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Nicosia L, Andreani S, Ruggieri R, Rusev B, Lawlor R, Pea A, Agolli L, Scarpa A, Corbo V, D'Agosto S, Alongi F. Combinatorial Effect of Magnetic Field and Radiotherapy in Pancreatic Ductal Adenocarcinoma Organoids. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.831] [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: 11/28/2022]
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Avuzzi B, Tittarelli A, Andreani S, Noris Chiorda B, Seregni E, Villa S, Tana S, Valdagni R, Salvioni R, Biasoni D, Catanzaro M, Stagni S, Nicolai N. Radiotherapy after testis-sparing surgery for seminoma in monorchid patients: safety and efficacy. Tumori 2021; 108:165-171. [PMID: 33588700 DOI: 10.1177/0300891621992428] [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] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate local control and longitudinal endocrine data in monorchid patients treated with testicular-sparing surgery and adjuvant radiotherapy (RT) for seminomatous germ-cell tumors. METHODS We searched our database established in 2009 for patients with seminoma who received testis irradiation following partial orchiectomy up to 2018. Eleven patients were identified. All had associated germ cell neoplasia in situ (GCNIS) in surrounding parenchyma. Analysis focused on local control and testosterone levels preservation after RT. We considered age, baseline (pre-RT) testosterone and luteinizing hormone (LH) levels, residual testicular volume, tumor size, and testosterone and LH levels trend over time in order to identify any association with endocrine impairment leading to hormonal replacement need. RESULTS After a median follow-up of 21 months, no local or distant relapses were observed and hormonal function was maintained in 54.5% of patients (6/11). No significant interactions were observed for the investigated covariates. Notably, we observed an association between higher baseline testosterone levels and a decreased risk of exogenous androgen replacement (hazard ratio [HR] 0.409, 95% confidence interval [CI] 0.161-1.039, p = 0.060), whereas tumor size was associated with an increased risk of exogenous androgen replacement (HR 1.847, 95% CI 0.940-3.627, p = 0.075). CONCLUSIONS Radiotherapy after testicular sparing surgery is effective in preventing local disease relapse in presence of GCNIS in the medium term. This strategy allows a preservation of adequate endocrine function in about half of patients. More patients and longer follow-up are needed to confirm these findings.
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Affiliation(s)
- Barbara Avuzzi
- Radiation Oncology 1 Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Tittarelli
- Cancer Registry Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefano Andreani
- Radiation Oncology 1 Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Barbara Noris Chiorda
- Radiation Oncology 1 Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Ettore Seregni
- Nuclear Medicine Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sergio Villa
- Radiation Oncology 1 Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Silvia Tana
- Radiation Oncology 2 Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Riccardo Valdagni
- Radiation Oncology 1 Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Department of Oncology and Hemato-oncology, Università degli Studi di Milano, Milan, Italy
| | - Roberto Salvioni
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Davide Biasoni
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Mario Catanzaro
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Silvia Stagni
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Nicola Nicolai
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Carpenter H, Hotouras A, English WJ, Taylor FGM, Andreani S. Revisional ileoanal pouch surgery: a systematic literature review assessing outcomes over the last 40 years. Colorectal Dis 2021; 23:52-63. [PMID: 33128840 DOI: 10.1111/codi.15418] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 05/14/2020] [Revised: 10/04/2020] [Accepted: 10/18/2020] [Indexed: 02/08/2023]
Abstract
AIM Failure of primary ileal pouch-anal anastomosis (IPAA) occurs in up to 15% of patients. Revision surgery may be offered to patients wishing to maintain gastrointestinal continuity. This paper explores the literature relating to IPAA revision surgery, focusing on pouch function after revision and factors associated with pouch failure. METHODS Search of PubMed database was carried out for 'ileal pouch anal anastomoses', 'ileoanal pouch', 'restorative proctocolectomy', 'revision surgery', 'redo surgery', 'failure', 'refashion surgery', 'reconstruction surgery' and 'salvage surgery'. Papers were screened using the PRISMA literature review strategy. Studies of adults published after 1980 in English with an available abstract were included. Case reports and studies that were superseded using the same data were excluded. RESULTS Nineteen papers (1424 patients) were identified. Bowel motion frequency doubled following revision surgery compared to primary IPAA although the increase was not always statistically significant. In patients failing primary IPAA, frequency of daytime bowel motions improved following revision in three studies but only reached significance in one (12.1 vs. 6.9, P = 0.021). Risk of pouch failure is increased in patients who develop pelvic sepsis after the primary procedure with the largest study demonstrating a four-fold increased risk (hazard ratio 3.691, P < 0.0001). A final diagnosis of Crohn's causes a four-fold increased risk of pouch failure (n = 81; OR 3.92, 95% CI 1.1-15.9, P = 0.04). CONCLUSIONS In patients undergoing revisional surgery, improved outcomes are observed but are inferior compared to primary IPAA patients. Pelvic sepsis after primary IPAA and a final diagnosis of Crohn's are associated with increased risk of pouch failure.
