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Galli M, Vergari A, Vitiello R, Nestorini R, Peruzzi M, Chierichini A, Spinazzola G, Rossi M. Comparative Evaluation of Two Different Post-Operative Analgesia after Hallux Valgus Correction in Day Surgery Patients. Malays Orthop J 2020; 14:57-63. [PMID: 32983378 PMCID: PMC7513642 DOI: 10.5704/moj.2007.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction The aim of this study was the evaluation of two different techniques on post-operative analgesia and motor recovery after hallux valgus correction in one-day surgery patients. Material and Methods We enrolled 26 patients scheduled for hallux valgus surgery and treated with the same surgical technique (SCARF osteotomy). After subgluteal sciatic nerve block with a short acting local anaesthetic (Mepivacaine 1.5%, 15ml), each patient received an ultrasound-guided Posterior Tibialis Nerve Block (PTNB) with Levobupivacaine 0.5% (7-8ml). We measured the postoperative intensity of pain using a Visual Analogue Scale (VAS), the consumption of oxycodone after operative treatment and the motor recovery. VAS was detected at baseline (time 0, before the surgery) and at 3, 6, 12 and 24 hours after the operative procedure (T1, T2, T3, T4 respectively). Control group of 26 patients were treated with another post-operative analgesia technique: local infiltration (Local Infiltration Anaesthesia, LIA) with Levobupivacaine 0.5% (15ml) performed by the surgeon. Results PTNB group showed a significant reduction of VAS score from the sixth hour after surgery compared to LIA group (p<0.028 at T2, p<0.05 at T3 and p<0.002 at T4, respectively). Instead, no significant differences were found in terms of post-operative oxycodone consumption and motor recovery after surgery.Conclusions: PTNB resulted in a valid alternative to LIA approach for post-operative pain control due to its better control of post-operative pain along the first 24 hours. In a multimodal pain management according to ERAS protocol, both PTNB and LIA should be considered as clinically effective analgesic techniques.
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Affiliation(s)
- M Galli
- Department of Orthopaedics and Traumatology, Universita Cattolica del Sacro Cuore, Rome, Italy
| | - A Vergari
- Department of Anaesthesiology, Universita Cattolica del Sacro Cuore, Rome, Italy
| | - R Vitiello
- Department of Orthopaedics and Traumatology, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - R Nestorini
- Department of Anaesthesiology, Universita Cattolica del Sacro Cuore, Rome, Italy
| | - M Peruzzi
- Department of Orthopaedics and Traumatology, Universita Cattolica del Sacro Cuore, Rome, Italy
| | - A Chierichini
- Department of Anaesthesiology, Universita Cattolica del Sacro Cuore, Rome, Italy
| | - G Spinazzola
- Department of Anaesthesiology, Universita Cattolica del Sacro Cuore, Rome, Italy
| | - M Rossi
- Department of Anaesthesiology, Universita Cattolica del Sacro Cuore, Rome, Italy
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Ferrone G, Tamburello E, Nestorini R, Concina G, Chierichini A, Rossi M, Vergari A. Dexmedetomidine sedation associated with suprainguinal fascia iliaca block for hip fracture surgery in high risk elderly patients. J BIOL REG HOMEOS AG 2020; 34:687-690. [PMID: 32466634 DOI: 10.23812/19-501-l-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- G Ferrone
- Department of Anesthesiology, Intensive Care Medicine and Toxicology, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | - E Tamburello
- Department of Anesthesiology, Intensive Care Medicine and Toxicology, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | - R Nestorini
- Department of Anesthesiology, Intensive Care Medicine and Toxicology, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | - G Concina
- Department of Anesthesiology, Intensive Care Medicine and Toxicology, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | - A Chierichini
- Department of Anesthesiology, Intensive Care Medicine and Toxicology, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy.,Catholic University of the Sacred Heart, Rome, Italy
| | - M Rossi
- Department of Anesthesiology, Intensive Care Medicine and Toxicology, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy.,Catholic University of the Sacred Heart, Rome, Italy
| | - A Vergari
- Department of Anesthesiology, Intensive Care Medicine and Toxicology, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy.,Catholic University of the Sacred Heart, Rome, Italy
