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Stabile G, Cracco F, Zinicola G, Carlucci S, Mangino FP, Stampalija T, Ricci G. Subserosal pregnancy: Systematic review with proposal of new diagnostic criteria and ectopic pregnancy classification. Eur J Obstet Gynecol Reprod Biol 2024; 297:254-259. [PMID: 38701545 DOI: 10.1016/j.ejogrb.2024.04.037] [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: 07/16/2023] [Revised: 04/24/2024] [Accepted: 04/28/2024] [Indexed: 05/05/2024]
Abstract
Ectopic pregnancy (EP) is a pregnancy where the growing blastocyst implants outside the endometrial cavity. EP account approximately for 0.5-1% of all pregnancies, and extrauterine implant is the leading cause of woman mortality in the first trimester of gestation. Non-tubal pregnancies (NTP) account for less than 5% of all EP. NTP are accompanied by a 7-8 times higher risk of maternal mortality when compared to tubal pregnancies, and their treatment might sometimes be very challenging. Subserosal pregnancy (SP) has been defined as rare variant of intramural pregnancy, where a portion of the gestational sac was surrounded only by the serosa of the uterus. Whereas the treatment of the ectopic pregnancies is crucial for patients' lives and for adequate fertility sparing and considering the need for surgical treatment in many cases, an early diagnosis is important; thus we believe it g might be useful to define some criteria to guide subserosal pregnancy identification, and to distinguish it from other types of non-tubal ectopic pregnancy. A systematic review on Pubmed, Scopus, Web of Science and Google Scholar was performed. Case reports, randomized controlled trials, prospective controlled studies, prospective cohort studies, retrospective studies, and case series were considered eligible. In all databases mentioned were considered manuscripts published from 1990 up to March 2023. Only four articles were eligible for inclusion in this review. All patients underwent to surgical management in laparoscopy. The main risk factors for this type of ectopic pregnancy were previous uterine surgery with opening of the endometrial cavity and assisted reproductive techniques procedures. Considering our results, we propose new classification and diagnostic criteria for subserosal pregnancy, to distinguish it from other types of non-tubal ectopic pregnancies with the aim to preserve fertility following the most correct management.
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Affiliation(s)
- Guglielmo Stabile
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, 71121 Foggia, Italy.
| | - Francesco Cracco
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34100 Trieste, Italy
| | - Giulia Zinicola
- Department of Woman and Child Health and Public Health, Woman Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Stefania Carlucci
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, 71121 Foggia, Italy
| | | | - Tamara Stampalija
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34100 Trieste, Italy; Institute for Maternal and Child Health IRCCS "Burlo Garofolo", 34100 Trieste, Italy
| | - Giuseppe Ricci
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34100 Trieste, Italy; Institute for Maternal and Child Health IRCCS "Burlo Garofolo", 34100 Trieste, Italy
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Abi Antoun M, Etrusco A, Chiantera V, Laganà AS, Feghali E, Khazzaka A, Stabile G, Della Corte L, Dellino M, Sleiman Z. Outcomes of conventional and advanced energy devices in laparoscopic surgery: a systematic review. MINIM INVASIV THER 2024; 33:1-12. [PMID: 38164811 DOI: 10.1080/13645706.2023.2274396] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 10/04/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Hemostasis is an important step in all surgical procedures. Mechanical methods of hemostasis have been gradually abandoned in favor of electrosurgery. The aim of this systematic review was to evaluate the effectiveness of electrosurgical instruments utilized in minimally invasive gynecological procedures. MATERIAL AND METHODS We performed a systematic review, including randomized controlled trials, prospective and retrospective studies, comparing the outcomes of different energy devices (EDs) used in laparoscopic gynecologic surgeries. We extracted data about blood loss (BL), mean operative time, post-operative pain, hospital stay and complications associated with each electrosurgical device. RESULTS We included 30 studies reporting comparative outcomes concerning conventional (bipolar and monopolar) and innovative EDs (Harmonic scalpel, LigaSure, Plasma kinetic gyrus, Thunderbeat, EnSeal, Marseal, Caiman and ALAN). New EDs were found to be more efficient in complex surgeries due to less intraoperative BL and shorter operative time. No significant decrease in hospital stay, post-operative pain or complications was found with the use of new energy instruments. CONCLUSIONS Although new electrosurgical devices seem an appealing and safer option, there is still insufficient evidence for one vessel-sealing technology to be considered superior to another. Therefore, monopolar and conventional bipolar (CB) are still widely used in laparoscopic gynecology.
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Affiliation(s)
- Melissa Abi Antoun
- Obstetrics and gynecology department, Saint Joseph University, Beirut, Lebanon
| | - Andrea Etrusco
- Unit of Obstetrics and Gynecology, "Paolo Giaccone" Hospital, Palermo, Italy
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Vito Chiantera
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
- Unit of Gynecologic Oncology, National Cancer Institute - IRCCS - Fondazione "G. Pascale", Naples, Italy
| | - Antonio Simone Laganà
- Unit of Obstetrics and Gynecology, "Paolo Giaccone" Hospital, Palermo, Italy
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Edwin Feghali
- Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon
| | - Aline Khazzaka
- Surgical Research Lab, Saint Joseph University, Beirut, Lebanon
| | - Guglielmo Stabile
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Miriam Dellino
- Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy
| | - Zaki Sleiman
- Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon
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Stabile G, Gentile RM, Carlucci S, Stampalija T, Biffi S, Oletto G, Guido M, Bruno M. Maternal and fetal outcomes of intraplacental choriocarcinoma complicated by fetomaternal hemorrhage: a systematic review. J Matern Fetal Neonatal Med 2023; 36:2285238. [PMID: 38010764 DOI: 10.1080/14767058.2023.2285238] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/14/2023] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Intraplacental choriocarcinoma is a gestational trophoblastic neoplasia located within the placenta. Due to the usual silent presentation, more than half of the cases are diagnosed incidentally. It has been demonstrated that this pathology is linked to feto-maternal hemorrhage (FMH), stillbirth, and intrauterine growth restriction. The aim of our review was to establish if there are recurrent signs that might lead to an early diagnosis and better management in cases complicated by FMH. MATERIALS AND METHODS We performed a systematic review of the literature from 2000 up to March 2023. The adopted research strategy included the following terms: (gestational choriocarcinoma obstetrics outcome) AND (intraplacental choriocarcinoma) AND (gestational choriocarcinoma). The MEDLINE (PubMed), Google Scholar, and Scopus databases were searched. RESULTS The research strategy identified 19 cases of FMH coexisting with intraplacental choriocarcinoma (IC), as described in 17 studies. The perinatal mortality rate was 36.8%. In eight cases, histological diagnosis of IC was made post-delivery. Metastatic lesions were found in 75% (6/8) of described cases. One case of maternal death has been described. Chemotherapy was necessary in seven cases. Sporadical prenatal ultrasound signs were described. DISCUSSION The diagnosis of IC is usually delayed, mostly due to aspecific symptoms and signs. Histological analysis of the placenta, when not routinely performed, should be performed when warning symptoms are encountered. The maternal prognosis was good, with a mortality rate of 5.5%. A fertility-sparing approach is always possible even in the presence of metastasis. Chemotherapy seems to be useful in cases of maternal and neonatal metastasis.
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Affiliation(s)
- Guglielmo Stabile
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Roberta Marie Gentile
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Stefania Carlucci
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Tamara Stampalija
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Stefania Biffi
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Giulia Oletto
- Department of Obstetrics and Gynecology, Center for Fetal Care and High-Risk Pregnancy, University of Chieti, Chieti, Italy
| | - Maurizio Guido
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Matteo Bruno
- Unit of Obstetrics and Gynecology, San Salvatore Hospital, L'Aquila, Italy
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Bruno M, Capanna G, Stanislao V, Ciuffreda R, Tabacco S, Fantasia I, Di Florio C, Stabile G, D’Alfonso A, Guido M, Ludovisi M. Ultrasound Features and Clinical Outcome of Patients with Ovarian Masses Diagnosed during Pregnancy: Experience of Single Gynecological Ultrasound Center. Diagnostics (Basel) 2023; 13:3247. [PMID: 37892068 PMCID: PMC10606809 DOI: 10.3390/diagnostics13203247] [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: 09/08/2023] [Revised: 09/30/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
(1) Background: The number of adnexal masses detected during pregnancy has increased due to the use of first-trimester screening and increasingly advanced maternal age. Despite their low risk of malignancy, other risks associated with these masses include torsion, rupture and labor obstruction. Correct diagnosis and management are needed to guarantee both maternal and fetal safety. Adnexal masses may be troublesome to classify during pregnancy due to the increased volume of the uterus and pregnancy-related hormonal changes. Management should be based on ultrasound examination to provide the best treatment. The aim of this study was to describe the ultrasound features of ovarian masses detected during pregnancy and to optimize and personalize their management with the expertise of gynecologists, oncologists and sonographers. (2) Methods: Clinical, ultrasound, histological parameters and type of management (surveillance vs. surgery) were retrospectively retrieved. Patient management, perinatal outcomes and follow-up were also evaluated. (3) Results: according to the literature, these masses are most frequently benign, ultrasound follow-up is the best management, and obstetric outcomes are not considerably influenced by the presence of adnexal masses. (4) Conclusions: the management of patients with ovarian masses detected during pregnancy should be based on ultrasound examination, and a centralization in referral centers for ovarian masses should be considered.
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Affiliation(s)
- Matteo Bruno
- Department of Obstetrics and Gynecology, San Salvatore Hospital, 67100 L’Aquila, Italy; (M.B.); (S.T.); (I.F.); (C.D.F.)
| | - Giulia Capanna
- Department of Clinical Medicine Life Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (V.S.); (R.C.); (A.D.); (M.G.); (M.L.)
| | - Veronica Stanislao
- Department of Clinical Medicine Life Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (V.S.); (R.C.); (A.D.); (M.G.); (M.L.)
| | - Raffaella Ciuffreda
- Department of Clinical Medicine Life Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (V.S.); (R.C.); (A.D.); (M.G.); (M.L.)
| | - Sara Tabacco
- Department of Obstetrics and Gynecology, San Salvatore Hospital, 67100 L’Aquila, Italy; (M.B.); (S.T.); (I.F.); (C.D.F.)
| | - Ilaria Fantasia
- Department of Obstetrics and Gynecology, San Salvatore Hospital, 67100 L’Aquila, Italy; (M.B.); (S.T.); (I.F.); (C.D.F.)
| | - Christian Di Florio
- Department of Obstetrics and Gynecology, San Salvatore Hospital, 67100 L’Aquila, Italy; (M.B.); (S.T.); (I.F.); (C.D.F.)
| | - Guglielmo Stabile
- Department of Obstetrics and Gynecology, Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy;
| | - Angela D’Alfonso
- Department of Clinical Medicine Life Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (V.S.); (R.C.); (A.D.); (M.G.); (M.L.)
| | - Maurizio Guido
- Department of Clinical Medicine Life Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (V.S.); (R.C.); (A.D.); (M.G.); (M.L.)
| | - Manuela Ludovisi
- Department of Clinical Medicine Life Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (V.S.); (R.C.); (A.D.); (M.G.); (M.L.)
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Stabile G, Topouzova GA, De Seta F. The role of microbiota in the management of genitourinary syndrome of menopause. Climacteric 2023; 26:353-360. [PMID: 37366082 DOI: 10.1080/13697137.2023.2223923] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/27/2023] [Accepted: 06/01/2023] [Indexed: 06/28/2023]
Abstract
It is estimated that the 25-50% of women who are reaching menopause every year report symptoms related to the genitourinary syndrome of menopause (GSM). The symptoms are not due simply to lack of estrogen. One possible contributing cause of symptoms is the vaginal microbiota. The vaginal microbiota is a dynamic entity and plays a critical role in the pathogenic interplay of postmenopausal changes. Treatment of this syndrome depends on the severity and type of the symptoms and on the preferences and expectations of women. As there are many treatment options, therapy should be individualized. While new evidence on the role of Lactobacilli in premenopause is emerging, the role of Lactobacilli is still unclear in GSM and the impact of microbiota on vaginal health remains conflictual. However, some reports show promising data on the effect of probiotic therapy in menopause. In the literature there are few studies and small population samples on the role of an exclusive therapy with Lactobacilli and further data will be mandatory. Studies involving large numbers of patients and different intervention periods will be necessary to obtain evidence of the preventive and curative role of vaginal probiotics.
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Affiliation(s)
- G Stabile
- Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', Trieste, Italy
| | - G A Topouzova
- UCO ClinicaOstetrica e Ginecologica, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - F De Seta
- Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', Trieste, Italy
- UCO ClinicaOstetrica e Ginecologica, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
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Stabile G, Ripepi C, Sancin L, Restaino S, Mangino FP, Nappi L, Ricci G. Management of Primary Uterine Cervix B-Cell Lymphoma Stage IE and Fertility Sparing Outcome: A Systematic Review of the Literature. Cancers (Basel) 2023; 15:3679. [PMID: 37509340 PMCID: PMC10377927 DOI: 10.3390/cancers15143679] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/15/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
The female genital tract can be involved as a secondary manifestation of disseminated lymphomas or leukaemia but can rarely be the primary site of so-called extranodal lymphomas. Primary lymphomas of the female genital tract can affect the uterine corpus, uterine cervix, vulva, vagina, or adnexa. Only about 0.008% of all cervical tumours are primary malignant lymphomas. The most common clinical presentation of primary cervical lymphomas is a history of prolonged minor abnormal uterine bleeding, while unstoppable bleeding at presentation is rarely reported in the literature. "B" symptoms related to nodal lymphomas are usually absent. Since vaginal bleeding is a nonspecific symptom, the first diagnostic hypothesis is usually of one of the more common female genital conditions such as cervical or endometrial carcinoma or sarcoma, fibroids, adenomyosis, or endometriosis. Cervical cytology is usually negative. Preoperative diagnosis requires deep cervical biopsy. No guidelines regarding optimal treatment exists; radiotherapy, chemotherapy, and surgery are used in different combinations. Conservative treatment with the combination of surgery and chemotherapy or surgery and radiotherapy has been reported in a few cases with apparent success. With this review, we aim to understand what the best therapeutic approaches for this rare pathology in young and elderly women are. Moreover, we find favorable pregnancy outcome in patients treated with a fertility sparing approach.
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Affiliation(s)
- Guglielmo Stabile
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Via dell'Istria 65/1, 34137 Trieste, Italy
| | - Chiara Ripepi
- UCO Clinica Ostetrica e Ginecologica, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34137 Trieste, Italy
| | - Lara Sancin
- UCO Clinica Ostetrica e Ginecologica, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34137 Trieste, Italy
| | - Stefano Restaino
- Obstetrics and Gynecology Unit, Department of Obstetrics, Gynecology and Pediatrics, Department of Medical Area DAME, Udine University Hospital, 33100 Udine, Italy
| | - Francesco Paolo Mangino
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Via dell'Istria 65/1, 34137 Trieste, Italy
| | - Luigi Nappi
- Departments of Obstetrics and Gynecology and Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Giuseppe Ricci
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Via dell'Istria 65/1, 34137 Trieste, Italy
- UCO Clinica Ostetrica e Ginecologica, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34137 Trieste, Italy
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Stabile M, Rispoli AF, Capuozzo M, Ferbo U, Stabile G. Bifid cardiac apex and spongiform cardiomyopathy in fetus with small microdeletion 16p12.2 of paternal origin. Critical points in family communication on 16p12.2 microdeletion. Clin Case Rep 2023; 11:e7602. [PMID: 37405046 PMCID: PMC10315447 DOI: 10.1002/ccr3.7602] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/26/2023] [Accepted: 06/07/2023] [Indexed: 07/06/2023] Open
Abstract
Key Clinical Message From a literature review, this is the first case of fetal 16p12.2 microdeletion syndrome inherited from a normal father with autopsy description and evidence of spongious cardiomyopathy. First trimester intake of doxycycline could be a cofactor. Abstract Prenatal diagnosis of a 16p12.2 microdeletion, inherited from normal father, is reported in a dysmorphic 20 weeks fetus. Histopathological examination of the myocardium (not present in the 65 cases in literature) showed bifid apex of the heart and spongiotic structure. Correlation between the deleted genes and cardiomyopathy is discussed.
