akpenyi O, Hall E, Caydiid H, Rob Z, Abbott T, Torrance HD, Johnston R, Gani MA, Gravante G, Rajmohan S, Majid K, Dindyal S, Smith C, Palliyil M, Patel S, Nicholson L, Harvey N, Baillie K, Shillito S, Kershaw S, Bamford R, Orton P, Reunis E, Tyler R, Soon WC, Jama GM, Dhillon D, Patel K, Nanthakumaran S, Heard R, Chen KY, Barmayehvar B, Datta U, Kamarajah SK, Karandikar S, Iftekhar Tani S, Monaghan E, Donnelly P, Walker M, Parakh J, Blacker S, Kaul A, Paramasivan A, Farag S, Nessa A, Awadallah S, Lim J, Chean Khun Ng J, Kiran RP, Murray A, Etchill E, Dasari M, Puyana J, Haddad N, Zielinski M, Choudhry A, Caliman C, Beamon M, Duane T, Swaroop M, Myers J, Deal R, Schadde E, Hemmila M, Napolitano L, To K, Makupe A, Musowoya J, van der Naald N, Kumwenda D, Reece-Smith A, Otten K, Verbeek A, Prins M, Baquero Suarez AA, Balmaceda R, Deane C, Dijan E, Elfiky M, Koskenvuo L, Thollot A, Limoges B, Capito C, Alexandre C, Kotobi H, Leroux J, Pinnagoda K, Henric N, Azzis O, Rosello O, Francois P, Etienne S, Buisson P, Hmila S, Clegg-Lamptey JN, Imoro O, Abem OE, Papageorgiou D, Soulou V, Asturias S, Peña L, O'Connor DB, Luc AR, Russo AA, Ruzzenente A, Taddei A, Cona C, Bottini C, Pascale G, Rotunno G, Solaini L, Pascale MM, Notarnicola M, Corbellino M, Sacco M, Ubiali P, Cautiero R, Bocchetti T, Muzio E, Guglielmo V, Morandi E, Mao P, de Luca E, Ali FM, Žilinskas J, Strupas K, Kondrotas P, Baltrunas R, Kutkevicius J, Ignatavicius P, Tan CL, Siaw JY, Yam SY, Wilson L, Aziz MRA, Bondin J, Zorrilla CD, Majbar A, Sale D, Abdullahi L, Osagie O, Faboya O, Fatuga A, Taiwo A, Nwabuoku E, Bliksøen M, Khan ZA, Coronel J, Miranda C, Vasquez I, Helguero-Santin LM, Rickard J, Adedeji A, Alqahtani S, Rath M, Van Niekerk M, Koto MZ, Matos-Puig R, Israelsson L, Schuetz T, Yuksek MA, Mericliler M, Ulusahin M, Wolf B, Fairfield C, Yong GL, Whitehurst K, Redgrave N, Musyoka CK, Olivier J, Lee K, Cox M, Farhan-Alanie MMH, Callan R, Chibuye C, Ali THA, Rekhis S, Rommaneh M, Sam ZH, Pugliesi TB, Pardo G, Blanco R. Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study. Lancet Infect Dis 2018; 18:516-525. [PMID: 29452941 PMCID: PMC5910057 DOI: 10.1016/s1473-3099(18)30101-4] [Citation(s) in RCA: 236] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 12/06/2017] [Accepted: 12/15/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. METHODS This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. FINDINGS Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p<0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05-2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p<0·001). INTERPRETATION Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication. FUNDING DFID-MRC-Wellcome Trust Joint Global Health Trial Development Grant, National Institute of Health Research Global Health Research Unit Grant.
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Porrello C, Gullo R, Vaglica A, Scerrino G, Salamone G, Licari L, Raspanti C, Gulotta E, Gulotta G, Cocorullo G. Pulmonary Laser Metastasectomy by 1318-nm Neodymium-Doped Yttrium-Aluminum Garnet Laser: A Retrospective Study About Laser Metastasectomy of the Lung. Surg Innov 2018; 25:142-148. [PMID: 29347883 DOI: 10.1177/1553350617752263] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND The lungs are among the first organ affected by remote metastases from many primary tumors. The surgical resection of isolated pulmonary metastases represents an important and effective element of therapy. This is a retrospective study about our entire experience with pulmonary resection for metastatic cancer using 1318-nm neodymium-doped yttrium-aluminum garnet laser. METHOD In this single-institution study, we retrospectively analyzed a group of 209 patients previously treated for primary malignant solid tumors. We excluded 103 patients. The number and location of lesions in the lungs was determined using chest computed tomography and positron emission tomography-computed tomography. Disseminated malignancy was excluded. All pulmonary laser resections are performed via an anteroaxillary muscle-sparing thoracotomy. All lesions were routinely removed by laser with a small (5-10 mm) margin of the healthy lung. Patients received systematic lymph node sampling with intraoperative smear cytology of sampled lymph nodes. RESULTS Mortality at 2 years from the first surgery is around 20% (10% annually). This value increases to 45% in the third year. The estimated median survival for patients who underwent the first surgery is reported to be approximately 42 months. CONCLUSION Our results show that laser resection of lung metastases can achieve good result, in terms of radical resection and survival, as conventional surgical metastasectomy. The great advantage is the possibility of limiting the damage to the lung. Stapler resection of a high number of metastases would mutilate the lung.