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Frassanito L, Messina A, Vergari A, Colombo D, Chierichini A, Della Corte F, Navalesi P, Antonelli M. Intravenous infusion of magnesium sulfate and postoperative analgesia in total knee arthroplasty. Minerva Anestesiol 2015; 81:1184-1191. [PMID: 25616206] [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: 06/04/2023]
Abstract
BACKGROUND The effectiveness of combining magnesium (Mg) administration with both general and spinal anesthesia to reduce postoperative pain and analgesic consumption is still debated. We evaluated the effects of an intravenous (IV) infusion of Mg sulphate on analgesic consumption and postoperative pain score after total knee arthroplasty performed under spinal anesthesia. METHODS We studied 40 patients who underwent spinal anesthesia with bupivacaine plus morphine. Patients were randomly assigned to two groups, each of 20 patients, who received either treatment (i.e., intravenous Mg sulphate 40 mg kg(-1) followed by an infusion of 10 mg kg(-1) h(-1)), or the same amounts of isotonic saline (controls). Irrespective of the group of randomization, all patients received postoperative paracetamol, ketorolac, and patient-controlled analgesia with morphine. RESULTS The Mg postoperative blood level was 0.85 ± 0.02 mmol/L and 1.25 ± 0.11 mmol/L for C and Mg groups, respectively (P<0.001). Sensory level of the spinal block, height of spinal block, mean time to first pain and incidence of PONV were similar in the two groups. Morphine consumption did not show any statistically significant difference between the two groups. The pain score was not significantly different between the two groups. No severe adverse effects were recorded after Mg infusion. CONCLUSION IV perioperative administration of Mg did not influence postoperative pain control and analgesic consumption after total knee arthroplasty. More studies should be performed with different intra and postoperative pain protocols to enhance the potential anti-nociceptive effect of Mg.
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Affiliation(s)
- L Frassanito
- Istituto di Anestesia e Rianimazione, Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy -
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Marchesi F, Mengarelli A, Giannotti F, Tendas A, Anaclerico B, Porrini R, Picardi A, Cerchiara E, Dentamaro T, Chierichini A, Romeo A, Cudillo L, Montefusco E, Tirindelli MC, De Fabritiis P, Annino L, Petti MC, Monarca B, Arcese W, Avvisati G. High incidence of post-transplant cytomegalovirus reactivations in myeloma patients undergoing autologous stem cell transplantation after treatment with bortezomib-based regimens: a survey from the Rome transplant network. Transpl Infect Dis 2013; 16:158-64. [PMID: 24215479 DOI: 10.1111/tid.12162] [Citation(s) in RCA: 33] [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: 02/19/2013] [Revised: 04/19/2013] [Accepted: 05/13/2013] [Indexed: 01/13/2023]
Abstract
The incidence of cytomegalovirus (CMV) reactivations in patients with multiple myeloma (MM) receiving autologous stem cell transplantation (ASCT) is relatively low. However, the recent increased use of novel agents, such as bortezomib and/or immunomodulators, before transplant, has led to an increasing incidence of Herpesviridae family virus infections. The aim of the study was to establish the incidence of post-engraftment symptomatic CMV reactivations in MM patients receiving ASCT, and to compare this incidence with that of patients treated with novel agents or with conventional chemotherapy before transplant. The study was a survey of 80 consecutive patients who underwent ASCT after treatment with novel agents (Group A). These patients were compared with a cohort of 89 patients treated with VAD regimen (vincristine, doxorubicin, and dexamethasone) before ASCT (Group B). Overall, 7 patients (4.1%) received an antiviral treatment for a symptomatic CMV reactivation and 1 died. The incidence of CMV reactivations was significantly higher in Group A than in Group B (7.5% vs. 1.1%; P = 0.048). When compared with Group B, the CMV reactivations observed in Group A were significantly more frequent in patients who received bortezomib, whether or not associated with immunomodulators (9.4% vs. 1.1%; P = 0.019), but not in those treated with immunomodulators only (3.7% vs. 1.1%; P = 0.396). These results suggest that MM patients treated with bortezomib-based regimens are at higher risk of developing a symptomatic CMV reactivation after ASCT.
