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Stuto A, Armaro B, Cosentino E, Canonico G, Ambu A, Cascone G, Lo Giudice A, Canonico S, Cassarisi S, Ierna S, Basile G, Gulletta S. P408 CERTIFICATION FOR COMPETITIVE SPORTS ACTIVITY IN A TEENAGER WITH WPW BY VIA INTRAHYSSIAN ACCESSORY PATHWAY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
The case of a 12–year–old male, height 160 cm, weight 46 kg, who practices water polo at a competitive level is reported. Negative family history of cardiovascular pathologies, general and cardiovascular physical examination within the limits of normality. On the electrocardiographic trace (ECG) presence of delta wave from ventricular pre–excitation from intrahyssian accessory pathway (Fig. 1). Echocardiography + color Doppler was normal. The subject underwent a cardiopulmonary stress test with an incremental ramp protocol and steps of 20 watts / min. Shutdown at 190 watts for muscle exhaustion with peak oxygen consumption (VO2) = 43.9 mL / Kg / min, Heart rate = 197 beats / minute, BP = 210/70 mmHg, VE / VCO2 slope = 27.6. Normal course of the cronotropic and pressure curve. The ventricular pre–excitation delta wave persisted for the entire duration of the test and in recovery (Fig. 2, Fig. 3). Secondary disturbances of ventricular repolarization characterized by ST segment sub–leveling and negative T wave appeared at high load and persisted in the first minutes of recovery, delta VO2 / delta WR = 12. Given the non–disappearance of the delta wave from ventricular pre–excitation during the maximal stress test, the subject was sent to an electrophysiological study and subsequent ablation of the accessory pathway. The electrophysiological study was negative for inducibility of atrial fibrillation (AF) and ventricular arrhythmias. Safe ablation was impossible given the intrahyssian position of the accessory pathway. Considering the negativity of the electrophysiological study due to non inducibility of supraventricular and ventricular arrhythmias, eligibility for competitive sports was granted.
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Affiliation(s)
- A Stuto
- STAR FOR LIFE, SIRACUSA; AMBULATORIO CARDIOLOGIA DR BIAGIO ARMARO SRL, SIRACUSA; ASP 8, SIRACUSA; AMBULATORIO DI CARDIOLOGIA DR BIAGIO ARMARO SRL, SIRACUSA; OSPEDALE SAN RAFFAELE, MILANO
| | - B Armaro
- STAR FOR LIFE, SIRACUSA; AMBULATORIO CARDIOLOGIA DR BIAGIO ARMARO SRL, SIRACUSA; ASP 8, SIRACUSA; AMBULATORIO DI CARDIOLOGIA DR BIAGIO ARMARO SRL, SIRACUSA; OSPEDALE SAN RAFFAELE, MILANO
| | - E Cosentino
- STAR FOR LIFE, SIRACUSA; AMBULATORIO CARDIOLOGIA DR BIAGIO ARMARO SRL, SIRACUSA; ASP 8, SIRACUSA; AMBULATORIO DI CARDIOLOGIA DR BIAGIO ARMARO SRL, SIRACUSA; OSPEDALE SAN RAFFAELE, MILANO
| | - G Canonico
- STAR FOR LIFE, SIRACUSA; AMBULATORIO CARDIOLOGIA DR BIAGIO ARMARO SRL, SIRACUSA; ASP 8, SIRACUSA; AMBULATORIO DI CARDIOLOGIA DR BIAGIO ARMARO SRL, SIRACUSA; OSPEDALE SAN RAFFAELE, MILANO
| | - A Ambu
- STAR FOR LIFE, SIRACUSA; AMBULATORIO CARDIOLOGIA DR BIAGIO ARMARO SRL, SIRACUSA; ASP 8, SIRACUSA; AMBULATORIO DI CARDIOLOGIA DR BIAGIO ARMARO SRL, SIRACUSA; OSPEDALE SAN RAFFAELE, MILANO
| | - G Cascone
- STAR FOR LIFE, SIRACUSA; AMBULATORIO CARDIOLOGIA DR BIAGIO ARMARO SRL, SIRACUSA; ASP 8, SIRACUSA; AMBULATORIO DI CARDIOLOGIA DR BIAGIO ARMARO SRL, SIRACUSA; OSPEDALE SAN RAFFAELE, MILANO