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Affiliation(s)
- Holly Carpenter
- Department of Colorectal Surgery, Whipps Cross Hospital, London, UK
| | - Alexander Hotouras
- Department of Colorectal Surgery, Whipps Cross Hospital, London, UK.,National Bowel Research Centre, Blizard Institute, QMUL, London, UK
| | - William J English
- Department of Colorectal Surgery, Whipps Cross Hospital, London, UK.,National Bowel Research Centre, Blizard Institute, QMUL, London, UK
| | - Fiona G M Taylor
- Department of Colorectal Surgery, Whipps Cross Hospital, London, UK
| | - Stefano Andreani
- Department of Colorectal Surgery, Whipps Cross Hospital, London, UK
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Ruan QZ, English W, Hotouras A, Bryant C, Taylor F, Andreani S, Wexner SD, Banerjee S. A systematic review of the literature assessing the outcomes of stapled haemorrhoidopexy versus open haemorrhoidectomy. Tech Coloproctol 2020; 25:19-33. [PMID: 33098498 PMCID: PMC7847454 DOI: 10.1007/s10151-020-02314-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 07/16/2020] [Indexed: 12/12/2022]
Abstract
Background Symptomatic haemorrhoids affect a large number of patients throughout the world. The aim of this systematic review was to compare the surgical outcomes of stapled haemorrhoidopexy (SH) versus open haemorrhoidectomy (OH) over a 20-year period. Methods Randomized controlled trials published between January 1998 and January 2019 were extracted from Pubmed using defined search criteria. Study characteristics and outcomes in the form of short-term and long-term complications of the two techniques were analyzed. Any changes in trend of outcomes over time were assessed by comparing article groups 1998–2008 and 2009–2019. Results Twenty-nine and 9 relevant articles were extracted for the 1998–2008 (period 1) and 2009–2019 (period 2) cohorts, respectively. Over the two time periods, SH was found to be a safe procedure, associated with statistically reduced operative time (in 13/21 studies during period 1 and in 3/8 studies during period 2), statistically less intraoperative bleeding (3/7 studies in period 1 and 1/1 study in period 2) and consistently less early postoperative pain on the visual analogue scale (12/15 studies in period 1 and 4/5 studies in period 2) resulting in shorter hospital stay (12/20 studies in period 1 and 2/2 studies in period 2) at the expense of a higher cost. In the longer term, although chronic pain in SH and OH patents is comparable, patient satisfaction with SH may decline with time and at 2-year follow-up OH appeared to be associated with greater patient satisfaction. Conclusions SH appears to be safe with potential advantages, at least in the short term, but the evidence is lacking at the moment to suggest its routine use in clinical practice.