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Affiliation(s)
- F Marchesi
- Hematology Unit, Campus Bio-Medico University Hospital, Rome, Italy
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Chierichini A, Messina A, Vergari A, Santoprete S, Rassanito L. Regional anesthesia in a child with sotos syndrome. Int J Immunopathol Pharmacol 2011; 24:21-3. [PMID: 21669133 DOI: 10.1177/03946320110241s205] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- A Chierichini
- Dept. of Anesthesiology, Catholic University of Sacred Heart, Rome, Italy.
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Maccauro G, Cittadini A, Magnani G, Sangiorgi S, Muratori F, Manicone P, Iommetti PR, Marotta D, Chierichini A, Raffaelli L, Sgambato A. In Vivo Characterization of Zirconia Toughened Alumina Material: A Comparative Animal Study. Int J Immunopathol Pharmacol 2010; 23:841-6. [DOI: 10.1177/039463201002300319] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The development of a new chromia-doped Zirconia Toughened Alumina (ZTA) material was previously reported as displaying mechanical properties suitable for implants with load bearing applications, such as orthopaedic and dental implants. This type of biomaterial is expected to be in contact with living tissues for a long period of time and its long-term toxicity must be carefully evaluated. In this study the suitability of this ZTA material as a candidate biomaterial for orthopaedic implants and dental devices was further investigated in vivo in comparison to alumina and zirconia, which are currently used in orthopaedic and dental surgery. Cylinders of the materials were implanted in vivo in white rabbits, and local and systemic tissue reactions were analyzed at different time intervals after surgery. Radiologic examinations displayed the absence of radiolucence around cylinders and no signs of implant loosening up to twelve months. No tumours developed in the animals either locally (at the site of implantation), or systemically in the peripheral organs. The results obtained suggest that this new ZTA material does not display any long term pathogenic effect in vivo. These findings extend our previous observations on the biocompatibility and the absence of any long-term carcinogenic effect in vitro of this material which displays interesting properties for biomedical applications. In conclusion, we report the in vivo characterization of a new chromia-doped ZTA material and confirm its suitability as a candidate biomaterial for orthopaedic implants and dental devices since it does not give any local nor systemic toxicity even after a long period of time after implantation.
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Affiliation(s)
| | - A. Cittadini
- Institute of General Pathology, Catholic University, Rome
| | | | | | | | - P.F. Manicone
- Institute of Clinical Dentistry, Catholic University
| | | | | | - A. Chierichini
- Institute of Anesthesiology, Catholic University, Rome, Italy
| | - L. Raffaelli
- Institute of Clinical Dentistry, Catholic University
| | - A. Sgambato
- Institute of General Pathology, Catholic University, Rome
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Pagano L, Valentini CG, Posteraro B, Girmenia C, Ossi C, Pan A, Candoni A, Nosari A, Riva M, Cattaneo C, Rossini F, Fianchi L, Caira M, Sanguinetti M, Gesu GP, Lombardi G, Vianelli N, Stanzani M, Mirone E, Pinsi G, Facchetti F, Manca N, Savi L, Mettimano M, Selva V, Caserta I, Scarpellini P, Morace G, D'Arminio Monforte A, Grossi P, Giudici D, Tortorano AM, Bonini A, Ricci L, Picardi M, Rossano F, Fanci R, Pecile P, Fumagalli L, Ferrari L, Capecchi PL, Romano C, Busca A, Barbui A, Garzia M, Minniti RR, Farina G, Montagna MT, Bruno F, Morelli O, Chierichini A, Placanica PM, Castagnola E, Bandettini R, Giordano S, Monastero R, Tosti ME, Rossi MR, Spedini P, Piane R, Nucci M, Pallavicini F, Bassetti M, Cristini F, LA Sorda M, Viviani M. Zygomycosis in Italy: a survey of FIMUA-ECMM (Federazione Italiana di Micopatologia Umana ed Animale and European Confederation of Medical Mycology). J Chemother 2009; 21:322-9. [PMID: 19567354 DOI: 10.1179/joc.2009.21.3.322] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The aims of the study were to analyze the clinical and epidemiological characteristics and treatments for patients who developed zygomycosis enrolled in Italy during the European Confederation of Medical Mycology of medical mycology survey. This prospective multicenter study was performed between 2004 and 2007 at 49 italian Departments. 60 cases of zygomycosis were enrolled: the median age was 59.5 years (range 1-87), with a prevalence of males (70%). The majority of cases were immunocompromised patients (42 cases, 70%), mainly hematological malignancies (37). Among non-immunocompromised (18 cases, 30%), the main category was represented by patients with penetrating trauma (7/18, 39%). The most common sites of infection were sinus (35%) with/without CNS involvement, lung alone (25%), skin (20%), but in 11 cases (18%) dissemination was observed. According to EORTC criteria, the diagnosis of zygomycosis was proven in 46 patients (77%) and in most of them it was made in vivo (40/46 patients, 87%); in the remaining 14 cases (23%) the diagnosis was probable. 51 patients received antifungal therapy and in 30 of them surgical debridement was also performed. The most commonly used antifungal drug was liposomal amphotericin B (L-AmB), administered in 44 patients: 36 of these patients (82%) responded to therapy. Altogether an attributable mortality rate of 32% (19/60) was registered, which was reduced to 18% in patients treated with L-AmB (8/44). Zygomycosis is a rare and aggressive filamentous fungal infection, still associated with a high mortality rate. This study indicates an inversion of this trend, with a better prognosis and significantly lower mortality than that reported in the literature. It is possible that new extensive, aggressive diagnostic and therapeutic procedures, such as the use of L-AmB and surgery, have improved the prognosis of these patients.
