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Lupi M, Carano A, Carlucci M, Acciavatti T, Pettorruso M, Cinosi E, De Berardis D, Martinotti G. Prevalence of Orthorexia Nervosa in a sample of italian young adults. Clin Ter 2024; 175:125-127. [PMID: 38571470 DOI: 10.7417/ct.2024.5044] [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] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
Abstract There is only limited epidemiological information on Orthorexia Nervosa; the aim of the present study is, therefore, to assess the prevalence of ON in a population of young adults and to identify possible specific features and eventual psychopatological dimensions. 1317 participants (732 females and 585 males; mean age 22.36 yrs) completed a battery containing the orthorexia measure (ORTHO-15), statements about demographic characteristics as well as physiological parameters. The mean ORTO-15 score was 31.89; considering the cut-off of 40 in the reference test, our results showed a 11.9% prevalence of ON. Analyzing the characteristics of the orthorexic group, the prevalence in females compared to males appears to be statistically very significant (115 vs 43; 72.8% vs 27.2%); moreover shows higher and statistically significant scores in each of the 15 items of the reference test compared to the non-orthorexic group. Our data confirming that ON might be a relevant and potentially underestimate phenomenon in the community. Further studies are warranted in order to explore the diagnostic boundaries of this syndrome, its course and outcome, and the possible therapeutic strategies.
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Affiliation(s)
- M Lupi
- NHS, Mental Health Department, Psychiatric Service of Diagnosis and Treatment, "Madonna del Soccorso" Hospital, San Benedetto del Tronto, AST Ascoli Piceno, Italy
| | - A Carano
- NHS, Mental Health Department, Psychiatric Service of Diagnosis and Treatment, "Madonna del Soccorso" Hospital, San Benedetto del Tronto, AST Ascoli Piceno, Italy
| | - M Carlucci
- Studi Cognitivi, Cognitive Psychotherapy School and Research Center, San Benedetto del Tronto, Italy
| | - T Acciavatti
- NHS, Mental Health Department, Psychiatric Service of Diagnosis and Treatment, "Santo Spirito" Hospital, ASL Pescara, Italy
| | - M Pettorruso
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", Chieti, Italy
| | - E Cinosi
- Department of Pharmacy, Pharmacology, Clinical Science, University of Hertfordshire, Herts, UK
| | - D De Berardis
- NHS, Head of Mental Health Department, ASL Teramo, Italy
| | - G Martinotti
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", Chieti, Italy
- Department of Pharmacy, Pharmacology, Clinical Science, University of Hertfordshire, Herts, UK
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Isgrò S, Giani M, Antolini L, Giudici R, Valsecchi MG, Bellani G, Chiara O, Bassi G, Latronico N, Cabrini L, Fumagalli R, Chieregato A, Sammartano F, Sechi G, Zoli A, Pagliosa A, Palo A, Valoti O, Carlucci M, Benini A, Foti G. Identifying Trauma Patients in Need for Emergency Surgery in the Prehospital Setting: The Prehospital Prediction of In-Hospital Emergency Treatment (PROPHET) Study. J Clin Med 2023; 12:6660. [PMID: 37892798 PMCID: PMC10607301 DOI: 10.3390/jcm12206660] [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: 08/29/2023] [Revised: 10/08/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
Prehospital field triage often fails to accurately identify the need for emergent surgical or non-surgical procedures, resulting in inefficient resource utilization and increased costs. This study aimed to analyze prehospital factors associated with the need for emergent procedures (such as surgery or interventional angiography) within 6 h of hospital admission. Additionally, our goal was to develop a prehospital triage tool capable of estimating the likelihood of requiring an emergent procedure following hospital admission. We conducted a retrospective observational study, analyzing both prehospital and in-hospital data obtained from the Lombardy Trauma Registry. We conducted a multivariable logistic regression analysis to identify independent predictors of emergency procedures within the first 6 h from admission. Subsequently, we developed and internally validated a triage score composed of factors associated with the probability of requiring an emergency procedure. The study included a total of 3985 patients, among whom 295 (7.4%) required an emergent procedure within 6 h. Age, penetrating injury, downfall, cardiac arrest, poor neurological status, endotracheal intubation, systolic pressure, diastolic pressure, shock index, respiratory rate and tachycardia were identified as predictors of requiring an emergency procedure. A triage score generated from these predictors showed a good predictive power (AUC of the ROC curve: 0.81) to identify patients requiring an emergent surgical or non-surgical procedure within 6 h from hospital admission. The proposed triage score might contribute to predicting the need for immediate resource availability in trauma patients.
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Affiliation(s)
- Stefano Isgrò
- Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy; (S.I.); (M.G.); (A.B.)
| | - Marco Giani
- Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy; (S.I.); (M.G.); (A.B.)
- Department of Medicine and Surgery, Università degli Studi di Milano-Bicocca, 20126 Monza, Italy; (L.A.); (M.G.V.); (R.F.)
| | - Laura Antolini
- Department of Medicine and Surgery, Università degli Studi di Milano-Bicocca, 20126 Monza, Italy; (L.A.); (M.G.V.); (R.F.)
| | - Riccardo Giudici
- Department of Anesthesia and Intensive Care Medicine, Niguarda Hospital, 20162 Milan, Italy; (R.G.); (G.B.)
| | - Maria Grazia Valsecchi
- Department of Medicine and Surgery, Università degli Studi di Milano-Bicocca, 20126 Monza, Italy; (L.A.); (M.G.V.); (R.F.)
| | - Giacomo Bellani
- Department of Anesthesia and Intensive Care, Santa Chiara Regional Hospital, APSS, 38122 Trento, Italy;
- Centre for Medical Sciences CISMed, University of Trento, 38122 Trento, Italy
| | - Osvaldo Chiara
- Department of Emergency and Trauma Surgery, Niguarda Hospital, 20162 Milan, Italy;
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20100 Milan, Italy
| | - Gabriele Bassi
- Department of Anesthesia and Intensive Care Medicine, Niguarda Hospital, 20162 Milan, Italy; (R.G.); (G.B.)
| | - Nicola Latronico
- Department of Emergency, Spedali Civili University Hospital, 25123 Brescia, Italy;
| | - Luca Cabrini
- General and Neurosurgical Intensive Care Units, Ospedale di Circolo, 21100 Varese, Italy;
- Department of Biotechnologies and Life Sciences, University of Insubria, ASST Sette Laghi, 21100 Varese, Italy
| | - Roberto Fumagalli
- Department of Medicine and Surgery, Università degli Studi di Milano-Bicocca, 20126 Monza, Italy; (L.A.); (M.G.V.); (R.F.)
- Department of Anesthesia and Intensive Care Medicine, Niguarda Hospital, 20162 Milan, Italy; (R.G.); (G.B.)
| | - Arturo Chieregato
- Department of Anesthesia and Intensive Care Medicine, Neuro Intensive Care, ASST Niguarda, 20162 Milan, Italy;
| | - Fabrizio Sammartano
- Emergency Department, Emergency and Trauma Surgery, ASST Santi Carlo e Paolo, 20142 Milan, Italy;
| | - Giuseppe Sechi
- Regional Agency of Emergency and Urgency (AREU), 20124 Milan, Italy; (G.S.); (A.Z.); (A.P.)
| | - Alberto Zoli
- Regional Agency of Emergency and Urgency (AREU), 20124 Milan, Italy; (G.S.); (A.Z.); (A.P.)
| | - Andrea Pagliosa
- Regional Agency of Emergency and Urgency (AREU), 20124 Milan, Italy; (G.S.); (A.Z.); (A.P.)
| | - Alessandra Palo
- Regional Agency of Emergency and Urgency (AREU), 27100 Pavia, Italy;
| | - Oliviero Valoti
- Regional Agency of Emergency and Urgency (AREU), 24121 Bergamo, Italy;
| | - Michele Carlucci
- General and Emergency Surgery Department, Ospedale San Raffaele, 20132 Milan, Italy;
| | - Annalisa Benini
- Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy; (S.I.); (M.G.); (A.B.)
| | - Giuseppe Foti
- Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy; (S.I.); (M.G.); (A.B.)
- Department of Medicine and Surgery, Università degli Studi di Milano-Bicocca, 20126 Monza, Italy; (L.A.); (M.G.V.); (R.F.)
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Crepaz L, Sartori A, Podda M, Ortenzi M, Di Leo A, Stabilini C, Carlucci M, Olmi S. Minimally invasive approach to incisional hernia in elective and emergency surgery: a SICE (Italian Society of Endoscopic Surgery and new technologies) and ISHAWS (Italian Society of Hernia and Abdominal Wall Surgery) online survey. Updates Surg 2023; 75:1671-1680. [PMID: 37069372 DOI: 10.1007/s13304-023-01505-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 03/22/2023] [Indexed: 04/19/2023]
Abstract
Minimally invasive abdominal wall surgery is growing worldwide, with a constant and fast improvement of surgical techniques and surgeons' confidence in treating both primary and incisional hernias (IH). The Italian Society of Endoscopic Surgery and new technologies (SICE) and the ISHAWS (Italian Society of Hernia and Abdominal Wall Surgery) worked together to investigate state of the art in IH treatment in elective and emergency settings in Italy. An online open survey was designed, and Italian surgeons interested in abdominal wall surgery were invited to fill out a 20-point questionnaire on IH surgical procedures performed in their departments. Surgeons were asked to express their points of view on specific questions about technical and clinical variables in IH treatment. Preferred approach in elective IH surgery was minimally invasive (59.7%). Open surgery was the preferred approach in 40.3% of the responses. In emergency settings, open surgery was the preferred approach (65.4%); however, 34.5% of the involved surgeons declare to prefer the laparoscopic/endoscopic approach. Most respondents opted for conversion to open surgery in case of relevant surgical field contamination, with a non-mesh repair of abdominal wall defects. Among those that used the laparoscopic approach in the emergent setting, the majority (74%) used the size of the defect of 5 cm as a decisional cut-off. The spread of minimally invasive approaches to IH repair in emergency surgery in Italy is gaining relevance. Code-sharing through scientific societies can improve clinical practice in different departments and promote a tailored approach to IH surgery.
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Affiliation(s)
- Lorenzo Crepaz
- General and Mini-Invasive Surgery, San Camillo Hospital, Via Giovanelli 19, 38122, Trento, Italy.
| | - Alberto Sartori
- Department of General Surgery, Ospedale Di Montebelluna, Via Palmiro Togliatti, 16, 31044, Montebelluna, Treviso, Italy
| | - Mauro Podda
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - Monica Ortenzi
- Department of General Surgery, Università Politecnica Delle Marche, Piazza Roma 22, 60121, Ancona, Italy
| | - Alberto Di Leo
- General and Mini-Invasive Surgery, San Camillo Hospital, Via Giovanelli 19, 38122, Trento, Italy
| | - Cesare Stabilini
- DISC (Department of Surgical Sciences), University of Genoa, Genoa, Italy
| | - Michele Carlucci
- General and Emergency Surgery, IRCCS San Raffaele Hospital, Milan, Italy
| | - Stefano Olmi
- Oncologic Surgery, Policlinico San Marco GSD, Zingonia (Bg), Corso Europa 7, 24040, Zingonia, Bg, Italy
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4
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Degiuli M, Ortenzi M, Tomatis M, Puca L, Cianflocca D, Rega D, Maroli A, Elmore U, Pecchini F, Milone M, La Mendola R, Soligo E, Deidda S, Spoletini D, Cassini D, Aprile A, Mineccia M, Nikaj H, Marchegiani F, Maiello F, Bombardini C, Zuolo M, Carlucci M, Ferraro L, Falato A, Biondi A, Persiani R, Marsanich P, Fusario D, Solaini L, Pollesel S, Rizzo G, Coco C, Di Leo A, Cavaliere D, Roviello F, Muratore A, D'Ugo D, Bianco F, Bianchi PP, De Nardi P, Rigamonti M, Anania G, Belluco C, Polastri R, Pucciarelli S, Gentilli S, Ferrero A, Scabini S, Baldazzi G, Carlini M, Restivo A, Testa S, Parini D, De Palma GD, Piccoli M, Rosati R, Spinelli A, Delrio P, Borghi F, Guerrieri M, Reddavid R. Correction: Minimally invasive vs. open segmental resection of the splenic flexure for cancer: a nationwide study of the Italian Society of Surgical Oncology-Colorectal Cancer Network (SICO-CNN). Surg Endosc 2023:10.1007/s00464-023-10102-0. [PMID: 37160809 DOI: 10.1007/s00464-023-10102-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Affiliation(s)
- Maurizio Degiuli
- University of Turin, Department of Oncology, San Luigi University Hospital, Div of Surgical Oncology, Orbassano, Turin, Italy.
- Department of Oncology, Head Surgical Oncology and Digestive Surgery, University of Torino, San Luigi University Hospital, Regione Gonzole 10 Orbassano, 10043, Turin, Italy.