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Affiliation(s)
- Q Z Ruan
- Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
| | - W English
- Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
- National Bowel Research Centre, Blizard Institute, QMUL, 2 Newark Street, London, E1 2AT, UK
| | - A Hotouras
- Whipps Cross University Hospital, Barts Health NHS Trust, London, UK.
- National Bowel Research Centre, Blizard Institute, QMUL, 2 Newark Street, London, E1 2AT, UK.
| | - C Bryant
- Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
| | - F Taylor
- Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
| | - S Andreani
- Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
| | - S D Wexner
- Cleveland Clinic Florida, Fort Lauderdale, FL, USA
| | - S Banerjee
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
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Buti S, Bersanelli M, Viansone A, Leonetti A, Masini C, Ratta R, Procopio G, Maines F, Iacovelli R, Ciccarese C, Vitale MG, De Giorgi U, Mucciarini C, Maruzzo M, Prati G, Lattanzi E, Ciammella P, Bruni A, Andreani S, D'Abbiero N. Treatment Outcome of metastatic lesions from renal cell carcinoma underGoing Extra-cranial stereotactic body radioTHERapy: The together retrospective study. Cancer Treat Res Commun 2019; 22:100161. [PMID: 31677494 DOI: 10.1016/j.ctarc.2019.100161] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 05/26/2019] [Revised: 08/24/2019] [Accepted: 09/26/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES stereotactic body radiation therapy (SBRT) use has increased overtime for the management of metastatic renal cell carcinoma (mRCC) patients, with a likely good control of irradiated lesions. We planned a retrospective multicenter Italian study, with the aim of investigating the outcome of treatment with SBRT for non-brain secondary lesions in mRCC patients. METHODS all consecutive metastatic non-brain lesions from mRCC that underwent SBRT at nine Italian institutions from January 2015 to June 2017 were considered. The primary endpoint of the study was the lesion-PFS, calculated from SBRT initiation to the local progression of the irradiated lesion. RESULTS 57 extracranial metastatic lesions from 48 patients with primary mRCC were treated with SBRT. At the median follow-up of 26.4 months, the median lesion-PFS was not reached (43 censored); 72.4% of lesions were progression-free at 40 months, with significantly better lesion-PFS for small metastatic lesions (<14 mm). SBRT was safe and the 1-year local disease control was 87.7%. After SBRT, 18 patients (37.5%) permanently interrupted systemic therapy. CONCLUSIONS consistently with the previous literature, our findings support the use of SBRT in selected mRCC patients.
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Affiliation(s)
- Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Melissa Bersanelli
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy; Medicine and Surgery Department, University of Parma, Parma, Italy.
| | | | | | - Cristina Masini
- Medical Oncology Unit, Clinical Cancer Centre, AUSL-IRCCS, Reggio Emilia, Italy
| | - Raffaele Ratta
- SS Oncologia Genitourinaria Fondazione Istituto Nazionale Tumori Milano, Milano, Italy
| | - Giuseppe Procopio
- SS Oncologia Genitourinaria Fondazione Istituto Nazionale Tumori Milano, Milano, Italy
| | - Francesca Maines
- Medical Oncology Department, Santa Chiara Hospital, Largo Medaglie d'Oro, Trento, Italy
| | - Roberto Iacovelli
- Medical Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Chiara Ciccarese
- Medical Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Maria Giuseppa Vitale
- Department of Oncology and Haematology and Respiratory Disease, University Hospital of Modena, Modena, Italy
| | - Ugo De Giorgi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Claudia Mucciarini
- Medical Oncology Department, Ramazzini Hospital - AUSL Modena, Carpi, Italy
| | - Marco Maruzzo
- Medical Oncology Unit 1, Istituto Oncologico Veneto, IOV-IRCCS, Padova, Italy
| | - Giuseppe Prati
- Day Hospital Oncology, Ospedale Civile di Guastalla, Reggio Emilia, Reggio Emilia, Italy
| | | | - Patrizia Ciammella
- Radiotherapy Unit, Clinical Cancer Centre, AUSL-IRCCS, Reggio Emilia, Italy
| | - Alessio Bruni
- Radiation Oncology Unit,University Hospital of Modena, Modena, Italy