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Affiliation(s)
- L Pagano
- Instituto di Ematologia, Università Cattolica del Sacro Cuore, Roma.
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Frassanito L, Vergari A, Messina A, Pitoni S, Puglisi C, Chierichini A. Anaesthesia for total knee arthroplasty: efficacy of single-injection or continuous lumbar plexus associated with sciatic nerve blocks--a randomized controlled study. Eur Rev Med Pharmacol Sci 2009; 13:375-382. [PMID: 19961044] [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: 05/28/2023]
Abstract
Total knee arthroplasty (TKA) often results in marked postoperative pain. We compared in a randomized controlled study tramadol consumption, postoperative pain and patient satisfaction after primary TKA in patients who received a single injection lumbar plexus and sciatic nerve blocks or a continuous lumbar plexus and sciatic nerve blocks. Forty-four patients scheduled for unilateral total knee arthroplasty were allocated to the single shot group (group A) or to the catheter group (group B). All patients (in both groups) reported being satisfied with their anaesthetic management. Although pain scores and tramadol consumption appeared lower in the active infusion group, the differences did not reach statistical significance. This study confirms that either single injection or continuous infusion of Ropivacaine in lumbar plexus provides reliable and long-acting anaesthesia and analgesia.
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Affiliation(s)
- L Frassanito
- Emergency and Admittance Department, Catholic University of Sacred Heart, Rome, Italy.
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Frassanito L, Rodolà F, Concina G, Messina A, Chierichini A, Vergari A. The efficacy of the psoas compartment block versus the intrathecal combination of morphine, fentanyl and bupivacaine for postoperative analgesia after primary hip arthroplasty: a randomized single-blinded study. Eur Rev Med Pharmacol Sci 2008; 12:117-122. [PMID: 18575162] [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: 05/26/2023]
Abstract
PURPOSE Intrathecal morphine and psoas compartment block represent two accepted techniques to provide postoperative analgesia after hip arthroplasty. We designed a prospective, randomized, single-blinded study to compare these two techniques. METHODS Forty patients scheduled for primary hip arthroplasty under general anesthesia were randomized to receive either an intrathecal administration of 0.1 mg morphine, 0.015 mg fentanyl and 15 mg hyperbaric bupivacaine (Group I, n = 20) or a psoas compartment block with ropivacaine 0.475% 25 mL (Group II, n = 20). Pain scores, morphine consumption, associated side-effects were assessed for 48 hr postoperatively. In addition, patient's satisfaction and acceptance of the postoperative analgesic technique were also recorded. RESULTS During the first 24 hr, pain scores (12 +/- 27 vs 24 +/- 25 at H + 12, 12 +/- 46 vs 20 +/- 26 mm at H + 24, 16 +/- 19 vs 20 +/- 29 mm at H + 36) and tramadol consumption (30 +/- 70 vs 210 +/- 400 mg at H + 12, 180 +/- 120 vs 320 +/- 100 mg at H + 24) were slightly lower in Group I than in Group II, but there were no statistically significant differences. Itching was the most frequent side-effect occurring in 45% of cases in Group I vs 10% in Group II (P < 0.05). No major complication occurred. There was no difference in satisfaction scores between the two groups. CONCLUSION Intrathecal administration of a combination of morphine, fentanyl and bupivacaine and single-shot psoas compartment block both provide very good postoperative analgesia after primary hip arthroplasty.