| | - Monica Ortenzi
- Clinica Chirurgica Universita' Politecnica delle Marche, Ospedali Riuniti, Ancona, Italy
| | - Mariano Tomatis
- BSIT, Department of Oncology, University of Turin, Orbassano, Turin, Italy
| | - Lucia Puca
- University of Turin, Department of Oncology, San Luigi University Hospital, Div of Surgical Oncology, Orbassano, Turin, Italy
| | - Desiree Cianflocca
- Department of Surgery, S. Croce e Carle Hospital, Cuneo, Italy
- Department of General and Emergency Surgery, Azienda Ospedaliero Universitaria, Città della Salute e della Scienza, Turin, Italy
| | - Daniela Rega
- Colorectal Surgical Oncology, Abdominal Oncology Department, Fondazione Giovanni Pascale IRCCS, Naples, Italy
| | - Annalisa Maroli
- Colon and Rectal Surgery Division, Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56, Rozzano, 20089, Milan, Italy
| | - Ugo Elmore
- Division of Gastrointestinal Surgery, Vita Salute University, San Raffaele Hospital, 20132, Milan, Italy
| | - Francesca Pecchini
- Unita' Operativa di chirurgia generale, d'urgenza e nuove tecnologie, OCSAE, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Marco Milone
- Department of Clinical Medicine and Surgery, Department of Gastroenterology, Endocrinology and Endoscopic Surgery, University of Naples "Federico II", Naples, Italy
| | - Roberta La Mendola
- General Surgery Unit, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Erica Soligo
- S.C. Chirurgia Generale, Ospedale S. Andrea, Vercelli, Italy
| | - Simona Deidda
- Chirurgia Coloproctologica-AOU Cagliari, Dipartimento di Scienze Chirurgiche, Università di Cagliari, Cagliari, Italy
| | - Domenico Spoletini
- UOC Chirurgia Generale, Ospedale S. Eugenio, Piazzale dell'Umanesimo, 10, 00144, Rome, Italy
| | - Diletta Cassini
- Unità Operativa Complessa di Chirurgia Generale, P.O. SSG, ASST NORD MILANO, Milan, Italy
| | - Alessandra Aprile
- Surgical Oncology Surgery, IRCCS Policlinico San Martino, Genoa, Italy
| | - Michela Mineccia
- Department of General and Oncological Surgery, "Umberto I" Mauriziano Hospital, Turin, Italy
| | - Herald Nikaj
- SCDU Clinica Chirurgica, General Surgery Department, AOU "Maggiore Della Carità" Hospital, Novara, Italy
| | - Francesco Marchegiani
- Department of Surgical, Oncological, and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Fabio Maiello
- Department of Surgery, General Surgery Unit, Hospital of Biella, Biella, Italy
| | - Cristina Bombardini
- Department of Surgical Morphology and Experimental Medicine, AOU Ferrara, Ferrara, Italy
| | - Michele Zuolo
- General Surgery Division, "Valli del Noce" Hospital, Cles, Provincial Agency for Health Services (APSS), Trento, Italy
| | - Michele Carlucci
- Gastrointestinal Surgery, San Raffaele Hospital, 20132, Milan, Italy
| | - Luca Ferraro
- Division of General and Robotic Surgery, Dipartimento di Scienze della Salute, Università di Milano, 20142, Milan, Italy
| | - Armando Falato
- General Surgery Unit, San Leonardo Hospital, ASL-NA3sud, Castellammare di Stabbia, Naples, Italy
| | - Alberto Biondi
- Fondazione Policlinico Gemelli, IRCCS, AREA di Chirurgia Addominale, Rome, Italy
| | - Roberto Persiani
- Fondazione Policlinico Gemelli, IRCCS, AREA di Chirurgia Addominale, Rome, Italy
| | | | - Daniele Fusario
- UOC General and Oncological Surgery, University of Siena, Siena, Italy
| | - Leonardo Solaini
- General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Ausl Romagna, Forlì, Italy
| | - Sara Pollesel
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Chirurgia Generale Presidio Columbus, Rome, Italy
| | - Gianluca Rizzo
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Chirurgia Generale Presidio Columbus, Rome, Italy
| | - Claudio Coco
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Chirurgia Generale Presidio Columbus, Rome, Italy
| | | | - Davide Cavaliere
- Department of Surgical Oncology, CRO Aviano, National Cancer Institute, IRCCS, Aviano, Italy
| | - Franco Roviello
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Chirurgia Generale Presidio Columbus, Rome, Italy
| | - Andrea Muratore
- Surgical Department, Edoardo Agnelli Hospital, Pinerolo, Italy
| | - Domenico D'Ugo
- Fondazione Policlinico Gemelli, IRCCS, AREA di Chirurgia Addominale, Rome, Italy
| | - Francesco Bianco
- General Surgery Unit, San Leonardo Hospital, ASL-NA3sud, Castellammare di Stabbia, Naples, Italy
| | - Paolo Pietro Bianchi
- Division of General and Robotic Surgery, Dipartimento di Scienze della Salute, Università di Milano, 20142, Milan, Italy
- Department of Surgery, Misericordia Hospital, Grosseto, Italy
| | - Paola De Nardi
- Division of General and Robotic Surgery, Dipartimento di Scienze della Salute, Università di Milano, 20142, Milan, Italy
| | - Marco Rigamonti
- General Surgery Division, "Valli del Noce" Hospital, Cles, Provincial Agency for Health Services (APSS), Trento, Italy
| | - Gabriele Anania
- Department of Surgical Morphology and Experimental Medicine, AOU Ferrara, Ferrara, Italy
| | - Claudio Belluco
- Department of Surgical Oncology, CRO Aviano, National Cancer Institute, IRCCS, Aviano, Italy
| | - Roberto Polastri
- Department of Surgery, General Surgery Unit, Hospital of Biella, Biella, Italy
| | - Salvatore Pucciarelli
- Department of Surgical, Oncological, and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Sergio Gentilli
- SCDU Clinica Chirurgica, General Surgery Department, AOU "Maggiore Della Carità" Hospital, Novara, Italy
| | - Alessandro Ferrero
- Department of General and Oncological Surgery, "Umberto I" Mauriziano Hospital, Turin, Italy
| | - Stefano Scabini
- Surgical Oncology Surgery, IRCCS Policlinico San Martino, Genoa, Italy
| | - Gianandrea Baldazzi
- Unità Operativa Complessa di Chirurgia Generale, P.O. SSG, ASST NORD MILANO, Milan, Italy
| | - Massimo Carlini
- UOC Chirurgia Generale, Ospedale S. Eugenio, Piazzale dell'umanesimo, 10, 00144, Rome, Italy
| | - Angelo Restivo
- Chirurgia Coloproctologica-AOU Cagliari, Dipartimento di Scienze Chirurgiche, Università di Cagliari, Cagliari, Italy
| | - Silvio Testa
- S.C. Chirurgia Generale, Ospedale S. Andrea, Vercelli, Italy
| | - Dario Parini
- General Surgery Unit, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Giovanni Domenico De Palma
- Department of Clinical Medicine and Surgery, Department of Gastroenterology, Endocrinology and Endoscopic Surgery, University of Naples "Federico II", Naples, Italy
| | - Micaela Piccoli
- Unita' Operativa di chirurgia generale, d'urgenza e nuove tecnologie, OCSAE, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Riccardo Rosati
- Division of Gastrointestinal Surgery, Vita Salute University, San Raffaele Hospital, 20132, Milan, Italy
| | - Antonino Spinelli
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
| | - Paolo Delrio
- Colorectal Surgical Oncology, Abdominal Oncology Department, Fondazione Giovanni Pascale IRCCS, Naples, Italy
| | - Felice Borghi
- Department of Surgery, S. Croce e Carle Hospital, Cuneo, Italy
- Oncological Surgery, Candiolo Cancer Institute-FPO-IRCCS, Candiolo, 10060, Torino, Italy
| | - Marco Guerrieri
- Clinica Chirurgica Universita' Politecnica delle Marche, Ospedali Riuniti, Ancona, Italy
| | - Rossella Reddavid
- University of Turin, Department of Oncology, San Luigi University Hospital, Div of Surgical Oncology, Orbassano, Turin, Italy
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5
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Degiuli M, Ortenzi M, Tomatis M, Puca L, Cianflocca D, Rega D, Maroli A, Elmore U, Pecchini F, Milone M, La Mendola R, Soligo E, Deidda S, Spoletini D, Cassini D, Aprile A, Mineccia M, Nikaj H, Marchegiani F, Maiello F, Bombardini C, Zuolo M, Carlucci M, Ferraro L, Falato A, Biondi A, Persiani R, Marsanich P, Fusario D, Solaini L, Pollesel S, Rizzo G, Coco C, Di Leo A, Cavaliere D, Roviello F, Muratore A, D’Ugo D, Bianco F, Bianchi PP, De Nardi P, Rigamonti M, Anania G, Belluco C, Polastri R, Pucciarelli S, Gentilli S, Ferrero A, Scabini S, Baldazzi G, Carlini M, Restivo A, Testa S, Parini D, De Palma GD, Piccoli M, Rosati R, Spinelli A, Delrio P, Borghi F, Guerrieri M, Reddavid R. Minimally invasive vs. open segmental resection of the splenic flexure for cancer: a nationwide study of the Italian Society of Surgical Oncology-Colorectal Cancer Network (SICO-CNN). Surg Endosc 2023; 37:977-988. [PMID: 36085382 PMCID: PMC9944710 DOI: 10.1007/s00464-022-09547-6] [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: 03/26/2022] [Accepted: 08/07/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Evidence on the efficacy of minimally invasive (MI) segmental resection of splenic flexure cancer (SFC) is not available, mostly due to the rarity of this tumor. This study aimed to determine the survival outcomes of MI and open treatment, and to investigate whether MI is noninferior to open procedure regarding short-term outcomes. METHODS This nationwide retrospective cohort study included all consecutive SFC segmental resections performed in 30 referral centers between 2006 and 2016. The primary endpoint assessing efficacy was the overall survival (OS). The secondary endpoints included cancer-specific mortality (CSM), recurrence rate (RR), short-term clinical outcomes (a composite of Clavien-Dindo > 2 complications and 30-day mortality), and pathological outcomes (a composite of lymph nodes removed ≧12, and proximal and distal free resection margins length ≧ 5 cm). For these composites, a 6% noninferiority margin was chosen based on clinical relevance estimate. RESULTS A total of 606 patients underwent either an open (208, 34.3%) or a MI (398, 65.7%) SFC segmental resection. At univariable analysis, OS and CSM were improved in the MI group (log-rank test p = 0.004 and Gray's tests p = 0.004, respectively), while recurrences were comparable (Gray's tests p = 0.434). Cox multivariable analysis did not support that OS and CSM were better in the MI group (p = 0.109 and p = 0.163, respectively). Successful pathological outcome, observed in 53.2% of open and 58.3% of MI resections, supported noninferiority (difference 5.1%; 1-sided 95%CI - 4.7% to ∞). Successful short-term clinical outcome was documented in 93.3% of Open and 93.0% of MI procedures, and supported noninferiority as well (difference - 0.3%; 1-sided 95%CI - 5.0% to ∞). CONCLUSIONS Among patients with SFC, the minimally invasive approach met the criterion for noninferiority for postoperative complications and pathological outcomes, and was found to provide results of OS, CSM, and RR comparable to those of open resection.
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Affiliation(s)
- Maurizio Degiuli
- University of Turin, Department of Oncology, San Luigi University Hospital, Div of Surgical Oncology, Orbassano, Turin, Italy. .,Department of Oncology, Head Surgical Oncology and Digestive Surgery, University of Torino, San Luigi University Hospital, Regione Gonzole 10 Orbassano, 10043, Turin, Italy.
| | - Monica Ortenzi
- grid.411490.90000 0004 1759 6306Clinica Chirurgica Universita’ Politecnica delle Marche, Ospedali Riuniti, Ancona, Italy
| | - Mariano Tomatis
- grid.7605.40000 0001 2336 6580BSIT, Department of Oncology, University of Turin, Orbassano, Turin, Italy
| | - Lucia Puca
- grid.7605.40000 0001 2336 6580University of Turin, Department of Oncology, San Luigi University Hospital, Div of Surgical Oncology, Orbassano, Turin, Italy
| | - Desiree Cianflocca
- grid.413179.90000 0004 0486 1959Department of Surgery, S. Croce e Carle Hospital, Cuneo, Italy ,grid.432329.d0000 0004 1789 4477Department of General and Emergency Surgery, Azienda Ospedaliero Universitaria, Città della Salute e della Scienza, Turin, Italy
| | - Daniela Rega
- Colorectal Surgical Oncology, Abdominal Oncology Department, Fondazione Giovanni Pascale IRCCS, Naples, Italy
| | - Annalisa Maroli
- grid.417728.f0000 0004 1756 8807Colon and Rectal Surgery Division, Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56, Rozzano, 20089 Milan, Italy
| | - Ugo Elmore
- grid.15496.3f0000 0001 0439 0892Division of Gastrointestinal Surgery, Vita Salute University, San Raffaele Hospital, 20132 Milan, Italy
| | - Francesca Pecchini
- grid.7548.e0000000121697570Unita’ Operativa di chirurgia generale, d’urgenza e nuove tecnologie, OCSAE, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Marco Milone
- grid.4691.a0000 0001 0790 385XDepartment of Clinical Medicine and Surgery, Department of Gastroenterology, Endocrinology and Endoscopic Surgery, University of Naples “Federico II”, Naples, Italy
| | - Roberta La Mendola
- grid.415200.20000 0004 1760 6068General Surgery Unit, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Erica Soligo
- grid.415230.10000 0004 1757 123XS.C. Chirurgia Generale, Ospedale S. Andrea, Vercelli, Italy
| | - Simona Deidda
- grid.7763.50000 0004 1755 3242Chirurgia Coloproctologica-AOU Cagliari, Dipartimento di Scienze Chirurgiche, Università di Cagliari, Cagliari, Italy
| | - Domenico Spoletini
- grid.416628.f0000 0004 1760 4441UOC Chirurgia Generale, Ospedale S. Eugenio, Piazzale dell’Umanesimo, 10, 00144 Rome, Italy
| | - Diletta Cassini
- Unità Operativa Complessa di Chirurgia Generale, P.O. SSG, ASST NORD MILANO, Milan, Italy
| | - Alessandra Aprile
- grid.410345.70000 0004 1756 7871Surgical Oncology Surgery, IRCCS Policlinico San Martino, Genoa, Italy
| | - Michela Mineccia
- grid.414700.60000 0004 0484 5983Department of General and Oncological Surgery, ”Umberto I” Mauriziano Hospital, Turin, Italy
| | - Herald Nikaj
- grid.412824.90000 0004 1756 8161SCDU Clinica Chirurgica, General Surgery Department, AOU “Maggiore Della Carità” Hospital, Novara, Italy
| | - Francesco Marchegiani
- grid.5608.b0000 0004 1757 3470Department of Surgical, Oncological, and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Fabio Maiello
- Department of Surgery, General Surgery Unit, Hospital of Biella, Biella, Italy
| | - Cristina Bombardini
- Department of Surgical Morphology and Experimental Medicine, AOU Ferrara, Ferrara, Italy
| | - Michele Zuolo
- General Surgery Division, “Valli del Noce” Hospital, Cles, Provincial Agency for Health Services (APSS), Trento, Italy
| | - Michele Carlucci
- grid.18887.3e0000000417581884Gastrointestinal Surgery, San Raffaele Hospital, 20132 Milan, Italy
| | - Luca Ferraro
- grid.4708.b0000 0004 1757 2822Division of General and Robotic Surgery, Dipartimento di Scienze della Salute, Università di Milano, 20142 Milan, Italy
| | - Armando Falato
- General Surgery Unit, San Leonardo Hospital, ASL-NA3sud, Castellammare di Stabbia, Naples, Italy
| | - Alberto Biondi
- grid.414603.4Fondazione Policlinico Gemelli, IRCCS, AREA di Chirurgia Addominale, Rome, Italy
| | - Roberto Persiani
- grid.414603.4Fondazione Policlinico Gemelli, IRCCS, AREA di Chirurgia Addominale, Rome, Italy
| | | | - Daniele Fusario
- grid.9024.f0000 0004 1757 4641UOC General and Oncological Surgery, University of Siena, Siena, Italy
| | - Leonardo Solaini
- grid.415079.e0000 0004 1759 989XGeneral and Oncologic Surgery, Morgagni-Pierantoni Hospital, Ausl Romagna, Forlì, Italy
| | - Sara Pollesel
- grid.414603.4Fondazione Policlinico Universitario A. Gemelli, IRCCS, Chirurgia Generale Presidio Columbus, Rome, Italy
| | - Gianluca Rizzo
- grid.414603.4Fondazione Policlinico Universitario A. Gemelli, IRCCS, Chirurgia Generale Presidio Columbus, Rome, Italy
| | - Claudio Coco
- grid.414603.4Fondazione Policlinico Universitario A. Gemelli, IRCCS, Chirurgia Generale Presidio Columbus, Rome, Italy
| | | | - Davide Cavaliere
- grid.414603.4Department of Surgical Oncology, CRO Aviano, National Cancer Institute, IRCCS, Aviano, Italy
| | - Franco Roviello
- grid.414603.4Fondazione Policlinico Universitario A. Gemelli, IRCCS, Chirurgia Generale Presidio Columbus, Rome, Italy
| | - Andrea Muratore
- Surgical Department, Edoardo Agnelli Hospital, Pinerolo, Italy
| | - Domenico D’Ugo
- grid.414603.4Fondazione Policlinico Gemelli, IRCCS, AREA di Chirurgia Addominale, Rome, Italy
| | - Francesco Bianco
- General Surgery Unit, San Leonardo Hospital, ASL-NA3sud, Castellammare di Stabbia, Naples, Italy
| | - Paolo Pietro Bianchi
- grid.4708.b0000 0004 1757 2822Division of General and Robotic Surgery, Dipartimento di Scienze della Salute, Università di Milano, 20142 Milan, Italy ,grid.415928.3Department of Surgery, Misericordia Hospital, Grosseto, Italy
| | - Paola De Nardi
- grid.4708.b0000 0004 1757 2822Division of General and Robotic Surgery, Dipartimento di Scienze della Salute, Università di Milano, 20142 Milan, Italy
| | - Marco Rigamonti
- General Surgery Division, “Valli del Noce” Hospital, Cles, Provincial Agency for Health Services (APSS), Trento, Italy
| | - Gabriele Anania
- Department of Surgical Morphology and Experimental Medicine, AOU Ferrara, Ferrara, Italy
| | - Claudio Belluco
- grid.414603.4Department of Surgical Oncology, CRO Aviano, National Cancer Institute, IRCCS, Aviano, Italy
| | - Roberto Polastri
- Department of Surgery, General Surgery Unit, Hospital of Biella, Biella, Italy
| | - Salvatore Pucciarelli
- grid.5608.b0000 0004 1757 3470Department of Surgical, Oncological, and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Sergio Gentilli
- grid.412824.90000 0004 1756 8161SCDU Clinica Chirurgica, General Surgery Department, AOU “Maggiore Della Carità” Hospital, Novara, Italy
| | - Alessandro Ferrero
- grid.414700.60000 0004 0484 5983Department of General and Oncological Surgery, ”Umberto I” Mauriziano Hospital, Turin, Italy
| | - Stefano Scabini
- grid.410345.70000 0004 1756 7871Surgical Oncology Surgery, IRCCS Policlinico San Martino, Genoa, Italy
| | - Gianandrea Baldazzi
- Unità Operativa Complessa di Chirurgia Generale, P.O. SSG, ASST NORD MILANO, Milan, Italy