| | - A Lo Giudice
- STAR FOR LIFE, SIRACUSA; AMBULATORIO CARDIOLOGIA DR BIAGIO ARMARO SRL, SIRACUSA; ASP 8, SIRACUSA; AMBULATORIO DI CARDIOLOGIA DR BIAGIO ARMARO SRL, SIRACUSA; OSPEDALE SAN RAFFAELE, MILANO
| | - S Canonico
- STAR FOR LIFE, SIRACUSA; AMBULATORIO CARDIOLOGIA DR BIAGIO ARMARO SRL, SIRACUSA; ASP 8, SIRACUSA; AMBULATORIO DI CARDIOLOGIA DR BIAGIO ARMARO SRL, SIRACUSA; OSPEDALE SAN RAFFAELE, MILANO
| | - S Cassarisi
- STAR FOR LIFE, SIRACUSA; AMBULATORIO CARDIOLOGIA DR BIAGIO ARMARO SRL, SIRACUSA; ASP 8, SIRACUSA; AMBULATORIO DI CARDIOLOGIA DR BIAGIO ARMARO SRL, SIRACUSA; OSPEDALE SAN RAFFAELE, MILANO
| | - S Ierna
- STAR FOR LIFE, SIRACUSA; AMBULATORIO CARDIOLOGIA DR BIAGIO ARMARO SRL, SIRACUSA; ASP 8, SIRACUSA; AMBULATORIO DI CARDIOLOGIA DR BIAGIO ARMARO SRL, SIRACUSA; OSPEDALE SAN RAFFAELE, MILANO
| | - G Basile
- STAR FOR LIFE, SIRACUSA; AMBULATORIO CARDIOLOGIA DR BIAGIO ARMARO SRL, SIRACUSA; ASP 8, SIRACUSA; AMBULATORIO DI CARDIOLOGIA DR BIAGIO ARMARO SRL, SIRACUSA; OSPEDALE SAN RAFFAELE, MILANO
| | - S Gulletta
- STAR FOR LIFE, SIRACUSA; AMBULATORIO CARDIOLOGIA DR BIAGIO ARMARO SRL, SIRACUSA; ASP 8, SIRACUSA; AMBULATORIO DI CARDIOLOGIA DR BIAGIO ARMARO SRL, SIRACUSA; OSPEDALE SAN RAFFAELE, MILANO
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Stuto A, Armaro B, Cosentino E, Canonico G, Ambu A, Raineri F, Lo Giudice A, Cascone G, Canonico S, Cassarisi S, Ierna S, Basile G. P4431Cardiopulmonary exerscise stress tests vs standard exercise stress tests in the rational prescription of physical activity in men. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The standard exercise stress test (ET) provides direct measurement of the load tolerated by the subject, but the cardiopulmonary exercise stress test (CPET) in addition to the measurement of the work load also provides direct measurement of the corresponding oxygen consumption.
Objective
The aim of the present study was to estimate the differences between the estimated oxygen consumption based on the load (ET) and the one directly measured with the CPET, and to highlight and quantify the inaccuracies of the indirect estimate of oxygen consumption and its consequences on the rational prescription of physical activity.
Material and method
The tests performed on 7544 males from January 2007 to October 2018 were analyzed. For each test the sustained load, the consumption of direct oxygen, and the estimated oxygen consumption based on the load sustained with the use of a formula provided by the American College of Sports Medicine and reported below:
VO2max (ml/kg/min) = (10.51 x Watt) + (6.35 x weight in kg) − (10.49 x Età) + 519.3.
The total population of the subjects examined was divided into two groups: Group A: 1358 subjects without signs of heart disease, and Group B: 6186 subjects with heart disease.
Results
In the total population the oxygen consumption (VO2) estimated on the basis of the load was overestimated in 22% of subjects, underestimated in 55% of subjects and overlapping in 23% of subjects. In Group B the calculated VO2 was overestimated in 38%, underestimated in 54% and overlapping in 8% of the subjects. In group A the calculated VO2 was overestimated in 33%, underestimated in 54% and overlapping in 9% of subjects.