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Affiliation(s)
- Mariano Stabile
- Zygote Center: Center for Genetics—Prenatal Diagnosis—FertilitySalernoItaly
| | - Anna F. Rispoli
- Zygote Center: Center for Genetics—Prenatal Diagnosis—FertilitySalernoItaly
| | | | | | - Guglielmo Stabile
- Departments of Obstetrics and GynecologyIRCCS “Burlo Garofolo”TriesteItaly
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Bortot B, Mangogna A, Di Lorenzo G, Stabile G, Ricci G, Biffi S. Image-guided cancer surgery: a narrative review on imaging modalities and emerging nanotechnology strategies. J Nanobiotechnology 2023; 21:155. [PMID: 37202750 DOI: 10.1186/s12951-023-01926-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 04/03/2023] [Accepted: 05/11/2023] [Indexed: 05/20/2023] Open
Abstract
Surgical resection is the cornerstone of solid tumour treatment. Current techniques for evaluating margin statuses, such as frozen section, imprint cytology, and intraoperative ultrasound, are helpful. However, an intraoperative assessment of tumour margins that is accurate and safe is clinically necessary. Positive surgical margins (PSM) have a well-documented negative effect on treatment outcomes and survival. As a result, surgical tumour imaging methods are now a practical method for reducing PSM rates and improving the efficiency of debulking surgery. Because of their unique characteristics, nanoparticles can function as contrast agents in image-guided surgery. While most image-guided surgical applications utilizing nanotechnology are now in the preclinical stage, some are beginning to reach the clinical phase. Here, we list the various imaging techniques used in image-guided surgery, such as optical imaging, ultrasound, computed tomography, magnetic resonance imaging, nuclear medicine imaging, and the most current developments in the potential of nanotechnology to detect surgical malignancies. In the coming years, we will see the evolution of nanoparticles tailored to specific tumour types and the introduction of surgical equipment to improve resection accuracy. Although the promise of nanotechnology for producing exogenous molecular contrast agents has been clearly demonstrated, much work remains to be done to put it into practice.
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Affiliation(s)
- Barbara Bortot
- Obstetrics and Gynecology, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Alessandro Mangogna
- Obstetrics and Gynecology, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Giovanni Di Lorenzo
- Obstetrics and Gynecology, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Guglielmo Stabile
- Obstetrics and Gynecology, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Giuseppe Ricci
- Obstetrics and Gynecology, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Stefania Biffi
- Obstetrics and Gynecology, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy.
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Feghali E, Etrusco A, Haydamous J, Ayed A, Laganà AS, Chiantera V, Vitale SG, Angioni S, Stabile G, Sleiman Z. Concurrent Diagnosis of Adenomyosis and Congenital Uterine Anomalies: A Review. J Pers Med 2023; 13:jpm13050716. [PMID: 37240886 DOI: 10.3390/jpm13050716] [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: 02/23/2023] [Revised: 03/21/2023] [Accepted: 04/23/2023] [Indexed: 05/28/2023] Open
Abstract
Background: Adenomyosis and congenital uterine anomalies (CUAs) can compromise reproductive potential and may coexist in the same patient, especially in cases of infertility. This review (CRD42022382850) aims to evaluate the published cases of concurrent adenomyosis and syndromic and nonsyndromic CUAs. Methods: A literature search for suitable articles published in the English language was performed using the following databases from inception to 30 November 2022: MEDLINE, EMBASE, Global Health, the Cochrane Library, Health Technology Assessment Database, and Web of Science. Articles including both CUAs and adenomyosis, with data about their potential relationship, were included. Results: The literature search retrieved 14 articles that met the purpose of this review and summarized the most recent findings regarding the concurrent diagnosis of adenomyosis and CUAs. Conclusions: Adenomyosis can be found in both syndromic and nonsyndromic CUAs, and may arise from several etiologies. The hypothesis that obstructions in CUAs increase uterine pressure and promote the development of adenomyosis remains to be further elucidated, and additional findings may also play a role. The patient's genetic, epigenetic, and hormonal patterns, as well as normal physiological processes, such as pregnancy, may influence the growth of adenomyosis.
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Affiliation(s)
- Edwin Feghali
- Department of Obstetrics and Gynecology, Lebanese American University Medical Center, Beirut 1100, Lebanon
| | - Andrea Etrusco
- Unit of Gynecologic Oncology, ARNAS "Civico-Di Cristina-Benfratelli", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Joe Haydamous
- Department of Obstetrics and Gynecology, University of Balamand, Beirut 1100, Lebanon
| | - Amal Ayed
- Department of Obstetrics and Gynecology, Farwaniah Hospital, Ministry of Health, Kuwait City 085700, Kuwait
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS "Civico-Di Cristina-Benfratelli", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Vito Chiantera
- Unit of Gynecologic Oncology, ARNAS "Civico-Di Cristina-Benfratelli", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Salvatore Giovanni Vitale
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy
| | - Stefano Angioni
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy
| | - Guglielmo Stabile
- Department of Obstetrics and Gynecology, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", 34137 Trieste, Italy
| | - Zaki Sleiman
- Department of Obstetrics and Gynecology, Lebanese American University Medical Center, Beirut 1100, Lebanon
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Stabile G, Scalia MS, Stampalija T, Bruno M, Laganà AS, Sartore A, Mangogna A, Carlucci S. Placental Chorangiocarcinoma a Specific Histological Pattern of Uncertain Incidence and Clinical Impact: Systematic Review of the Literature. J Clin Med 2023; 12:jcm12093065. [PMID: 37176506 PMCID: PMC10179247 DOI: 10.3390/jcm12093065] [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: 02/23/2023] [Revised: 04/15/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023] Open
Abstract
Chorangiocarcinoma is a very rare and misdiagnosed placental neoplasm. The unique morphologic features of the lesion distinguish it from other trophoblastic tumors and vascular abnormalities. We present a systematic review of the literature to provide clarity on chorangiocarcinoma entity and biology. A literature search was carried out in December 2022 using the keywords "Placental chorangiocarcinoma", "Chorangioma", "Placenta", and "Throphoblast proliferation". Articles published from 1988 to 2022 were obtained from Scopus, Google Scholar, and PUBMED. In our review, we examined maternal age, gestational age at the time of delivery, parity, type of pregnancy, placental weight, ultrasound features of the placenta, macroscopic examination and tumor size, microscopic examination, immunostaining, maternal beta-human chorionic gonadotropin, fetal and maternal outcome. Eight manuscripts were detected. They are all case reports. The macroscopic characteristics of the lesions were represented by the presence of a grey-yellow-white color well-demarcated round nodule. Microscopically, all the authors described typical aspects of malignancy as a high rate of mitosis, nuclear atypia and necrotic areas. In some cases, the presence of AE1/AE3 cytoplasmic positivity, p63 nuclear staining, and beta-human chorionic gonadotropin (BHCG) were reported. A good fetal outcome was reported in all cases of newborns with normal birth weight, except one with fetal growth restriction. Maternal outcome was good in all cases except one with maternal lung metastasis three months after delivery. The clinical course has probably underestimated the real incidence of the pathology. Only greater knowledge of its histology and its clinical course will allow us to evaluate the real prevalence of the disease.
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Affiliation(s)
- Guglielmo Stabile
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Via dell'Istria 65/1, 34137 Trieste, Italy
| | - Maria Sole Scalia
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34137 Trieste, Italy
| | - Tamara Stampalija
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34137 Trieste, Italy
| | - Matteo Bruno
- Unit of Obstetrics and Gynecology, San Salvatore Hospital, 67100 L'Aquila, Italy
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS "Civico-Di Cristina-Benfratelli", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Andrea Sartore
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Via dell'Istria 65/1, 34137 Trieste, Italy
| | - Alessandro Mangogna
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Via dell'Istria 65/1, 34137 Trieste, Italy
| | - Stefania Carlucci
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Via dell'Istria 65/1, 34137 Trieste, Italy
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Bruno M, Ludovisi M, Ronsini C, Capanna G, Stabile G, Guido M. Tertiary Cytoreduction for Isolated Lymphnode Recurrence (ILNR) Ovarian Cancer in a BRCA2 Mutated Patient: Our Experience and Prevalence of BRCA 1 or 2 Genes Mutational Status in ILNR. Medicina (B Aires) 2023; 59:medicina59030606. [PMID: 36984607 PMCID: PMC10056081 DOI: 10.3390/medicina59030606] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/11/2023] [Accepted: 03/17/2023] [Indexed: 03/22/2023] Open
Abstract
We report the case of a tertiary cytoreductive surgery for isolated lymph-node recurrence (ILNR) in a 54-years old Brest cancer 2 (BRCA 2) mutated patients, with a personal history of ovarian cancer previously treated elsewhere. She was admitted to our department for a suspected isolated lymph-nodal pelvic recurrence. A positron emission tomography acquisition with contrast enhanced computed tomography (PET-CT) scan revealed an increased node at the level of the right external iliac (SUV 6.9) in correspondence with the obturator nerve, which was confirmed by transvaginal ultrasound. Since the recurrence was in a single site and the patient had previously undergone three lines of chemotherapy and maintenance with Poly(ADP-ribose) polymerase (PARP) inhibitors, we decided to perform tertiary cytoreductive surgery by minimally invasive laparoscopic approach. After gradual and careful isolation of the obturator nerve, lumbo-sacral trunk and venous vessels afferent to the external and internal iliac vein, the suspected node has been removed. No intra- and postoperative complications occurred. The patient was discharged three days after procedure. We decided to quarterly follow-up; actually, after 16 months no recurrence was detected. Several studies have reported ILNR as a unique clinical disease with low growth rate and less chemosensitivity; this can lead to considered ILNR more susceptible to take advantage of surgical treatment, even in case of second or third recurrence. The BRCA mutational status seems to play a role in the decision-making process in the approach to patients with platinum sensitive relapse of ovarian cancer or in specific isolated forms of recurrence such as the hepatic one. However, data on frequency and prognostic impact of BRCA gene mutation in ILNR are very limited. In this article we investigated the role of BRCA 1 or 2 mutational status in this rare pattern of recurrence according to more recent advances in literature.
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Affiliation(s)
- Matteo Bruno
- Obstetrics and Gynaecology Unit, San Salvatore Hospital, 67100 L’Aquila, Italy
| | - Manuela Ludovisi
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Carlo Ronsini
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Giulia Capanna
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Guglielmo Stabile
- Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, Department of Obstetrics and Gynaecology, 34137 Trieste, Italy
- Correspondence:
| | - Maurizio Guido
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
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Stabile G, Zinicola G, Cracco F, Mangino FP, Fanfani F, Laganà AS, Ricci G. Subserosal pregnancy: a new type of ectopic pregnancy? J Minim Invasive Gynecol 2023:S1553-4650(23)00077-8. [PMID: 36906256 DOI: 10.1016/j.jmig.2023.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/22/2023] [Accepted: 02/28/2023] [Indexed: 03/12/2023]
Affiliation(s)
- Guglielmo Stabile
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", 34100 Trieste, Italy.
| | - Giulia Zinicola
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34100 Trieste, Italy
| | - Francesco Cracco
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34100 Trieste, Italy
| | | | - Francesco Fanfani
- UOC Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Antonio Simone Laganà
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Piazza Marina, 61, 90133 Palermo, Italy
| | - Giuseppe Ricci
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", 34100 Trieste, Italy; Department of Medicine, Surgery and Health Sciences, University of Trieste, 34100 Trieste, Italy
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Babbo GL, Stabile G, Scalia MS, Nardin S. Granulosa cell tumour of the ovary complicated by spontaneous haemoperitoneum in menopause - a case report and systematic review of the literature. Prz Menopauzalny 2023; 22:49-54. [PMID: 37206680 PMCID: PMC10189670 DOI: 10.5114/pm.2023.126399] [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] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 09/11/2022] [Indexed: 05/21/2023]
Abstract
Introduction A possible cause for acute abdomen is haemoperitoneum resulting from the rupture of an ovarian tumour. Here we discuss a case of spontaneous haemoperitoneum caused by granulosa cell tumour (GCT) rupture in a postmenopausal woman. Material and methods We present a systematic review of the current literature to draw attention to this rare gynaecological complication and provide guidance about the most appropriate management. Results Eight case reports and one retrospective study were identified. A total of 11 patients were analysed in this review including the present case report. The first case was described in 1948, while the last one was in 2019. The mean age of the patients was 60.8 years. All cases were treated with primary surgery. The mean diameter of the masses was 10.1 cm. Discussion We found endometrial pathology in 45% of the cases, of which 4 (36%) were associated with postmenopausal bleeding. The presentation of GCT is not always in the form of overt endocrine disturbance but can onset (10-15%) with acute abdomen. Conclusions Granulosa cell tumour should remain in the differential diagnosis of all patients presenting with acute abdomen and imaging suspicious for gynaecological malignancy originating from the ovary.
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Affiliation(s)
- Gian Luca Babbo
- Department of Obstetrics and Gynaecology, “San Tommaso dei Battuti” Hospital, Portogruaro, Italy
- Corresponding author: Guglielmo Stabile, PhD, MD, Institute for Maternal and Child Health IRCCS Burlo Garofolo, 34100 Trieste, Italy, e-mail:
| | - Guglielmo Stabile
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Maria Sole Scalia
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Serena Nardin
- Department of Obstetrics and Gynaecology, “San Tommaso dei Battuti” Hospital, Portogruaro, Italy
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De Seta F, Ianniello P, Carlucci S, Nappi L, Sorrentino F, Stabile G. New Topical Therapy for Provoked Vestibulodynia: Improvement of Psychological and Sexual Well-Being. Int J Environ Res Public Health 2023; 20:1931. [PMID: 36767294 PMCID: PMC9915117 DOI: 10.3390/ijerph20031931] [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] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/14/2023] [Accepted: 01/18/2023] [Indexed: 06/18/2023]
Abstract
Vulvodynia is a vulvar discomfort that occurs in the absence of any specific, clinically identifiable disorder. Few therapies have shown to be effective for the treatment of vulvodynia. In our recently published study, we tested a drug-free gel in women affected by vulvar vestibulitis. It is a cosmetic gel which acts locally without any metabolic, pharmacological or immunological effect. In order to further promote the validity of this new product, in this manuscript we analyzed the results obtained from the administration of four questionnaires in the same two groups of women affected by PVD and treated with a placebo and the new product. The questionnaires used: Female Sexual Function Index Scoring (FSFI), Female Sexual Distress Scale (FSDS), Hospital Anxiety and Depression Scale (HADS), and health-related quality of life measured by SF-36 (SF-36). The results obtained by this current analysis showed that the new gel has also proven benefits on women's quality of life and sexual function, including improvements in arousal, desire, orgasm and satisfaction.