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Salamone G, Licari L, Falco N, Augello G, Tutino R, Campanella S, Guercio G, Gulotta G. Mannheim Peritonitis Index (MPI) and elderly population: prognostic evaluation in acute secondary peritonitis. G Chir 2017; 37:243-249. [PMID: 28350970 DOI: 10.11138/gchir/2016.37.6.243] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Acute Secondary Peritonitis due to abdominal visceral perforation is characterized by high mortality and morbidity risk. Risk stratification allows prognosis prediction to adopt the best surgical treatment and clinical care support therapy. In Western countries elderly people represent a significant percentage of population Aim. Evaluation of Mannheim Peritonitis Index (MPI) and consideration upon old people. PATIENTS AND METHODS Retrospective study on 104 patients admitted and operated for "Acute Secondary Peritonitis due to visceral perforation". MPI was scored. In our study we want to demonstrate efficacy of MPI and the possibility to consider older age an independent prognostic factor. RESULTS Mortality was 25.96%. Greatest sensitivity and specificity for the MPI score as a predictor of mortality was at the score of 20. MPI score of <16 had 0.15 times lower risk of mortality compared to patients with MPI score 17 - 21 and 0.61 lower than patients with MPI >22. Patients with MPI score 17-21 had 0.46 times lower risk of mortality compared to patients with MPI score >21. In the group of patients with MPI score of >20 the mortality rate was 48.5% for patients older than 80 years old and 12.1% for younger patients (p < 0.005); in the group with MPI score of < 20 mortality rate was respectively 8.4% and 1.4% (p < 0.005). DISCUSSION AND CONCLUSIONS Data confirm the accuracy of the test. MPI score and age over 80 years old resulted independent predictors of mortality at multivariate analysis.
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Cocorullo G, Tutino R, Falco N, Salamone G, Fontana T, Licari L, Gulotta G. Laparoscopic ileocecal resection in acute and chronic presentations of Crohn's disease. A single center experience. G Chir 2017; 37:220-223. [PMID: 28098059 DOI: 10.11138/gchir/2016.37.5.220] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The terminal ileum is the most involved tract in Crohn's disease. The obstruction in this location is the most frequent complication. Acute or chronic presentations can occur. Surgery finds a role in the management of chronic strictures and in acute clinical presentations with complications not improving with conservative therapy. PATIENTS AND METHODS We investigate the outcome of patients with obstruction of the ileo-cecal bowel tract laparoscopically managed. It was analyzed the average operative time (OT), the conversion rate and the occurrence of re-operation due to surgical complications. RESULTS 21 patients underwent an ileocecal resection for complicated Crohn's disease between January 2013 and December 2014. The admissions were performed in emergency in 42% of patients. The preintervention hospital stay was 5.8 (Sd 6.23). The mean operative time was 154 min (Sd 41). 28% of the procedures were converted to open surgery. The average hospital stay was 10 days (Sd 5) in uncomplicated patients. The morbidity rate was 28%. In 19% of cases a re-intervention was needed due to anastomotic leakage (3pts) and one hemoperitoneum for bleeding from the suture line. DISCUSSION Laparoscopy seems an affordable technique in the management of obstructive pattern of Crohn's disease. It should be the preferable approach in young patients that probably will be submitted to subsequent surgery for the same disease; in fact, the reduced adhesions formation provided by the less bowel manipulation make easy the subsequent access. Older patients had usually more post-operative morbidity and mortality mostly due to pre-existing conditions; if possible in these patients the treatment should be medical.
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Salamone G, Licari L, Randisi B, Falco N, Tutino R, Vaglica A, Gullo R, Porello C, Cocorullo G, Gulotta G. Uncommon localizations of hydatid cyst. Review of the literature. G Chir 2017; 37:180-185. [PMID: 27938537 DOI: 10.11138/gchir/2016.37.4.180] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Hydatid disease is an endemic anthropozoonosis with usual localization in liver and lungs. Rarely it localizes in uncommon sites as spleen, skeleton, kidney, brain, cardiac muscle, peritoneum, sub cutis. Complications of uncommon localizations are the same that for usual ones. MATERIAL AND METHODS Review of the literature on rare and atypical localization of hydatid cysts in soft tissues. Key-words used on Pub-Med [(echinococ OR hydatid) AND (soft tissue OR subcutaneous OR cutaneous)] without time limit. There were found 282 articles; 242 were excluded because of muscular or bone localizations. 40 were coherent. RESULTS Different variables are taken into account: age, sex, geographic area, anatomic localization of the cyst, dimension, symptoms, signs, mobility, blood exams and specific serological tests, imaging techniques for diagnosis, existing of septa in the structure, treatment, anaesthesia, spillage, neo-adjuvant and adjuvant treatment, follow-up period, recurrent lesions. CONCLUSION It would be useful create an homogeneous and standardized collection of data of these rare and potentially life-threatening conditions in order to create guide-line of diagnostic and therapeutic process and create (or adopt) unique classification of the lesions.