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Maddalo M, Moschini I, Benecchi G, Calabri E, Rossi R, Losardo P, Bergamini M, Dell’Anna C, Ceccon G, Grondelli C, Nurmahomed S, Gianni S, Rossi R, Manicone M, Andreani S, Ghetti F, Salaroli F, Ghetti C, D’Abbiero N. 42. The role of emphysema on radiation-induced lung toxicity and the feasibility of a “functional treatment plan”. Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.04.052] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Maddalo M, Benecchi G, Grondelli C, Calabri E, Rossi R, Losardo P, Bergamini M, Dell’Anna C, Ceccon G, Nurmahomed S, Gianni S, Rossi R, Manicone M, Andreani S, Ghetti F, Salaroli F, Ghetti C, D’Abbiero N. 172. Predictors of cardiac dose reduction achieved with deep inspiration breath hold technique over free breathing technique in left breast radiotherapy. Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.04.183] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Torrente S, Andreani S, Badenchini F, Rancati T, Marenghi C, Avuzzi B, Morlino S, Bedini N, Villa S, Noris Chiorda B, Palorini F, Andreoli L, Di Florio T, Catanzaro M, Stagni S, Biasoni D, Torelli T, Tesone A, Nicolai N, Valdagni R. Clinical Results for an Active Surveillance Cohort with Localized Prostate Cancer Receiving RT after Exiting Active Surveillance. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.282] [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: 10/28/2022]
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Leonetti A, D'Abbiero N, Baldari G, Andreani S, Ruffini L, Viansone AA, Buti S. Radiotherapy for the treatment of distant nodes metastases from oligometastatic urothelial cancer: A retrospective case series. Int J Urol 2018; 25:879-886. [DOI: 10.1111/iju.13773] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 07/09/2018] [Indexed: 01/08/2023]
Affiliation(s)
| | | | - Giorgio Baldari
- Nuclear Medicine Unit; University Hospital of Parma; Parma Italy
| | | | - Livia Ruffini
- Nuclear Medicine Unit; University Hospital of Parma; Parma Italy
| | | | - Sebastiano Buti
- Medical Oncology Unit; University Hospital of Parma; Parma Italy
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Grondelli C, Benecchi G, Maddalo M, Nurmohamed S, Gianni S, Rossi R, Manicone M, Andreani S, Ghetti F, Salaroli F, Calabri E, Rossi R, Moschini I, Dell'Anna C, Ceccon G, Bergamini M, Losardo P, Ghetti C, D'Abbiero N. EP-1965: Predictors of cardiac dose reduction achieved with deep inspiration breath hold. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32274-6] [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: 10/14/2022]
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Naik R, Warren G, Andreani S. Measuring and improving safety culture in theatres: A closed-loop audit. Int J Surg 2016. [DOI: 10.1016/j.ijsu.2016.08.291] [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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Lallas A, Pyne J, Kyrgidis A, Andreani S, Argenziano G, Cavaller A, Giacomel J, Longo C, Malvestiti A, Moscarella E, Piana S, Specchio F, Hofmann-Wellenhof R, Zalaudek I. The clinical and dermoscopic features of invasive cutaneous squamous cell carcinoma depend on the histopathological grade of differentiation. Br J Dermatol 2015; 172:1308-15. [PMID: 25363081 DOI: 10.1111/bjd.13510] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND Little is known about the variability of the dermoscopic criteria of squamous cell carcinoma (SCC) according to the histopathological differentiation grade. OBJECTIVES To evaluate whether specific dermoscopic criteria can predict the diagnosis of poorly differentiated SCC compared with well- and moderately differentiated SCC. METHODS Clinical and dermoscopic images of SCCs were retrospectively evaluated for the presence of predefined criteria. Univariate and adjusted odds ratios were calculated. Discriminant functions were used to plot receiver-operator characteristic curves. RESULTS Of 143 SCCs included, 48 (33·5%) were well differentiated, 45 (31·5%) were moderately differentiated and 50 (35·0%) were poorly differentiated. Flat tumours had a fourfold increased probability of being poorly differentiated. Dermoscopically, the presence of a predominantly red colour posed a 13-fold possibility of poor differentiation, whereas a predominantly white and white-yellow colour decreased the odds of poorly differentiated SCC by 97% each. The presence of vessels in more than 50% of the tumour's surface, a diffuse distribution of vessels and bleeding were significantly associated with poor differentiation, while scale/keratin was a potent predictor of well- or moderately differentiated tumours. CONCLUSIONS Dermoscopy may be regarded as a reliable preoperative tool to distinguish poorly from well- and moderately differentiated SCC. Given that poor differentiation of SCC represents an independent risk factor for recurrence, metastasis and disease-specific death, identifying poorly differentiated tumours in vivo may enhance their appropriate management.