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Affiliation(s)
- Francesco De Seta
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, 34100 Trieste, Italy
| | - Patrizia Ianniello
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34100 Trieste, Italy
| | - Stefania Carlucci
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, 34100 Trieste, Italy
| | - Luigi Nappi
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, 71121 Foggia, Italy
| | - Felice Sorrentino
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, 71121 Foggia, Italy
| | - Guglielmo Stabile
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, 34100 Trieste, Italy
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Salvatore S, Ruffolo AF, Stabile G, Casiraghi A, Zito G, De Seta F. A Randomized Controlled Trial Comparing a New D-Mannose-based Dietary Supplement to Placebo for the Treatment of Uncomplicated Escherichia coli Urinary Tract Infections. Eur Urol Focus 2023:S2405-4569(22)00297-8. [PMID: 36621376 DOI: 10.1016/j.euf.2022.12.013] [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: 10/02/2022] [Revised: 11/28/2022] [Accepted: 12/29/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND The rise in antimicrobial resistance means that alternative approaches for the treatment and prevention of urinary tract infection (UTIs) are required. OBJECTIVE To evaluate the safety and efficacy of a D-mannose-based dietary supplement (D-mannose, citric acid, prebiotic fibers, Astragalus, and dandelion; DAPAD complex) for the treatment of uncomplicated acute E. coli UTIs. DESIGN, SETTING, AND PARTICIPANTS This was a single-center, randomized, double-blind, placebo-controlled trial conducted from April 2021 to October 2021 in Rajalakshmi Hospital and Research Centre (Bangalore, India). The participants were nonmenopausal women with an acute uncomplicated E. coli UTI. UTI was diagnosed according to the presence of at least one urinary symptom and bacteriuria (>100 000 CFU/ml). INTERVENTION The DAPAD complex was administered twice a day for 5 d, with phenazopyridine and alkalizing agents as the standard of care (SOC). The control group received placebo with SOC. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Subjective (clinical resolution/response) and objective (midstream bacteriuria) outcomes were evaluated at the end of therapy (day 6) and at day 35 of follow-up. Adverse events were recorded. Categorical variables were analyzed using χ2 and Fisher's exact tests; a p value <0.05 was considered significant. RESULTS AND LIMITATIONS Seventy women were enrolled and equally randomized to the two groups. Clinical resolution was higher in the DAPAD group at 6 d (34.3% vs 0%; p < 0.0001) and 35 d from baseline (88.6% vs 20%, p < 0.0001). At day 35, no patients in the DAPAD group had moderate or severe symptoms, whereas 25.7% (nine/35) and 11.4% (four/35) of patients in the placebo group had moderate and severe symptoms, respectively. Bacteriological resolution was also higher in the DAPAD group at day 6 (85.7% vs 14.3%; p < 0.0001) and day 35 (100% vs 40%; p < 0.0001). Three mild adverse events (4.26%) unrelated to the investigated product were recorded, all of which were medically treated. CONCLUSIONS The DAPAD complex dietary supplement is effective and safe for treatment of acute uncomplicated E. coli UTIs. PATIENT SUMMARY Our results show that for nonmenopausal women with an uncomplicated Escherichia coli urinary tract infection, those treated with a dietary supplement (containing D-mannose, citric acid, prebiotic fibers, Astragalus, and dandelion) had a higher rate of clinical resolution or response than women who received a placebo.
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Affiliation(s)
- Stefano Salvatore
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Ferdinando Ruffolo
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Guglielmo Stabile
- Department of Medical, Surgical and Health Sciences, Institute for Maternal and Child Health, University of Trieste, IRCCS Burlo Garofolo, Trieste, Italy
| | - Arianna Casiraghi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gabriella Zito
- Department of Medical, Surgical and Health Sciences, Institute for Maternal and Child Health, University of Trieste, IRCCS Burlo Garofolo, Trieste, Italy
| | - Francesco De Seta
- Department of Medical, Surgical and Health Sciences, Institute for Maternal and Child Health, University of Trieste, IRCCS Burlo Garofolo, Trieste, Italy
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Boriani G, Guerra F, De Ponti R, D'Onofrio A, Accogli M, Bertini M, Bisignani G, Forleo GB, Landolina M, Lavalle C, Notarstefano P, Ricci RP, Zanotto G, Palmisano P, De Bonis S, Pangallo A, Talarico A, Maglia G, Aspromonte V, Nigro G, Bianchi V, Rapacciuolo A, Ammendola E, Solimene F, Stabile G, Biffi M, Ziacchi M, Malpighi PSO, Saporito D, Casali E, Turco V, Malavasi VL, Vitolo M, Imberti JF, Bertini M, Anna AS, Zardini M, Placci A, Quartieri F, Bottoni N, Carinci V, Barbato G, De Maria E, Borghi A, Ramazzini OB, Bronzetti G, Tomasi C, Boggian G, Virzì S, Sassone B, Corzani A, Sabbatani P, Pastori P, Ciccaglioni A, Adamo F, Scaccia A, Spampinato A, Patruno N, Biscione F, Cinti C, Pignalberi C, Calò L, Tancredi M, Di Belardino N, Ricciardi D, Cauti F, Rossi P, Cardinale M, Ansalone G, Narducci ML, Pelargonio G, Silvetti M, Drago F, Santini L, Pentimalli F, Pepi P, Caravati F, Taravelli E, Belotti G, Rordorf R, Mazzone P, Bella PD, Rossi S, Canevese LF, Cilloni S, Doni LA, Vergara P, Baroni M, Perna E, Gardini A, Negro R, Perego GB, Curnis A, Arabia G, Russo AD, Marchese P, Dell’Era G, Occhetta E, Pizzetti F, Amellone C, Giammaria M, Devecchi C, Coppolino A, Tommasi S, Anselmino M, Coluccia G, Guido A, Rillo M, Palamà Z, Luzzi G, Pellegrino PL, Grimaldi M, Grandinetti G, Vilei E, Potenza D, Scicchitano P, Favale S, Santobuono VE, Sai R, Melissano D, Candida TR, Bonfantino VM, Di Canda D, Gianfrancesco D, Carretta D, Pisanò ECL, Medico A, Giaccari R, Aste R, Murgia C, Nissardi V, Sanna GD, Firetto G, Crea P, Ciotta E, Sgarito G, Caramanno G, Ciaramitaro G, Faraci A, Fasheri A, Di Gregorio L, Campsi G, Muscio G, Giannola G, Padeletti M, Del Rosso A, Notarstefano P, Nesti M, Miracapillo G, Giovannini T, Pieragnoli P, Rauhe W, Marini M, Guarracini F, Ridarelli M, Fedeli F, Mazza A, Zingarini G, Andreoli C, Carreras G, Zorzi A, Zanotto G, Rossillo A, Ignatuk B, Zerbo F, Molon G, Fantinel M, Zanon F, Marcantoni L, Zadro M, Bevilacqua M. Five waves of COVID-19 pandemic in Italy: results of a national survey evaluating the impact on activities related to arrhythmias, pacing, and electrophysiology promoted by AIAC (Italian Association of Arrhythmology and Cardiac Pacing). Intern Emerg Med 2023; 18:137-149. [PMID: 36352300 PMCID: PMC9646282 DOI: 10.1007/s11739-022-03140-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 10/17/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND The subsequent waves of the COVID-19 pandemic in Italy had a major impact on cardiac care. METHODS A survey to evaluate the dynamic changes in arrhythmia care during the first five waves of COVID-19 in Italy (first: March-May 2020; second: October 2020-January 2021; third: February-May 2021; fourth: June-October 2021; fifth: November 2021-February 2022) was launched. RESULTS A total of 127 physicians from arrhythmia centers (34% of Italian centers) took part in the survey. As compared to 2019, a reduction in 40% of elective pacemaker (PM), defibrillators (ICD), and cardiac resynchronization devices (CRT) implantations, with a 70% reduction for ablations, was reported during the first wave, with a progressive and gradual return to pre-pandemic volumes, generally during the third-fourth waves, slower for ablations. For emergency procedures (PM, ICD, CRT, and ablations), recovery from the initial 10% decline occurred in most cases during the second wave, with some variability. However, acute care for atrial fibrillation, electrical cardioversions, and evaluations for syncope showed a prolonged reduction of activity. The number of patients with devices which started remote monitoring increased by 40% during the first wave, but then the adoption of remote monitoring declined. CONCLUSIONS The dramatic and profound derangement in arrhythmia management that characterized the first wave of the COVID-19 pandemic was followed by a progressive return to the volume of activities of the pre-pandemic periods, even if with different temporal dynamics and some heterogeneity. Remote monitoring was largely implemented during the first wave, but full implementation is needed.
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Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo 71, 41121, Modena, Italy.
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital Umberto I-Lancisi-Salesi, Ancona, Italy
| | - Roberto De Ponti
- Department of Heart and Vessels, Ospedale di Circolo-University of Insubria, Varese, Italy
| | - Antonio D'Onofrio
- Departmental Unit of Electrophysiology, Evaluation and Treatment of Arrhythmias, Monaldi Hospital, Naples, Italy
| | | | - Matteo Bertini
- Cardiology Unit, Azienda Ospedaliero-Universitaria di Ferrara "Arcispedale S. Anna", Cona, Ferrara, Italy
| | - Giovanni Bisignani
- Cardiology Division, Castrovillari Hospital, ASP Cosenza, Castrovillari, Italy
| | | | | | - Carlo Lavalle
- Department of Cardiology, Policlinico Universitario Umberto I, Rome, Italy
| | | | | | - Gabriele Zanotto
- Department of Cardiology, Mater Salutis Hospital, Legnago, Verona, Italy
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Stabile M, Cipullo LMA, Carlucci S, Rispoli AF, Stabile G. Prognostic dilemmas for SIDS in idiopathic fetal right atrium dilatation: Case report and review literature. J Neonatal Perinatal Med 2023; 16:741-746. [PMID: 38043023 DOI: 10.3233/npm-230137] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2023]
Abstract
The authors describe a case of fetal isolated right atrial enlargement or IDRA (idiopathic dilatations of the right atrium) evident in third trimester, complicated by arrhythmia in the female infant during the 1° month of life with ECG diagnosis of Wolf-Parkinson-White syndrome (WPW). The eldest sister died at 6 years because of an arrhythmia with the same diagnosis of WPW. The review of the literature on IDRA frequently shows a familial genetic aggregation. The pathogenetic mechanism underlying the dilation of the right atrium could consist of a myopathy or electrical conduction disorder. The exclusive involvement of the right atrium may be due to the increased pressure in the fetal right atrium. On the basis of our case and after review of the literature, we must be careful in defining as physiological the enlargement of the right fetal atrium in the third trimester of pregnancy. The ultrasound sign of IDRA may be a fetal prodrome of SIDS (sudden infant death syndrome).
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Affiliation(s)
- M Stabile
- Prenatal Diagnosis, Fertility, Zygote Center, Center for Genetics, Salerno, Italy
| | - L M A Cipullo
- Departments of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria, San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - S Carlucci
- Departments of Obstetrics and Gynecology, IRCCS Burlo Garofolo, Trieste, Italy
| | - A F Rispoli
- Prenatal Diagnosis, Fertility, Zygote Center, Center for Genetics, Salerno, Italy
| | - G Stabile
- Departments of Obstetrics and Gynecology, IRCCS Burlo Garofolo, Trieste, Italy
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Bruno M, Legge F, Gentile C, Carone V, Stabile G, Di Leo F, Ludovisi M, Di Florio C, Guido M. Risk Assessment Model for Complications in Minimally Invasive Hysterectomy: A Pilot Study. Int J Environ Res Public Health 2022; 20:ijerph20010234. [PMID: 36612556 PMCID: PMC9819802 DOI: 10.3390/ijerph20010234] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 12/14/2022] [Accepted: 12/16/2022] [Indexed: 06/01/2023]
Abstract
Objective: To estimate the rate of intra-operative and postoperative complications, and to define the risk of 30-day major postoperative complications (Clavien-Dindo > 2) according to the presence of one of 10 different variables of minimally invasive (MI) hysterectomy; and then to create a risk assessment model easily applicable in clinical practice. Methods: A single center single arm retrolective study. Data of consecutive patients who have undergone MI hysterectomy for gynaecologic disorders between May 2018 and April 2021 were analyzed. Perioperative surgical outcomes, occurrence of intra- and postoperative complications, and readmissions within 30 days from surgery were registered. Univariate and multivariable analyses were performed to determine the factors associated with major postoperative complications. Results: Over the study period, 445 patients were included in the study. The majority of patients developed a minor event, while major complications (grade III) were required in 14 patients. None of the patients showed a grade IV or V complication. Univariate analysis was performed on patients who had developed intra- or postoperative complications from those who did not experience complications. Body mass index (BMI) (p-value 0.045) and surgeon’s experience (p-value 0.015) were found to be associated with a different surgery time. Regarding major postoperative complications, a statistically significant association was found for the variables: BMI (p-value 0.006), previous abdominal surgery (p-value 0.015), and surgeon’s experience (p-value 0.035) in the univariate analysis. Also in the multivariate analysis, the risk of major postoperative complications was higher in these three different variables. BMI, previous surgery, and surgeon’s experience were inserted in a reproducible risk assessment model in order to stratify the risk of major postoperative complications. Conclusions: We proposed a risk assessment model including factors not previously considered in the literature: the standardization of the surgical technique, the surgeon’s experience, the best MI approach (laparoscopy or robot-assisted), and previous abdominal surgery are crucial tools to consider. Further prospective studies with a larger population sample are needed to validate these preliminary evaluations for patients undergoing MI hysterectomy.
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Affiliation(s)
- Matteo Bruno
- Obstetrics and Gynaecology Unit, San Salvatore Hospital, 67100 L’Aquila, Italy
| | - Francesco Legge
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology “F. Miulli” General Regional Hospital, Acquaviva delle Fonti, 70021 Bari, Italy
| | - Cosimo Gentile
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology “F. Miulli” General Regional Hospital, Acquaviva delle Fonti, 70021 Bari, Italy
| | - Vito Carone
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology “F. Miulli” General Regional Hospital, Acquaviva delle Fonti, 70021 Bari, Italy
| | - Guglielmo Stabile
- Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, Department of Obstetrics and Gynaecology, 34137 Trieste, Italy
| | - Federico Di Leo
- Obstetrics and Gynaecology Unit, San Salvatore Hospital, 67100 L’Aquila, Italy
| | - Manuela Ludovisi
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Christian Di Florio
- Obstetrics and Gynaecology Unit, San Salvatore Hospital, 67100 L’Aquila, Italy
| | - Maurizio Guido
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
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19
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Stabile G, Godina C, Cracco F, Mangino FP, Canton M, Romano F, Ricci G. Hysteroscopic removal of intrauterine device in early pregnancy. BMC Womens Health 2022; 22:425. [PMID: 36303205 PMCID: PMC9609195 DOI: 10.1186/s12905-022-02012-5] [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: 04/17/2022] [Accepted: 10/16/2022] [Indexed: 11/05/2022] Open
Abstract
Background Intrauterine devices (IUDs) are commonly used as contraceptives worldwide. However, pregnancies in patients carrying this kind of device may occur. IUD removal when the woman wishes to continue their pregnancy may be very challenging. Only 9 manuscripts in literature reported such similar procedure. Case presentation We report the case of an hysteroscopic removal of IUD in a young woman at 6 weeks of gestation. Discussion The case reported highlights safety and efficacy of operative hysteroscopy as a method of IUD removal in early pregnancy, although other different methods have been reported in literature. In our opinion, maintaining a low infusion pressure during the procedure may help avoiding potential gestational sac damage and IUD displacement for better grasping. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-02012-5.