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Cocorullo G, Tutino R, Falco N, Fontana T, Salamone G, Licari L, Gulotta G. Rectal bleeding and prolapse… not always benign diseases rather anal cancer. The importance of a correct decision making since primary care. G Chir 2017; 37:133-135. [PMID: 27734798 DOI: 10.11138/gchir/2016.37.3.133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Rectal bleeding is very common in general population with a prevalence of 10-20 %. Primary care physicians have to stratify patients basing on urgency and on the colo-rectal cancer risk and to conduct a decision making for the correct management. We report a case of a 61-years-old woman, complaining rectal bleeding and an anal mass attended to their family doctor who does a visit but without a digital rectal examination and diagnosed a hemorrhoidal prolapse suggesting medical therapy. For the persistence of symptoms she comes to our service from emergency attention. Inspection and digital rectal examination revealed an anal mass. CT scan was performed showing a large anal mass involving half anal circumference. Histologic samples showed an epithelial proliferation compatible with a squamous carcinoma. Oncological consult was requested and a chemo-radiotherapy treatment was proposed. This case report highlights the difficulty when physicians assess patients with anorectal complaints in differentiating anal cancer from benign disease, presumably because symptoms are similar. Primary care physicians must maintain a high index of suspicion of cancer in high-risk population. Sensitization of these colleagues is required since digital rectal examination is of inestimable value to verify the presence of a rectal or an anal mass.
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Cocorullo G, Falco N, Tutino R, Fontana T, Scerrino G, Salamone G, Licari L, Gulotta G. Open versus laparoscopic approach in the treatment of abdominal emergencies in elderly population. G Chir 2017; 37:108-112. [PMID: 27734793 DOI: 10.11138/gchir/2016.37.3.108] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIM To evaluate the role of laparoscopy in the treatment of surgical emergency in old population. PATIENTS AND METHODS Over-70 years-old patients submitted to emergency abdominal surgery from January 2013 to December 2014 were collected and grouped according to admission diagnoses. These accounted small bowel obstruction, colonic acute disease, appendicitis, ventral hernia, gastro-duodenal perforation, biliary disease. In each group it was analyzed the operation time (OT), the morbidity rate and the mortality rate comparing open and laparoscopic management using T-test and Chi-square test. RESULTS 159 over 70-years-old patients underwent emergency surgery in the General and Emergency surgery Operative Unit (O.U.) of the Policlinic of Palermo. 75 patients were managed by a laparoscopic approach and 84 underwent traditional open emergency surgery. T-Test for OT and Chi-square test for morbidity rate and mortality rate showed no differences in small bowel emergencies (p=0,4; 0,25<p<0,9; 0,25<p<0,9), in colonic acute diseases (p=0,35; 0,25<p<0,9; 0,25<p<0,9), in appendicitis (p=0,22; 0,05<p<0,1; 0,25<p<0,9), in complicated ventral hernia (p=0,12; p>0,9; p>0,95) and in gastro-duodenal perforation (p=0,9; p>0.9; p>0.95). In cholecystitis, laparoscopy group showed lower OT (T-Test: p= 0,0002) while Chi-square test for morbidity rate (0,1<p<0,25) and mortality rate (0,25<p<0,9) showed no differences. CONCLUSIONS The collected data showed the feasibility of laparoscopic management as an alternative to open surgery in surgical emergencies in elderly population.
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Salamone G, Raspanti C, Licari L, Falco N, Rotolo G, Augello G, Melfa G, Gulotta G. Non-Occlusive Mesenteric Ischemia (NOMI) in Parkinson's disease: case report. G Chir 2017; 38:71-76. [PMID: 28691670 PMCID: PMC5509387 DOI: 10.11138/gchir/2017.38.2.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Non-occlusive mesenteric ischemia (NOMI) is a severe pathological condition characterized by signs and symptoms of bowel obstruction, intestinal necrosis resulting from acute and/or chronic inadequate blood perfusion, in the absence of an organic vascular obstruction detectable by imaging techniques. A 64 years old man case with a history of Parkinson's disease in high-functioning levodopa treatment is presented. Clinical and radiological signs of intestinal obstruction were observed. He underwent surgical operation with total colectomy and terminal ileostomy for generalized secondary peritonitis due to perforation of sigmoid colon. Ischemic pancolitis was first suspected. In third post-operative day a contrastenhanced CT scan was performed in the evidence of fever and sub-occlusive symptoms. It was found absence of reliable evidence of vascular changes; superior mesenteric artery and vein patency is maintained A NOMI was then diagnosed. NOMI represents about 0.04% of mesenteric artery diseases. It is correlated with a poor prognosis with a mortality estimated of 70-90%. Parkinson's disease, considering neurodegenerative alterations that characterize it, can be considered as a predisposing factor. The combined treatment with high doses of levodopa and vasodilators, such as PGE (Prostaglandin E), can contribute to an improvement in prognosis.