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Affiliation(s)
- A Lallas
- Skin Cancer Unit, Arcispedale Santa Maria Nuova IRCCS, Viale Risorgimento 80, 42100, Reggio Emilia, Italy
| | - J Pyne
- School of Medicine, The University of Queensland, Brisbane, Australia
| | - A Kyrgidis
- Skin Cancer Unit, Arcispedale Santa Maria Nuova IRCCS, Viale Risorgimento 80, 42100, Reggio Emilia, Italy
| | - S Andreani
- Dermatology Service Hospital Salvador, Santiago, Chile
| | - G Argenziano
- Skin Cancer Unit, Arcispedale Santa Maria Nuova IRCCS, Viale Risorgimento 80, 42100, Reggio Emilia, Italy
| | | | - J Giacomel
- Skin Spectrum Medical Services, Como, Western Australia, Australia
| | - C Longo
- Skin Cancer Unit, Arcispedale Santa Maria Nuova IRCCS, Viale Risorgimento 80, 42100, Reggio Emilia, Italy
| | - A Malvestiti
- Albert Einstein Israelite Hospital, São Paulo, Brazil
| | - E Moscarella
- Skin Cancer Unit, Arcispedale Santa Maria Nuova IRCCS, Viale Risorgimento 80, 42100, Reggio Emilia, Italy
| | - S Piana
- Pathology Unit, Arcispedale Santa Maria Nuova IRCCS, Viale Risorgimento 80, 42100, Reggio Emilia, Italy
| | - F Specchio
- Department of Dermatology, University of Rome Tor Vergata, Italy
| | | | - I Zalaudek
- Department of Dermatology, Medical University of Graz, Graz, Austria
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Sud A, Tase A, Baker E, Bhattacharjee S, Dindyal S, Andreani S. A proposed standard for pre-operative laparoscopic colorectal cancer resection endoscopic tattooing. identification of modifiable practices at an enhanced recovery cancer centre. Int J Surg 2012. [DOI: 10.1016/j.ijsu.2012.06.127] [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: 10/27/2022]
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Human S, Andreani S, Sihono S, Indriatama W. Stability Test For Sorghum Mutant Lines Derived From Induced Mutations with Gamma-Ray Irradiation. Atom Indo 2011. [DOI: 10.17146/aij.2011.76] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Tincknell L, Burton S, Cooke C, Black S, Andreani S, Jourdan I, Gudgeon M. The emergency surgical team - the way forward in emergency care? Ann R Coll Surg Engl 2009. [PMID: 19126331 DOI: 10.1308/003588409x358944a] [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: 11/22/2022] Open
Abstract
INTRODUCTION With reduced working hours and shift patterns, surgical training and continuity of patient care is being put at risk. We have devised a system for managing the emergency surgical patients in an effort to counteract these perceived problems. This study describes the emergency surgical team and audits its activity. PATIENTS AND METHODS The emergency surgery team concept is described in detail. Over a 2-week period, general surgical referral data, patient management and operative activity were audited. RESULTS A total of 229 patients were referred to the emergency surgical team with 159 treated conservatively, 45 underwent operative intervention and 25 were discharged without admission. Of the emergency surgical team referrals, 58% had gallstone pathology, appendicitis or constipation/non-specific abdominal pain. Average daily number of patients under the care of the emergency surgical team was 26 (range, 10-40). CONCLUSIONS The consultant-led emergency surgical team look after many of the acutely sick surgical patients. Our system not only provides good teaching opportunities but ensures optimal continuity of patient care in a busy district general hospital. Such an approach to emergency surgical care has been successfully developed to optimise training opportunities and improve patient care in a setting of reduced working hours and shift systems in our hospital.