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Affiliation(s)
- Guglielmo Stabile
- grid.418712.90000 0004 1760 7415Department of Obstetrics and Gynaecology, Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, 34137 Trieste, Italy
| | - Caterina Godina
- grid.5133.40000 0001 1941 4308Department of Medicine, Surgery and Health Sciences, University of Trieste, 34100 Trieste, Italy
| | - Francesco Cracco
- grid.5133.40000 0001 1941 4308Department of Medicine, Surgery and Health Sciences, University of Trieste, 34100 Trieste, Italy
| | - Francesco Paolo Mangino
- grid.418712.90000 0004 1760 7415Department of Obstetrics and Gynaecology, Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, 34137 Trieste, Italy
| | - Melania Canton
- grid.5133.40000 0001 1941 4308Department of Medicine, Surgery and Health Sciences, University of Trieste, 34100 Trieste, Italy
| | - Federico Romano
- grid.418712.90000 0004 1760 7415Department of Obstetrics and Gynaecology, Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, 34137 Trieste, Italy
| | - Giuseppe Ricci
- grid.418712.90000 0004 1760 7415Department of Obstetrics and Gynaecology, Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, 34137 Trieste, Italy ,grid.5133.40000 0001 1941 4308Department of Medicine, Surgery and Health Sciences, University of Trieste, 34100 Trieste, Italy
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20
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Stabile G, Sancin L, Boschian Bailo P, Ripepi C, Romano A, Carlucci S, Ricci G. Hysteroscopic Resection Followed by Adjuvant Radiotherapy: Report of a New Therapeutic Approach to Primary Cervical Diffuse Large B-Cell Lymphoma. Int J Environ Res Public Health 2022; 19:11779. [PMID: 36142052 PMCID: PMC9517014 DOI: 10.3390/ijerph191811779] [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] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/16/2022] [Accepted: 09/17/2022] [Indexed: 06/16/2023]
Abstract
The female genital tract can be involved as a secondary manifestation of disseminated lymphomas or leukemia but can rarely be the primary site of so-called extranodal lymphomas. Primary lymphomas of the female genital tract can affect the uterine corpus, uterine cervix, vulva, vagina or adnexa. Only about 0.008% of all cervical tumors are primary malignant lymphomas. The presenting symptoms are unspecific and also refer to much more common diseases of the female genital tract. Cervical cytology is usually negative. Preoperative diagnosis requires deep cervical biopsy. To date there is no consensus regarding optimal treatment. Radiotherapy, chemotherapy and surgery are used in different association. We report the first case reported in literature managed with an urgent hysteroscopic resection of a primary cervical diffuse large B-cell lymphoma, followed by adjuvant radiotherapy. Relevant literature was reviewed. Our conservative approach needs to be validated in the future, especially for women with pregnancy desire and for those with low performance status. To date, after 24 months from diagnosis, our patient is still disease-free.
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Affiliation(s)
- Guglielmo Stabile
- Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, Department of Obstetrics and Gynaecology, 34137 Trieste, Italy
| | - Lara Sancin
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127 Trieste, Italy
| | - Pierino Boschian Bailo
- Department of Obstetrics and Gynecology, Azienda Sanitaria Universitaria Giuliano-Isontina, San Polo Hospital, Gorizia-Monfalcone, 34149 Trieste, Italy
| | - Chiara Ripepi
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127 Trieste, Italy
| | - Andrea Romano
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127 Trieste, Italy
| | - Stefania Carlucci
- Department of Obstetrics and Gynecology, Azienda Sanitaria Universitaria Giuliano-Isontina, San Polo Hospital, Gorizia-Monfalcone, 34149 Trieste, Italy
| | - Giuseppe Ricci
- Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, Department of Obstetrics and Gynaecology, 34137 Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127 Trieste, Italy
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21
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Sorrentino F, Vasciaveo L, De Feo V, Zanzarelli E, Grandone E, Stabile G, Nappi L. Interstitial Pregnancy Treated with Mifepristone and Methotrexate with High Serum β-hCG Level in a Patient Wishing to Preserve Fertility: Time to Define Standardized Criteria for Medical/Surgical Therapy? Int J Environ Res Public Health 2022; 19:11464. [PMID: 36141736 PMCID: PMC9516977 DOI: 10.3390/ijerph191811464] [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] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 06/16/2023]
Abstract
Interstitial pregnancy (IP) accounts for 2% of all ectopic pregnancies and has a mortality rate of 2-2.5%. The diagnosis is made by a transvaginal ultrasound and the treatment can be medical or surgical. We report the case of a 36-year-old primigravida who was 6 + 5 weeks pregnant, diagnosed with interstitial pregnancy by ultrasound, who had a very high serum β-hCG level (31,298 mIU/mL) and wanted to preserve her fertility. The patient was treated with one dose of mifepristone and a double dose of methotrexate since the decrease in the β-hCG serum level was less than 15% after the first dose. At the beginning, medical therapy was effective, as no embryonal cardiac activity was detected and serum β-hCG levels decreased early, but on the 20th day of hospitalization, the patient underwent surgery for her clinical symptoms and the evidence of free fluid in the Douglas pouch at a transvaginal ultrasound exam. Our experience showed that medical treatment should be considered, especially in women wishing to preserve their fertility. Further studies are needed to establish a standardized protocol and maybe a clinical score that can be useful in predicting the patients in which medical therapy could be most successful.
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Affiliation(s)
- Felice Sorrentino
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, 71121 Foggia, Italy
| | - Lorenzo Vasciaveo
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, 71121 Foggia, Italy
| | - Vincenzo De Feo
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, 71121 Foggia, Italy
| | - Erika Zanzarelli
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, 71121 Foggia, Italy
| | - Elvira Grandone
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, 71121 Foggia, Italy
- Thrombosis and Haemostasis Unit, Fondazione IRCCS “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy
- Ob/Gyn Department of the First I.M. Sechenov Moscow State Medical University, 119991 Moscow, Russia
| | - Guglielmo Stabile
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34100 Trieste, Italy
| | - Luigi Nappi
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, 71121 Foggia, Italy
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22
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Restaino S, De Gennaro E, Floris S, Stabile G, Zinicola G, Sorrentino F, Vizzielli G, Driul L. Surgical Treatment Following Failed Medical Treatment of an Interstitial Pregnancy. Medicina (Kaunas) 2022; 58:medicina58070937. [PMID: 35888656 PMCID: PMC9316431 DOI: 10.3390/medicina58070937] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 11/30/2022]
Abstract
Interstitial pregnancy (IP) is a type of ectopic pregnancy in which the embryo implants in the interstitial part of the Fallopian tube. It accounts for 2% of all ectopic pregnancies. Signs and symptoms appear later than the other forms of ectopic pregnancies because of its peculiar location. The gold standard for its diagnosis is transvaginal ultrasound. The treatment can be medical or surgical. Medical treatment is based on the systemic or local injection of methotrexate (MTX); a dose of mifepristone can be added with a reported 85–90% success rate. The surgical option is laparoscopic unilateral cornuostomy or unilateral salpingectomy. The therapeutic choice is based on symptoms, serum β-human chorionic gonadotropin (β-hCG) values, and sonographic features. Furthermore, the patient’s fertility perspectives should be considered. We report a case of IP in a Caucasian woman of 29 years old, with a previous salpingectomy for ectopic pregnancy medically treated by a double dose of intramuscular MTX 50 mg/m2 combined with a single dose of leucovorin 15 mg and a single dose of mifepristone 600 mg orally. Medical therapy failed as suggested by the sudden onset of intense pelvic pain after 10 days. Because of the clinical symptoms and the sonographic suspicious of pregnancy rupture due to the modest amount of fluid in the pouch of Douglas, clinicians decided on an urgent unilateral laparoscopic salpingectomy. The hemoperitoneum was drained. The patient was discharged two days later and β-hCG serum levels became negative after 45 days. The advantages of fertility sparing should be weighted according to the patient’s reproductive perspectives. Appropriate counseling is therefore key in managing the treatment of interstitial pregnancy.
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Affiliation(s)
- Stefano Restaino
- Obstetrics and Gynecology Unit, Department of Obstetrics, Gynecology and Pediatrics, Department of Medical Area DAME, Udine University Hospital, 33100 Udine, Italy; (S.R.); (S.F.)
| | - Elena De Gennaro
- Clinic of Obstetrics and Gynecology, Department of Medical Area (DAME), Hospital of Udine, University of Udine, 33100 Udine, Italy; (E.D.G.); (G.V.); (L.D.)
| | - Stefano Floris
- Obstetrics and Gynecology Unit, Department of Obstetrics, Gynecology and Pediatrics, Department of Medical Area DAME, Udine University Hospital, 33100 Udine, Italy; (S.R.); (S.F.)
| | - Guglielmo Stabile
- Institute for Maternal and Child Health IRCCS “Burlo Garofolo”, 34100 Trieste, Italy;
| | - Giulia Zinicola
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34100 Trieste, Italy;
| | - Felice Sorrentino
- Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy
- Correspondence:
| | - Giuseppe Vizzielli
- Clinic of Obstetrics and Gynecology, Department of Medical Area (DAME), Hospital of Udine, University of Udine, 33100 Udine, Italy; (E.D.G.); (G.V.); (L.D.)
| | - Lorenza Driul
- Clinic of Obstetrics and Gynecology, Department of Medical Area (DAME), Hospital of Udine, University of Udine, 33100 Udine, Italy; (E.D.G.); (G.V.); (L.D.)
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23
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Stabile G, Foti C, Mordeglia D, De Santo D, Mangino FP, Laganà AS, Ricci G. Alternative Insertion Site of Nexplanon: Description of a Case Report and Systematic Review of the Literature. J Clin Med 2022; 11:jcm11113226. [PMID: 35683613 PMCID: PMC9181553 DOI: 10.3390/jcm11113226] [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: 04/27/2022] [Revised: 06/01/2022] [Accepted: 06/03/2022] [Indexed: 02/04/2023] Open
Abstract
The etonogestrel (ENG) implant is among the most effective reversible contraceptives. It can be a good option for patients with different chronic diseases due to no clinically significant effects on lipid metabolism or liver function. Some limitations in the use of this type of device are represented by social and psychiatric disorders, where the easy accessibility of the device becomes a negative feature. In these patients several cases of self-removal or damage to the device have been reported. We report the successful insertion of the Nexplanon® device into the scapular region in a young woman with a chronic psychiatric disorder. To verify the presence in the literature of other possible implantation sites, we performed a systematic review of the literature on Pubmed, Google scholar and Scopus from 2000 to 2021 using different combinations of the following terms: (Nexplanon), (contraceptive implant), (insertion). Two manuscripts with three cases were detected. Nexplanon® was implanted in the upper back. In all cases, there were no complications during the insertions and the follow up demonstrated no side effects with contraceptive efficacy. Our report and review is a further confirmation that the scapular region can become a valid insertion site, maintaining good efficacy and safety of the subcutaneous device.
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Affiliation(s)
- Guglielmo Stabile
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, 34100 Trieste, Italy; (D.D.S.); (F.P.M.); (G.R.)
- Correspondence:
| | - Carmelina Foti
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127 Trieste, Italy; (C.F.); (D.M.)
| | - Denise Mordeglia
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127 Trieste, Italy; (C.F.); (D.M.)
| | - Davide De Santo
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, 34100 Trieste, Italy; (D.D.S.); (F.P.M.); (G.R.)
| | - Francesco Paolo Mangino
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, 34100 Trieste, Italy; (D.D.S.); (F.P.M.); (G.R.)
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS “Civico—Di Cristina—Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy;
| | - Giuseppe Ricci
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, 34100 Trieste, Italy; (D.D.S.); (F.P.M.); (G.R.)
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127 Trieste, Italy; (C.F.); (D.M.)
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24
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Lorenzo GD, Romano F, Mirenda G, Cracco F, Stabile G, Ricci G. Regarding "Complete Resection of Retroperitoneal Ectopic Pregnancy Adherent to the Inferior Vena Cava by Laparoscopy". J Minim Invasive Gynecol 2022; 29:1019. [PMID: 35671954 DOI: 10.1016/j.jmig.2022.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/11/2022] [Accepted: 04/18/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Giovanni Di Lorenzo
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Via dell'istria 65/1, 34137 Trieste, Italy.
| | - Federico Romano
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Via dell'istria 65/1, 34137 Trieste, Italy
| | - Giuseppe Mirenda
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Via dell'istria 65/1, 34137 Trieste, Italy
| | - Francesco Cracco
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34137 Trieste, Italy
| | - Guglielmo Stabile
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Via dell'istria 65/1, 34137 Trieste, Italy
| | - Giuseppe Ricci
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Via dell'istria 65/1, 34137 Trieste, Italy; Department of Medical, Surgical and Health Sciences, University of Trieste, 34137 Trieste, Italy
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25
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Schillaci V, Stabile G, Arestia A, Shopova G, Agresta A, Salito A, De Simone A, Solimene F. Dielectric-based tissue thickness measured during radiofrequency ablation catheter. Europace 2022. [DOI: 10.1093/europace/euac053.111] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
A new dielectric-based method of KODEX-EPD mapping system (EPD Solutions) for measuring tissue thickness at the catheter-tissue interface has recently been developed. We reported preliminary data on real-time catheter-based measuring myocardial wall thickness in vivo, during typical atrial flutter (AFL) RF ablation.
The Kodex version used to perform this type of analysis is a version not commercially available yet but only for case replay and research purpose, not used in clinical practice.
The study population consisted of 12 consecutive patients, suffering from symptomatic paroxysmal or persistent cavo-tricuspid isthmus (CTI) dependent. The Wall Viewer (WV) function is measured by assessing a series of dielectric signals derived directly from real-time local interrogation of the catheter-tissue interface. WV is displayed in millimeters, with either high or low confidence levels per met or unmet prerequisite acquisition criteria respectively and it is displayed as a color code scale (Fig. 1, A).
The anatomy of the CTI was identified using the 4mm MAP-iT irrigated ablation catheter. A suitable starting point for the ablation, in the proximity of the tricuspid valve, and a final location in the junction between the inferior vena cava and the right atrium, were precisely defined based on electrograms recorded. Subsequently, "point by point" CTI ablation was performed delivering RF energy with 30/40 Watts for 20-40 seconds with an interlesion distance ≤6 mm.
9 patients had paroxysmal common AFL, 3 persistent common AFL. The mean age was 64±9 years, 10 (83%) were male. The mean body mass index was 30±6, 9 (75%) patients had hypertension, and 1 (8%) had coronary artery disease. The mean procedure time was 37±13 min, the mean fluoroscopic time was 690±378 s, the mean RF time 763±205 s, with a mean number of RF pulses of 28±7. The mean cavo-tricuspid isthmus length was 29.5±2.6 mm. The atrial wall thickness was significantly higher close to the tricuspid annulus than close to the inferior vena cava (3.6±0.5 mm vs 2.4±0.3 mm, p<0.001) and a trend towards a progressive decrease of atrial wall thickness was observed moving the mapping catheter from the tricuspid valve to the inferior vena cava (Fig. 1, B). Acute bidirectional cavo-tricuspid isthmus block was achieved in all patients without any complications.