| | - Massimo Carlini
- grid.416628.f0000 0004 1760 4441UOC Chirurgia Generale, Ospedale S. Eugenio, Piazzale dell’umanesimo, 10, 00144 Rome, Italy
| | - Angelo Restivo
- grid.7763.50000 0004 1755 3242Chirurgia Coloproctologica-AOU Cagliari, Dipartimento di Scienze Chirurgiche, Università di Cagliari, Cagliari, Italy
| | - Silvio Testa
- grid.415230.10000 0004 1757 123XS.C. Chirurgia Generale, Ospedale S. Andrea, Vercelli, Italy
| | - Dario Parini
- grid.415200.20000 0004 1760 6068General Surgery Unit, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Giovanni Domenico De Palma
- grid.4691.a0000 0001 0790 385XDepartment of Clinical Medicine and Surgery, Department of Gastroenterology, Endocrinology and Endoscopic Surgery, University of Naples “Federico II”, Naples, Italy
| | - Micaela Piccoli
- grid.7548.e0000000121697570Unita’ Operativa di chirurgia generale, d’urgenza e nuove tecnologie, OCSAE, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Riccardo Rosati
- grid.15496.3f0000 0001 0439 0892Division of Gastrointestinal Surgery, Vita Salute University, San Raffaele Hospital, 20132 Milan, Italy
| | - Antonino Spinelli
- grid.417728.f0000 0004 1756 8807Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56 Rozzano, 20089 Milan, Italy ,grid.452490.eDepartment of Biomedical Science, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Paolo Delrio
- Colorectal Surgical Oncology, Abdominal Oncology Department, Fondazione Giovanni Pascale IRCCS, Naples, Italy
| | - Felice Borghi
- grid.413179.90000 0004 0486 1959Department of Surgery, S. Croce e Carle Hospital, Cuneo, Italy ,grid.419555.90000 0004 1759 7675Oncological Surgery, Candiolo Cancer Institute-FPO-IRCCS, Candiolo, 10060 Torino, Italy
| | - Marco Guerrieri
- grid.411490.90000 0004 1759 6306Clinica Chirurgica Universita’ Politecnica delle Marche, Ospedali Riuniti, Ancona, Italy
| | - Rossella Reddavid
- grid.7605.40000 0001 2336 6580University of Turin, Department of Oncology, San Luigi University Hospital, Div of Surgical Oncology, Orbassano, Turin, Italy
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6
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Giudici R, Lancioni A, Gay H, Bassi G, Chiara O, Mare C, Latronico N, Pesenti A, Faccincani R, Cabrini L, Fumagalli R, Chieregato A, Briani L, Sammartano F, Sechi G, Zoli A, Pagliosa A, Foti G, Borotto E, Palo A, Valoti O, Botteri M, Carlucci M, Reitano E, Bini R. Impact of the COVID-19 outbreak on severe trauma trends and healthcare system reassessment in Lombardia, Italy: an analysis from the regional trauma registry. World J Emerg Surg 2021; 16:39. [PMID: 34281575 PMCID: PMC8287111 DOI: 10.1186/s13017-021-00383-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 07/07/2021] [Indexed: 11/30/2022] Open
Abstract
Backgrounds The COVID-19 pandemic drastically strained the health systems worldwide, obligating the reassessment of how healthcare is delivered. In Lombardia, Italy, a Regional Emergency Committee (REC) was established and the regional health system reorganized, with only three hospitals designated as hubs for trauma care. The aim of this study was to evaluate the effects of this reorganization of regional care, comparing the distribution of patients before and during the COVID-19 outbreak and to describe changes in the epidemiology of severe trauma among the two periods. Methods A cohort study was conducted using retrospectively collected data from the Regional Trauma Registry of Lombardia (LTR). We compared the data of trauma patients admitted to three hub hospitals before the COVID-19 outbreak (September 1 to November 19, 2019) with those recorded during the pandemic (February 21 to May 10, 2020) in the same hospitals. Demographic data, level of pre-hospital care (Advanced Life Support-ALS, Basic Life Support-BLS), type of transportation, mechanism of injury (MOI), abbreviated injury score (AIS, 1998 version), injury severity score (ISS), revised trauma score (RTS), and ICU admission and survival outcome of all the patients admitted to the three trauma centers designed as hubs, were reviewed. Screening for COVID-19 was performed with nasopharyngeal swabs, chest ultrasound, and/or computed tomography. Results During the COVID-19 pandemic, trauma patients admitted to the hubs increased (46.4% vs 28.3%, p < 0.001) with an increase in pre-hospital time (71.8 vs 61.3 min, p < 0.01), while observed in hospital mortality was unaffected. TRISS, ISS, AIS, and ICU admission were similar in both periods. During the COVID-19 outbreak, we observed substantial changes in MOI of severe trauma patients admitted to three hubs, with increases of unintentional (31.9% vs 18.5%, p < 0.05) and intentional falls (8.4% vs 1.2%, p < 0.05), whereas the pandemic restrictions reduced road- related injuries (35.6% vs 60%, p < 0.05). Deaths on scene were significantly increased (17.7% vs 6.8%, p < 0.001). Conclusions The COVID-19 outbreak affected the epidemiology of severe trauma patients. An increase in trauma patient admissions to a few designated facilities with high level of care obtained satisfactory results, while COVID-19 patients overwhelmed resources of most other hospitals.
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Affiliation(s)
- Riccardo Giudici
- Department of Anesthesia and Intensive Care Medicine, ASST Niguarda, Milan, Italy
| | - Armando Lancioni
- Department of Anesthesia and Intensive Care Medicine, University Milano Bicocca, Monza, Italy
| | - Hedwige Gay
- Department of Anesthesia and Intensive Care Medicine, University Milano Bicocca, Monza, Italy
| | - Gabriele Bassi
- Department of Anesthesia and Intensive Care Medicine, ASST Niguarda, Milan, Italy
| | - Osvaldo Chiara
- Emergency Department, General Surgery and Trauma Team, ASST Niguarda, University of Milano, Piazza Ospedale Maggiore 3, 20162, Milano, Italy.
| | - Claudio Mare
- Regional Agency of Emergency and Urgency, Milan, Italy
| | - Nicola Latronico
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.,Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy
| | - Antonio Pesenti
- Department of Anesthesia, Critical Care and Emergency, Fondazione Policlinico, University of Milan, Milan, Italy
| | | | - Luca Cabrini
- Department of Anesthesia and Intensive Care, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy
| | - Roberto Fumagalli
- Department of Anesthesia and Intensive Care Medicine, ASST Niguarda, Milan, Italy.,Department of Anesthesia and Intensive Care Medicine, University Milano Bicocca, Milan, Italy
| | - Arturo Chieregato
- Department of Anesthesia and Intensive Care Medicine, Neuro Intensive Care, ASST Niguarda, Milan, Italy
| | - Laura Briani
- Emergency Department, Department of General Surgery and Trauma Team, ASST Niguarda, Milan, Italy
| | - Fabrizio Sammartano
- Emergency Department, Emergency and Trauma Surgery, ASST Santi Carlo e Paolo, Milan, Italy
| | | | - Alberto Zoli
- Regional Agency of Emergency and Urgency, Milan, Italy
| | | | - Giuseppe Foti
- Department of Anesthesia and Intensive Care Medicine, S.Gerardo Hospital, University Milano Bicocca, Monza, Italy
| | - Erika Borotto
- Department of Anesthesia and Intensive Care, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | | | | | - Marco Botteri
- Regional Agency of Emergency and Urgency, Brescia, Italy
| | - Michele Carlucci
- General and Emergency Surgery and Emergency Department, Ospedale San Raffaele, Milan, Italy
| | - Elisa Reitano
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Roberto Bini
- Emergency Department, Department of General Surgery and Trauma Team, ASST Niguarda, Milan, Italy
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7
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Faccincani R, Trucco P, Nocetti C, Carlucci M, Weinstein ES. Assessing Hospital Adaptive Resource Allocation Strategies in Responding to Mass Casualty Incidents. Disaster Med Public Health Prep 2021; 16:1-9. [PMID: 34114535 DOI: 10.1017/dmp.2021.113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hospitals are expected to operate at a high performance level even under exceptional conditions of peak demand and resource disruptions. This understanding is not mature yet and there are wide areas of possible improvement. In particular, the fast mobilization and reconfiguration of resources frequently result into the severe disruption of elective activities, worsening the quality of care. This becomes particularly evident during the on-going coronavirus disease 2019 (COVID-19) pandemic. More resilient resource allocation strategies, that is, which adapt to the dynamics of the prevailing circumstance, are needed to maximize the effectiveness of health-care delivery. In this study, a simulation approach was adopted to assess and compare different hospital's adaptive resource allocation strategies in responding to a sudden onset disaster mass casualty incident (MCI). METHODS A specific set of performance metrics was developed to take into consideration multiple objectives and priorities and holistically assess the effectiveness of health-care delivery when coping with an MCI event. Discrete event simulation (DES) and system dynamics (SD) were used to model the key hospital processes and the MCI plan. RESULTS In the daytime scenario, during the recovery phase of the disaster, a gradual disengagement of resources from the emergency department (ED) to restart ordinary activities in operating rooms and wards returned the best performance. In the night scenario, the absorption capacity of the ED was evaluated by identifying the current bottleneck and assessment of the benefit of different resource mobilization strategies. CONCLUSIONS The present study offers a robust approach, effective strategies and new insights to design more resilient plans to cope with MCIs. It becomes particularly relevant when considering the risk of indirect damage of emergencies, where all the available resources are shifted from the care of the ordinary to the "disaster" patients, like during the on-going COVID-19 pandemic. Future research is needed to widen the scope of the analysis and take into consideration additional resilience capacities such as operational coordination mechanisms among multiple hospitals in the same geographic area.
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Affiliation(s)
| | - Paolo Trucco
- School of Management, Politecnico di Milano, Milano, Italy
| | | | - Michele Carlucci
- Pronto Soccorso e Chirurgia Generale e delle Urgenze, Ospedale San Raffsele, Milano, Italy
| | - Eric S Weinstein
- Research Center in Emergency and Disaster Medicine, CRIMEDIM, Novara, Italy
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8
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Archibugi L, Mariani A, Ciambriello B, Petrone MC, Rossi G, Testoni SGG, Carlucci M, Aldrighetti L, Falconi M, Balzano G, Doglioni C, Capurso G, Arcidiacono PG. High sensitivity of ROSE-supported ERCP-guided brushing for biliary strictures. Endosc Int Open 2021; 9:E363-E370. [PMID: 33655035 PMCID: PMC7895655 DOI: 10.1055/a-1322-2638] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/21/2020] [Indexed: 01/15/2023] Open
Abstract
Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) plays a major role in biliary strictures, with brushing being a cheap and fast method to acquire a cytological specimen, despite a sensitivity around 45 %. Rapid on-site evaluation (ROSE) is widely used for endoscopic ultrasound-acquired cytological specimen adequacy, improving its sensitivity and specificity. Nevertheless, no study has evaluated its role for ERCP-guided brushing. Our aim was to assess the diagnostic yield of ERCP-guided brushing of biliary strictures when supported by ROSE. Patients and methods This was a retrospective single-center study that included patients undergoing ERCP-guided brush cytology supported by ROSE for biliary strictures. Recorded data included patient clinical-radiological and ERCP features. Final diagnosis was determined after surgery, intraductal biopsy or adequate follow-up. The diagnostic yield was calculated and a subgroup analysis for factors associated with false-negative or true-positive results was performed. Results Two hundred six patients were included, 57.3 % males, median age 72 years, 77.2 % having extrahepatic biliary strictures. Of the patients, 99 % had an adequate sample at ROSE after a mean of 2.6 passages. The diagnostic yield was accuracy 83 %, sensitivity 74.6 %, and specificity 98 %, positive and negative predictive values 98 % and 71 % respectively, with an area under the curve of 0.86. A diagnosis of cholangiocarcinoma was significantly more frequent among true-positive cases (68 % vs 46.8 %; P = 0.04). Conclusions This is the first study evaluating the use of ROSE as support for ERCP-guided brushing of biliary strictures, with a sensitivity far higher than those reported for brushing alone and at least comparable to those of more expensive and invasive techniques.
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Affiliation(s)
- Livia Archibugi
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, Vita-Salute San Raffaele University, Milan, Italy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Mariani
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, Vita-Salute San Raffaele University, Milan, Italy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Maria Chiara Petrone
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, Vita-Salute San Raffaele University, Milan, Italy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gemma Rossi
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, Vita-Salute San Raffaele University, Milan, Italy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sabrina Gloria Giulia Testoni
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, Vita-Salute San Raffaele University, Milan, Italy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Michele Carlucci
- Department of General and Emergency Surgery, Vita-Salute San Raffaele University Milan, Italy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, Vita-Salute San Raffaele University Milan, Italy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Falconi
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, Vita-Salute San Raffaele University Milan, Italy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gianpaolo Balzano
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, Vita-Salute San Raffaele University Milan, Italy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Claudio Doglioni
- Pathology Unit, Pancreas Translational and Clinical Research Center, Vita-Salute San Raffaele University Milan, Italy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gabriele Capurso
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, Vita-Salute San Raffaele University, Milan, Italy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Giorgio Arcidiacono
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, Vita-Salute San Raffaele University, Milan, Italy, IRCCS San Raffaele Scientific Institute, Milan, Italy
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9
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De Cobelli F, Palumbo D, Ciceri F, Landoni G, Ruggeri A, Rovere-Querini P, D'Angelo A, Steidler S, Galli L, Poli A, Fominskiy E, Calabrò MG, Colombo S, Monti G, Nicoletti R, Esposito A, Conte C, Dagna L, Ambrosio A, Scarpellini P, Ripa M, Spessot M, Carlucci M, Montorfano M, Agricola E, Baccellieri D, Bosi E, Tresoldi M, Castagna A, Martino G, Zangrillo A. Pulmonary Vascular Thrombosis in COVID-19 Pneumonia. J Cardiothorac Vasc Anesth 2021; 35:3631-3641. [PMID: 33518461 PMCID: PMC7836419 DOI: 10.1053/j.jvca.2021.01.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/04/2021] [Accepted: 01/06/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVES During severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, dramatic endothelial cell damage with pulmonary microvascular thrombosis have been was hypothesized to occur. The aim was to assess whether pulmonary vascular thrombosis (PVT) is due to recurrent thromboembolism from peripheral deep vein thrombosis or to local inflammatory endothelial damage, with a superimposed thrombotic late complication. DESIGN Observational study. SETTING Medical and intensive care unit wards of a teaching hospital. PARTICIPANTS The authors report a subset of patients included in a prospective institutional study (CovidBiob study) with clinical suspicion of pulmonary vascular thromboembolism. INTERVENTIONS Computed tomography pulmonary angiography and evaluation of laboratory markers and coagulation profile. MEASUREMENTS AND MAIN RESULTS Twenty-eight of 55 (50.9%) patients showed PVT, with a median time interval from symptom onset of 17.5 days. Simultaneous multiple PVTs were identified in 22 patients, with bilateral involvement in 16, mostly affecting segmental/subsegmental pulmonary artery branches (67.8% and 96.4%). Patients with PVT had significantly higher ground glass opacity areas (31.7% [22.9-41] v 17.8% [10.8-22.1], p < 0.001) compared with those without PVT. Remarkably, in all 28 patients, ground glass opacities areas and PVT had an almost perfect spatial overlap. D-dimer level at hospital admission was predictive of PVT. CONCLUSIONS The findings identified a specific radiologic pattern of coronavirus disease 2019 (COVID-19) pneumonia with a unique spatial distribution of PVT overlapping areas of ground-glass opacities. These findings supported the hypothesis of a pathogenetic relationship between COVID-19 lung inflammation and PVT and challenged the previous definition of pulmonary embolism associated with COVID-19 pneumonia.