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Affiliation(s)
- L Frassanito
- Dipartimento di Emergenza e Accettazione, Catholic University of Sacred Heart, A. Gemelli Hospital, Rome, Italy.
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Dalla Riva B, Messineo A, Imperatore A, Chierichini A, Sperduto B. [Correlation between exhaled benzene and environmental exposure in refinery workers]. G Ital Med Lav Ergon 2007; 29:531-532. [PMID: 18409815] [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: 05/26/2023]
Abstract
Benzene is still present in various working processes. Many methods are available for the biological monitoring of benzene exposure. The Authors present a study concerning a series of 23 workers of a refinery exposed to benzene. The measurement of benzene in alveolar air was preferred to quantify exposure. In this paper, adopting an original, simple and reliable device to collect the samples of alveolar air, a good correlation was found between the levels of benzene in the alveolar air and the environmental individual sampling.
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Rodolà F, Conti C, Abballe C, Chierichini A, Ciano F, Forte E, Iacobucci T, Sorrentino L, Vagnoni S, Vergari A, D'Avolio S. Anaesthesia for shock wave therapy in musculoskeletal disorders: a preliminary report. Eur Rev Med Pharmacol Sci 2002; 6:133-8. [PMID: 12776807] [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: 03/02/2023]
Abstract
The potential for using external applied energy to rectify or ameliorate musculoskeletal disorders has been explored for decades. A shock wave is a pressure disturbance: tissue effect is cavitation, producing microtrauma or microfracture and haematoma formation, inducing, as to date is thought, increase in vascularization, increased soft callus and faster enchondral ossification. Anaesthesiological interest in this field is focused in non-union or delayed osseous union, joint stiffness or osteochondrosis and femoral head necrosis in adults. Actually, because of the pain associated with high energy extracorporeal shock wave therapy on bones, anaesthesia is necessary, but, since almost all patients have no complaint after treatment, there is no need of postoperative analgesia. Therefore, short duration anaesthetic techniques and agents should be preferred. Loco-regional anaesthesia or general anaesthesia are both suitable to the purpose. Fifty patients have been treated nowadays in our Institution with shock wave therapy needing anaesthesia. 18 patients (36%) received general anaesthesia. Since patient's stay in hospital was expected to be short, short duration agents have been used, avoiding those causing unpleasent side effects, first emesis. We used Propofol or Remifentanil by continuous infusion, titrated to maintain stable haemodynamics and an appropriate level of anaesthesia. The short duration of action of Propofol depends on its rapid elimination, whereas Remifentanil undergoes rapid biotransformation to minimally active metabolites. 32 patients (64%) received regional anaesthesia. We avoided long acting agents or high concentration drugs. Spinal blocks have been performed with 0.5% hyperbaric bupivacaine; brachial plexus blocks, sciatic-femoral blocks and an epidural block have been performed with 0.5-1% xylocaine or 1% mepivacaine. Shock Wave Therapy has been done during a 3-day hospital stay. With suitable anaesthesiological treatment and preparation, almost all patients could be treated as outpatients or with an overnight hospital stay.