We first describe a new mapping technology that allows atrial wall thickness measurement and, as expected, the wall thickness was higher close the tricuspid annulus and lower towards the inferior vena cava. The possibility to calculate the substrate thickness before RF delivery could deeply change the way to perform RF ablation, allowing a tailored energy delivery thus increasing the efficiency of the procedures and potentially reduction of the risk of complications.
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Affiliation(s)
| | - G Stabile
- Montevergine Clinic, Mercogliano, Italy
| | - A Arestia
- Montevergine Clinic, Mercogliano, Italy
| | - G Shopova
- Montevergine Clinic, Mercogliano, Italy
| | - A Agresta
- Montevergine Clinic, Mercogliano, Italy
| | - A Salito
- Montevergine Clinic, Mercogliano, Italy
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26
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Schillaci VS, Strisciuglio TS, Stabile G, Arestia AA, Agresta AA, Shopova GS, Salito AS, De Simone ADS, Solimene FS. Safety and efficacy of very high-power short-duration ablation for pulmonary vein isolation. Europace 2022. [DOI: 10.1093/europace/euac053.068] [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: 11/15/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
A very high-power short-duration (vHPSD) strategy of radiofrequency (RF) ablation aims to minimize conductive heating and increase resistive heating.
Purpose
The aim of our study is to evaluate the feasibility, efficacy and safety of the vHPSD ablation of the for pulmonary vein (PV) isolation in patients presenting with paroxysmal or persistent atrial fibrillation (AF).
Methods
This prospective non-randomized study enrolled consecutive AF patients undergoing PV isolation. The vHPSD ablation was performed with the QDOT catheter, applying 90 W, for 4 s, with an irrigation of 8 ml/min. RF was delivered targeting interlesion distance ≤ 6 mm. The PVI was assessed at the end of the encirclement with the Pentaray catheter by entrance block and by remapping.
Results
Overall 163 patients (29 with persistent AF) were enrolled. The mean age was 61±8 years, 60% had hypertension and 10% diabetes mellitus. PV isolation was obtained in all patients and at first-pass in 144 (88%) with a mean number of 83±15 RF pulses. The mean procedural time was 85±26 min, the mean fluoroscopy time was 9±6 min and the mean RF time was 5,5±1 min. In 5 patients (3%) access-related vascular complications occurred. The mean follow-up (fu) was 8±3 months (fu³6 months in 109 patients; fu³12 months in 15 patients) and the freedom from AF recurrence was 97% in the overall population and in the paroxysmal and persistent subgroups as well (Figure 1).
Conclusions
The vHPSD ablation represents an effective and safe ablation strategy to achieve PV isolation in paroxysmal and persistent AF patients.
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Affiliation(s)
| | - TS Strisciuglio
- Federico II University Hospital, Department of Advanced Biomedical Sciences, Naples, Italy
| | - G Stabile
- Montevergine Clinic, Mercogliano, Italy
| | | | | | | | - AS Salito
- Montevergine Clinic, Mercogliano, Italy
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27
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Meynet I, Stabile G, Mantica M, Ferraro A, D’ammando M, Scaglione M, Di Cori A, Schillaci V, Ottaviano L, Mantovan R, Ferrari F, Bianchi S, Solimene F, Malacrida M, De Sanctis V. The impact of RF wattage level on local impedance and procedural parameters in AF ablation cases. Europace 2022. [DOI: 10.1093/europace/euac053.222] [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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Local impedance (LI) measurement can provide information on catheter tip contact, but also changes in LI during ablation can inform the extent and effectiveness of RF energy delivery. To date the relationship between highly LI measurements and contact force (CF) during atrial fibrillation (AF) ablation at different levels of energy delivery is still lacking.
Purpose
We aimed to evaluate the impact of power setting on LI and key procedural parameters in AF ablation cases.
Methods
A novel CF ablation catheter equipped with dedicated algorithm was used to measure LI at the distal electrode of this catheter. Radiofrequency (RF) catheter applications ≥45 watts were categorized as high power (HP) and applications <45w as standard power (SP). Ablations were also grouped according to different levels of CF (<5g, 5-14g, 15-24g and ≥25g). Data are reported as mean±SD.
Results
Sixty-two consecutive pts undergoing RF catheter ablation of AF from the CHARISMA registry were included A total of 4619 ablation spots performed around PVs were analyzed (58% paroxysmal, 84% de novo, RF deliveries per pt=76±27, RF delivery time=9.1±5s, CF=12.3±8g). The majority of these were HP applications (n=4192, 91%). The mean LI was 158±17Ω prior to ablation and 138±14Ω after ablation (p<0.0001, absolute LI drop of 21.9±8Ω) with a LI drop rate equal to 4.4±3Ω/s. HP ablations had significantly shorter RF delivery times, 8.8±4s vs 12±7s (p<0.0001), larger LI drops (22.2±8Ω vs 19.3±9Ω, p<0.0001) and higher LI drop rates (4.5±3Ω/s vs 3.6±2Ω/s, p<0.0001) than SP, respectively. For both HP and SP settings, the magnitude of LI drop increased and RF delivery time decreased with increasing amounts of CF. The largest differences between HP and SP were found when CF was <15g (RF delivery time: 9±5s at HP vs 12.9±7s at SP, percentage of difference 26.3%, p<0.0001; LI drop: 21.2±8Ω at HP vs 18.6±9Ω, percentage of difference -14.3%, p<0.0001). No major complications occurred during the procedures. All PVs were successfully isolated.
Conclusions
This preliminary experience suggests that, HP ablation is effective and safe and resulting in shorter RF delivery times and larger LI drops than SP ablation.
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Affiliation(s)
| | - G Stabile
- Montevergine Clinic, Mercogliano, Italy
| | - M Mantica
- Clinical Institute Saint Ambrogio, Milan, Italy
| | | | - M D’ammando
- Hospital Santa Maria Della Misericordia, Perugia, Italy
| | | | - A Di Cori
- University Hospital of Pisa, Pisa, Italy
| | | | - L Ottaviano
- Clinical Institute Saint Ambrogio, Milan, Italy
| | - R Mantovan
- Conegliano General Hospital, Conegliano, Italy
| | - F Ferrari
- Hospital Molinette of the University Hospital S. Giovanni Battista, Turin, Italy
| | - S Bianchi
- Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
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Schillaci V, De Sanctis V, Mazza A, Zucchelli G, Notaristefano F, Gagliardi M, Meynet I, Mantica M, Solimene F, Anselmino M, Stabile G, Ottaviano L, Cavaiani M, Malacrida M, Varbella F. Influence of catheter orientation on local impedance parameters during radiofrequency delivery in AF ablation. Europace 2022. [DOI: 10.1093/europace/euac053.224] [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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Recently, a novel contact force (CF) sensing catheter able to measure local tissue impedance (LI) providing a measure of tissue characteristics has become available for clinical use.
Purpose
We sought to evaluate the influence of catheter contact angle on LI and CF parameters in consecutive atrial fibrillation ablation cases.
Methods
Consecutive pts undergoing radiofrequency catheter (RFC) ablation of AF from the CHARISMA registry were included. A novel ablation catheter (IntellaNav Stablepoint catheter) with dedicated algorithm (DirectSense) was used to measure LI at the distal electrode of this catheter. Each targeted spot was characterized in terms of RF delivery time, catheter contact angle, baseline LI and subsequent LI drop during ablation at different levels of CF (<5g, 5-19g and ≥20g). RFC ablations were performed at ≥45 watts. Data are reported as mean±SD.
Results
A total of 4193 point ablations performed around PVs from 54 cases of AF ablation were analyzed (57% paroxysmal, 85% de novo). The LI was 157±17Ω prior to ablation and 137±14Ω after ablation (p<0.0001, absolute LI drop of 22±8Ω). The CF was 12.5±8g and the RFC delivery time was 8.8±4s. The LI drop increased as CF increased (ranging from 18.9±7Ω for CF<5g to 24.8±7Ω for CF≥20g, p<0.0001) as well as RFC delivery time decreased (ranging from 12.7±4s for CF<5g to 6.6±4s for CF≥20g, p<0.0001). The LI drop at perpendicular orientations was significantly lower than at parallel orientations (19.5±8Ω vs 23.4±8Ω, p<0.0001) and RFC delivery time was higher (9.6±5s vs 8.4±4s, p<0.0001). This trend was confirmed among different level of CF both for LI drop and RFC delivery time. Figure
Conclusions
In this experience, the magnitude of the LI drop at perpendicular orientation were significantly lower than at parallel orientation and RFC delivery time was greater in parallel instances than in perpendicular instances. Thus, perpendicular RF ablations required longer RF applications and produced weaker LI decreases that parallel lesions, suggesting that catheter orientation may have critical role in RF delivery for ablation.
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Affiliation(s)
| | | | - A Mazza
- Infermi Hospital, Rivoli, Italy
| | | | | | | | | | - M Mantica
- Clinical Institute Saint Ambrogio, Milan, Italy
| | | | - M Anselmino
- Hospital Molinette of the University Hospital S. Giovanni Battista, Turin, Italy
| | - G Stabile
- Montevergine Clinic, Mercogliano, Italy
| | - L Ottaviano
- Clinical Institute Saint Ambrogio, Milan, Italy
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29
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Viola G, Stabile G, Rossi L, Figus F, Gazzale E, Casu G, Bottoni N, Deruvo E, Scaglione M, Santoro A, Armenta-Pastor J, Primo J, Ferraris F, Castro A, Donzelli S. Long term success of cavotricuspid isthmus ablation guided by the ablation index: results of the FLAI registry. Europace 2022. [DOI: 10.1093/europace/euac053.069] [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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Cavotricuspid isthmus ablation (CTIA) is an effective treatment for typical atrial flutter (AFL) with a recurrence rate of about 10%. A prospective multicentric registry (FLAI registry) has recently shown that a protocol including ‘point by point’ CTI ablation targeting an a quality lesion marker (Ablation Index AI) ≥ 500 and a maximum inter-lesion distance (ILD) measurement of ≤6 mm allowed an acute success rate of 98.3%. In this study, we aimed to describe the incidence and predictors of recurrence of both AFL and atrial fibrillation (AF) in a long-term follow-up of the patients enrolled in the FLAI registry.
Methods
The FLAI registry was a multicentric non-randomized study that enrolled 412 consecutive patients (mean age 64.9±9.8; 72.1% males; 27.7% with structural heart disease). Patients with typical AFL underwent an AI-guided cavotricuspid isthmus ablation. The procedures targeted an AI of 500 and an ILD measurement of ≤ 6mm. The primary endpoints were CTI ‘first pass’ block and persistent block after a 20-minute waiting period. The CTI bidirectional "first pass block" was reached in 355 patients (88.3%), whereas CTI block at the end of the waiting period was achieved in 405 patients (98.3%). No complications were reported.
The mean time of follow-up was 21±4.24 months and it was available for 397 patients. The FU included outpatient clinical evaluation, ECG and 24-h Holter ECG at three, six- and 12-months post-ablation, followed by an annual clinical evaluation and ECG. Documented ECG Atrial fibrillation events, in follow up, were also included in the data set.
Results
Atrial flutter recurrence: 22 AFL events were observed (5.5%) at 34 months. According to the Kaplan Meier analysis, the growth of recurrence rate was constant between 6 and 12 months, after 19 months recurrences were unlikely. At the univariate analysis predictors of AFL recurrence were: absence of bidirectional block after the waiting time period (p= 0,001); failure of the CTIA index procedure (p=<0,0005); ablation line lengths > 32 mm (p=0.,018), number of automatic ablation lesion tags (VISITAG) > 20 (p=0,.005) and At the increathe reported numbers of ‘g"gap’" in the ablation line lengths: the more the gaps increase the more the probability of AFL recurrence in FU increases (p=0.,037).
In the Multivariate aAnalysis, the independent predictors of AFL recurrence were: the procedural success and the number of VISITAG (OR =1.062)
Atrial fibrillation recurrence: 45 patients developed atrial fibrillation after CTI ablation (11.3%). In the multivariate analysis, the major independent predictor was a documented pre-procedural Afib and the risk increases with the younger age (< 53 yo).
Conclusions
The FLAI protocol is safe, reproducible and effective in the follow-up, with a long term success of 94,5%. The reported incidence of atrial fibrillation in FU was 11,3%
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Affiliation(s)
- G Viola
- SS. Annunziata Hospital, Cardiology, Sassari, Italy
| | - G Stabile
- Montevergine Clinic, Cardiology, Mercogliano, Italy
| | - L Rossi
- Guglielmo da Saliceto Hospital, Cardiology, Piacenza, Italy
| | - F Figus
- SS. Annunziata Hospital, Cardiology, Sassari, Italy
| | - E Gazzale
- SS. Annunziata Hospital, Cardiology, Sassari, Italy
| | - G Casu
- SS. Annunziata Hospital, Cardiology, Sassari, Italy
| | - N Bottoni
- Santa Maria Nuova Hospital, Cardiology, Reggio Emilia, Italy
| | - E Deruvo
- Polyclinic Casilino, Rome, Italy
| | - M Scaglione
- Cardinal Massaia Hospital, Cardiology, Asti, Italy
| | - A Santoro
- Polyclinic Santa Maria alle Scotte, Cardiology, Siena, Italy
| | | | - J Primo
- Hospital da Luz Arrabida, Cardiology, Vila Nova de Gaia, Portugal
| | | | - A Castro
- Sandro Pertini Hospital, Cardiology, Rome, Italy
| | - S Donzelli
- Hospital Santa Maria, Cardiology, Terni, Italy
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30
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Fassini GM, De Simone A, Iacopino S, Bianchi S, Bencardino G, Pecora D, Iuliano A, Moltrasio M, Rossi P, Perna F, La Greca C, Placentino F, Riva S, Tondo C, Stabile G. Novel cryo-balloon technology for a successful pulmonary vein isolation: acute outcome and follow-up from a large multicenter Italian clinical setting. Europace 2022. [DOI: 10.1093/europace/euac053.217] [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: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Complete electrical pulmonary vein isolation (PVI) by cryo-balloon approach is a well-established ablation strategy of atrial fibrillation (AF). Recently, a new cryoablation system (POLARx) with unique features has been made available for clinical use. To date, limited data exist on acute and follow-up outcome of this system in a multicentric clinical practice.
Purpose
We reported the preliminary experience of this novel technology in a multicenter Italian registry.