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Falco N, Fontana T, Tutino R, Raspanti C, Mascolino A, Melfa I, Scerrino G, Salamone G, Gulotta G. Complication of endoscopic tattooing: a case report of covered perforation. G Chir 2017; 37:74-8. [PMID: 27381693 DOI: 10.11138/gchir/2016.37.2.074] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIM Laparoscopy is considered a good approach in treatment of colorectal neoplastic diseases; the endoscopic tattooing is then recommended (Evidence Level III and grade of recommendation A) to mark a lesion or a polypectomy site for intraoperative identification. We describe the case of perforation after tattoing treated conservatively. CASE REPORT 63 years old woman, underwent colonoscopy for lipoma tattooing with India ink SPOT® solution kit and saline test. Immediately after the procedure the patient has been referred the appearance of colic epi-mesogastric pain and fever; Computed Tomography (CT) without MDC identified an irregular thickening of transverse colon with some microbubbles compatible with focal peritonitis. Initial paralytic ileus was present too. The blood count and metabolic panel examinations reveal a neutrophil leucocytosis (WBC: 11.000/mmc, 80% neutrophils). RESULTS On the base of WSES sepsis severity score and recent literature patient was treated conservatively with total parenteral nutrition, and intravenous antibiotic therapy. After the resolution of fever and reactivation of peristalsis. The discharge occurred after six days with no early complications. CONCLUSION India ink tattooing with SPOT® solution kit and saline test represent the first choice. It is a feasible technique although perforation is a possible complication. It may need an immediately surgical operation but in most cases a conservative management is a good and safe tool even if surgery may be attempted too.
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Gori S, Vermeulen M, Remes-Lenicov F, Jancic C, Scordo W, Ceballos A, Towstyka N, Bestach Y, Belli C, Sabbione F, Geffner J, Salamone G. Acetylcholine polarizes dendritic cells toward a Th2-promoting profile. Allergy 2017; 72:221-231. [PMID: 27138374 DOI: 10.1111/all.12926] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND A growing body of research shows a reciprocal regulation between the neural and immune systems. Acetylcholine (ACh) is the most important parasympathetic neurotransmitter, and increasing evidence indicates that it is able to modulate the immune response. Interestingly, in recent years, it has become clear that immune cells express a non-neuronal cholinergic system, which is stimulated in the course of inflammatory processes. We have previously shown that dendritic cells (DC) express muscarinic receptors, as well as the enzymes responsible for the synthesis and degradation of ACh. Here, we analyzed whether ACh could also modulate the functional profile of DC. METHODS Dendritic cells were obtained from monocytes cultured for 5 days with GM-CSF+IL-4 or isolated from peripheral blood (CD1c+ DC). The phenotype of DC was evaluated by flow cytometry, the production of cytokines was analyzed by ELISA or intracellular staining and flow cytometry, and the expression of muscarinic and nicotinic receptors was evaluated by flow cytometry or qRT-PCR. RESULTS Treatment of DC with ACh stimulated the expression of the Th2-promoter OX40L, the production of the Th2-chemokines MDC (macrophage-derived chemokine/CCL22) and TARC (thymus and activation-regulated chemokine/CCL17), and the synthesis of IL-4, IL-5, and IL-13 by T cells, in the course of the mixed lymphocyte reaction (MLR). Moreover, we found that the stimulation of OX40L, HLA-DR, and CD83 expressions in DC induced by the Th2-promoting cytokine TSLP, as well as the production of IL-13, IL-4, and IL-5 by T cells in the course of the MLR, was further enhanced when DC were treated with TSLP plus ACh, instead of TSLP or ACh alone. CONCLUSIONS Our observations suggest that ACh polarizes DC toward a Th2-promoting profile.