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Affiliation(s)
- F Rodolà
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
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Pagano L, Girmenia C, Mele L, Ricci P, Tosti ME, Nosari A, Buelli M, Picardi M, Allione B, Corvatta L, D'Antonio D, Montillo M, Melillo L, Chierichini A, Cenacchi A, Tonso A, Cudillo L, Candoni A, Savignano C, Bonini A, Martino P, Del Favero A. Infections caused by filamentous fungi in patients with hematologic malignancies. A report of 391 cases by GIMEMA Infection Program. Haematologica 2001; 86:862-70. [PMID: 11522544] [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: 02/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVES To evaluate the clinical characteristics of patients with hematologic malignancies developing a filamentous fungi infection (FFI) and to define the prognostic factors for their outcome. DESIGN AND METHODS A retrospective study, conducted on patients admitted to 14 Hematology divisions of tertiary care or university hospitals, participating in the GIMEMA Infection Program, over a ten-year period (1988-1997). The study included patients with hematological malignancies and a histologically and/or microbiologically proven or probable FFI. RESULTS We included 391 patients (male/female: 262/129, median age 49 years) with hematologic malignancies (225 acute myeloid leukemia, 67 acute lymphocytic leukemia, 30 chronic myeloid leukemia, 22 non-Hodgkin's lymphoma, 12 myelodysplastic syndrome, 10 aplastic anemia, 7 Hodgkin's disease, 8 chronic lymphocytic leukemia, 5 multiple myeloma, and 5 hairy cell leukemia) who developed a proven FFI. Eighty percent of the patients had been neutropenic for an average of 14 days before the infection, and 71% had an absolute neutrophil count lower than 0.5 x 10(9)/L at the time of FFI diagnosis. The primary sites of infection were: lungs (85%), nose and paranasal sinus (10%), and other sites (5%). The diagnosis was made while still alive in 310 patients (79%), and at autopsy in the remaining 81 patients (21%). Chest X-ray was diagnostic in 77% of patients with pulmonary FFI, while computed tomography (CT) scan of the thorax was positive in 95% of cases. A significant diagnostic advantage for CT scan was observed in 145 patients who had both a chest X-ray and CT scan. Aspergillus was identified as the cause of FFI in 296 patients, Mucorales in 45 patients, Fusarium in 6 patients and other filamentous fungi species in 4 patients, while in a further 40 patients no agent was identifiable. The overall mortality rate three months after the diagnosis of FFI was 74%, and fungal infection had been the cause of death in 51% of patients. INTERPRETATION AND CONCLUSIONS Our retrospective study shows that FFI still remains a life-threatening complication in neutropenic patients. Despite appropriate treatment, half of the patients die due to this complication. The use of glucocorticoids and recovery from neutropenia are the most important prognostic factors. Mucorales infections are associated with a significantly poorer prognosis than those due to Aspergillus spp.
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Affiliation(s)
- L Pagano
- Istituto di Semeiotica Medica, Università Cattolica del Sacro Cuore, largo Francesco Vito 1, 00168 Rome, Italy.
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Rodolà F, Vagnoni S, D'Avolio S, Vurchio M, Micci D, Chierichini A, Vergari A, Ciano F. Intra-articular analgesia following arthroscopic surgery of the shoulder. Eur Rev Med Pharmacol Sci 2001; 5:143-6. [PMID: 12067083] [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: 02/25/2023]
Abstract
Shoulder surgery is very often followed by severe postoperative pain. Loco-regional anaesthesia has greatly contributed as a solution of this problem. Nevertheless most of surgery is still performed under general anaesthesia. In this case many different methods have been proposed in order to mitigate postoperative pain. Intra-articular administration of local anaesthetics after shoulder surgery is not yet in routinely clinical practice. In this study efficacy of intra-articular administration of Ropivacaine versus Bupivacaine has been evaluated. Analysis of results showed both drugs to share the same effectiveness within four hours postoperatively. In subsequent period (6-24 hours) Ropivacaine demonstrated to provide a statistically significant better postoperative pain relief. Furthermore Ropivacaine group patients needed postoperative analgesics to a lesser extent than Bupivacaine group. The long-losting satisfactory level of analgesia, particularly with Ropivacaine, could recommend the use of intra-articular analgesia even for day-hospital or one-day surgery procedures.