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Affiliation(s)
- Francesco De Cobelli
- Vita-Salute San Raffaele University, Milan, Italy; Radiology Department, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Diego Palumbo
- Vita-Salute San Raffaele University, Milan, Italy; Radiology Department, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabio Ciceri
- Vita-Salute San Raffaele University, Milan, Italy; Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Landoni
- Vita-Salute San Raffaele University, Milan, Italy; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Annalisa Ruggeri
- Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Patrizia Rovere-Querini
- Vita-Salute San Raffaele University, Milan, Italy; Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Armando D'Angelo
- Vita-Salute San Raffaele University, Milan, Italy; Coagulation Service and Thrombosis Research Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stephanie Steidler
- Radiology Department, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Laura Galli
- Unit of Infectious Diseases, IRCCS, San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Poli
- Unit of Infectious Diseases, IRCCS, San Raffaele Scientific Institute, Milan, Italy
| | - Evgeny Fominskiy
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Grazia Calabrò
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sergio Colombo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giacomo Monti
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberto Nicoletti
- Radiology Department, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Esposito
- Vita-Salute San Raffaele University, Milan, Italy; Radiology Department, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Caterina Conte
- Vita-Salute San Raffaele University, Milan, Italy; Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Dagna
- Vita-Salute San Raffaele University, Milan, Italy; Unit of Immunology, Rheumatology, Allergy, and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Ambrosio
- Clinical Governance, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Scarpellini
- Unit of Infectious Diseases, IRCCS, San Raffaele Scientific Institute, Milan, Italy
| | - Marco Ripa
- Unit of Infectious Diseases, IRCCS, San Raffaele Scientific Institute, Milan, Italy
| | - Marzia Spessot
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Matteo Montorfano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Eustachio Agricola
- Vita-Salute San Raffaele University, Milan, Italy; Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Domenico Baccellieri
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Emanuele Bosi
- Vita-Salute San Raffaele University, Milan, Italy; Unit of General Medicine, Endocrine and Metabolic Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Moreno Tresoldi
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonella Castagna
- Vita-Salute San Raffaele University, Milan, Italy; Unit of Infectious Diseases, IRCCS, San Raffaele Scientific Institute, Milan, Italy
| | - Gianvito Martino
- Vita-Salute San Raffaele University, Milan, Italy; Division of Neuroscience, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Zangrillo
- Vita-Salute San Raffaele University, Milan, Italy; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
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10
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di Filippo L, Formenti AM, Doga M, Frara S, Rovere-Querini P, Bosi E, Carlucci M, Giustina A. Hypocalcemia is a distinctive biochemical feature of hospitalized COVID-19 patients. Endocrine 2021; 71:9-13. [PMID: 33165763 PMCID: PMC7649576 DOI: 10.1007/s12020-020-02541-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 10/27/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Luigi di Filippo
- Institute of Endocrine and Metabolic Sciences, Vita-Salute San Raffaele University and IRCCS San Raffaele Hospital, Milan, Italy
| | - Anna Maria Formenti
- Institute of Endocrine and Metabolic Sciences, Vita-Salute San Raffaele University and IRCCS San Raffaele Hospital, Milan, Italy
| | - Mauro Doga
- Institute of Endocrine and Metabolic Sciences, Vita-Salute San Raffaele University and IRCCS San Raffaele Hospital, Milan, Italy
| | - Stefano Frara
- Institute of Endocrine and Metabolic Sciences, Vita-Salute San Raffaele University and IRCCS San Raffaele Hospital, Milan, Italy
| | - Patrizia Rovere-Querini
- Vita-Salute San Raffaele University and Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Hospital, Milan, Italy
| | - Emanuele Bosi
- Vita-Salute San Raffaele University and Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Hospital, Milan, Italy
| | - Michele Carlucci
- Emergency Department, IRCCS San Raffaele Scientific Hospital, Milan, Italy
| | - Andrea Giustina
- Institute of Endocrine and Metabolic Sciences, Vita-Salute San Raffaele University and IRCCS San Raffaele Hospital, Milan, Italy.
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11
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Gola M, Caggiano G, De Giglio O, Napoli C, Diella G, Carlucci M, Carpagnano LF, D'Alessandro D, Joppolo CM, Capolongo S, Montagna MT. SARS-CoV-2 indoor contamination: considerations on anti-COVID-19 management of ventilation systems, and finishing materials in healthcare facilities. Ann Ig 2020; 33:381-392. [PMID: 33270076 DOI: 10.7416/ai.2020.2396] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Abstract Many of the devastating pandemics and outbreaks of last centuries have been caused by enveloped viruses. The recent pandemic of Coronavirus disease 2019 (COVID-19) has seriously endangered the global health system. In particular, hospitals have had to deal with a frequency in the emergency room and a request for beds for infectious diseases never faced in the last decades. It is well-known that hospitals are environments with a high infectious risk. Environmental control of indoor air and surfaces becomes an important means of limiting the spread of SARS-CoV-2. In particular, to preserve an adequate indoor microbiological quality, an important non-pharmacological strategy is represented by Heating, Ventilation and Air Conditioning (HVAC) systems and finishing materials. Starting from the SARS-CoV-2 transmission routes, the paper investigates the hospital risk analysis and management, the indoor air quality and determination of microbial load, surface management and strategies in cleaning activities, HVAC systems' management and filters' efficiency. In conclusion, the paper suggests some strategies of interventions and best practices to be taken into considerations for the next steps in design and management.
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Affiliation(s)
- M Gola
- Architecture, Built environment and Construction engineering Department and Design & Health LAB, Politecnico di Milano, Milan, Italy
| | - G Caggiano
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - O De Giglio
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - C Napoli
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy
| | - G Diella
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - M Carlucci
- Azienda Ospedaliero-Universitaria Consorziale, Policlinico - "Giovanni XXIII", Bari, Italy
| | - L F Carpagnano
- Azienda Ospedaliero-Universitaria Consorziale, Policlinico - "Giovanni XXIII", Bari, Italy
| | - D D'Alessandro
- Department of Civil Construction and Environmental Engineering, Sapienza University of Rome, Rome, Italy
| | - C M Joppolo
- Department of Energy and Air Lab, Politecnico di Milano, Milan, Italy
| | - S Capolongo
- Architecture, Built environment and Construction engineering Department and Design & Health LAB, Politecnico di Milano, Milan, Italy
| | - M T Montagna
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
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12
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Rovere-Querini P, Tresoldi C, Conte C, Ruggeri A, Ghezzi S, De Lorenzo R, Di Filippo L, Farina N, Ramirez GA, Ripa M, Mancini N, Cantarelli E, Galli L, Poli A, De Cobelli F, Bonini C, Manfredi AA, Franchini S, Spessot M, Carlucci M, Dagna L, Scarpellini P, Ambrosio A, Di Napoli D, Bosi E, Tresoldi M, Lazzarin A, Landoni G, Martino G, Zangrillo A, Poli G, Castagna A, Vicenzi E, Clementi M, Ciceri F. Biobanking for COVID-19 research. Panminerva Med 2020; 64:244-252. [PMID: 33073557 DOI: 10.23736/s0031-0808.20.04168-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Biobanks are imperative infrastructures, particularly during outbreaks, when there is an obligation to acquire and share knowledge as quick as possible to allow for implementation of science-based preventive, diagnostic, prognostic and therapeutic strategies. METHODS We established a COVID-19 biobank with the aim of collecting high-quality and well-annotated human biospecimens, in the effort to understand the pathogenic mechanisms underlying COVID-19 and identify therapeutic targets (COVID-BioB, NCT04318366). Here we describe our experience and briefly review the characteristics of the biobanks for COVID-19 that have been so far established. RESULTS A total of 46,677 samples have been collected from 913 participants (63.3% males, median [IQR] age 62.2 [51.2 - 74.0] years) since the beginning of the program. Most patients (66.9%) had been admitted to hospital for COVID-19, with a median length of stay of 15.0 (9.0 - 27.0) days. A minority of patients (13.3% of the total) had been admitted for other reasons and subsequently tested positive for SARS-CoV-2. The remainder were managed at home after being seen at the Emergency Department. CONCLUSIONS Having a solid research infrastructure already in place, along with flexibility and adaptability to new requirements, allowed for the quick building of a COVID-19 biobank that will help expand and share the knowledge of SARS-CoV-2.
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Affiliation(s)
- Patrizia Rovere-Querini
- Vita-Salute San Raffaele University, Milan, Italy - .,Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy -
| | - Cristina Tresoldi
- Molecular Hematology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Caterina Conte
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Annalisa Ruggeri
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Ghezzi
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | | | | | - Giuseppe A Ramirez
- Vita-Salute San Raffaele University, Milan, Italy.,Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Ripa
- Vita-Salute San Raffaele University, Milan, Italy.,Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicasio Mancini
- Vita-Salute San Raffaele University, Milan, Italy.,Laboratory of Microbiology and Virology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisa Cantarelli
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Laura Galli
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Poli
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco De Cobelli
- Vita-Salute San Raffaele University, Milan, Italy.,Experimental Imaging Center, Radiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Bonini
- Vita-Salute San Raffaele University, Milan, Italy.,Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Angelo A Manfredi
- Vita-Salute San Raffaele University, Milan, Italy.,Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Franchini
- Emergency Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marzia Spessot
- Emergency Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Michele Carlucci
- Emergency Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Dagna
- Vita-Salute San Raffaele University, Milan, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Scarpellini
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Ambrosio
- Clinical Governance Division, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Davide Di Napoli
- Clinical Governance Division, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Emanuele Bosi
- Vita-Salute San Raffaele University, Milan, Italy.,Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Moreno Tresoldi
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Adriano Lazzarin
- Vita-Salute San Raffaele University, Milan, Italy.,Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Landoni
- Vita-Salute San Raffaele University, Milan, Italy.,Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gianvito Martino
- Vita-Salute San Raffaele University, Milan, Italy.,Division of Neuroscience, Institute of Experimental Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Zangrillo
- Vita-Salute San Raffaele University, Milan, Italy.,Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Guido Poli
- Vita-Salute San Raffaele University, Milan, Italy.,Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonella Castagna
- Vita-Salute San Raffaele University, Milan, Italy.,Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisa Vicenzi
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Clementi
- Vita-Salute San Raffaele University, Milan, Italy.,Laboratory of Microbiology and Virology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabio Ciceri
- Vita-Salute San Raffaele University, Milan, Italy.,Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
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13
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Montagna MT, Diella G, De Giglio O, Triggiano F, Carlucci M, Carpagnano FL, Caggiano G. Can beaches and bathing environments represent a risk of spreading COVID-19? Ann Ig 2020; 32:593-596. [PMID: 32744590 DOI: 10.7416/ai.2020.2379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- M T Montagna
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Italy
| | - G Diella
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Italy
| | - O De Giglio
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Italy
| | - F Triggiano
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Italy
| | - M Carlucci
- Medical Director, A.O.U. Policlinico di Bari Aldo Moro, Italy
| | - F L Carpagnano
- MD in Public Health Residency Training, University of Bari Aldo Moro, Italy
| | - G Caggiano
- Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Italy
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14
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Ciceri F, Castagna A, Rovere-Querini P, De Cobelli F, Ruggeri A, Galli L, Conte C, De Lorenzo R, Poli A, Ambrosio A, Signorelli C, Bossi E, Fazio M, Tresoldi C, Colombo S, Monti G, Fominskiy E, Franchini S, Spessot M, Martinenghi C, Carlucci M, Beretta L, Scandroglio AM, Clementi M, Locatelli M, Tresoldi M, Scarpellini P, Martino G, Bosi E, Dagna L, Lazzarin A, Landoni G, Zangrillo A. Early predictors of clinical outcomes of COVID-19 outbreak in Milan, Italy. Clin Immunol 2020; 217:108509. [PMID: 32535188 PMCID: PMC7289745 DOI: 10.1016/j.clim.2020.108509] [Citation(s) in RCA: 197] [Impact Index Per Article: 49.3] [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: 05/25/2020] [Revised: 06/07/2020] [Accepted: 06/10/2020] [Indexed: 01/08/2023]
Abstract
Background National health-system hospitals of Lombardy faced a heavy burden of admissions for acute respiratory distress syndromes associated with coronavirus disease (COVID-19). Data on patients of European origin affected by COVID-19 are limited. Methods All consecutive patients aged ≥18 years, coming from North-East of Milan's province and admitted at San Raffaele Hospital with COVID-19, between February 25th and March 24th, were reported, all patients were followed for at least one month. Clinical and radiological features at admission and predictors of clinical outcomes were evaluated. Results Of the 500 patients admitted to the Emergency Unit, 410 patients were hospitalized and analyzed: median age was 65 (IQR 56–75) years, and the majority of patients were males (72.9%). Median (IQR) days from COVID-19 symptoms onset was 8 (5–11) days. At hospital admission, fever (≥ 37.5 °C) was present in 67.5% of patients. Median oxygen saturation (SpO2) was 93% (range 60–99), with median PaO2/FiO2 ratio, 267 (IQR 184–314). Median Radiographic Assessment of Lung Edema (RALE) score was 9 (IQR 4–16). More than half of the patients (56.3%) had comorbidities, with hypertension, coronary heart disease, diabetes and chronic kidney failure being the most common. The probability of overall survival at day 28 was 66%. Multivariable analysis showed older age, coronary artery disease, cancer, low lymphocyte count and high RALE score as factors independently associated with an increased risk of mortality. Conclusion In a large cohort of COVID-19 patients of European origin, main risk factors for mortality were older age, comorbidities, low lymphocyte count and high RALE.
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Affiliation(s)
- Fabio Ciceri
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Antonella Castagna
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Patrizia Rovere-Querini
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco De Cobelli
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Laura Galli
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Caterina Conte
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Rebecca De Lorenzo
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Poli
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Carlo Signorelli
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Eleonora Bossi
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Fazio
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | | | - Giacomo Monti
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | | | | | | | | | - Luigi Beretta
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Massimo Clementi
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | | | | | - Gianvito Martino
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Emanuele Bosi
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Dagna
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Adriano Lazzarin
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Landoni
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Zangrillo
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy
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15
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Di Filippo L, Formenti AM, Rovere-Querini P, Carlucci M, Conte C, Ciceri F, Zangrillo A, Giustina A. Hypocalcemia is highly prevalent and predicts hospitalization in patients with COVID-19. Endocrine 2020; 68:475-478. [PMID: 32533508 PMCID: PMC7292572 DOI: 10.1007/s12020-020-02383-5] [Citation(s) in RCA: 121] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 06/03/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Luigi Di Filippo
- Department of Endocrinology, Vita-Salute San Raffaele University and IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Anna Maria Formenti
- Department of Endocrinology, Vita-Salute San Raffaele University and IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Patrizia Rovere-Querini
- Vita-Salute San Raffaele University and Division of Transplantation, Immunology and Transplantation Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Michele Carlucci
- Emergency Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Caterina Conte
- Vita-Salute San Raffaele University and Division of Transplantation, Immunology and Transplantation Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabio Ciceri
- Vita-Salute San Raffaele University and Division of Transplantation, Immunology and Transplantation Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Zangrillo
- Department of Anesthesia and Intensive Care, Vita-Salute San Raffaele University and IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Giustina
- Department of Endocrinology, Vita-Salute San Raffaele University and IRCCS San Raffaele Scientific Institute, Milan, Italy.
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16
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Abstract
Abstract
Introduction
Adolescence is associated with sleep regulatory changes that prompt sleep and circadian timing to shift later (delay). Poor quality, insufficient sleep, and misaligned sleep-wake schedules increase adolescents’ risk for physical and mental health consequences. Little data exists on potential sleep health risks and sleep-wake environments of juvenile justice facilities. This descriptive study examined the sleep-wake environment and daily schedules at juvenile detention and treatment centers in a Mid-Atlantic state.
Methods
Using our Sleep Justice Observational Checklist, researchers recorded number of windows in sleep and non-sleep areas, and number of beds in sleeping quarters. Illuminance was measured with a light meter during the daytime (standing, sitting, etc.) and averaged. Facility-level 24-hour schedules were obtained to determine youth’s daily routines during the observation period.
Results
In comparison to treatment centers, detention centers have earlier lights-on (MDet = 6:07 am, SDDet =:40 vs. MTreat = 6:54 am, SDTreat =:07, p = .04) and lights-off (MDet = 8:42 pm, SDDet =:36 vs. MTreat = 9:06 pm, SDTreat =:19, N.S.) times. Treatment center illuminance levels (M = 296.60 lux, SD = 150.30) were greater (brighter) compared to detention centers (M = 124.00 lux, SD = 60.40, p = .01). Per sleep area, treatment centers had more windows (MTreat = 7.84, SDTreat = 6.70 vs. MDet = 1.73, SDDet = .77, p = .02) and more beds (MTreat = 13.30, SDTreat = 14.00 vs. MDet = 1.46, SDDet = .96, p = .03) than detention centers.
Conclusion
Preliminary results indicate a variation in the sleep-wake environments and daily schedules in this sample of juvenile justice centers. Early lights-on and lights-off times can impose a higher risk for circadian misalignment in adolescents, though schedule consistency may reduce this risk. Ongoing data collection will help to further understand the sleep environment of adolescents in the juvenile justice system.