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Affiliation(s)
- S. Gori
- Instituto de Medicina Experimental (IMEX) CONICET; Academia Nacional de Medicina; CABA Argentina
| | - M. Vermeulen
- Instituto de Medicina Experimental (IMEX) CONICET; Academia Nacional de Medicina; CABA Argentina
- Departamento de Microbiología; Parasitología e Inmunología; Facultad de Medicina; Universidad de Buenos Aires; CABA Argentina
| | - F. Remes-Lenicov
- Instituto de Investigaciones Biomédicas en Retrovirus y SIDA (INBIRS); Universidad de Buenos Aires - CONICET; CABA Argentina
| | - C. Jancic
- Instituto de Medicina Experimental (IMEX) CONICET; Academia Nacional de Medicina; CABA Argentina
- Departamento de Microbiología; Parasitología e Inmunología; Facultad de Medicina; Universidad de Buenos Aires; CABA Argentina
| | - W. Scordo
- Servicio de Medicina Transfusional; Hospital Italiano de Buenos Aires; CABA Argentina
| | - A. Ceballos
- Instituto de Investigaciones Biomédicas en Retrovirus y SIDA (INBIRS); Universidad de Buenos Aires - CONICET; CABA Argentina
| | - N. Towstyka
- Instituto de Medicina Experimental (IMEX) CONICET; Academia Nacional de Medicina; CABA Argentina
| | - Y. Bestach
- Instituto de Medicina Experimental (IMEX) CONICET; Academia Nacional de Medicina; CABA Argentina
| | - C. Belli
- Instituto de Medicina Experimental (IMEX) CONICET; Academia Nacional de Medicina; CABA Argentina
| | - F. Sabbione
- Instituto de Medicina Experimental (IMEX) CONICET; Academia Nacional de Medicina; CABA Argentina
| | - J. Geffner
- Departamento de Microbiología; Parasitología e Inmunología; Facultad de Medicina; Universidad de Buenos Aires; CABA Argentina
- Instituto de Investigaciones Biomédicas en Retrovirus y SIDA (INBIRS); Universidad de Buenos Aires - CONICET; CABA Argentina
| | - G. Salamone
- Instituto de Medicina Experimental (IMEX) CONICET; Academia Nacional de Medicina; CABA Argentina
- Departamento de Microbiología; Parasitología e Inmunología; Facultad de Medicina; Universidad de Buenos Aires; CABA Argentina
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Cocorullo G, Mirabella A, Falco N, Fontana T, Tutino R, Licari L, Salamone G, Scerrino G, Gulotta G. An investigation of bedside laparoscopy in the ICU for cases of non-occlusive mesenteric ischemia. World J Emerg Surg 2017; 12:4. [PMID: 28115983 PMCID: PMC5241960 DOI: 10.1186/s13017-017-0118-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/13/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Acute mesenteric ischemia is a rare affection with high related mortality. NOMI presents the most important diagnostic problems and is related with the higher risk of white laparotomy. This study wants to give a contribution for the validation of laparoscopic approach in case of NOMI. METHODS Thirty-two consecutive patients were admitted in last 10 years in ICU of Paolo Giaccone University Hospital of Palermo for AMI. Diagnosis was obtained by multislice CT and selective angiography was done if clinical conditions were permissive. If necrosis was already present or suspected, surgical approach was done. Endovascular or surgical embolectomy was performed when necessary. Twenty NOMI patients underwent medical treatment performing laparoscopy 24 h later to verify the evolution of AMI. A three-port technique was used. In all patients we performed a bed side procedure 48-72 h later in both non-resected and resected group. RESULTS In 14 up 20 case of NOMI the disease was extended throughout the splanchnic district, in 6 patients it involved the ileum and the colon; after a first look, only 6 patients underwent resection. One patient died 35 h after diagnosis of NOMI. The second look, 48 h later, demonstrated 4 infarction recurrences in the group of resected patients and onset signs of necrosis in 5 patients of non-resected group. A total of 15 resections were performed on 11 patients. Mortality rate was 6/20-30% but it was much higher in resected group (5/11-45,5%). Non-therapeutic laparotomy was avoided in 9/20 patients and in this group mortality rate was 1/9-11%. No morbidity was recorded related to laparoscopic procedure. CONCLUSIONS Laparoscopy could be a feasible and safety surgical approach for management of patient with NOMI. Our retrospective study demonstrates that laparoscopy don't increase morbidity, reduce mortality avoiding non-therapeutic laparotomy.
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Affiliation(s)
- G. Cocorullo
- General and Emergency Surgery–Policlinico P. Giaccone, University of Palermo, Via Liborio Giuffrè, 5, Palermo, Italy
| | - A. Mirabella
- General and Emergency Surgery–Villa Sofia Hospita, Palermo, Italy
| | - N. Falco
- General and Emergency Surgery–Policlinico P. Giaccone, University of Palermo, Via Liborio Giuffrè, 5, Palermo, Italy
| | - T. Fontana
- General and Emergency Surgery–Policlinico P. Giaccone, University of Palermo, Via Liborio Giuffrè, 5, Palermo, Italy
| | - R. Tutino
- General and Emergency Surgery–Policlinico P. Giaccone, University of Palermo, Via Liborio Giuffrè, 5, Palermo, Italy
| | - L. Licari
- General and Emergency Surgery–Policlinico P. Giaccone, University of Palermo, Via Liborio Giuffrè, 5, Palermo, Italy
| | - G. Salamone
- General and Emergency Surgery–Policlinico P. Giaccone, University of Palermo, Via Liborio Giuffrè, 5, Palermo, Italy
| | - G. Scerrino
- General and Emergency Surgery–Policlinico P. Giaccone, University of Palermo, Via Liborio Giuffrè, 5, Palermo, Italy
| | - G. Gulotta
- General and Emergency Surgery–Policlinico P. Giaccone, University of Palermo, Via Liborio Giuffrè, 5, Palermo, Italy