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Affiliation(s)
- F Rodolà
- Istituto di Anestesiologia e Rianimazione, Catholic University of Sacred Heart, Rome, Italy
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Perilli V, Sollazzi L, Bozza P, Modesti C, Chierichini A, Tacchino RM, Ranieri R. The effects of the reverse trendelenburg position on respiratory mechanics and blood gases in morbidly obese patients during bariatric surgery. Anesth Analg 2000; 91:1520-5. [PMID: 11094011 DOI: 10.1097/00000539-200012000-00041] [Citation(s) in RCA: 123] [Impact Index Per Article: 5.1] [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: 11/26/2022]
Abstract
Anesthesia adversely affects respiratory function, particularly in morbidly obese patients. Although many studies have been performed to determine the optimal ventilatory settings in these patients, this question has not been answered. The aim of this study was to evaluate the effect of reverse Trendelenburg position (RTP) on gas exchange and respiratory mechanics in 15 obese patients undergoing biliopancreatic diversion. A standardized anesthetic regimen was used and patients were examined at standard times: 1) after tracheal intubation, 2) after laparotomy, 3) after positioning of subcostal retractors, 4) with retractors in RTP. The measurements of respiratory mechanics were repeated for a wide range of tidal volumes by using the technique of rapid occlusion during constant flow inflation. We noted a wide alveolar-arterial oxygen difference [P(A-a)O(2)] in all patients, particularly during Phase 3. When the patients were placed in RTP, P(A-a)O(2) showed a significant improvement and a return toward baseline values. As for mechanics, total respiratory system compliance was significantly higher in RTP than in the other phases. In conclusion, our data suggest that RTP is an appropriate intraoperative posture for obese subjects because it causes minimal arterial blood pressure changes and improves oxygenation.
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Affiliation(s)
- V Perilli
- Department of Anesthesiology and Surgery, Catholic University of Sacred Heart Rome, Rome, Italy
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15
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Vescia N, Chierichini A, Mastroeni I. [Surveillance and prevention of invasive candidiasis in oncohematology]. Ann Ig 2000; 12:103-9. [PMID: 11100559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Affiliation(s)
- N Vescia
- Ist. di Igiene Università di Roma La Sapienza, ITBA Milano
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16
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Rodolà F, D'Avolio S, Chierichini A, Vagnoni S, Forte E, Iacobucci T. Wake-up test during major spinal surgery under remifentanil balanced anaesthesia. Eur Rev Med Pharmacol Sci 2000; 4:67-70. [PMID: 11558627] [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: 02/21/2023]
Abstract
Damage to spinal cord and subsequent neurological deficit is a recognised complication of major spinal surgery. It may be produced by a number of causes, not last excessive stretching when surgical instrumentation is positioned; it is easy to understand that early intraoperative warning of potential damage is highly desiderable. Wake-up test is a simple, safe and reliable method of recognition of such a complication, allowing rapid neurological recovery by reduction of spinal distraction. Remifentanil belongs to a new pharmacokinetic class of opioids (EMO: Esterase Metabolised Opioid) undergoing rapid biotransformation to minimally active metabolites, showing a short and predictable duration of action with no effect of accumulation. Authors describe a first 10 patient series subjected to wake-up-test during spinal surgery under remifentanil balanced anaesthesia. The protocol the authors set up allowed a very rapid intraoperative neurological examination (in average less than 5 min), without pain and/or disagreement for the patient and no complication related to the test was observed. Authors conclude that the use of Remifentanil for intraoperative awakening during major spinal surgery seems to be a safe, reliable and pratictical method to detect very quickly any potential neurological damage during the operation.
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Affiliation(s)
- F Rodolà
- Istituto di Anestesiologia e Rianimazione, Catholic University of Sacred Heart, Rome, Italy
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17
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Pagano L, Ricci P, Montillo M, Cenacchi A, Nosari A, Tonso A, Cudillo L, Chierichini A, Savignano C, Buelli M, Melillo L, La Barbera EO, Sica S, Hohaus S, Bonini A, Bucaneve G, Del Favero A. Localization of aspergillosis to the central nervous system among patients with acute leukemia: report of 14 cases. Gruppo Italiano Malattie Ematologiche dell'Adulto Infection Program. Clin Infect Dis 1996; 23:628-30. [PMID: 8879790 DOI: 10.1093/clinids/23.3.628] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.5] [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: 02/02/2023] Open
Abstract
We retrospectively studied a consecutive series of 100 patients with acute leukemia and aspergillosis to evaluate the clinical findings and risk factors for colonization of the central nervous system (CNS) by Aspergillus species. The diagnosis of CNS aspergillosis was made in 14 patients on the basis of the following criteria: neurological signs of CNS involvement (13 of 14 patients); cerebral CT scan findings (9 of 12); microbiological findings (6 of 12); and histological findings at autopsy (11 of 11). The majority of patients had severe neurological complications (i.e., hemiparesis or seizures), due mainly to brain abscesses or mycetomas. Autopsies were performed on 11 of 14 patients and provided evidence that CNS localization was secondary to invasive aspergillosis; in each case, the most likely primary focus of infection was the lung. Although all patients had received oral antimycotic prophylaxis and had received timely empirical antifungal treatment, they all died within a median time of 5 days from the onset of neurological symptoms. Analysis of the characteristics of patients with invasive aspergillosis did not reveal any difference between those with CNS localization and those without CNS localization.