Methods
Consecutive patients (pts) undergoing AF ablation from the CHARISMA registry at 6 Italian centres were included. Protocol-directed cryoablation was delivered for 180 sec or 240 sec according to operator’s preference for isolation achieved in ≤60 sec, or 240 sec if isolation occurred >60 sec or when time to isolation (TTI) was not available. The ablation endpoint was PV isolation as assessed by entrance and exit block. Rhythm monitoring during the follow-up examinations was performed via the clinical assessment of AF recurrence, ECG and Holter monitoring, according to the clinical practice of each center. All patients were followed-up for at least 6 months after the procedure. Arrhythmia recurrences within the first 3 months (blanking period) were classified as early recurrences and were not considered procedural failures
Results
Six-hundred twenty-four cryoapplications from 112 pts (439 PVs) were analyzed (n=89, 79.5% paroxysmal AF, n=23, 20.5% persistent AF, mean age 61.5±9 years, 76% male, 22% with an history of AT, mean LVEF 49±10%). PVI was achieved in all pts using only cryoablation. The mean number of freeze applications per pt was 5.6±2.1 (1.4±1.2 for LSPV, 1.5±1.1 for LIPV, 1.3±0.8 for RSPV and 1.3±0.8 for RIPV), with 318 (72.4%) PVs treated with a single cryoablation (92, 21% with 2 cryoablation; 29, 6.6% with more than 2 cryoablations). Fourty-four (39.3%) pts were treated with a single application to each of the PVs. Over a median of 296[245 to 382] days of follow-up, five (4.5%) patients experienced an early recurrence of AF/AT during the 90-day blanking period. Overall, 12 patients (10.7%) suffered an AF/AT recurrence after the 90-day blanking period (median time to recurrence 200[124 to 297] days). Specifically, 8 (7.1%) patients had AF recurrence only, 3 (2.7%) had AT recurrence only and 1 (0.9%) experienced both events. One (0.9%) patient underwent a repeated ablation procedure. The proportion of patients exhibiting AF/AT recurrences was similar between AF types (10 out 89, 11.2% for paroxysmal AF vs 2 out 23, 8.7% for persistent AF, p=1.00) with a hazard ratio of 0.9 (95%CI: 0.2 to 3.9, log-rank p=0.8894). One transient phrenic nerve palsy was observed, with full recovery in the 48-h post procedure; no major procedure-related adverse events were reported.
Conclusion
In this first multicentric experience, the novel cryo-balloon system proved to be safe and effective and resulted in a very low rate of AF/AT recurrence during follow-up.
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Affiliation(s)
- GM Fassini
- Cardiology Center Monzino (IRCCS), Arrhythmology Unit, University of Milan, Milan, Italy
| | | | - S Iacopino
- Maria Cecilia Hospital, Cotignola, Italy
| | - S Bianchi
- Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - G Bencardino
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - D Pecora
- Poliambulanza Foundation Hospital Institute of Brescia, Brescia, Italy
| | - A Iuliano
- San Michele Clinic, Maddaloni, Italy
| | - M Moltrasio
- Cardiology Center Monzino (IRCCS), Arrhythmology Unit, University of Milan, Milan, Italy
| | - P Rossi
- Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - F Perna
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - C La Greca
- Poliambulanza Foundation Hospital Institute of Brescia, Brescia, Italy
| | | | - S Riva
- Cardiology Center Monzino (IRCCS), Arrhythmology Unit, University of Milan, Milan, Italy
| | - C Tondo
- Cardiology Center Monzino (IRCCS), Arrhythmology Unit, University of Milan, Milan, Italy
| | - G Stabile
- San Michele Clinic, Maddaloni, Italy
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31
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Segreti L, Maggio R, De Sanctis V, Stabile G, Battaglia A, Zingarini G, Mantica M, Agresta A, Mazza A, Pandozi C, Dello Russo A, Ottaviano L, Cavaiani M, Malacrida M, Solimene F. A novel local impedance algorithm to guide effective pulmonary vein isolation in AF patients: preliminary experience among different voltages of atrial substrate. Europace 2022. [DOI: 10.1093/europace/euac053.223] [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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Recently, a novel technology able to measure local tissue impedance (LI) and contact force (CF) aimed at validating ablation endpoints has become available for clinical use.
Purpose
This analysis explores the relationship between LI parameters, substrate characteristics and AF type during ablation in AF patients.
Methods
A novel ablation catheter with dedicated algorithm was used to measure LI at the distal electrode. Each ablation point was characterized in terms of RF delivery time, baseline LI and LI drop during ablation according to different voltages (above or below 0.5 mV) of the atrial substrate. Ablation endpoint was PVI as assessed by entrance and exit block with local capture. Data are reported as mean±SD.
Results
A total of 2032 RFC deliveries from 34 consecutive patients were analyzed (71% paroxysmal AF, 29% persistent AF). All PVs were successfully isolated with an overall procedure time of 128±33min (fluoroscopy time=15.6±9min, RF delivery time=9.6±4s, CF=11.1±7g). The baseline LI was 155±17Ω prior to ablation and 136±14Ω after ablation (p<0.0001, absolute LI drop of 21.0±8Ω) with a LI drop rate equal to 2.8±2Ω/s. Ablation spots were more frequently deployed in high-voltage areas (>0.5mv, n=1240, 61%). Baseline LI and LI drops were both higher when underlying atrial voltages were >0.5mV than when <0.5mV (156±18Ω vs 153.6±16Ω for starting LI, p=0.0032; 22.2±8Ω vs 19.1±8Ω for LI drop, p<0.0001, respectively). No differences were found in terms of both CF and LI after ablation between >0.5mV and <0.5mV (11.0±7g vs 11.2±7g for CF, p=0.3435; 136.4±13Ω vs 135.3±15Ω for ablated tissue LI, p=0.1521, respectively). Low-voltage areas were more frequently detected at ablated spots in persistent AF cases (n=288, 51.9%) than in paroxysmal AF cases (n=504, 35.1%, p<0.0001), however, no differences were found in terms of both baseline LI and LI drop between persistent and paroxysmal AF cases (156.3±17Ω vs 154.6±17Ω for starting LI, p=0.135; 20.7±8Ω vs 21.1±9Ω for LI drop, p=0.1722, respectively).
Conclusions
LI measurements well distinguished contact with high-voltage areas from low-voltage areas and were able to detect significant differences in LI drop during ablation according to the voltage level.
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Affiliation(s)
- L Segreti
- University Hospital of Pisa, Pisa, Italy
| | | | | | - G Stabile
- Montevergine Clinic, Mercogliano, Italy
| | | | - G Zingarini
- Hospital Santa Maria Della Misericordia, Perugia, Italy
| | - M Mantica
- Clinical Institute Saint Ambrogio, Milan, Italy
| | - A Agresta
- Montevergine Clinic, Mercogliano, Italy
| | - A Mazza
- Infermi Hospital, Rivoli, Italy
| | - C Pandozi
- San Filippo Neri Hospital, Rome, Italy
| | | | - L Ottaviano
- Clinical Institute Saint Ambrogio, Milan, Italy
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32
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De Seta F, Stabile G, Antoci G, Zito G, Nappi RE. Provoked Vestibulodynia and Topical Treatment: A New Option. Healthcare (Basel) 2022; 10:healthcare10050830. [PMID: 35627968 PMCID: PMC9142053 DOI: 10.3390/healthcare10050830] [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: 04/08/2022] [Revised: 04/22/2022] [Accepted: 04/29/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Provoked vestibulodynia is commonly associated with dyspareunia and affects 7% to 15% of women. This pathology has major implications on sexual function and quality of life, and several types of treatments are available for its management. However, a consensus has not been reached concerning the best treatment of vulvar pain. The aim of this study was to assess the efficacy and safety of a brand-new product, the vulvar emulgel Meclon® Lenex, for the management of provoked vestibulodynia and non-infective vulvitis. Methods: This was a monocentric, prospective, randomized, double-blind and placebo-controlled study. We enrolled 40 women with provoked vestibulodynia; 20 patients received Meclon® Lenex, whereas the remaining received a placebo. Each woman was assessed subjectively (through questionnaires) and objectively by evaluating vaginal and vulvar symptoms (Friedrichs criteria and Marinoff dyspareunia grade). We evaluated efficacy, safety, compliance and tolerability of the brand-new product vulvar gel Meclon® Lenex in provoked vestibulodynia. Results: After administration of Meclon® Lenex, we evaluated all parameters of the Friedrichs criteria (burning, dyspareunia, erythema, vulvar pain at the 5 o’clock position and 7 o’clock position), as well as the levels of Marinoff dyspareunia. The active treatment showed to be statistically significantly effective (p value ≤ 0.05) in reducing all symptoms of Friedrichs criteria, vulvar pain and Marinoff dyspareunia. Conclusion: This prospective study showed that Meclon® Lenex vulvar emulgel revealed an excellent tolerability and compliance, demonstrating to be a safe and effective option in the treatment of provoked vestibulodynia and non-infective vulvitis.
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Affiliation(s)
- Francesco De Seta
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, 34100 Trieste, Italy; (F.D.S.); (G.Z.)
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34100 Trieste, Italy;
| | - Guglielmo Stabile
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, 34100 Trieste, Italy; (F.D.S.); (G.Z.)
- Correspondence:
| | - Graziana Antoci
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34100 Trieste, Italy;
| | - Gabriella Zito
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, 34100 Trieste, Italy; (F.D.S.); (G.Z.)
| | - Rossella E. Nappi
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, 27100 Pavia, Italy;
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, School of Medicine, University of Pavia, 27100 Pavia, Italy
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Laganà AS, Garzon S, D’Alterio MN, Noventa M, Stabile G, Naem A, Ghezzi F. Mini-Laparoscopy or Single-Site Robotic Surgery in Gynecology? Let’s Think out of the Box. J INVEST SURG 2022; 35:440-441. [DOI: https:/doi.org/10.1080/08941939.2020.1857480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Antonio Simone Laganà
- Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, Varese, Italy
| | - Simone Garzon
- Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, Varese, Italy
| | - Maurizio Nicola D’Alterio
- Department of Surgical Sciences, Division of Gynecology and Obstetrics, University of Cagliari, Cagliari, Italy
| | - Marco Noventa
- Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Guglielmo Stabile
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Antoine Naem
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, Varese, Italy
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34
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Nappi L, Angioni S, De Feo V, Greco P, Stabile G, Greco F, D'Alterio MN, Sorrentino F. Diagnostic accuracy of hysteroscopy vs dilation and curettage (D&C) for atypical endometrial hyperplasia in patients performing hysterectomy or serial follow-up. CLIN EXP OBSTET GYN 2022. [DOI: 10.31083/j.ceog4901024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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35
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Scrimin F, Campisciano G, Comar M, Ragazzon C, Davanzo R, Quadrifoglio M, Giangreco M, Stabile G, Ricci G. IgG and IgA Antibodies Post SARS-CoV-2 Vaccine in the Breast Milk and Sera of Breastfeeding Women. Vaccines (Basel) 2022; 10:vaccines10010125. [PMID: 35062786 PMCID: PMC8778843 DOI: 10.3390/vaccines10010125] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 12/16/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 02/04/2023] Open
Abstract
The COVID-19 pandemic has carried massive global health and economic burden that is currently counteracted by a challenging anti-COVID-19 vaccination campaign. Indeed, mass vaccination against COVID-19 is expected to be the most efficacious intervention to mitigate the pandemic successfully. The primary objective of the present study is to test the presence of neutralizing anti-SARS-CoV-2 antibodies (IgA and IgG) in the breast milk and sera samples from vaccinated women at least 20 days after the complete vaccine cycle. A secondary aim is to compare the IgG antibodies level in maternal serum and breast milk. The third target is to evaluate the presence of the IgG antibodies in breast milk after several weeks from the vaccination. Finally, we collected information on the health status of infants in the days following maternal vaccination. Forty-two mothers were enrolled in the study. Thirty-six received the Pfizer/BioNTech vaccine, four the Astra Zeneca vaccine, one the Moderna vaccine and another woman Astra Zeneca in the first dose and Pfizer/BioNTech in the second dose. All 42 milk samples confirmed the presence of anti-SARS-CoV-2 IgG, and none showed IgA presence. Regarding the matched 42 sera samples, 41 samples detected IgG presence, with one sample testing negative and only one positive for seric IgA. None of the 42 infants had fever or changes in sleep or appetite in the seven days following the maternal vaccination. The level of IgG antibodies in milk was, on average, lower than that in maternal serum. According to our analysis, the absence of IgA could suggest a rapid decrease after vaccination even if frequent breastfeeding could favour its persistence. IgG were present in breast milk even 4 months after the second vaccine dose. Information on the immunological characteristics of breast milk could change mothers’ choices regarding breastfeeding.
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Affiliation(s)
- Federica Scrimin
- Department of Obstetrics and Gynaecology, Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (F.S.); (M.Q.); (G.R.)
| | - Giuseppina Campisciano
- Department of Advanced Microbiology Diagnosis and Translational Research, Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (G.C.); (M.C.)
| | - Manola Comar
- Department of Advanced Microbiology Diagnosis and Translational Research, Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (G.C.); (M.C.)
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34100 Trieste, Italy;
| | - Chiara Ragazzon
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34100 Trieste, Italy;
| | - Riccardo Davanzo
- Neonatal Intensive Care Unit, Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, 34137 Trieste, Italy;
| | - Mariachiara Quadrifoglio
- Department of Obstetrics and Gynaecology, Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (F.S.); (M.Q.); (G.R.)
| | - Manuela Giangreco
- Epidemiology and Biostatistics Unit, Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, 34137 Trieste, Italy;
| | - Guglielmo Stabile
- Department of Obstetrics and Gynaecology, Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (F.S.); (M.Q.); (G.R.)
- Correspondence:
| | - Giuseppe Ricci
- Department of Obstetrics and Gynaecology, Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (F.S.); (M.Q.); (G.R.)
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34100 Trieste, Italy;
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De Seta F, Johnson Z, Stabile G, Martin A, Larsen B. Rational development and evaluation of novel formulations for urinary health. Eur J Obstet Gynecol Reprod Biol 2021; 269:90-97. [PMID: 34979364 DOI: 10.1016/j.ejogrb.2021.12.031] [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: 09/30/2021] [Accepted: 12/23/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Urinary tract infections (UTI) among women form a substantial part of medical practice and both patients and medical professionals have an interest in non-antibiotic treatments and preventative measures. This research provides preliminary data on a multi-functional composition, DAPAD, which explored several biologic activities of relevance to UTI. STUDY DESIGN This formulation included D-mannose, citric acid, three prebiotic compounds, and extracts of dandelion and astragalus. Studies performed employed 4 bacterial strains that have relevance to UTI including E. coli, Proteus mirabilis, Streptococcus agalactiae and Enterococcus faecalis. RESULTS Key findings from in vitro studies included: DAPAD at full- and half-strength inhibited growth of all UTI bacteria. Evidence for D-mannose agglutination of E. coli was demonstrated. D-mannose also showed unexpected effects on bacterial membrane integrity with vital staining and modest growth restriction. We did not demonstrate growth inhibition by dandelion or astragalus extracts but the latter showed diminished cytokine elaboration by bladder epithelial cells. CONCLUSION DAPAD is a multifunctional composition that may warrant further development as a UTI treatment or preventive if supported by clinical evaluation.