Support
Kolvenbach Research Grant, Loyola University Maryland
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Affiliation(s)
| | - M Carlucci
- Loyola University Maryland, Baltimore, MD
| | - S J Crowley
- Rush Medical University Medical Center, Chicago, IL
| | - C M Fleshman
- Warren Alpert Medical School of Brown, Providence, RI
| | - S L Jobe
- University of Maryland School of Medicine, Baltimore, MD
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17
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Coimbra R, Edwards S, Kurihara H, Bass GA, Balogh ZJ, Tilsed J, Faccincani R, Carlucci M, Martínez Casas I, Gaarder C, Tabuenca A, Coimbra BC, Marzi I. European Society of Trauma and Emergency Surgery (ESTES) recommendations for trauma and emergency surgery preparation during times of COVID-19 infection. Eur J Trauma Emerg Surg 2020; 46:505-510. [PMID: 32303798 PMCID: PMC7164519 DOI: 10.1007/s00068-020-01364-7] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [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: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 02/07/2023]
Abstract
A series of recommendations regarding hospital perioperative preparation for the COVID-19 pandemic were compiled to inform surgeons worldwide on how to provide emergency surgery and trauma care during enduring times.The recommendations are divided into eight domains: (1) General recommendation for surgical services; (2) Emergency Surgery for critically ill COVID-19 positive or suspected patients -Preoperative planning and case selection; (3) Operating Room setup; (4) patient transport to the OR; (5) Surgical staff preparation; (6) Anesthesia considerations; (7) Surgical approach; and (8) Case Completion.The European Society of Emergency Surgery board endorsed these recommendations.
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Affiliation(s)
- Raul Coimbra
- Comparative Effectiveness and Clinical Outcomes Research Center-CECORC, Riverside University Health System Medical Center, Moreno Valley, CA, USA. .,Loma Linda University School of Medicine, Loma Linda, USA.
| | - Sara Edwards
- Comparative Effectiveness and Clinical Outcomes Research Center-CECORC, Riverside University Health System Medical Center, Moreno Valley, CA, USA
| | - Hayato Kurihara
- Emergency Surgery and Trauma Unit, Department of Surgery, Humanitas Research Hospital, Milan, Italy
| | - Gary Alan Bass
- Department of Surgery, Tallaght University Hospital, Dublin, Ireland
| | - Zsolt J Balogh
- John Hunter Hospital and Hunter New England Health, University of Newcastle, Newcastle, NSW, Australia
| | | | | | | | | | - Christine Gaarder
- Department of Traumatology, Oslo University Hospital Ulleval, Oslo, Norway
| | - Arnold Tabuenca
- Comparative Effectiveness and Clinical Outcomes Research Center-CECORC, Riverside University Health System Medical Center, Moreno Valley, CA, USA
| | - Bruno C Coimbra
- Comparative Effectiveness and Clinical Outcomes Research Center-CECORC, Riverside University Health System Medical Center, Moreno Valley, CA, USA
| | - Ingo Marzi
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt, Germany
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18
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Franchini S, Scarallo L, Carlucci M, Cabrini L, Tresoldi M. SIRS or qSOFA? Is that the question? Clinical and methodological observations from a meta-analysis and critical review on the prognostication of patients with suspected sepsis outside the ICU. Intern Emerg Med 2019; 14:593-602. [PMID: 30324278 DOI: 10.1007/s11739-018-1965-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 10/06/2018] [Indexed: 12/29/2022]
Abstract
The purpose of the study was to assess the prognostic performances, in terms of in-hospital mortality, of the quick sequential organ failure assessment (qSOFA) score and the systemic inflammatory response syndrome (SIRS) criteria applied to patients with suspected infection outside the ICU, and to critically reappraise the results and the clinical impact of the SEPSIS-3 study and of the subsequent trials. We performed bivariate meta-analysis, evaluation of the Bayesian post-test probabilities of death, and computation of the unidentified deaths for every 1000 screened cases (UDS1000). The use of qSOFA for screening instead of the SIRS implies a relevant increase in the UDS1000. However, this difference appears far smaller in the SEPSIS-3 study, largely due to an underestimation of SIRS sensitivity. The increment in the pre-test probability of death implied by a positive qSOFA is higher than that implied by a positivity of the SIRS. However, the included studies use highly variable definitions of "suspected sepsis" and carry very high levels of heterogeneity. SIRS overperforms qSOFA as a rule-out tool for mortality, while qSOFA shows a higher rule-in power. However, the evident lack of consistency across the published studies undermines the significance of both the meta-analytic approach and the reproducibility of the outcomes, and demands for a standardized definition of the target population.
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Affiliation(s)
- Stefano Franchini
- Emergency Department, Ospedale San Raffaele Scientific Institute, Pronto Soccorso, Via Olgettina 60, 20132, Milan, Italy.
| | - Luca Scarallo
- Faculty of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, 20132, Milan, Italy
| | - Michele Carlucci
- Emergency Department, Ospedale San Raffaele Scientific Institute, Pronto Soccorso, Via Olgettina 60, 20132, Milan, Italy
- Department of General and Emergency Surgery, Ospedale San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Luca Cabrini
- Department of Anaesthesia and Intensive Care, Ospedale San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Moreno Tresoldi
- Unit of General Medicine and Advanced Care, Ospedale San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
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Redondo MJ, Geyer S, Steck AK, Sharp S, Wentworth JM, Weedon MN, Antinozzi P, Sosenko J, Atkinson M, Pugliese A, Oram RA, Antinozzi P, Atkinson M, Battaglia M, Becker D, Bingley P, Bosi E, Buckner J, Colman P, Gottlieb P, Herold K, Insel R, Kay T, Knip M, Marks J, Moran A, Palmer J, Peakman M, Philipson L, Pugliese A, Raskin P, Rodriguez H, Roep B, Russell W, Schatz D, Wherrett D, Wilson D, Winter W, Ziegler A, Benoist C, Blum J, Chase P, Clare-Salzler M, Clynes R, Eisenbarth G, Fathman C, Grave G, Hering B, Kaufman F, Leschek E, Mahon J, Nanto-Salonen K, Nepom G, Orban T, Parkman R, Pescovitz M, Peyman J, Roncarolo M, Simell O, Sherwin R, Siegelman M, Steck A, Thomas J, Trucco M, Wagner J, Greenbaum ,CJ, Bourcier K, Insel R, Krischer JP, Leschek E, Rafkin L, Spain L, Cowie C, Foulkes M, Krause-Steinrauf H, Lachin JM, Malozowski S, Peyman J, Ridge J, Savage P, Skyler JS, Zafonte SJ, Kenyon NS, Santiago I, Sosenko JM, Bundy B, Abbondondolo M, Adams T, Amado D, Asif I, Boonstra M, Bundy 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P, Dinning L, Rahman S, Ray S, Dimicri C, Guppy S, Nielsen H, Vogel C, Ariza C, Morales L, Chang Y, Gabbay R, Ambrocio L, Manley L, Nemery R, Charlton W, Smith P, Kerr L, Steindel-Kopp B, Alamaguer M, Tabisola-Nuesca E, Pendersen A, Larson N, Cooper-Olviver H, Chan D, Fitz-Patrick D, Carreira T, Park Y, Ruhaak R, Liljenquist D. A Type 1 Diabetes Genetic Risk Score Predicts Progression of Islet Autoimmunity and Development of Type 1 Diabetes in Individuals at Risk. Diabetes Care 2018; 41:1887-1894. [PMID: 30002199 PMCID: PMC6105323 DOI: 10.2337/dc18-0087] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 06/06/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We tested the ability of a type 1 diabetes (T1D) genetic risk score (GRS) to predict progression of islet autoimmunity and T1D in at-risk individuals. RESEARCH DESIGN AND METHODS We studied the 1,244 TrialNet Pathway to Prevention study participants (T1D patients' relatives without diabetes and with one or more positive autoantibodies) who were genotyped with Illumina ImmunoChip (median [range] age at initial autoantibody determination 11.1 years [1.2-51.8], 48% male, 80.5% non-Hispanic white, median follow-up 5.4 years). Of 291 participants with a single positive autoantibody at screening, 157 converted to multiple autoantibody positivity and 55 developed diabetes. Of 953 participants with multiple positive autoantibodies at screening, 419 developed diabetes. We calculated the T1D GRS from 30 T1D-associated single nucleotide polymorphisms. We used multivariable Cox regression models, time-dependent receiver operating characteristic curves, and area under the curve (AUC) measures to evaluate prognostic utility of T1D GRS, age, sex, Diabetes Prevention Trial-Type 1 (DPT-1) Risk Score, positive autoantibody number or type, HLA DR3/DR4-DQ8 status, and race/ethnicity. We used recursive partitioning analyses to identify cut points in continuous variables. RESULTS Higher T1D GRS significantly increased the rate of progression to T1D adjusting for DPT-1 Risk Score, age, number of positive autoantibodies, sex, and ethnicity (hazard ratio [HR] 1.29 for a 0.05 increase, 95% CI 1.06-1.6; P = 0.011). Progression to T1D was best predicted by a combined model with GRS, number of positive autoantibodies, DPT-1 Risk Score, and age (7-year time-integrated AUC = 0.79, 5-year AUC = 0.73). Higher GRS was significantly associated with increased progression rate from single to multiple positive autoantibodies after adjusting for age, autoantibody type, ethnicity, and sex (HR 2.27 for GRS >0.295, 95% CI 1.47-3.51; P = 0.0002). CONCLUSIONS The T1D GRS independently predicts progression to T1D and improves prediction along T1D stages in autoantibody-positive relatives.
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Affiliation(s)
- Maria J. Redondo
- Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
| | | | - Andrea K. Steck
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Seth Sharp
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
| | - John M. Wentworth
- Walter and Eliza Hall Institute of Medical Research and Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Michael N. Weedon
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
| | | | | | | | | | - Richard A. Oram
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
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| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | 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20
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Stabilini C, Cavallaro G, Bocchi P, Campanelli G, Carlucci M, Ceci F, Crovella F, Cuccurullo D, Fei L, Gianetta E, Gossetti F, Greco DP, Iorio O, Ipponi P, Marioni A, Merola G, Negro P, Palombo D, Bracale U. Defining the characteristics of certified hernia centers in Italy: The Italian society of hernia and abdominal wall surgery workgroup consensus on systematic reviews of the best available evidences. Int J Surg 2018; 54:222-235. [PMID: 29730074 DOI: 10.1016/j.ijsu.2018.04.052] [Citation(s) in RCA: 18] [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: 03/08/2018] [Revised: 04/06/2018] [Accepted: 04/28/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The terms "Hernia Center" (HC) and Hernia Surgeon" (HS) have gained more and more popularity in recent years. Nevertheless, there is lack of protocols and methods for certification of their activities and results. The Italian Society of Hernia and Abdominal Wall Surgery proposes a method for different levels of certification. METHODS The national board created a commission, with the task to define principles and structure of an accreditation program. The discussion of each topic was preceded by a Systematic Review, according to PRISMA Guidelines and Methodology. In case of lack or inadequate data from literature, the parameter was fixed trough a Commission discussion. RESULTS The Commission defined a certification process including: "FLC - First level Certification": restricted to single surgeon, it is given under request and proof of a formal completion of the learning curve process for the basic procedures and an adequate year volume of operations. "Second level certification": Referral Center for Abdominal Wall Surgery. It is a public or private structure run by at least two already certified and confirmed FLC surgeons. "Third level certification": High Specialization Center for Abdominal Wall Surgery. It is a public or private structure, already confirmed as Referral Centers, run by at least three surgeons (two certified and confirmed with FLC and one research fellow in abdominal wall surgery). Both levels of certification have to meet the Surgical Requirements and facilities criteria fixed by the Commission. CONCLUSION The creation of different types of Hernia Centers is directed to create two different entities offering the same surgical quality with separate mission: the Referral Center being more dedicated to clinical and surgical activity and High Specialization Centers being more directed to scientific tasks.
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Affiliation(s)
| | | | | | | | - Michele Carlucci
- Department of General and Emergency Surgery, IRCCS San Raffaele, Milan, Italy
| | - Francesca Ceci
- Department of Surgery "P. Stefanini", Sapienza University, Rome, Italy
| | | | - Diego Cuccurullo
- Department of General, Laparoscopic, and Robotic Surgery, Ospedale Monaldi, Azienda Ospedaliera Dei Colli, Naples, Italy
| | - Landino Fei
- Department of Anaesthesiological, Surgical and Emergency Sciences, Second University of Naples, Italy
| | - Ezio Gianetta
- Department of Surgical Sciences, University of Genoa, Italy
| | | | | | - Olga Iorio
- General Surgery Unit, Aprilia Hospital, Aprilia (RM), Italy
| | - Pierluigi Ipponi
- General Surgery Unit, San Giovanni di Dio Hospital, Florence, Italy
| | | | - Giovanni Merola
- Department of Surgical Spaciailties and Nephrology, Federico II University, Naples, Italy
| | - Paolo Negro
- Department of Surgery "P. Stefanini", Sapienza University, Rome, Italy
| | - Denise Palombo
- Department of Surgical Sciences, University of Genoa, Italy
| | - Umberto Bracale
- Department of Surgical Spaciailties and Nephrology, Federico II University, Naples, Italy
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21
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Fossati V, Cattaneo GM, Zerbi A, Galli L, Bordogna G, Reni M, Parolini D, Carlucci M, Bissi A, Staudacher C. The Role of Intraoperative Therapy by Electron Beam and Combination of Adjuvant Chemotherapy and External Radiotherapy in Carcinoma of the Pancreas. Tumori 2018; 81:23-31. [PMID: 7754537 DOI: 10.1177/030089169508100106] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background In the treatment of pancreatic carcinomas, one modality is intraoperative radiotherapy (IORT). A study was carried out to assess the feasibility of IORT alone or in a multimodality approach with postoperative adjuvant chemotherapy and external radiotherapy and to compare local control and survival of patients. Another objective of this retrospective study was to verify prognostic factors in resected patients treated with IORT. Methods From January 1985 through September 1992, 54 adenocarcinomas of the pancreas (unresectable and resected patients) were treated with IORT by electron beam at the San Raffaele Hospital and then analyzed. Comparison was also carried out between IORT-treated resected patients and a non-randomized control group of resected patients treated without IORT in the same period. Results In unresectable patients treated by laparotomy bypass and IORT, overall median survival was 6 months and 8 months in non-metastatic patients. Relief of severe pain present in 14 patients was observed in 85% within 12 days of IORT. As regards resected patients, the most important finding was that significantly better local control resulted from IORT. In fact, overall, local relapses were 25% in the IORT group and 55.8% in the non-IORT group (control group); instead, survival of the IORT group was not significantly longer than that of the control group. From a statistical analysis of resected patients treated with IORT and performed on prognostic factors on the basis of available data, survival was significantly influenced by tumor pathologic grading and diameter; postoperative adjuvant therapy was not a significant prognosis factor. Conclusions IORT has a role in local control of unresectable pancreatic carcinomas and in control of resultant severe pain. In resected patients, IORT is effective in decreasing local recurrences but has little impact on survival. To obtain more satisfactory results, new and more effective adjuvant therapies and better abdominal prophylaxis should be tested.