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Affiliation(s)
- L Pagano
- Istituto di Semeiotica Medica, Università Cattolica S. Cuore, Rome, Italy
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18
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Sammartino M, Valenti M, Pietrini D, Vergari A, Chierichini A, Zanghi F. [Pediatric neuroanesthesia. Hemodynamic changes during total intravenous anesthesia]. Minerva Anestesiol 1993; 59:715-7. [PMID: 8177414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- M Sammartino
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Roma
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19
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Perotti V, Chierichini A, Pusateri A, Stoppa F, Sammartino M, Zanghi F. [Total intravenous anesthesia (TIVA) in neurosurgery]. Minerva Anestesiol 1993; 59:703-5. [PMID: 8177411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- V Perotti
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Roma
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20
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Perotti V, Valenti M, Chierichini A, Pietrini D, Pusateri A, Zanghi F. [Trans-sphenoid surgery of hypophyseal adenoma. Postoperative water-electrolyte complications]. Minerva Anestesiol 1992; 58:133-4. [PMID: 1620433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- V Perotti
- Istituto di Anesthesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Roma
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21
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Mantovani L, Guglielmi C, Martelli M, Chierichini A, Deriu L, Sertoli MR, Ardizzoni A, Mandelli F. Recombinant alpha interferon in the treatment of low-grade non-Hodgkin's lymphoma: results of a cooperative phase II trial in 31 patients. Haematologica 1989; 74:571-5. [PMID: 2628239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Thirty-one patients with advanced stage of favorable histology non-Hodgkin's lymphomas were entered into a multicenter phase II trial with recombinant alpha A interferon as single agent. Interferon was administered intramuscular in doses of 6 x 10(6)/IU/m2 three times per week for 12 weeks. Dose escalation was applied, in the absence of toxicities greater than WHO grade II, in patients not responding after 4 weeks. In responding patients treatment was continued at the same dose with a weekly maintenance schedule for 12 additional weeks. Objective responses (4 complete, 10 partial) were obtained in 14 of the 27 evaluable patients (52%). Median time to progression was 15 months for partial responders, while none of the complete responders has relapsed up to the present time. Toxicity was generally moderate and manageable. Treatment was discontinued in three patients because of side effects, and one patient refused therapy after 3 weeks. Our study shows that recombinant alpha A interferon has antitumor activity in patients with favorable histology non-Hodgkin's lymphoma.
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22
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Barelli A, Della Corte F, Calimici R, Bradariolo S, Chierichini A, Proietti R. [Neurophysiological monitoring of the brain injured patient: usefulness of the electroencephalographic mapping]. Agressologie 1988; 29:375-7. [PMID: 3213883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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23
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Amadori S, Petti MC, De Francesco A, Chierichini A, Mastrovincenzo C, Testa MG, Mandelli F. Lack of prognostic significance of the pretreatment labeling and mitotic indices of marrow blasts in acute nonlymphocytic leukemia (ANLL). Cancer 1978; 41:1154-60. [PMID: 638960 DOI: 10.1002/1097-0142(197803)41:3<1154::aid-cncr2820410353>3.0.co;2-e] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The prognostic significance of the pretreatment growth characteristics of marrow blasts was examined in 37 patients with acute nonlymphocytic leukemia (ANLL) treated with a similar therapeutic regimen. Initial mitotic index (MI) and in vitro 3H-thymidine labeling index (LI) were broadly distributed showing no correlation to other initial variables, such as age or absolute blast count. No relationship whatsoever was observed between the pretreatment LI, MI and either the likelihood of achieving a complete remission or the remission and survival length. We conclude that the initial growth characteristics of marrow blasts do not play a significant role in predicting the therapeutic response in ANLL; age, modality of therapy and, possibly, the dynamic perturbations of the proliferative activity of the blast cells induced by treatment should be regarded as more reliable prognostic indicators in ANLL.
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