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Rodolico V, Di Carlo P, Gulotta G, D'Arpa F, Salamone G, Cocorullo G, Agrusa A, Giammanco A, Sergi C. Intra-abdominal Candida spp infection in acute abdomen in a quality assurance (QA)-certified academic setting. J Clin Pathol 2016; 70:579-583. [PMID: 27941028 PMCID: PMC5484093 DOI: 10.1136/jclinpath-2016-203936] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 11/04/2016] [Accepted: 11/09/2016] [Indexed: 01/24/2023]
Abstract
AIMS To evaluate the contribution of light microscopy to detecting Candida spp infection in patients with complicated intra-abdominal infections (IAIs) admitted for acute abdomen to a quality assurance (QA)-certified surgical emergency ward. METHODS We conducted a retrospective study (2008-2012) of 809 abdominal intraoperative or biopsy tissue specimens obtained from patients admitted with acute abdomen and microbiological samples positive for Candida spp. Demographic data, mortality, comorbidities, specimen type, microscopy results, special histological staining performed, antimicrobial therapy were collected and analysed. Any comments at the multidisciplinary team meeting was recorded in minutes of and approved. RESULTS Sixty-six patients with complicated IAIs due to Candida spp were identified (39 male, 27 female, mean±SD age 75±20 years). Candida albicans was isolated in 35 cases and Candida non-albicans spp in 31 cases. Candida spp were isolated from blood in 50% of all selected microbiological specimens. Patients were stratified according to Candida spp (albicans vs non-albicans), underlying cancer disease and no previous antimicrobial administration, and a positive correlation with C. albicans isolation was found (p=0.009 and p=0.048, respectively). Out of 41 cases with microscopic evaluation, we identified yeast forms, pseudohyphae or both, indicative of Candida spp, in 23. Identification of Candida spp in histological specimens was higher in C. albicans cases than in C. non-albicans cases (73% vs 37.5%). Microscopy allowed prompt treatment of all patients. CONCLUSIONS Light microscopy still has great diagnostic significance, being a solid QA step. It provides rapid information and clues in patients who may harbour impaired defence mechanisms, concurrent chronic conditions and/or cancer.
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Affiliation(s)
- Vito Rodolico
- Department of Sciences for Health Promotion and Mother & Child Care, Section of Anatomic Pathology, University of Palermo, Palermo, Italy
| | - Paola Di Carlo
- Department of Sciences for Health Promotion and Mother & Child Care, Section of Infectious Disease, University of Palermo, Palermo, Italy
| | - Gaspare Gulotta
- Department of General Surgery and Emergency, University of Palermo, Palermo, Italy
| | - Francesco D'Arpa
- Department of General Surgery and Emergency, University of Palermo, Palermo, Italy
| | - Giuseppe Salamone
- Department of General Surgery and Emergency, University of Palermo, Palermo, Italy
| | - Gianfranco Cocorullo
- Department of General Surgery and Emergency, University of Palermo, Palermo, Italy
| | - Antonino Agrusa
- Department of General Surgery and Emergency, University of Palermo, Palermo, Italy
| | - Anna Giammanco
- Department of Sciences for Health Promotion and Mother & Child Care, Section of Microbiology, University of Palermo, Palermo, Italy
| | - Consolato Sergi
- Department of Lab. Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada.,Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
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Melfa GI, Raspanti C, Attard M, Cocorullo G, Attard A, Mazzola S, Salamone G, Gulotta G, Scerrino G. Comparison of minimally invasive parathyroidectomy under local anaesthesia and minimally invasive video-assisted parathyroidectomy for primary hyperparathyroidism: a cost analysis. G Chir 2016; 37:61-7. [PMID: 27381690 DOI: 10.11138/gchir/2016.37.2.061] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Primary hyperparathyroidism (PHPT) origins from a solitary adenoma in 70- 95% of cases. Moreover, the advances in methods for localizing an abnormal parathyroid gland made minimally invasive techniques more prominent. This study presents a micro-cost analysis of two parathyroidectomy techniques. PATIENTS AND METHODS 72 consecutive patients who underwent minimally invasive parathyroidectomy, video-assisted (MIVAP, group A, 52 patients) or "open" under local anaesthesia (OMIP, group B, 20 patients) for PHPT were reviewed. Operating room, consumable, anaesthesia, maintenance costs, equipment depreciation and surgeons/anaesthesiologists fees were evaluated. The patient's satisfaction and the rate of conversion to conventional parathyroidectomy were investigated. T-Student's, Kolmogorov-Smirnov tests and Odds Ratio were used for statistical analysis. RESULTS 1 patient of the group A and 2 of the group B were excluded from the cost analysis because of the conversion to the conventional technique. Concerning the remnant patients, the overall average costs were: for Operative Room, 1186,69 € for the MIVAP group (51 patients) and 836,11 € for the OMIP group (p<0,001); for the Team, 122,93 € (group A) and 90,02 € (group B) (p<0,001); the other operative costs were 1388,32 € (group A) and 928,23 € (group B) (p<0,001). The patient's satisfaction was very strongly in favour of the group B (Odds Ratio 20,5 with a 95% confidence interval). CONCLUSIONS MIVAP is more expensive compared to the "open" parathyroidectomy under local anaesthesia due to the costs of general anaesthesia and the longer operative time. Moreover, the patients generally prefer the local anaesthesia. Nevertheless, the rate of conversion to the conventional parathyroidectomy was relevant in the group of the local anaesthesia compared to the MIVAP, since the latter allows a four-gland exploration.