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Affiliation(s)
- V Fossati
- Radiation-Oncology Department, Istituto Nazionale Tumori, Milan, Italy
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22
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Bonanno L, Attili I, Zulato E, Nardo G, Verza M, Pavan A, Del Bianco P, Pasello G, Zago G, Polo V, Frega S, Milite N, Carlucci M, Calabrese F, De Salvo G, Conte P, Indraccolo S. P3.02-006 Monitoring Genetic Alterations in Plasma during Anti-Cancer Treatment in Advanced NSCLC (MAGIC1-Validation Cohort: Preliminary Results). J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1535] [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: 10/18/2022]
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23
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Lupi M, Acciavatti T, Marini S, Cinosi E, Santacroce R, Corbo M, Mancini V, Galanti T, Carlucci M, Martinotti G, Di Giannantonio M. Novel psychoactive substances in a psychiatric young adults sample: A multicenter, observational study. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.02.214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
IntroductionComorbidities between psychiatric diseases and consumption of traditional substances of abuse are common. Nevertheless, there is no data regarding the use of novel psychoactive substances (NPS) in the psychiatric population.ObjectivesThe purpose of this multicentre survey is to investigate the consumption of a wide variety of psychoactive substances in a young psychiatric sample.MethodsBetween September 2013 and November 2015, a questionnaire has been administered, in ten Italian psychiatric care facilities, to a sample of 671 psychiatric patients (48.5% men; 51.5% women), aged between 18 and 26 years (mean age: 22.24).Results8.2% of the sample declared use of NPS at least once in a lifetime and 2.2% have assumed NPS in the last three months. The NPS more used were synthetic cannabinoids (4.5%), followed by methamphetamine (3.6%). The three psychiatric diagnosis with more frequent NPS consumption were bipolar disorder (23.1%), personality disorders (11.8%) and schizophrenia and related disorders (11.6%). Bipolar disorder was associated with NPS consumption (P < .001). Among the illicit drugs investigated, 31.4% of the sample was cannabis smoker and 10.7% cocaine user. Moreover, 70.6% of the sample declared alcohol use and 47.7% had binge drinking conducts. In univariate regression analysis, bipolar disorder was positive associated with binge drinking while obsessive compulsive disorder resulted negative associated.ConclusionsThe use of novel psychoactive substances in a young psychiatric population appears to be a frequent phenomenon, probably still underestimated. Bipolar disorder shows an association with NPS use. Therefore, careful and constant monitoring and accurate evaluations of possible clinical effects related to their use are necessary.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Salvati L, Kosmas C, Kairis O, Karavitis C, Acikalin S, Belgacem A, Solé-Benet A, Chaker M, Fassouli V, Gokceoglu C, Gungor H, Hessel R, Khatteli H, Kounalaki A, Laouina A, Ocakoglu F, Ouessar M, Ritsema C, Sghaier M, Sonmez H, Taamallah H, Tezcan L, de Vente J, Kelly C, Colantoni A, Carlucci M. Assessing the effectiveness of sustainable land management policies for combating desertification: A data mining approach. J Environ Manage 2016; 183:754-762. [PMID: 27649608 DOI: 10.1016/j.jenvman.2016.09.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 01/12/2016] [Revised: 08/26/2016] [Accepted: 09/03/2016] [Indexed: 06/06/2023]
Abstract
This study investigates the relationship between fine resolution, local-scale biophysical and socioeconomic contexts within which land degradation occurs, and the human responses to it. The research draws on experimental data collected under different territorial and socioeconomic conditions at 586 field sites in five Mediterranean countries (Spain, Greece, Turkey, Tunisia and Morocco). We assess the level of desertification risk under various land management practices (terracing, grazing control, prevention of wildland fires, soil erosion control measures, soil water conservation measures, sustainable farming practices, land protection measures and financial subsidies) taken as possible responses to land degradation. A data mining approach, incorporating principal component analysis, non-parametric correlations, multiple regression and canonical analysis, was developed to identify the spatial relationship between land management conditions, the socioeconomic and environmental context (described using 40 biophysical and socioeconomic indicators) and desertification risk. Our analysis identified a number of distinct relationships between the level of desertification experienced and the underlying socioeconomic context, suggesting that the effectiveness of responses to land degradation is strictly dependent on the local biophysical and socioeconomic context. Assessing the latent relationship between land management practices and the biophysical/socioeconomic attributes characterizing areas exposed to different levels of desertification risk proved to be an indirect measure of the effectiveness of field actions contrasting land degradation.
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Affiliation(s)
- L Salvati
- Italian Council of Agricultural Research and Economics (CREA), Rome, Italy
| | - C Kosmas
- Agricultural University of Athens, Greece.
| | - O Kairis
- Agricultural University of Athens, Greece
| | | | | | | | - A Solé-Benet
- Estacion Experimental de Zonas Áridas (EEZA-CSIC), Spain
| | - M Chaker
- University of Mohamed V, Chair UNESCO-GN, Morocco
| | - V Fassouli
- Agricultural University of Athens, Greece
| | | | - H Gungor
- Eskisehir Osmangazi University, Turkey
| | - R Hessel
- Alterra, Wageningen UR, Netherlands
| | | | | | - A Laouina
- University of Mohamed V, Chair UNESCO-GN, Morocco
| | | | - M Ouessar
- Institut des Regions Arides, Tunisia
| | | | - M Sghaier
- Institut des Regions Arides, Tunisia
| | - H Sonmez
- Eskisehir Osmangazi University, Turkey
| | | | - L Tezcan
- Eskisehir Osmangazi University, Turkey
| | - J de Vente
- Estacion Experimental de Zonas Áridas (EEZA-CSIC), Spain
| | - C Kelly
- Department of Geography, University of Plymouth, United Kingdom
| | - A Colantoni
- Department of Agricultural and Forestry scieNcEs (D.A.F.N.E.), Viterbo, Italy
| | - M Carlucci
- University of Rome 'La Sapienza', Department of Social and Economic Science, Rome, Italy
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25
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Eerland A, Sherrill AM, Magliano JP, Zwaan RA, Arnal JD, Aucoin P, Berger SA, Birt AR, Capezza N, Carlucci M, Crocker C, Ferretti TR, Kibbe MR, Knepp MM, Kurby CA, Melcher JM, Michael SW, Poirier C, Prenoveau JM. Registered Replication Report. Perspect Psychol Sci 2016; 11:158-71. [DOI: 10.1177/1745691615605826] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Language can be viewed as a complex set of cues that shape people’s mental representations of situations. For example, people think of behavior described using imperfective aspect (i.e., what a person was doing) as a dynamic, unfolding sequence of actions, whereas the same behavior described using perfective aspect (i.e., what a person did) is perceived as a completed whole. A recent study found that aspect can also influence how we think about a person’s intentions (Hart & Albarracín, 2011). Participants judged actions described in imperfective as being more intentional ( d between 0.67 and 0.77) and they imagined these actions in more detail ( d = 0.73). The fact that this finding has implications for legal decision making, coupled with the absence of other direct replication attempts, motivated this registered replication report (RRR). Multiple laboratories carried out 12 direct replication studies, including one MTurk study. A meta-analysis of these studies provides a precise estimate of the size of this effect free from publication bias. This RRR did not find that grammatical aspect affects intentionality ( d between 0 and −0.24) or imagery ( d = −0.08). We discuss possible explanations for the discrepancy between these results and those of the original study.
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26
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Pini Prato A, Carlucci M, Bagolan P, Gamba PG, Bernardi M, Leva E, Paradies G, Manzoni C, Noccioli B, Tramontano A, Jasonni V, Vaccarella F, De Pascale S, Alberti D, Riccipetitoni G, Falchetti D, Caccia F, Pelizzo G, Schleef J, Lima M, Andriolo P, Franchella A, Cacciari A, Caravaggi F, Federici S, Andermarcher M, Perrino G, Codrich D, Camoglio FS, Chiarenza FS, Martino A, Appignani A, Briganti V, Caterino S, Cozzi D, Messina M, Rizzo A, Liotta L, Salerno D, Aceti MGR, Bartoli F, Romeo C, Esposito C, Lelli Chiesa PL, Clemente E, Mascia L, Cacciaguerra S, Di Benedetto V, Licciardi S, De Grazia E, Ubertazzi M, Piazza G, Mattioli G, Rossi F, Nobili M. A cross-sectional nationwide survey on esophageal atresia and tracheoesophageal fistula. J Pediatr Surg 2015; 50:1441-56. [PMID: 25783403 DOI: 10.1016/j.jpedsurg.2015.01.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 01/07/2015] [Accepted: 01/09/2015] [Indexed: 01/29/2023]
Abstract
BACKGROUND Our study aims at disclosing epidemiology and most relevant clinical features of esophageal atresia (EA) pointing to a model of multicentre collaboration. METHODS A detailed questionnaire was sent to all Italian Units of pediatric surgery in order to collect data of patients born with EA between January and December 2012. The results were crosschecked by matching date and place of birth of the patients with those of diagnosis-related group provided by the Italian Ministry of Health (MOH). RESULTS A total of 146 questionnaires were returned plus a further 32 patients reported in the MOH database. Basing on a total of 178 patients with EA born in Italy in 2012, the incidence of EA was calculated in 3.33 per 10,000 live births. Antenatal diagnosis was suspected in 29.5% patients. 55.5% showed associated anomalies. The most common type of EA was Gross type C (89%). Postoperative complications occurred in 37% of type C EA and 100% of type A EA. A 9.5% mortality rate was reported. CONCLUSIONS This is the first Italian cross-sectional nationwide survey on EA. We can now develop shared guidelines and provide more reliable prognostic expectations for our patients.
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Affiliation(s)
| | - M Carlucci
- Istituto Giannina Gaslini, Genova, Italy
| | - P Bagolan
- Ospedale Pediatrico Bambino Gesù, Roma, Italy
| | - P G Gamba
- Azienda Ospedaliero-Universitaria, Padova, Italy
| | - M Bernardi
- Azienda Ospedaliera della Provincia di Lecco, Merate, Italy
| | - E Leva
- Ospedale Maggiore Policlinico Magiagalli, Milano, Italy
| | | | | | - B Noccioli
- Ospedale Pediatrico Meyer, Firenze, Italy
| | - A Tramontano
- Azienda Ospedaliera Pediatrica Santobono Pausilipon, Napoli, Italy
| | - V Jasonni
- Istituto Giannina Gaslini, Genova, Italy; Università degli Studi di Genova, Genova, Italy
| | - F Vaccarella
- ASN SS: Antonio e Biagio e Cesare Arrigo, Alessandria
| | | | | | | | | | - F Caccia
- Ospedale San Carlo Borromeo, Milano
| | | | - J Schleef
- Ospedale Infantile Regina Margherita, Torino
| | - M Lima
- Ospedale Sant'Orsola Malpighi, Bologna
| | | | | | | | | | | | | | | | - D Codrich
- Ospedale Infantile Burlo Garofalo, Trieste
| | | | | | | | - A Appignani
- Ospedale Santa Maria della Misericordia, Perugia
| | | | | | | | - M Messina
- Ospedale Policlinico Santa Maria alle Scotte, Siena
| | | | - L Liotta
- Ospedale Francesco Ferrari, Casarano
| | - D Salerno
- Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro
| | | | - F Bartoli
- Azienda Ospedaliera Universitaria-Ospedali Riuniti, Foggia
| | - C Romeo
- Azienda Ospedaliero-Universitaria G. Martino, Messina
| | - C Esposito
- Policlinico Universitario Federico II, Napoli
| | | | - E Clemente
- Azienda Ospedaliera Universitaria S. Giovanni di Dio e Ruggi d'Aragona, Salerno
| | | | | | | | | | - E De Grazia
- Azienda Ospedaliero-Universitaria Policlinico P. Giaccone
| | | | - G Piazza
- Ospedale Sant'Antonio Abate, Trapani
| | | | - F Rossi
- Ospedale Maggiore della carità, Novara
| | - M Nobili
- Azienda Ospedaliera Universitaria-Ospedali Riuniti, Foggia
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Mattioli G, Barabino A, Aloi M, Arrigo S, Caldaro T, Carlucci M, Cucchiara S, De Angelis P, Di Leo G, Illiceto MT, Impellizzeri P, Leonelli L, Lisi G, Lombardi G, Martelossi S, Martinelli M, Miele E, Randazzo A, Romano C, Romeo C, Romeo E, Selvaggi F, Valenti S, Dall'Oglio L. Paediatric ulcerative colitis surgery: Italian survey. J Crohns Colitis 2015; 9:558-64. [PMID: 25895877 DOI: 10.1093/ecco-jcc/jjv065] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 04/13/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Recent epidemiological studies showed an increase in ulcerative colitis among children, especially in its aggressive form, requiring surgical treatment. Although medical therapeutic strategies are standardized, there is still no consensus regarding indications, timing and kind of surgery. This study aimed to define the surgical management of paediatric ulcerative colitis and describe attitudes to it among paediatric surgeons. METHODS This was a retrospective cohort study. All national gastroenterology units were invited to participate. From January 2009 to December 2013, data on paediatric patients diagnosed with ulcerative colitis that required surgery were collected. RESULTS Seven units participated in the study. Seventy-one colectomies were performed (77.3% laparoscopically). Main surgical indications were a severe ulcerative colitis attack (33.8%) and no response to medical therapies (56.3%). A three-stage strategy was chosen in 71% of cases. Straight anastomosis was performed in 14% and J-pouch anastomosis in 86% of cases. A reconstructive laparoscopic approach was used in 58% of patients. Ileo-anal anastomosis was performed by the Knight-Griffen technique in 85.4% and by the pull-through technique in 9.1% of patients. Complications after colectomy, after reconstruction and after stoma closure were reported in 12.7, 19.3 and 35% of cases, respectively. CONCLUSIONS This study shows that there is general consensus regarding indications for surgery. The ideal surgical technique remains under debate. Laparoscopy is a procedure widely adopted for colectomy but its use in reconstructive surgery remains limited. Longer follow-up must be planned to define the quality of life of these patients.
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Affiliation(s)
- G Mattioli
- DINOGMI, University of Genova, Genova, Italy Pediatric Surgery Unit, G. Gaslini Children's Hospital-IRCCS, Genova, Italy
| | - A Barabino
- Pediatric Gastroenterology Unit, G. Gaslini Children's Hospital-IRCCS, Genova, Italy
| | - M Aloi
- Department of Pediatrics, Sapienza University of Rome, Rome, Italy
| | - S Arrigo
- Pediatric Gastroenterology Unit, G. Gaslini Children's Hospital-IRCCS, Genova, Italy
| | - T Caldaro
- Surgery and Digestive Endoscopy Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - M Carlucci
- DINOGMI, University of Genova, Genova, Italy Pediatric Surgery Unit, G. Gaslini Children's Hospital-IRCCS, Genova, Italy
| | - S Cucchiara
- Department of Pediatrics, Sapienza University of Rome, Rome, Italy
| | - P De Angelis
- Surgery and Digestive Endoscopy Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - G Di Leo
- Gastroenterology Unit, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - M T Illiceto
- Department of Pediatrics, Unit of Pediatric Gastroenterology and Digestive Endoscopy - Ospedale Civile Spirito Santo, Pescara, Italy
| | - P Impellizzeri
- Pediatric Surgery Unit, Department of Pediatric, Gynecological, Microbiological and Biomedical Sciences, University of Messina, Messina, Italy
| | - L Leonelli
- DINOGMI, University of Genova, Genova, Italy Pediatric Surgery Unit, G. Gaslini Children's Hospital-IRCCS, Genova, Italy
| | - G Lisi
- Pediatric Surgery Unit, 'G. d'Annunzio' University of Chieti, Chieti Italy
| | - G Lombardi
- Department of Pediatrics, Unit of Pediatric Gastroenterology and Digestive Endoscopy - Ospedale Civile Spirito Santo, Pescara, Italy
| | - S Martelossi
- Gastroenterology Unit, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - M Martinelli
- Department of Translational Medical Science, Section of Pediatrics, University of Naples 'Federico II', Naples, Italy
| | - E Miele
- Department of Translational Medical Science, Section of Pediatrics, University of Naples 'Federico II', Naples, Italy
| | - A Randazzo
- IBD Unit Pediatric Department,University of Messina, Messina, Italy
| | - C Romano
- IBD Unit Pediatric Department,University of Messina, Messina, Italy
| | - C Romeo
- Pediatric Surgery Unit, Department of Pediatric, Gynecological, Microbiological and Biomedical Sciences, University of Messina, Messina, Italy
| | - E Romeo
- Surgery and Digestive Endoscopy Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - F Selvaggi
- Unit of General Surgery, University of Naples 'Fedrico II', Naples, Italy
| | - S Valenti
- IBD Unit Pediatric Department,University of Messina, Messina, Italy
| | - L Dall'Oglio
- Surgery and Digestive Endoscopy Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Guida E, Pini-Prato A, Mattioli G, Carlucci M, Avanzini S, Buffa P, Michelazzi A, Montobbio G, Jasonni V. Abdominal wall defects: a 33-year unicentric experience. Minerva Pediatr 2013; 65:179-185. [PMID: 23612263] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIM The aim of this paper was to provide the main clinical features, surgical details, and long term outcome of patients with gastroschisis and omphalocele operated on at Giannina Gaslini Institute between 1976 and 2009. METHODS All patients who were operated on between 1976 and 2009 for omphalocele or gastroschisis were included. Detailed informations regarding demographics, maternal history, type of delivery, associated anomalies, surgical details, complications, morbidity and mortality were collected. RESULTS Sixty-one patients were included. Type of delivery did not interfere with outcome. Although patients with omphalocele had higher incidence of associated anomalies with their obvious impact on survival and quality of life, they showed a quicker recovery from surgery. Mortality rate was around 5%. Long-term outcome was available in 18 of them and proved to be satisfactory in all although almost 70% of them complained some gastrointestinal issues. CONCLUSION Gastroschisis and Omphalocele showed improving survival and outcome during the last decades. Caesarean section proved not to confer advantages over vaginal delivery. Associated anomalies have the highest impact on survival being cardiac malformation the most significant risk factors. Although overall outcome is good in the majority of the patients, gastrointestinal and cosmetic issues seem to have a significant impact on quality of life and overall patients' perspectives.