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Affiliation(s)
- Francesco De Seta
- Department of Medical Sciences, University of Trieste, Institute for Maternal and Child Health- IRCCS, Burlo Garofolo, Trieste, Italy
| | - Zoe Johnson
- OB/GYN PGY1, Metro Health Hospital, Wyoming, MI, USA
| | - Guglielmo Stabile
- Institute for Maternal and Child Health-IRCCS, Burlo Garofolo, Trieste, Italy.
| | | | - Bryan Larsen
- Marian University College of Osteopathic Medicine (Retired), Indianapolis, IN, USA
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Stabile G, Gentile RM, Carlucci S, Restaino S, De Seta F. A New Therapy for Uncomplicated Vulvovaginal Candidiasis and Its Impact on Vaginal Flora. Healthcare (Basel) 2021; 9:healthcare9111555. [PMID: 34828601 PMCID: PMC8625853 DOI: 10.3390/healthcare9111555] [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: 10/13/2021] [Revised: 11/11/2021] [Accepted: 11/13/2021] [Indexed: 11/18/2022] Open
Abstract
Background: An estimated 75% of women will have one episode of vulvovaginal candidiasis (VCC) during their lifetime, and 40–50% of these will experience further episodes. The high incidence of vulvovaginal candidiasis, combined with the problems of azole resistance and toxicity, highlights the necessity for new strategies for the treatment of this condition. In this context, natural compounds represent promising alternatives. Methods: We enrolled, between January 2020 and April 2021, forty women affected by uncomplicated vulvovaginal candidiasis. Women were divided into two groups. In the first group, we treated 20 women with clotrimazole daily administration for six days. In the second group, 20 women were treated with clotrimazole associated with Unilen® Microbio+, a new product containing Saccharomyces cerevisiae, melatonin, and GLA-14. Women underwent a check at days 15, 30, and 90. A clinical and cultural examination were performed to establish the effect of the treatments on vaginal flora. Results: In the group treated with Unilen® Microbio+, clinical and microbiological cure at 15 and 30 days was observed in 18 women (90%), compared with 16 women (80%) in the group treated only with clotrimazole. The efficacy of the association between clotrimazole and Unilen® Microbio+ in these uncomplicated forms was therefore not inferior to the azole treatment alone. Only four women (20%) in the Unilen® Microbio+ group presented symptomatic recurrences within the 3 months, compared with eight women (40%) in the clotrimazole-only group. Microscopic wet mount analysis at 1 and 3 months demonstrated a significant increase in lactobacillus count and a reduction in the polymorphonucleate cells in the Unilen® Microbio+ group. Conclusions: Unilen® Microbio+ supplementation was demonstrated to cure uncomplicated vulvovaginal candidiasis with clotrimazole, reducing recurrence and improving vaginal flora better than clotrimazole treatment alone.
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Affiliation(s)
- Guglielmo Stabile
- Institute for Maternal and Child Health IRCCS “Burlo Garofolo”, 34137 Trieste, Italy;
- Correspondence:
| | - Roberta Marie Gentile
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127 Trieste, Italy;
| | - Stefania Carlucci
- Department of Obstetrics and Gynecology, Azienda Sanitaria Universitaria Giuliano-Isontina, San Polo Hospital, Gorizia-Monfalcone, 34149 Trieste, Italy;
| | - Stefano Restaino
- Department of Maternal and Child Health, University-Hospital of Udine, P.le S. Maria della Misericordia n° 15, 33100 Udine, Italy;
| | - Francesco De Seta
- Institute for Maternal and Child Health IRCCS “Burlo Garofolo”, 34137 Trieste, Italy;
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127 Trieste, Italy;
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Stabile G, Romano F, Topouzova GA, Mangino FP, Di Lorenzo G, Laganà AS, De Manzini N, Ricci G. Spondylodiscitis After Surgery for Pelvic Organ Prolapse: Description of a Rare Complication and Systematic Review of the Literature. Front Surg 2021; 8:741311. [PMID: 34778360 PMCID: PMC8586200 DOI: 10.3389/fsurg.2021.741311] [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: 07/14/2021] [Accepted: 09/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Spondylodiscitis can be a rare complication of gynecological surgery, typically of procedures involving the sacrum and the sacrospinous ligament. This report presents a case of spondylodiscitis arising after a laparoscopic sacrocolpopexy with a mesh. We also review the literature finding 52 cases of spondylodiscitis following sacrocolpopexy and (or) rectopexy with or without a mesh. Methods: We performed a comprehensive search from the electronic databases MEDLINE (Pubmed), Scopus, Web of Science, Embase, CINAHL, and Google Scholar from 1990 to February 2021 in order to identify case reports or case series reporting on spondylodiscitis after rectopexy or sacrocolpopexy. Results: We identified 52 total postoperative spondylodiscitis. We examined the mean age of patients, the surgical history, the time from initial surgery to spondylodiscitis, the presenting symptoms, the diagnostic tools, the medical and surgical treatment, the type of mesh used, the surgical access, and the possible causes of spondylodiscitis. Conclusions: Diagnosis of spondylodiscitis may be challenging. From our review emerges that recurrent pelvic pain and lumbosciatalgia may be signals of lumbar spondylodiscitis. Magnetic resonance is the gold standard examination for spondylodiscitis. Surgical practice needs to be improved further in order to establish the best procedure to minimize the incidence of this complication. Awareness of symptoms, timely diagnosis, and treatment are fundamental to prevent irreversible complications.
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Affiliation(s)
- Guglielmo Stabile
- Department of Gynecology and Obstetrics, Institute for Maternal and Child Health Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) "Burlo Garofolo", Trieste, Italy
| | - Federico Romano
- Department of Gynecology and Obstetrics, Institute for Maternal and Child Health Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) "Burlo Garofolo", Trieste, Italy
| | - Ghergana A Topouzova
- University Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Francesco Paolo Mangino
- Department of Gynecology and Obstetrics, Institute for Maternal and Child Health Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) "Burlo Garofolo", Trieste, Italy
| | - Giovanni Di Lorenzo
- Department of Gynecology and Obstetrics, Institute for Maternal and Child Health Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) "Burlo Garofolo", Trieste, Italy
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy
| | - Nicolò De Manzini
- University Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Giuseppe Ricci
- Department of Gynecology and Obstetrics, Institute for Maternal and Child Health Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) "Burlo Garofolo", Trieste, Italy.,University Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
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Stabile G, Cracco F, De Santo D, Zinicola G, Romano F, De Manzini N, Scomersi S, Ricci G. Spontaneous Bladder Rupture after Normal Vaginal Delivery: Description of a Rare Complication and Systematic Review of the Literature. Diagnostics (Basel) 2021; 11:1885. [PMID: 34679583 PMCID: PMC8534473 DOI: 10.3390/diagnostics11101885] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/30/2021] [Accepted: 10/08/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To identify the possible causes of spontaneous bladder rupture after normal vaginal delivery and to propose a diagnostic and therapeutic algorithm. MATERIAL AND METHODS MEDLINE (PubMed), Web of Science and Scopus databases were searched up to August 2020. Manuscripts considered were published from 1990 and only English articles were included. The research strategy adopted included the following terms: (bladder rupture) AND (spontaneous) AND (delivery). 103 studies were identified. Duplicates were found through an independent manual screening. Subsequently, two authors independently screened the full text of articles and excluded those not pertinent to the topic. Discrepancies were resolved by consensus. Finally, thirteen studies were included. RESULTS PRISMA guidelines were followed. For each study, fetal weight, catheterization during labor, parity, maternal age, occurrence time, previous abdominal or pelvic surgery, symptoms complained of, diagnostic methods, and treatment were considered. Median age was 26.0 (range 20-34 years); median presentation time was 3.0 days after delivery (range 1-20 days); and median newborn weight was 3227.0 g (range 2685-3600 g). Catheterization during labor was reported only in four of the thirteen cases (30.8%) identified. The symptoms most frequently complained of were abdominal pain and distension, fever, oliguria, haematuria and vomiting. Instrumental diagnosis was performed using X-rays in five cases and computerized tomography in six cases. Ultrasound was chosen in five cases as a first diagnostic tool. In two cases, cystography was performed. Treatment was always laparotomic repair of the visceral defect. CONCLUSION Abdominal pain, increased creatinine and other signs of kidney failure on blood tests should lead to suspicion of this complication. Cystourethrography is regarded as a procedure of choice, but a first ultrasound approach is recommended. The main factor for the therapeutic choice is the intraperitoneal or extraperitoneal rupture of the bladder. Classical management for intraperitoneal rupture of the bladder is surgical repair and urinary rest.
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Affiliation(s)
- Guglielmo Stabile
- Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Via dell’Istria 65/1, 34137 Trieste, Italy; (D.D.S.); (F.R.); (G.R.)
| | - Francesco Cracco
- UCO Clinica Ostetrica e Ginecologica, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34137 Trieste, Italy; (F.C.); (G.Z.)
| | - Davide De Santo
- Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Via dell’Istria 65/1, 34137 Trieste, Italy; (D.D.S.); (F.R.); (G.R.)
| | - Giulia Zinicola
- UCO Clinica Ostetrica e Ginecologica, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34137 Trieste, Italy; (F.C.); (G.Z.)
| | - Federico Romano
- Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Via dell’Istria 65/1, 34137 Trieste, Italy; (D.D.S.); (F.R.); (G.R.)
| | - Nicolò De Manzini
- SC (UCO) Clinica Chirurgica, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy; (N.D.M.); (S.S.)
| | - Serena Scomersi
- SC (UCO) Clinica Chirurgica, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy; (N.D.M.); (S.S.)
| | - Giuseppe Ricci
- Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Via dell’Istria 65/1, 34137 Trieste, Italy; (D.D.S.); (F.R.); (G.R.)
- UCO Clinica Ostetrica e Ginecologica, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34137 Trieste, Italy; (F.C.); (G.Z.)
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Schillaci V, Stabile G, Shopova G, Arestia A, Agresta A, Salito A, Solimene F. Feasibility and efficacy using the KODEX-EPD imaging system in right atrial flutter ablation: a single center experience. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0383] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Isthmus-dependent right atrial flutter is the most frequently encountered atrial flutter in clinical practice (80–90% of atrial flutters).
Purpose
The aim of our study was to assess as first experience the feasibility and safety of radiofrequency catheter ablation (RFCA) of cavo-tricuspid isthmus (CTI) guided by KODEX-EPD imaging system in patients presenting with typical atrial flutter (AFL).
Methods
16 consecutive patients (mean age 68,46±7,8 years, 80% males) with diagnosis of AFL underwent RFCA guided by KODEX-EPD imaging system. In 15 patients the analysis performed during tachycardia showed a counter-clockwise activation. In 1 patient no tachycardia could be induced and the ablation was performed in sinus rhythm with fixed pacing from the coronary sinus. The KODEX-EPD imaging system was also used to guide ablation and to confirm persistent bidirectional block after ablation.
Results
Mean procedural time was 37,6±8,2 min, mean radiofrequency ablation time was 7,8±3,4 min, and mean fluoroscopy time was 2,1±1,2 min. All procedures were acutely successful with interruption of AFL during RFCA along the inferior CTI in 15 patients and achievement of the bidirectional conduction block in 16 patients proven by atrial pacing medial and lateral to the ablation line. There were no major procedural and 30-day complications. Over a mean follow-up of 18 months, we observed no recurrence of arrhythmia and no complications.
Conclusions
Our study shows that RFCA for AFL using the KODEX-EPD imaging system is feasible, safe, and effective.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- V Schillaci
- Montevergine Cardiology Clinic, Mercogliano, Italy
| | - G Stabile
- Montevergine Cardiology Clinic, Mercogliano, Italy
| | - G Shopova
- Montevergine Cardiology Clinic, Mercogliano, Italy
| | - A Arestia
- Montevergine Cardiology Clinic, Mercogliano, Italy
| | - A Agresta
- Montevergine Cardiology Clinic, Mercogliano, Italy
| | - A Salito
- Montevergine Cardiology Clinic, Mercogliano, Italy
| | - F Solimene
- Montevergine Cardiology Clinic, Mercogliano, Italy
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Tutolo M, Rosiello G, Van der Aa F, Stabile G, Cannoletta D, Oreggia D, De Wever L, Esposito A, De Cobelli F, Everaerts W, De Ridder D, Tasso G, Salonia A, Montorsi F, Briganti A. The key role of levator ani thickness for early urinary continence recovery in patients undergoing robot-assisted radical prostatectomy: a multi-institutional study. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00840-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Stabile G, Ricci G, Scalia MS, De Seta F. Induced Dryness Stress on Human Vaginal Epithelium: The Efficacy of a New Vaginal Gel. Gels 2021; 7:gels7040157. [PMID: 34698175 PMCID: PMC8544400 DOI: 10.3390/gels7040157] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 08/29/2021] [Revised: 09/23/2021] [Accepted: 09/25/2021] [Indexed: 12/17/2022] Open
Abstract
An experimental model of dryness on vaginal mucosa is proposed to assess the efficacy of a new vaginal gel (Respecta® Hydragel Ref 17031). The dryness model was induced on reconstituted human vaginal epithelium (HVE) by incubating the tissues in modified environmental conditions (R.H. < 50% and T = 40 °C) for 48 h. The products were applied on the ‘Dry’ HVE models for 24 h (series 48 h + 24 h) in standard culture conditions (37 °C 5% CO2). Their efficacy in counteracting vaginal dryness was assessed and compared to tissues treated with saline solution and cultured in standard culture conditions (negative control) and to untreated tissues incubated in dryness conditions for 48 h and then recovered after 24 h in standard culture conditions (positive control). The products’ efficacy was quantified by measuring the following parameters: (1) water flux and direct moisturization by AQP3 immunohistochemical staining, and (2) maintenance of moisturization and elasticity of the mucosa by hyaluronic acid (CD44) immunofluorescence staining. Respecta® Hydragel demonstrated efficacy in regulating the water flux by inducing AQP3 expression thus determining a positive water balance within the vaginal epithelium. It induced a remodelling of the epithelium morphology with restored trophism compared to the dry HVE control. Furthermore, it demonstrated a significant increase of the expression of CD44, related to hyaluronic acid (HA) distribution in the extracellular matrix. HA has the ability to act on the cellular matrix composition and its renewal compared to the dry HVE control. Through these mechanisms it induces a deep hydration and elasticity of the vaginal mucosa.
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Affiliation(s)
- Guglielmo Stabile
- Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (G.R.); (F.D.S.)
- Correspondence:
| | - Giuseppe Ricci
- Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (G.R.); (F.D.S.)
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127 Trieste, Italy;
| | - Maria Sole Scalia
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127 Trieste, Italy;
| | - Francesco De Seta
- Institute for Maternal and Child Health—IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (G.R.); (F.D.S.)
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127 Trieste, Italy;
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Buzzaccarini G, Stabile G, Török P, Petousis S, Mikuš M, Della Corte L, Barra F, Laganà AS. Surgical Approach for Enlarged Uteri: Further Tailoring of vNOTES Hysterectomy. J INVEST SURG 2021; 35:924-925. [PMID: 34433349 DOI: 10.1080/08941939.2021.1967528] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
| | - Guglielmo Stabile
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Péter Török
- Department of Obstetrics and Gynecology, University of Debrecen Clinical Center, Debrecen, Hungary
| | - Stamatios Petousis
- 2nd Department of Obstetrics and Gynecology, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Ippokratio General Hospital, Thessaloniki, Greece
| | - Mislav Mikuš
- Department of Obstetrics and Gynecology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Fabio Barra
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Italy.,Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
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Tutolo M, Rosiello G, Van Der Aa F, Stabile G, Oreggia D, Barletta F, Scuderi S, Cannoletta D, De Wever L, De Ridder D, Tasso G, Everaerts W, Esposito A, De Cobelli F, Salonia A, Montorsi F, Briganti A. The key role of levator ani thickness for early urinary continence recovery in patients undergoing robot-assisted radical prostatectomy: A multi-institutional study. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01533-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Segreti L, De Simone A, Schillaci V, Pandozi C, Bongiorni MG, Stabile G, Arestia A, Giannotti Santoro M, Pelargonio G, Scaglione M, Rossi P, Pecora D, Stocco C, Malacrida M, Solimene F. Early rhythm-control ablation therapy in preventing AF recurrences: insight from the CHARISMA Registry. Europace 2021. [DOI: 10.1093/europace/euab116.192] [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: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
An early and comprehensive rhythm-control therapy emerges as a need to treat AF in an effective way and to improve the ablation outcomes, in terms of arrhythmia-free survival.