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Cabibi D, Tutino R, Salamone G, Cocorullo G, Agrusa A, Gulotta G. Diffuse malignant biphasic peritoneal mesothelioma with cystic areas. Ann Ital Chir 2016; 87:S2239253X16025378. [PMID: 27320084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
UNLABELLED We report a case of peritoneal biphasic mesothelioma with cystic areas in a patient with professional exposure to asbestos. It showed focal epithelial glandular and papillary proliferations, also presenting fluid filled cysts, whose wall consisted of a proliferation of spindle cells. Atypia and mitoses were very scanty. EMA, vimentin, CK5/6, D2-40, calretinin and P53 were positive and desmin was negative in both epithelial and spindle areas, including the ones surrounding the cystic spaces. These findings gave an essential aid in the differential diagnosis with a benign cystic mesothelioma and with a cystic epithelial mesothelioma with secondary pseudosarcomatous myofibroblastic proliferation. The presence of cystic areas in a malignant mesothelioma could make difficult the diagnosis. A large amount of tumour tissue is necessary for confirming the biphasic histotype, an aggressive histotype, even in the presence of mild histological features and of some others favourable clinical prognostic indices as in this case. To our knowledge this is the first case of malignant peritoneal biphasic mesothelioma with cystic features reported in the literature. KEY WORDS Cystic Mesothelioma, Immunohistochemistry, Malignant Mesothelioma, Peritoneal Diseases, Mesothelial Neoplasms.
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Salamone G, Licari L, Randisi B, Di Carlo P, Tutino R, Falco N, Augello G, Raspanti C, Cocorullo G, Gulotta G. A primary subcutaneous hydatid cyst in the thigh A case report. Ann Ital Chir 2016; 87:S2239253X16024324. [PMID: 27054545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM Hydatid disease is a parasitic disease considered endemic in many parts of the world such as South America, Middle East, Africa, Australia and the Mediterranean regions. Liver and lung hydatid disease accounts for 90% of all echinococcal cysts. Primary hydatid disease of subcutaneous sites is rare and the subcutaneous localization of a solitary hydatid cyst accounts for 1.6%. Not enough data exist for this localization, and only many heterogeneous data are described in order to define this rare condition. MATERIAL OF STUDY We present the case of a 68-year-old-woman affected by a mass in upper-medial side of her right thigh with a 12-year-growing history. Anamnestic data were accurately collected. Many different radiological and specific serum tests were performed in order to define the diagnosis. Surgical approach was decided in order to excide the mass, and a 6-months follow-up was performed. CONCLUSIONS Hydatid disease is common in endemic area but uncommon localizations, as in subcutaneous tissues, are a rare condition. Scientific Community lacks of complete and homogeneous data about the approach to this manifestation of the disease. Would be useful a complete review of the literature in order to plan guide-lines for the treatment of uncommon localization. KEY WORDS Echinococcosis, Hydatid cyst, Subcutaneous localization.
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Salamone G, Licari L, Agrusa A, Romano G, Cocorullo G, Falco N, Tutino R, Gulotta G. Usefulness of ileostomy defunctioning stoma after anterior resection of rectum on prevention of anastomotic leakage A retrospective analysis. Ann Ital Chir 2016; 87:155-160. [PMID: 27179231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSES Anastomotic leakage is one of the major complications occurring after anterior resection of rectum. A defunctioning stoma is usually created routinely or on surgeons' discretion. The aim of this study was to investigate the usefulness of temporary ileostomy to prevent anastomotic leakage comparing the postoperative course of patients with and without defunctioning loop ileostomy. METHODS Patients that underwent anterior resection of rectum were recruited. 140 patients were enrolled and divided in two groups: patients without and with defunctioning loop ileostomy. Patients' characteristics and other useful data were recorded. A comparison between the two groups was made. The minimum follow-up was 11 months. RESULTS AND CONCLUSIONS 18.6% of patients had a symptomatic anastomotic leakage. We observed more anastomotic leakages after medium-low resections of rectum with anastomosis than after resections with high anastomosis (15.7% vs 2.9%; p=0.03). There were no significant differences in overall and related mortality between patients without/with ileostomy. The presence of ileostomy was not protective towards anastomotic leakage either in the medium-low resections or in the high ones but it was towards its consequences such as clinical features. Nevertheless we found a statistically significative difference between recurrence rate of leakage in patients with and without ileostomy (p-Value=0.009). KEY WORDS Anterior resection of rectum, Ileostomy, Leakage.