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Affiliation(s)
- Laura Tincknell
- Department of Colorectal Surgery, Frimley Park Hospital, Frimley, Surrey, UK
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Tincknell L, Burton S, Cooke C, Black S, Andreani S, Jourdan I, Gudgeon M. The Emergency Surgical Team – The Way Forward in Emergency Care? Ann R Coll Surg Engl 2009; 91:18-22. [DOI: 10.1308/rcsann.2009.91.1.18] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION With reduced working hours and shift patterns, surgical training and continuity of patient care is being put at risk. We have devised a system for managing the emergency surgical patients in an effort to counteract these perceived problems. This study describes the emergency surgical team and audits its activity. PATIENTS AND METHODS The emergency surgery team concept is described in detail. Over a 2-week period, general surgical referral data, patient management and operative activity were audited. RESULTS A total of 229 patients were referred to the emergency surgical team with 159 treated conservatively, 45 underwent operative intervention and 25 were discharged without admission. Of the emergency surgical team referrals, 58% had gallstone pathology, appendicitis or constipation/non-specific abdominal pain. Average daily number of patients under the care of the emergency surgical team was 26 (range, 10–40). CONCLUTIONS The consultant-led emergency surgical team look after many of the acutely sick surgical patients. Our system not only provides good teaching opportunities but ensures optimal continuity of patient care in a busy district general hospital. Such an approach to emergency surgical care has been successfully developed to optimise training opportunities and improve patient care in a setting of reduced working hours and shift systems in our hospital.
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Affiliation(s)
- Laura Tincknell
- Departments of Colorectal, Frimley Park Hospital Frimley, Surrey, UK
| | - Sarah Burton
- Departments of Colorectal, Frimley Park Hospital Frimley, Surrey, UK
| | - Claire Cooke
- Vascular Surgery, Frimley Park Hospital Frimley, Surrey, UK
| | - Stephen Black
- Vascular Surgery, Frimley Park Hospital Frimley, Surrey, UK
| | - Stefano Andreani
- Departments of Colorectal, Frimley Park Hospital Frimley, Surrey, UK
| | - Iain Jourdan
- Departments of Colorectal, Frimley Park Hospital Frimley, Surrey, UK
| | - Mark Gudgeon
- Departments of Colorectal, Frimley Park Hospital Frimley, Surrey, UK
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Chiara O, Cimbanassi S, Andreani S, Girotti P, Pizzilli G, Vesconi S. Niguarda Trauma Team: outcome of three years of activity. Minerva Anestesiol 2008; 74:11-15. [PMID: 18216763] [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: 05/25/2023]
Abstract
BACKGROUND The aim of this study was to prove the existence of a direct relationship between the comprehensive strategy of trauma management and an enhancement in outcome. Tests were carried out on the impact of the Niguarda Trauma Team System on mortality rates due to severe trauma. METHODS The epidemiological data was retrospectively reviewed along with, the severity scores: Abbreviated Injury Scale (AIS), Injury Severity Score (ISS), Revised Trauma Score (RTS), Probability of survival (Ps) and the outcome of severe trauma admitted to Niguarda hospital between October 2002 and September 2005. All data were collected from the Trauma Registry of the Niguarda Hospital. Two subsequent periods of 20 and 16 months were compared. RESULTS Nine hundred forty-two severe traumas (94.05% blunt trauma) were recorded with an overtriage rate of 36.09%. Most patients were admitted for bone and muscular injuries (52.22%). Excluding the patients who were overtriaged, there were 129 patients who died. Comparing the two periods, the Authors observed a significant reduction in mortality from 22.56% to 19.75%, mainly related to a decrease in early mortality due to hemodynamic instability. Central nervous system injury was the main cause of death (65%). Average hospital stay significantly decreased from 17.01+/-12.07 days to 14.97+/-10.34 days. CONCLUSION Introducing a comprehensive strategy of severe trauma management, the Niguarda Trauma Team System had a significant impact on mortality rates and hospital stay.