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Affiliation(s)
- E Guida
- Pediatric Surgery Department, Giannina Gaslini Institute, Genoa, Italy.
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Agresta F, Ansaloni L, Baiocchi GL, Bergamini C, Campanile FC, Carlucci M, Cocorullo G, Corradi A, Franzato B, Lupo M, Mandalà V, Mirabella A, Pernazza G, Piccoli M, Staudacher C, Vettoretto N, Zago M, Lettieri E, Levati A, Pietrini D, Scaglione M, De Masi S, De Placido G, Francucci M, Rasi M, Fingerhut A, Uranüs S, Garattini S. Laparoscopic approach to acute abdomen from the Consensus Development Conference of the Società Italiana di Chirurgia Endoscopica e nuove tecnologie (SICE), Associazione Chirurghi Ospedalieri Italiani (ACOI), Società Italiana di Chirurgia (SIC), Società Italiana di Chirurgia d'Urgenza e del Trauma (SICUT), Società Italiana di Chirurgia nell'Ospedalità Privata (SICOP), and the European Association for Endoscopic Surgery (EAES). Surg Endosc 2012; 26:2134-64. [PMID: 22736283 DOI: 10.1007/s00464-012-2331-3] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 04/16/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND In January 2010, the SICE (Italian Society of Endoscopic Surgery), under the auspices of the EAES, decided to revisit the clinical recommendations for the role of laparoscopy in abdominal emergencies in adults, with the primary intent being to update the 2006 EAES indications and supplement the existing guidelines on specific diseases. METHODS Other Italian surgical societies were invited into the Consensus to form a panel of 12 expert surgeons. In order to get a multidisciplinary panel, other stakeholders involved in abdominal emergencies were invited along with a patient's association. In November 2010, the panel met in Rome to discuss each chapter according to the Delphi method, producing key statements with a grade of recommendations followed by commentary to explain the rationale and the level of evidence behind the statements. Thereafter, the statements were presented to the Annual Congress of the EAES in June 2011. RESULTS A thorough literature review was necessary to assess whether the recommendations issued in 2006 are still current. In many cases new studies allowed us to better clarify some issues (such as for diverticulitis, small bowel obstruction, pancreatitis, hernias, trauma), to confirm the key role of laparoscopy (such as for cholecystitis, gynecological disorders, nonspecific abdominal pain, appendicitis), but occasionally previous strong recommendations have to be challenged after review of recent research (such as for perforated peptic ulcer). CONCLUSIONS Every surgeon has to develop his or her own approach, taking into account the clinical situation, her/his proficiency (and the experience of the team) with the various techniques, and the specific organizational setting in which she/he is working. This guideline has been developed bearing in mind that every surgeon could use the data reported to support her/his judgment.
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Affiliation(s)
- Ferdinando Agresta
- Department of General Surgery, Presidio Ospedaliero di Adria, Piazza degli Etruschi, 9, 45011 Adria, RO, Italy.
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30
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Tshomba Y, Coppi G, Marone E, Bertoglio L, Kahlberg A, Carlucci M, Chiesa R. Diagnostic Laparoscopy for Early Detection of Acute Mesenteric Ischaemia in Patients with Aortic Dissection. J Vasc Surg 2012. [DOI: 10.1016/j.jvs.2012.04.031] [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: 11/29/2022]
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Carlucci M, Teixeira F, Brum F, Duarte L. Edge expansion ofAraucariaforest over southern Brazilian grasslands relies on nurse plant effect. COMMUNITY ECOL 2011. [DOI: 10.1556/comec.12.2011.2.7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Duarte L, Carlucci M, Fontana C, Hartz S, Pillar V. Plant diaspore traits as indicators of mutualistic interactions in woody vegetation patches developing into a grassland-forest mosaic. COMMUNITY ECOL 2011. [DOI: 10.1556/comec.12.2011.1.15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
PURPOSE Our study aimed to evaluate the feasibility and outcome of laparoscopic excision of deep pelvic endometriosis with extensive rectal involvement causing severe symptoms. METHODS Ten patients, mean age 32 years (range, 27-43), with deep pelvic endometriosis and rectal wall involvement, requiring surgical resection, were studied since January 2004. Prior to surgery and 6 months postsurgery, patients completed a 100-point rank questionnaire on intensity of intestinal and extraintestinal symptoms. A laparoscopic approach was performed by a team of a gynecologist and colorectal surgeons. RESULTS At surgery, complete excision of infiltrating endometriosis was achieved, with 7 low rectal resections, 2 rectosigmoid resections, and 1 proctectomy with coloanal anastomosis. Additional procedures were: ureter resections (n = 2) with one reimplantation in the bladder, left ovariectomies (n = 2), ovarian endometrioma resections (n = 4), and laser ablation of superficial peritoneal lesions (n = 4). In four cases, a laparotomic conversion was needed. Mean follow-up was 27.6 months (range, 18-37). Neither intraoperative nor postoperative serious complications were observed. All the patients experienced significant improvement of intestinal and extraintestinal symptoms. CONCLUSIONS Laparoscopic resection of deep pelvic endometriosis with rectal involvement can be successful in improving digestive and gynecologic symptoms; however, this approach is challenging with a high rate of laparotomic conversion.
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Affiliation(s)
- Paola De Nardi
- Department of Surgery, Scientific Institute S. Raffaele Hospital, Vita-Salute University San Raffaele, Milan, Italy.
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Ruffini E, Pace F, Carlucci M, De Conciliis E, Staffolani P, Carlucci A. Urinary tract infection caused by Kluyvera ascorbata in a child: case report and review of the kluyvera infections in children. Minerva Pediatr 2008; 60:1451-1454. [PMID: 18971906] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Kluyvera species are described infrequently in association with clinically significant infections, and infections caused by these gram negative rods are rare in children. The spectrum of disease due to Kluyvera infection in children includes urinary tract infections, enteritis, soft tissue infections, sepsis, central venous catheter infections and peritonitis. The authors report a case of Kluyvera ascorbata urinary tract infection in a 3-month-old female baby, and they review the literature on Kluyvera infections in children.
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Affiliation(s)
- E Ruffini
- Department of Pediatrics, C. e G. Mazzoni Hospital, Ascoli Piceno, Italy
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35
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Martorana G, Carlucci M, Alia C, Barrianco G, Iacopinelli SM, Labruzzo C, Noto N, Restivo FP, Viola M, Mastrandrea G. [Laparoscopic incisional hernia repair: our experience and review of the literature]. Chir Ital 2007; 59:671-677. [PMID: 18019639] [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] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Incisional hernia after laparotomy closure continues to be an important postoperative complication. Historically, the best results have been obtained with the open Rives-Stoppa technique. This approach is done by fixing a prosthetic mesh behind the posterior fascia of the rectus muscle. The laparoscopic approach allows similar mesh placement with minimal dissection. In this study, we review the scientific literature and report our experience, describing the clinical outcome of patients who have undergone laparoscopic repair of ventral hernias. After describing the standard technique of laparoscopic insertion of a prosthesis, we reviewed the records of all our patients who underwent such a procedure from March 2004 to January 2006. A laparoscopic approach was attempted in all patients. The patients' demographic characteristics, operative details and outcomes were recorded. Of 55 patients scheduled to undergo laparoscopic incisional herniorrhaphy, conversion to an open procedure was necessary in 2/55 (3.6%). All the remaining 53 patients (31 men and 22 women; mean age 51.8 years) underwent laparoscopic repair of ventral hernias. The mean fascial defect size was 98.3 cm (range: 5-200 cm). In 52/53 patients (98%) a dual mesh was used. 40% of patients (22/53) had multiple wall defects. The mean operative time was 90 minutes (range: 32-190 minutes). The average hospital stay was 2.6 days (range: 1-16 days). 50/53 patients (94.3%) tolerated an oral diet 24 hours after the operation. 49/53 (92.4%) returned to normal working activity within two weeks. The percentage of complications amounted to 13% (7/55), with 5.6% (5/53) minor and 3.7% (2/55) major complications. In one patient it was necessary to remove the mesh 6 months after surgery because of pain. The recurrence rate of 5.6% confirms the permanence of the repair. The follow-up was 12 months for 44/53 patients and 6 months for 9/53 patients. The procedure for incisional hernia repair used in our study may be performed safely with low complication and recurrence rates and should be considered for the majority of incisional hernia repairs requiring a mesh prosthesis.
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Affiliation(s)
- Guido Martorana
- Istituto S. Raffaele, Fondazione G., - 90015 Cefalù, Palermo
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Passavanti G, Pizzuti V, Costantini F, Bragaglia A, Carlucci M, Aloisi A, Paolini R. POS-03.86: The meaning of anaesthesia by periprostatic injection in TR prostate biopsy. Urology 2007. [DOI: 10.1016/j.urology.2007.06.977] [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: 11/16/2022]
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Passavanti G, Pizzuti V, Carlucci M, Aloisi A, Costantini F, Lia AB, Lini RPAO. Sexual rehabilitation with intracavernous PGE1 injections and oral drug administration in diabetic patients non-responder to oral therapy alone. Urologia 2007. [DOI: 10.1177/039156030707400207] [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: 11/17/2022]
Abstract
Diabetes is an important risk factor in erectile dysfunction (ED), acting via several mechanisms. We assessed the efficacy of intracavernous injections (ICI) rehabilitation and oral systematic therapy in diabetic patients, as well as the response of controls to oral therapy ‘on demand’. Materials and Methods Sixteen diabetic patients with ED were treated with vasoactive drugs orally when needed, without satisfactory erections. The patients underwent then ICI rehabilitation with PGE1 20 mcg twice weekly for 4 weeks, followed by the administration of oral drugs twice weekly for 4 weeks. Before and after rehabilitation, the patients completed a detailed anamnestic protocol to study their libido (always present); they answered questions Q3 and Q4 of the IIEF questionnaire. During ICI, a study with dynamic echocolordoppler (ECCD) was carried out. All patients had Type 2 diabetes: 10 were treated with oral antidiabetics, 4 were treated with insulin, and in the other 2 patients, treated with insulin, a sensitive neuropathy of the lower limbs was diagnosed. Fourteen patients were treated with antihypertensive drugs. Results Before rehabilitation, the mean responses to questions 3 and 4 of the IIEF (International Index of Erectile Function) questionnaire were 1.6 and 1.5 respectively; after rehabilitation, the mean responses were 2.68 and 2.5, respectively. The ECCD test showed an arterial component in 4 cases and a high end-diastolic velocity (EDV) in 14 cases. Four patients (25%), 2 of which had neuropathy, and 2 were in advanced age, did not respond to PGE1 or to oral therapy, 4 patients (25%) (2 treated with insulin and 2 by oral therapy) responded to ICI but not to oral therapy, while 8 patients (50%) showed a good response to both injectable and oral therapy, with good Q3 and Q4 scores. Conclusions Good endothelial function appears to be essential for the maintenance of acceptable erectile function. Diabetes has a negative effect on this function, as does hypoxia and low perfusion. Based on the principle that a good erection improves endothelial function, we tried to determine if oral systematic and intracavernous rehabilitation would improve erectile function in diabetic patients. The results indicate that diabetes interferes with erectile function, compromising the effects of the vasoactive drugs. However, integrated systematic rehabilitation appears to allow a good erectile response to both intracavernous and oral therapy in a large number of cases. Therefore, we support this kind of rehabilitative protocol in the treatment of ED in diabetic patients.
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Affiliation(s)
| | - V. Pizzuti
- UO Urologia Ospedale “Misericordia”, Grosseto
| | - M. Carlucci
- Dip. Fisiologia Fac. Medicina e Chirurgia Università di Siena
| | - A.M. Aloisi
- Dip. Fisiologia Fac. Medicina e Chirurgia Università di Siena
| | | | | | - R. PAO Lini
- UO Urologia Ospedale “Misericordia”, Grosseto
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Orsenigo E, Tomajer V, Palo SD, Carlucci M, Vignali A, Tamburini A, Staudacher C. Impact of age on postoperative outcomes in 1118 gastric cancer patients undergoing surgical treatment. Gastric Cancer 2007; 10:39-44. [PMID: 17334717 DOI: 10.1007/s10120-006-0409-0] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2006] [Accepted: 11/15/2006] [Indexed: 02/07/2023]
Abstract
BACKGROUND The purpose of the study was to evaluate the impact of age on outcomes in gastric cancer surgery. METHODS Patients on the hospital database who underwent gastric resection for gastric cancer during the period 1990-2005 (n = 1118) were divided into two groups: group A, patients 75 years or older (n = 249), and group B, those younger than 75 years (n = 869). RESULTS Overall preoperative complications were diagnosed in 92 (37%) patients of group A, compared with 147 (17%) in group B (P = 0.002). Fifty-five percent of patients underwent resection with D2 or more lymph node dissection (37% [n = 93] in group A, and 60% [n = 521] in group B; P = 0.003). Postoperative overall morbidity was higher in the elderly group (29% in group A versus 23% in group B), but the difference between the two groups was not significant (P = NS). Overall postoperative surgical complications were recorded in 201 (18%) patients; 49 (20%) in the elderly cohort, compared with 147 (17%) in the younger group (P = NS). The postoperative mortality rate was 3% (n = 7) in the elderly group, compared with 3% (n = 26) in the younger cohort (P = NS). Multivariate Cox analysis showed that age was not an independent risk factor for postoperative morbidity and mortality. Overall 5-year survival was 47% in group A and 54% in group B (P = NS). CONCLUSION Due to improved perioperative management, resection of gastric carcinoma is the treatment of choice in elderly patients. Although comorbidities were more frequent among the elderly patients, postoperative morbidity and mortality, even after extensive resections, was low. Survival rates were comparable to those in the younger patients.
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Affiliation(s)
- Elena Orsenigo
- Chirurgia gastroenterologica, Department of Surgery, University Vita-Salute, San Raffaele Scientific Institute, Via Olgettina, 60-20132, Milan, Italy
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Tomajer V, Orsenigo E, Carlucci M, Castoldi R, Di Palo S, Staudacher C. 147 POSTER Laparoscopic partial gastrectomy with D2 lymph-node dissection for pT1-pT2 gastric cancer: result in a single Institute. Eur J Surg Oncol 2006. [DOI: 10.1016/s0748-7983(06)70582-0] [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: 10/23/2022] Open
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Orsenigo E, Socci C, Carlucci M, Zuber V, Fiorina P, Gavazzi F, Secchi A, Di Carlo V, Staudacher C. Multivariate Analysis of Factors Affecting Patient and Graft Survival After Renal Transplant. Transplant Proc 2005; 37:2461-3. [PMID: 16182709 DOI: 10.1016/j.transproceed.2005.06.099] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM To evaluate factors affecting patient and kidney survival after renal transplant. PATIENT AND METHODS Among 361 patients undergoing renal transplant: 52% (n = 189) were simultaneous with pancreas transplant (SPKT group) and 48% (n = 172), a kidney transplant alone (KT group). Out of 361 patients, 75% (n = 270) were diabetics. The patients were 220 (61%) men and 141 (39%) women of mean age 41 +/- 9 years. The mean time of dialysis was 42 +/- 21 months (range 0 to 126), and the mean duration of diabetes 24 +/- 7 years (range 5 to 51). A Cox regression analysis was done. RESULTS The multivariate analysis revealed that in the final model diabetes and donor age were significant predictors of kidney graft survival; moreover, diabetes and recipient age were predictors of patient survival. Overall patient survival was significantly greater among nondiabetic patients (P = .002) or in diabetic patients who received SPKT, when compared with diabetics in whom only the kidney was transplanted (P = .001). CONCLUSIONS Diabetes and donor age were independent prognostic factors affecting kidney graft survival after renal transplant, and recipient age and diabetes were prognostic factors affecting patient survival. Combined pancreas and kidney transplantation should be offered to patients with end-stage diabetic nephropathy.
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Affiliation(s)
- E Orsenigo
- Department of Surgery, Vita e Salute University, San Raffaele Scientific Institute, Milan, Italy.