Purpose
We aimed to investigate the importance of timing of ablation in preventing AF recurrences.
Methods
153 consecutive patients (pts) undergoing AF ablation from the CHARISMA registry at 8 Italian centres were included. Ablations were guided by a novel radiofrequency ablation catheter with local impedance (LI)-sensing capability through a dedicated algorithm (DirectSense, Boston Scientific). Pts were grouped as early treated (ET) if the procedure was performed within 1 year after the first AF episode and as delayed treated (DT) if admitted for ablation after more than 1 year. The ablation endpoint was PVI as assessed by entrance and exit block. Post-ablation follow-up was scheduled at 3, 6 and 12 months. AF and atrial tachycardia (AT) recurrences were considered as long-term endpoint.
Results
Of the 153 pts enrolled (69.9% male, 59 ± 10 years, 61.4% paroxysmal AF, 38.6% persistent AF), 123 (80.4%) met Class I indications, 23 (15%) Class IIa indications and 7 (4.6%) Class IIb indications according to current ESC AF guidelines. The mean time to ablation procedure from the first AF episode was 1034 ± 1483 days. Eighty pts (52.3%) were included in ET group, whereas 73 pts (47.7%) in DT group. No differences were found between AF type in terms of ablation strategy (53.3% of the cases -52 out 94- were classified as ET for paroxysmal AF vs 47.5% of the cases -28 out 59- were ET for persistent AF, p = 0.4346). At the end of the procedures, all PVs had been successfully isolated in all study pts. During a mean follow-up of 366 ± 130 days, 18 pts (11.8%) suffered an AF/AT recurrence after the 90-day blanking period. Recurrences occurred mostly in the DT group compared to the ET one (13 out 73 -17.8%- vs 5 out 80 -6.3%-, p = 0.042) and the time to AT/AF recurrence was longer in the ET group (HR = 0.2876, 95%CI: 0.1029 to 0.8038; p = 0.0181). On multivariate logistic analysis adjusted for baseline confounders, only hypertension (HR = 4.66, 95%CI: 1.5 to 14.48, p = 0.0081) was independently associated with recurrences. An early rhythm-control therapy was associated with a low risk of recurrences beyond the hypertension risk factor, ranging from 2% (no hypertension and an ET ablation therapy) to 30.3% (with hypertension and a DT procedure) (Figure 1).
Conclusion
A LI-guided ablation strategy for PVI proved to be safe and effective and resulted in a very high recurrence-free rate. An early rhythm-control therapy in the absence of common risk factors was associated with the lowest rate of recurrences. Abstract Figure. AT/AF Recurrence
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Affiliation(s)
- L Segreti
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | - V Schillaci
- Montevergine Cardiology Clinic, Mercogliano, Italy
| | - C Pandozi
- San Filippo Neri Hospital, Rome, Italy
| | - MG Bongiorni
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - G Stabile
- Casa di cura San Michele, Maddaloni, Italy
| | - A Arestia
- Montevergine Cardiology Clinic, Mercogliano, Italy
| | | | - G Pelargonio
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University, Rome, Italy
| | | | - P Rossi
- Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - D Pecora
- Poliambulanza Foundation Hospital Institute of Brescia, Brescia, Italy
| | - C Stocco
- Boston Scientific Italy, Milan, Italy
| | | | - F Solimene
- Montevergine Cardiology Clinic, Mercogliano, Italy
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Tondo C, Stabile G, Filannino P, Moltrasio M, De Simone A, Artale P, Fassini G, La Rocca V, Bianchi S, Perna F, Tundo F, Colella J, Iuliano A, Malacrida M, Iacopino S. Novel cryo-balloon ablation technology for pulmonary vein isolation in patients with atrial fibrillation: preliminary experience from a multicenter clinical practice. Europace 2021. [DOI: 10.1093/europace/euab116.201] [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: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Complete electrical pulmonary vein isolation (PVI) by cryo-balloon approach is a well-established ablation strategy of atrial fibrillation (AF). Recently, a new cryoablation system (POLARx) with unique features has been made available for clinical use. To date, no data exist on procedural characteristics of this system in a multicentric clinical practice.
Purpose
We aimed to characterize the initial experience of this technology in the Italian clinical practice.
Methods
Consecutive patients (pts) undergoing AF ablation from the CHARISMA registry at 5 Italian centres were included. Protocol-directed cryoablation was delivered for 180 sec or 240 sec according to operator’s preference for isolation achieved in ≤60 sec, or 240 sec if isolation occurred >60 sec or when time to isolation (TTI) was not available. The ablation endpoint was PV isolation as assessed by entrance and exit block.
Results
Two-hundred sixty-two cryoapplications from 49 pts (194 PVs) were analyzed. PVI was achieved with cryoablation only in all pts. The mean number of freeze applications per pt was 5.3 ± 1.5 (1.3 ± 0.6 for LIPV, LSPV and RSPV, 1.6 ± 1.3 for RIPV), with 143 (73.7%) PVs treated in a single-shot fashion (38, 19.6% with 2 shots; 13, 6.7% with more than 2 shots). Sixteen (33%) pts were treated with a single freeze to each of the PVs. The mean nadir temperature was -55.5 ± 6.9 °C and was colder than -50°C in 83% of the PVs. TTI information was evaluable in 120 (46%) cryoapplications with a median TTI of 47 [32-75] sec (median temperature at TTI = -49 [-53 to -42] °C). The mean time to target -40 °C (TTT) was 30.1 ± 6.9 sec with a TTT < 60 sec achieved in 99.2% of the cryoapplications; the mean thaw time to 0 °C was 18.6 ± 5.8 sec (thaw time >15 sec in 70.3% of the cryoapplications). The mean PV occlusion grade (rank 1-4) was 3.6 ± 0.6 (grade 2 in 5.2% of the cases, grade 3 in 25.6% and grade 4 in 69.2%). No complications were observed at 30 days post-procedure.
Conclusion
In this first multicentric experience in a clinical practice setting, the novel cryo-balloon system proved to be safe and effective and resulted in a high proportion of successful single-freeze isolation. Cooling parameters seem to be slightly different from reference cryo-balloon technology.
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Affiliation(s)
- C Tondo
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - G Stabile
- Casa di cura San Michele, Maddaloni, Italy
| | | | - M Moltrasio
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | - P Artale
- Maria Cecilia Hospital, Cotignola, Italy
| | - G Fassini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - V La Rocca
- Casa di cura San Michele, Maddaloni, Italy
| | - S Bianchi
- Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - F Perna
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University, Rome, Italy
| | - F Tundo
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - J Colella
- Maria Cecilia Hospital, Cotignola, Italy
| | - A Iuliano
- Casa di cura San Michele, Maddaloni, Italy
| | | | - S Iacopino
- Maria Cecilia Hospital, Cotignola, Italy
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Schillaci V, Stabile G, Arestia A, Shopova G, Solimene F. Near zero fluoroscopy in cryoballoon catheter ablation in patients with atrial fibrillation using the new KODEX-EPD imaging system. Europace 2021. [DOI: 10.1093/europace/euab116.086] [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: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background. Fluoroscopy is commonly used in cryoballoon catheter ablation for pulmonary vein (PV) isolation procedures in patients with atrial fibrillation (AF).
Objective The purpose of this study was to verify the feasibility of a new dielectric imaging system in reducing the radiation exposure during cryoballoon ablation in patients with AF.
Methods We enrolled 26 consecutive patients with paroxysmal AF: 13 patients underwent the procedure under fluoroscopy guidance before the new system introduction, while 13 patient underwent the procedure under fluoroscopy and KODEX-EPD system guidance with its occlusion tool software. After transseptal access a detailed image reconstruction of left atrium and PVs was achieved with the Achieve octapolar circular mapping catheter and the cryoablation was performed with the Arctic Front Advance cryoballoon.
Results Total time of the procedure was comparable between the two groups (90.15 ± 28.67 vs 80.77 ± 17.17 using KODEX-EPD, p = 0.34), while fluoroscopy time was significantly lower in the group using KODEX-EPD (16.92 ± 8.96 vs 5.54 ± 2.06, p < 0.01). Acute isolation was achieved in all PVs. No 30 days complication was observed.
Conclusion This is the first study that demonstrates the feasibility of a reduce fluoroscopy workflow using the novel KODEX-EPD system in a cryoballoon procedure. Abstract Figure. Fluoroscopy time
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Affiliation(s)
- V Schillaci
- Montevergine Cardiology Clinic, Mercogliano, Italy
| | - G Stabile
- Montevergine Cardiology Clinic, Mercogliano, Italy
| | - A Arestia
- Montevergine Cardiology Clinic, Mercogliano, Italy
| | - G Shopova
- Montevergine Cardiology Clinic, Mercogliano, Italy
| | - F Solimene
- Montevergine Cardiology Clinic, Mercogliano, Italy
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Schillaci V, Zucchelli G, Solimene F, De Simone A, Pandozi C, Stabile G, Di Cori A, Arestia A, Narducci ML, Battaglia A, Cauti F, La Greca C, Terzaghi C, Malacrida M, Segreti L. The magnitude and the course of local impedance drop to guide successful AF ablation: insight from an Italian registry. Europace 2021. [DOI: 10.1093/europace/euab116.193] [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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
It has been demonstrated that an ablation strategy based on local impedance (LI) algorithm is helpful in guiding successful ablation of atrial fibrillation (AF) cases. How the magnitude and the course of LI drop could impact the effectiveness of ablation has to be proved.
Purpose
We aimed to evaluate LI drop characteristics in predicting effective radiofrequency (RF) ablation of consecutive AF cases.
Methods
Consecutive patients undergoing AF ablation at 8 Italian centers were included in the CHARISMA registry. A RF ablation catheter equipped with mini-electrodes technology and a dedicated algorithm was used to measure LI and to guide ablation. For our purpose, we defined the time to drop (τ) as the time for the first deflection of LI drop to the plateau. RF applications were targeted to a LI drop of 10 Ω and were stopped when a maximum cut-off LI drop of <40 Ω was observed. Successful single RF ablation was defined according with a reduction of signal voltage by at least 50% and inability to capture local tissue on pacing. The ablation endpoint was PVI as assessed by entrance and exit block. Follow-up were scheduled at 3, 6 and 12 months post-ablation.
Results
153 consecutive patients (61% paroxysmal AF, 39% persistent AF) were enrolled in the study. 3556 point-by-point first-pass RF applications of >10 s duration were performed around PVs. The mean LI drop was 13 ± 8Ω, the mean τ was 18.7 ± 13s and the median LI drop/τ was 0.67 [QI-QIII, 0.37 – 1.17] Ω/s. Both absolute drops in LI and LI drop/τ were greater at successful ablation sites (n = 3122, 88%) than at ineffective ablation sites (n = 434, 12%) (14 ± 8Ω vs 6 ± 4Ω, p < 0.0001 for LI; 0.73[0.41–1.25]Ω/s vs 0.35[0.22–0.59]Ω/s for LI drop/τ, p < 0.0001). Every 5-point increment in LI drop was associated with successful ablation, with an OR of 3.13 (95%CI: 2.7 to 3.6, p < 0.0001), reaching the highest point when a value larger than 15 Ω was observed (99.9% of acute success). A significant trend was observed from lower to higher LI drop/τ values and a value greater than 0.65 Ω/s (best cut-off value on the basis of the ROC analysis) was significantly associated with successful RF delivery with an OR of 5.54 (95%CI: 4.31 to 7.11, p < 0.0001). No complications occurred during and after procedures. At 1-year follow-up, the AF recurrence rate was 12% after the 90-day blanking period.
Conclusions
The magnitude and time-course of the LI drop during RF delivery were associated with effective lesion formation. This ablation strategy for PVI guided by LI technology proved safe and effective, and resulted in a very low rate of AF recurrence over 1-year follow-up.
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Affiliation(s)
- V Schillaci
- Montevergine Cardiology Clinic, Mercogliano, Italy
| | - G Zucchelli
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - F Solimene
- Montevergine Cardiology Clinic, Mercogliano, Italy
| | | | - C Pandozi
- San Filippo Neri Hospital, Rome, Italy
| | - G Stabile
- Casa di cura San Michele, Maddaloni, Italy
| | - A Di Cori
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - A Arestia
- Montevergine Cardiology Clinic, Mercogliano, Italy
| | - ML Narducci
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University, Rome, Italy
| | | | - F Cauti
- Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - C La Greca
- Poliambulanza Foundation Hospital Institute of Brescia, Brescia, Italy
| | | | | | - L Segreti
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
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Stabile G, Romano F, De Santo D, Sorrentino F, Nappi L, Cracco F, Ricci G. Case Report: Bowel Occlusion Following the Use of Barbed Sutures in Abdominal Surgery. A Single-Center Experience and Literature Review. Front Surg 2021; 8:626505. [PMID: 33959630 PMCID: PMC8093862 DOI: 10.3389/fsurg.2021.626505] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 03/11/2021] [Indexed: 12/20/2022] Open
Abstract
Introduction: A high level of surgical ability is required to perform endoscopic knot tying. Barbed sutures help in avoiding this procedure, thus reducing intraoperative time and lowering blood loss and hospitalization time when compared to traditional sutures. Some cases of bowel occlusion following the use of barbed sutures have been described in literature. All of them are characterized by the entanglement of an intestinal loop in wire barbs with bowel occlusion symptoms. Case Presentation: We report two more cases which occurred in our Institute in 2020 and review those which have been reported in the literature by searching on Pubmed, Scopus, and Embase. We used the search terms: “Barbed,” ”Suture,” “Bowel,” and ”Obstruction.” We examined in the literature the surgical procedures, the type of complications, the time to onset of the complications, and the type of barbed suture. Discussion: Twenty-two cases in total were reported in the literature from 2011 to 2020, and bowel complications were largely subsequent to interventions such as hernia surgical repair and myomectomy. In order to take advantage of barbed sutures while minimizing the risk of adverse events, such as intestinal occlusion, some precautions may be considered, such as the shortening of thread tails and use of antiadhesive barriers. Moreover, performing a few stitches backwards when ending the suture might be a useful suggestion. Further studies in this field may be useful in order to assess whether it might be better avoiding barbed suture application on serosal tissues to prevent bowel damage.
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Affiliation(s)
- Guglielmo Stabile
- Institute for Maternal and Child Health, Istituto di Ricovero e Cura a Carattere Scientifico "Burlo Garofolo", Trieste, Italy
| | - Federico Romano
- Institute for Maternal and Child Health, Istituto di Ricovero e Cura a Carattere Scientifico "Burlo Garofolo", Trieste, Italy
| | - Davide De Santo
- Institute for Maternal and Child Health, Istituto di Ricovero e Cura a Carattere Scientifico "Burlo Garofolo", Trieste, Italy
| | - Felice Sorrentino
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, Foggia, Italy
| | - Luigi Nappi
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, Foggia, Italy
| | - Francesco Cracco
- University Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Giuseppe Ricci
- Institute for Maternal and Child Health, Istituto di Ricovero e Cura a Carattere Scientifico "Burlo Garofolo", Trieste, Italy.,University Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
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Lepillier A, Solimene F, De Ruvo E, Scaglione M, Anselmino M, Sebag F, Pecora D, Gallagher M, Rillo M, Stabile G. Reproducibility of pulmonary vein isolation guided by the ablation index: One-year outcome of the AIR registry. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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