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Affiliation(s)
- O Chiara
- DEA-EAS Department, SSD Trauma Team, Niguarda Ca' Granda Hospital, Milan, Italy.
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Alvear J, Andreani S, Cortés F. [Fetal alcohol syndrome and fetal alcohol effects: importance of early diagnosis and nutritional treatment]. Rev Med Chil 1998; 126:407-12. [PMID: 9699371] [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: 02/08/2023]
Abstract
BACKGROUND Fetal alcohol syndrome (FAS) and fetal alcohol effects (FAE) encompass a pattern of birth defects in persons whose mothers ingested alcohol during pregnancy. People with FAE display fewer of the FAS traits. AIM To assess the prevalence and features of these affections in a secondary nutritional recovery centre. PATIENTS AND METHODS All charts of children admitted between 1985 and 1995 were reviewed, and those children diagnosed as having a FAS or FAE by a geneticist were considered for this study. Birth, maternal, social and economic characteristics, psychomotor abilities (using Denver test) and response to nutritional treatment were assessed. RESULTS During the study period, 1572 infants were admitted to the centre, and 1.97% (70% female) were diagnosed as having a FAS or FAE. These infants were admitted at 11.1 +/- 4.5 months of age and discharged after 96.7 +/- 58.1 months of hospitalisation. Mean mother's age was 33 +/- 7 years, and all belonged to low socioeconomic levels. Mean birth weight was 2048 +/- 431 g and 2469 +/- 619 g in children with FAS and FAE respectively (p < 0.03). Children with FAE performed better for gross and fine motor abilities than those with FAS. No differences were observed for language performance. Sixty five percent of children with FAS and 71% of children with FAE had an adequate weight and height increment during nutritional therapy. A multiple regression analysis showed that age at admission and gestational age were significant predictors of weight gain during therapy. CONCLUSIONS Alcohol has teratogenic effects on the foetus that affect craneal size and psychomotor development. Alcohol also affects pre and post natal growth.
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Affiliation(s)
- J Alvear
- Unidad de Genética y Enfermedades Metabólicas, INTA, Universidad de Chile
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Bedini AV, Valente M, Andreani S, Ravasi G. Reverse flap of distal latissimus dorsi for diaphragm reconstruction in the adult: specification of the technical procedure and report on six cases. J Thorac Cardiovasc Surg 1997; 114:846-8. [PMID: 9375617 DOI: 10.1016/s0022-5223(97)70091-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- A V Bedini
- Thoracic Surgery Department, National Cancer Institute, Milan, Italy
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Abstract
BACKGROUND Many oncologists have now accepted a combined radiosurgical approach as the treatment of choice in patients with Pancoast tumour but most reports show an incorrect assessment of the disease. METHODS Stage III lung cancer was classified as Pancoast tumour if the pulmonary extent was limited to the upper apical segment and if at least one of the features of Pancoast syndrome, indicating tumour spread to the para-apical structures, was present. Between 1984 and 1988 15 consecutive patients were treated with primary radiotherapy followed by surgery or with primary excision and subsequent radiotherapy in the absence of an initial histological diagnosis. RESULTS The mortality of patients given the combined treatment was 6.6% (one death due to pulmonary embolism), and the five year survival rate was 26.6% for all patients and 57% for those who underwent complete resection without N2 disease. Long-term survival was 0% for those cases with incomplete resection, N2 disease, or malignant invasion of the first rib. CONCLUSIONS Stage III lung cancer, classified as Pancoast tumour according to strict, consistent criteria, is best treated by primary radiotherapy; combined treatment should be used only for patients with potentially resectable cancer without N2 disease and/or malignant invasion of the first rib.