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Cocorullo G, Tutino R, Falco N, Salamone G, Gulotta G. Three-port colectomy: reduced port laparoscopy for general surgeons. A single center experience. Ann Ital Chir 2016; 87:350-355. [PMID: 27174020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM To evaluate three-port colectomy as an alternative reduced-port laparoscopy technique in colonic surgery. MATERIAL OF STUDY Retrospective study carried out through the analysis of 32 consecutive patients that underwent alternatively to a three ports left colectomy or a conventional laparoscopic colectomy for colonic diseases in order to evaluate the benefits of the reduced-port technique. A multivariate analysis among duration of surgery, hospital stay and conversion rate was performed using the OLS regression and the binary logistic regression. RESULTS We found a reduced operative time in the three-port colectomy in comparison to the four-port technique (p=0.07). The hospital stay was not found related to the number of port. Conversion rate was higher in the three-port colectomy group and in patients admitted in emergency (p=0.009). DISCUSSION We did not found difference between three-port and traditional lap in relation to hospital stay. The reduced port technique allows to reduce operative times even adds more conversions. CONCLUSIONS Three-port colectomy seems an affordable reduced port laparoscopy technique. General surgeons can use it without the need of specific tools minimizing the port-related complications. KEY WORDS Colon Colectomy, Laparoscopy, Three ports.
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Romano G, Scerrino G, Profita G, Amato G, Salamone G, Di Buono G, Lo Piccolo C, Sorce V, Agrusa A, Gulotta G. Terminal or truncal ligation of the inferior thyroid artery during thyroidectomy? A prospective randomized trial. Int J Surg 2015; 28 Suppl 1:S13-6. [PMID: 26708858 DOI: 10.1016/j.ijsu.2015.05.057] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 05/03/2015] [Accepted: 05/20/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Thyroidectomy is a common procedure in general and endocrine surgery. The technique of ligation of inferior thyroid artery (ITA) has been invoked as a possible cause of appearance of postoperative hypocalcemia. METHODS We performed a prospective randomized study involving 184 patients undergoing total thyroidectomy to evaluate the differences of truncal ligation versus distal ligation of ITA in terms of postoperative hypocalcemia, vocal fold palsy, voice and swallowing impairment. The patients were divided into group A (trunk ligation of ITA) and group B (terminal branches ligation of ITA). RESULTS We evaluated postoperative PTH and calcemia (immediate, 6 and 12 months after thyroidectomy), postoperative day of discontinuation of calcium and vitamin D supplementation, voice and swallowing complaints, evaluated by mean of two specific tests available in literature, day of hospital discharge. CONCLUSION The only significant differences between the two groups were a higher immediate postoperative calcemia and a greater number of patients discharged without calcium and vitamin-D supplementation in the group B. In conclusion, no substantial differences were found between the two groups. The choice depends on the experience of the surgeon.
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Affiliation(s)
- G Romano
- Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Via L. Giuffrè, 5, 90127, Palermo, Italy.
| | - G Scerrino
- Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Via L. Giuffrè, 5, 90127, Palermo, Italy.
| | - G Profita
- Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Via L. Giuffrè, 5, 90127, Palermo, Italy.
| | - G Amato
- Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Via L. Giuffrè, 5, 90127, Palermo, Italy.
| | - G Salamone
- Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Via L. Giuffrè, 5, 90127, Palermo, Italy.
| | - G Di Buono
- Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Via L. Giuffrè, 5, 90127, Palermo, Italy.
| | - C Lo Piccolo
- Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Via L. Giuffrè, 5, 90127, Palermo, Italy.
| | - V Sorce
- Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Via L. Giuffrè, 5, 90127, Palermo, Italy.
| | - A Agrusa
- Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Via L. Giuffrè, 5, 90127, Palermo, Italy.
| | - G Gulotta
- Department of General Surgery, Urgency and Organ Transplantation, University of Palermo, Via L. Giuffrè, 5, 90127, Palermo, Italy.
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D'Arpa F, Orlando G, Tutino R, Salamone G, Battaglia EO, Gulotta G. Conservative management of intestinal obstruction by isolated intramural duodenal hematoma. A case report and review of the literature. Ann Ital Chir 2015; 86:S2239253X1502410X. [PMID: 26675664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The duodenal injuries occur in the 3-5% of blunt abdominal traumas. The isolated intramural duodenal hematoma is a very rare lesion. An early diagnosis and an adequate therapy are crucial because a delay, beyond 24 hours, increases the mortality from the 11% to 40%. However, diagnosis is often hindered by a lack of specific symptoms. We report a case of a 21 years-old man with an intestinal obstruction from isolated intramural duodenal hematoma occurred after a blunt abdominal trauma in a sport competition. The patient was treated conservatively with total parenteral nutrition, gastric decompression and intravenous PPIs. The progressive spontaneous resolution of the hematoma was checked with periodical endoscopies. The discharge occurred after three weeks with no early complications. No late complications occurred at one-year follow-up. The endoscopy is a good and safe tool in the management of this intestinal obstructions with the possibility of conservative or interventional treatment.
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