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Baccari P, Castoldi R, Bisagni P, Bissolotti G, Orsenigo E, Di Palo S, Casiraghi T, Carlucci M, Staudacher C. [Minimally invasive esophagectomy for adenocarcinoma of the lower esophagus and the gastroesophageal junction]. Suppl Tumori 2005; 4:S129. [PMID: 16437948] [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] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Adenocarcinoma of lower esophagus and GEJ shows worldwide an increasing incidence. The optimal approach to resection is still controversial. One of the major disadvantages of radical esophagectomy with extensive lymphadenectomy with open technique is its high rate of morbidity and mortality. Recent advances in minimally invasive surgical technology have allowed surgeons to apply laparoscopy and thoracoscopy to perform esophagectomy. PATIENT AND METHODS In the video we report the case of a 79 years old man with Siewert I adenocarcinoma of GEJ, who was submitted to a 3-stage minimally invasive esophagectomy by laparoscopy, right thoracoscopy and cervicotomy. Preoperative endoscopic ultrasound and CT scan showed a marked thickening of the wall of the distal esophagus, with extension proximal to the mediastinal pleura and the anterior surface of the aorta, but still showing features of resectability. Four ports were used for the abdominal approach. A complete mobilization of the stomach preserving the right gastroepiploic arcade was achieved. The patient was then turned to the left lateral decubitus position proned to 30 degrees. Three ports were needed for right thoracoscopy. Mobilization of the thoracic esophagus was carried out from the diaphragm to the thoracic inlet. After extraction of the specimen through a small abdominal incision, the stomach was pulled up to the neck and esophagogastric anastomosis with the Orringer technique was constructed through a left cervicotomy. Pathology showed pT3 pN1 G3 adenocarcinoma. CONCLUSIONS The minimally invasive approach to adenocarcinoma of the lower esophagus, in center with expertise in minimally invasive surgical technique, is feasible and safe.
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Affiliation(s)
- P Baccari
- Dipartimento Assistenziale di Scienze Chirurgiche, Università Vita-Salute, Istituto Scientifico Universitario San Raffaele, Milano
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Orsenigo E, Carlucci M, Braga M, Tomajer V, Di Palo S, Tamburini A, Di Carlo V, Staudacher C. [Prognostic factors of gastric neoplasms: experience with 1,074 cases undergoing surgical treatment at a single center]. Suppl Tumori 2005; 4:S86-7. [PMID: 16437921] [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] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
AIM The aim of our study was to identify clinicopathological predictors of survival among patients undergoing potentially curative resections for gastric carcinoma. PATIENTS AND METHODS From January 1987-March 2004, 1074 patients have been submitted to curative gastric resection for gastric cancer (647 males and 427 females, mean age, 65 +/- 12, min 22, max 92). The surgical procedure consisted of 289 (27%) total and 785 (63%) subtotal gastrectomies. The extent of lymph node dissection was limited D1 (n = 376, 35%) or extended D2 (n = 578, 54%) and D3 (n = 12, 1%); no lymphadenectomy was performed in 108 (10%) cases. The pathological nodal status has been defined based on the number of involved lymph nodes (N1: 1 to 6 positive nodes; N2: 7 to 15 positive nodes; N3: more than 15 positive nodes). The distribution of N stage was: N0 = 278 (26%), N1 = 344 (32%); N2 = 215 (20%); N3 = 129 (12%). Univariate analyses were performed for gender, age, pT stage, pN stage, tumor site, tumor size, and extent of lymphadenectomy. Significant factors were then entered into a Cox regression analysis. RESULTS The median number of examined lymph nodes was 17 (mean, 18). Overall, 688 (64%) of patients had lymph node metastases. Of these patients, the median number of involved nodes was 2 (mean, 6). In the univariate analysis age, pT stage, pN stage, tumor size, and extent of lymphadenectomy were found to be significant factors. In the multivariate analysis T stage, N stage, and extent of lymphadenectomy were all independent predictors of survival. The median and mean survival time were 69 and 87 months, respectively. Overall survival was 80%, 51% and 40% at 1, 5, and 10 years, respectively. CONCLUSIONS T stage, N stage, and extent of lymphadenectomy were all independent predictors of survival in patients submitted to curative gastric resections.
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Affiliation(s)
- E Orsenigo
- Dipartimento Assistenziale di Scienze Chirurgiche, Università Vita-Salute, Istituto Scientifico Universitario San Raffaele, Milano
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Orsenigo E, Carlucci M, Tomajer V, Di Palo S, Baccari P, Tamburini A, Mereu A, Staudacher C. [Gastrectomy and laparoscopic lymphadenectomy for carcinoma: preliminary experience with 59 cases]. Suppl Tumori 2005; 4:S138. [PMID: 16437953] [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] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Laparoscopic surgery has been used in the treatment of gastric cancer with low mortality and morbidity and improvement in patient's quality of life. AIM To evaluate the results of laparoscopic gastric resection. METHODS A retrospective review of 59 patients after laparoscopic surgery for gastric cancer was performed. The patients were 31 males and 28 females with a mean age of 67 (+/- 11) years (min 39, max 90). RESULTS Tumor stage was IA in 15 patients, IB in 10, II in 9, IIIA in 6, IIIB in 9, and IV in 10. In 15 cases the tumor was an early gastric cancer. The mean number of dissected lymph nodes was 29 +/-10. Conversion rate was 16%. Morbidity rate was 37%. The median length of hospital stay was 10 days. Operative mortality was 3%. The mean time of follow-up was 23 months. Two-year survival was 75%. CONCLUSIONS Laparoscopic radical total or subtotal gastrectomy with extended lymphadenectomy for gastric cancer is a feasible, safe, and oncologically effective procedure.
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Affiliation(s)
- E Orsenigo
- Dipartimento Assistenziale di Scienze Chirurgiche, Università Vita-Salute, Istituto Scientifico Universitario San Raffaele, Milano
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Venturini M, Angeli E, Salvioni M, De Cobelli F, Ronzoni M, Aldrighetti L, Stella M, Carlucci M, Staudacher C, Di Carlo V, Ferla G, Villa E, Del Maschio A. Complications After Percutaneous Transaxillary Implantation of a Catheter for Intraarterial Chemotherapy of Liver Tumors:Clinical Relevance and Management in 204 Patients. AJR Am J Roentgenol 2004; 182:1417-26. [PMID: 15149985 DOI: 10.2214/ajr.182.6.1821417] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purposes of the study were to evaluate the complications of patients who underwent percutaneous transaxillary implantation of a permanent catheter-port system for intraarterial hepatic chemotherapy and determine their clinical relevance and specific management. SUBJECTS AND METHODS. Catheter-port systems were placed in 204 patients with liver tumors (86.7% from colorectal metastases). Under sonographic and fluoroscopic guidance, a 5.8-French catheter was placed in the hepatic artery and connected to a subcutaneous reservoir after embolization of the gastroduodenal and right gastric arteries. Floxuridine plus dexamethasone and systemic low-dose heparin were administered. During the follow-up period, complications were classified as clinically not significant (type 1), clinically significant not requiring interruption of intrahepatic chemotherapy (type 2), clinically significant needing temporary suppression of intrahepatic chemotherapy (type 3), and clinically significant causing permanent suppression of intrahepatic chemotherapy (type 4). RESULTS No complications occurred during the implantation procedures. The mean number of intrahepatic chemotherapy cycles was 8.1. The mean follow-up period was 270 days. Primary and secondary patency rates of the system were 71.6% and 91.2%, respectively. Temporary suppression of intrahepatic chemotherapy was necessary in 19.6% of the patients and definitive suppression, in 8.8%. Hepatic artery thrombosis, not recanalized by local thrombolysis, was the main cause of permanent intrahepatic chemotherapy interruption (4.4%). Catheter occlusions and cerebral complications were not observed. In 91.2% of the patients, intrahepatic chemotherapy could be completed. CONCLUSION Percutaneous implantation of a removable and reimplantable catheter-port system for intrahepatic chemotherapy can be a safe procedure to treat unresectable liver metastases from colorectal cancer. Technical and pharmacologic complications with variable clinical relevance occurred, and various specific management strategies were necessary to reduce their incidence.
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Affiliation(s)
- Massimo Venturini
- Department of Radiology, Scientific Institute S. Raffaele, Vita-Salute University, Olgettina 60, Milan 20132, Italy
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Venturini M, Angeli E, Salvioni M, De Cobelli F, Trentin C, Carlucci M, Staudacher C, Del Maschio A. Hemorrhage from a right hepatic artery pseudoaneurysm: endovascular treatment with a coronary stent-graft. J Endovasc Ther 2002. [PMID: 12010105 DOI: 10.1583/1545-1550(2002)009<0221:hfarha>2.0.co;2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To report a novel case demonstrating the successful endovascular treatment of a right hepatic artery pseudoaneurysm using a balloon-expandable coronary stent-graft. CASE REPORT A 60-year-old woman underwent surgical treatment for a Klatskin tumor, but her postoperative course was complicated by serious blood loss. An emergent celiac angiogram through a right transfemoral approach demonstrated a small iatrogenic pseudoaneurysm in the proximal right hepatic artery. A 7-F guiding catheter was positioned at the origin of the celiac trunk, and a Jostent coronary stent-graft mounted on a 2.7-F, 4-mm x 30-mm balloon catheter was successfully placed across the aneurysm neck. The final angiogram demonstrated total exclusion of the pseudoaneurysm with preservation of the arterial lumen. The hemodynamic condition of the patient became stable. At 12-month follow-up, duplex scanning confirmed regular right hepatic artery patency and absence of thrombotic tissue or signs of infection around the stent-graft. CONCLUSION For hepatic artery pseudoaneurysms, endovascular repair using small covered stents may be a viable alternative to transcatheter embolization. The use of coronary instruments facilitates treatment of vascular lesions in small caliber visceral vessels.
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Affiliation(s)
- Massimo Venturini
- Department of Radiology, Scientific Institute S. Raffaele, University Hospital, Milan, Italy.
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Venturini M, Angeli E, Salvioni M, De Cobelli F, Trentin C, Carlucci M, Staudacher C, Del Maschio A. Hemorrhage From a Right Hepatic Artery Pseudoaneurysm:Endovascular Treatment With a Coronary Stent-Graft. J Endovasc Ther 2002. [DOI: 10.1583/1545-1550(2002)009<0221:hfarha>2.0.co;2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Venturini M, Angeli E, Salvioni M, De Cobelli F, Trentin C, Carlucci M, Staudacher C, Del Maschio A. Hemorrhage from a right hepatic artery pseudoaneurysm: endovascular treatment with a coronary stent-graft. J Endovasc Ther 2002; 9:221-4. [PMID: 12010105 DOI: 10.1177/152660280200900215] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To report a novel case demonstrating the successful endovascular treatment of a right hepatic artery pseudoaneurysm using a balloon-expandable coronary stent-graft. CASE REPORT A 60-year-old woman underwent surgical treatment for a Klatskin tumor, but her postoperative course was complicated by serious blood loss. An emergent celiac angiogram through a right transfemoral approach demonstrated a small iatrogenic pseudoaneurysm in the proximal right hepatic artery. A 7-F guiding catheter was positioned at the origin of the celiac trunk, and a Jostent coronary stent-graft mounted on a 2.7-F, 4-mm x 30-mm balloon catheter was successfully placed across the aneurysm neck. The final angiogram demonstrated total exclusion of the pseudoaneurysm with preservation of the arterial lumen. The hemodynamic condition of the patient became stable. At 12-month follow-up, duplex scanning confirmed regular right hepatic artery patency and absence of thrombotic tissue or signs of infection around the stent-graft. CONCLUSION For hepatic artery pseudoaneurysms, endovascular repair using small covered stents may be a viable alternative to transcatheter embolization. The use of coronary instruments facilitates treatment of vascular lesions in small caliber visceral vessels.
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Affiliation(s)
- Massimo Venturini
- Department of Radiology, Scientific Institute S. Raffaele, University Hospital, Milan, Italy.
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Carlucci M, Cimmino A, Fiore MG, Lepera A, Tantimonaco L, Ricco R. [The Pap test in HIV-positive women]. Pathologica 2001; 93:651-3. [PMID: 11785116] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
The aim of this work was to estimate the frequency of abnormal Papanicolau (Pap) smears in a group of HIV-infected women undergoing cervical screening. We re-examined 162 Pap smears from 118 patients infected with HIV. The patients were aged 23-55 years. A total of 108 smears (66.6%) from 80 patients were negative; 14 smears (8.6%) from 14 patients showed inflammation; 3 smears (1.8%) from 3 patients had atypical squamous cells of undetermined significance (ASCUS); 20 smears (13.5%) from 16 patients were abnormal for human papillomavirus (HPV); 13 smears (8.0%) from 9 patients revealed low-grade, squamous intraepithelial lesions; 10 smears (6.2%) from 7 patients were SIL-HG; the diagnosis of carcinoma was made in 3 cases (1.8%) and 2 smears from 2 patients were unsatisfactory. HIV-infected women have an increased rate of abnormal Pap smears for both HPV infections and cervical dysplasia. These results confirm the validity of cervical screening by Pap test.
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Affiliation(s)
- M Carlucci
- Dipartimento di Anatomia Patologica e Genetica, Università di Bari, Piazza G. Cesare 11, I-70124 Bari, Italia.
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Baccari P, Di Palo S, Redaelli A, Carlucci M, Staudacher C. [Laparoscopic versus conventional surgery in the treatment of colorectal diseases]. Chir Ital 2000; 52:17-27. [PMID: 10832523] [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] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
The aim of the study was to compare the results obtained with laparoscopic (LPS) and laparotomic (LPT) colorectal resection after our initial experience with the laparoscopic technique. Fifty-six patients were submitted to colorectal resection, 26 with the LPS and 30 with the LPT technique. Eighteen patients out of 26 in the LPS group and 22/30 in the LPT group had malignancies. All resections were performed with a curative intent. The mean operating time was 220 min in the LPS group and 208 min in the LPT group. Mean blood loss was 287 ml and 312 ml, respectively (blood transfusions were needed in 1/26 and in 7/30 patients). The rates of major complications were 9.5% and 5.7%, respectively. There was no mortality. The conversion rate for the LPS group was 19.2%. In the cancer patients, no significant difference was observed between the two groups as regards postoperative staging. The mean length of specimens and the mean distance of the tumours from the resection margins were adequate. The mean number of lymph nodes harvested was 11.8 in the LPS group as against 18.5 in the LPT group. No early recurrences were observed. Resumption of gastrointestinal function was faster in the LPS patients who underwent the surgical procedure under general anaesthesia associated with epidural anaesthesia/postoperative analgesia. In conclusion, these preliminary results indicate that laparoscopic colorectal surgery is feasible and that the resections in cancer patients appear to be oncologically adequate. Long-term follow-up is needed for reliable assessment of oncological outcomes.
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Affiliation(s)
- P Baccari
- Cattedra di Chirurgia d'Urgenza, Università degli Studi, Milano
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Staudacher C, Carlucci M, Zerbi A, Balzano G, Cappio S, Di Carlo V. [Intraoperative radiotherapy as adjuvant treatment for resection of carcinoma of the pancreas]. Ann Ital Chir 1997; 68:631-4. [PMID: 9577039] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Local recurrence is the most frequent site of failure after resection for pancreatic cancer. We reported our experience in term of tolerance, local control and survival obtained by the association of resection and intraoperative radiation therapy (IORT). Between January 1985 and July 1996 152 resection for pancreatic cancer were performed at the authors' institution. For 77 patients, IORT was added to resection (group 1), whereas the other 75 patients underwent resection alone (group 2), because of either the unavailability of the linear accelerator or the patient's refusal. In group 1, radiation doses from 12.5 to 20 Gy, with electron beam energies between 6 and 12 MeV, were delivered. Extension of the disease, percentage of radical resection and postoperative chemotherapy were similar in the two groups of patients. Operative mortality and overall early postoperative complications were respectively 1.3% and 31.2% in group 1 and 4% and 32% in group 2. The median survival was 17 months in group 1 and 15 months in group 2 and the median disease free survival was 12 months in group 1 and 8 months in group 2. A local recurrence was detected in 31% of patients in group 1 and in 49.3% of patients in group 2 (p < 0.1). The results suggest a better local control in patients with pancreatic cancer undergoing adjuvant IORT.
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Affiliation(s)
- C Staudacher
- Università degli Studi di Milano, IRCCS H San Raffaele, Cattedra di Chirurgia d'Urgenza
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