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Affiliation(s)
- G Muscolino
- Istituto Nazionale Tumori, Department of Thoracic Surgery, Milan, Italy
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Infante M, Valente M, Andreani S, Catanese C, Dal Fante M, Pizzetti P, Giudice G, Basilico M, Spinelli P, Ravasi G. Conservative management of esophageal leaks by transluminal endoscopic drainage of the mediastinum or pleural space. Surgery 1996; 119:46-50. [PMID: 8560385 DOI: 10.1016/s0039-6060(96)80212-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The management of postoperative leaks into the mediastinum or pleural cavities after esophageal surgery yields unsatisfactory results. A recently described method, drainage of the mediastinum or pleural cavity through suture line defects, has been used in our department with eight patients. METHODS A suction tube was advanced over an endoscopically placed guide wire into the abscess from inside the esophagus, and gentle aspiration was used to remove saliva and secretions. Intravenous antibiotics and total parenteral nutrition were also given. RESULTS The sepsis was rapidly controlled, and the abscess cavity progressively collapsed in all cases. Seven patients recovered and were discharged 34 to 61 days after operation; one died of concomitant complications. CONCLUSIONS This method seems promising for the management of intrathoracic esophageal leaks.
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Pastorino U, Muscolino G, Valente M, Andreani S, Tavecchio L, Infante M, Terno G, Ravasi G. Safety of absorbable suture for sternal closure after pulmonary or mediastinal resection. J Thorac Cardiovasc Surg 1994; 107:596-9. [PMID: 8302079] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The reliability of polyglyconate monofilament (Maxon) suture for sternal closure was tested on 216 consecutive sternotomies, performed on 208 patients in our department from January 1986 to December 1990. The reason of sternotomy was primary lung cancer in 34 cases (16%), lung metastases in 127 (59%), and disorders of the thymus in 55 (25%). Mean age was 38 years (range 3 to 78 years); multiple lung resections were performed in 102 patients (average 7 lesions, range 2 to 30); maximum extent of the operation was pneumonectomy in 2 cases, lobectomy in 53, segmentectomy in 27, and wedge resection in 74. Prior chemotherapy had been administered in 75 cases (35%). A second sternotomy was performed in 8 cases. No cases of sternal dehiscence, sternal infection, or empyema were observed, after a median follow-up of 27 months. Overall perioperative mortality was 0.9% (2/216). Our series demonstrates the safety of polyglyconate monofilament (Maxon) suture for sternal closure. Absorbable sutures appear to be a safe alternative to steel wire closure in patients undergoing extended pulmonary or mediastinal resection.
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Affiliation(s)
- U Pastorino
- Department of Thoracic Surgery, Istituto Nazionale Tumori, Milan, Italy
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Pastorino U, Muscolino G, Valente M, Andreani S, Tavecchio L, Infante M, Terno G, Ravasi G. Safety of absorbable suture for sternal closure after pulmonary or mediastinal resection. J Thorac Cardiovasc Surg 1994. [DOI: 10.1016/s0022-5223(94)70108-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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