Conclusions
In subjects with heart disease the VO2 calculated on the basis of the sustained load is overestimated or underestimated in 92% of subjects. The CPET through direct measurement of oxygen consumption provides a precise estimate of functional capacity, an essential prerequisite for a correct rational prescription of physical activity. Because of this peculiarity, the CPET is absolutely irreplaceable in cardiac patients in which a correct rational prescription of physical activity is crucial.
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Affiliation(s)
- A Stuto
- STAR FOR LIFE Cardiac Rehabilitation Centre, Siracusa, Italy
| | - B Armaro
- Ambulatorio Cardiologia Dr. Biagio Armaro srl, Siracusa, Italy
| | - E Cosentino
- STAR FOR LIFE Cardiac Rehabilitation Centre, Siracusa, Italy
| | - G Canonico
- Ambulatorio Cardiologia Dr. Biagio Armaro srl, Siracusa, Italy
| | - A Ambu
- STAR FOR LIFE Cardiac Rehabilitation Centre, Siracusa, Italy
| | - F Raineri
- Ambulatorio Cardiologia Dr. Biagio Armaro srl, Siracusa, Italy
| | | | - G Cascone
- Ambulatorio Cardiologia Dr. Biagio Armaro srl, Siracusa, Italy
| | - S Canonico
- Ambulatorio Cardiologia Dr. Biagio Armaro srl, Siracusa, Italy
| | - S Cassarisi
- Ambulatorio Cardiologia Dr. Biagio Armaro srl, Siracusa, Italy
| | - S Ierna
- Ambulatorio Cardiologia Dr. Biagio Armaro srl, Siracusa, Italy
| | - G Basile
- STAR FOR LIFE Cardiac Rehabilitation Centre, Siracusa, Italy
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Maternini M, Guttadauro A, Mascagni D, Milito G, Stuto A, Renzi A, Ripamonti L, Bottini C, Nudo R, Del Re L, Gabrielli F. Non cross-linked equine collagen (Salvecoll-E gel) for treatment of complex ano-rectal fistula. Asian J Surg 2019; 43:401-404. [PMID: 31320233 DOI: 10.1016/j.asjsur.2019.06.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/22/2019] [Accepted: 06/25/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Fistula-in-ano is one of the most commonly presenting anorectal diseases. Sphincter sparing treatment options should be considered in patients with complex fistulas. Salvecoll-E gel is a native collagen deantigenated and purified, non-cross-linked equine dermal extract, with an amino acid composition identical to human collagen. METHODS The multicentric trial study was a prospective, single-arm observational clinical study with the objective to assess the efficacy of Salvecoll-E gel for anal fistula repair in 70 patients. All patients had undergone preliminary surgical treatment consisting of positioning of a draining loosing seton that was maintained for a period of 4-6 weeks. After seton removal, a gentle debridement and washing of the fistula track was performed. The scar tissue was removed from the internal orifice. Internal opening was covered by a side-to side mucosal suture. Salvecoll-E was injected through the external opening into the fistula track, the external opening it has been opened. RESULTS Twelve months after surgery, 55 patients demonstrated a clinically healed fistula (78,5%), 15 patients have a recurrence (21,5%). Most of the recurrences were observed in the first 6 months of treatment (13/15, 86.6%). We don't observe any worsening in CCF score. The results obtained at 1 year certainly seem satisfactory and in line with the best results published in literature using mini-invasive techniques. CONCLUSION Salvecoll-E gel is a promising non-invasive technique for conservative treatment of anal fistulas, it's well tolerated by the patients and, in case of recurrence, reinjection or all other known techniques are feasible.
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Affiliation(s)
- M Maternini
- University of Milano-Bicocca, General Surgery Department, Istituti Clinici Zucchi-Monza, Italy.
| | - A Guttadauro
- University of Milano-Bicocca, General Surgery Department, Istituti Clinici Zucchi-Monza, Italy
| | - D Mascagni
- University of Milano-Bicocca, General Surgery Department, Istituti Clinici Zucchi-Monza, Italy
| | - G Milito
- University of Milano-Bicocca, General Surgery Department, Istituti Clinici Zucchi-Monza, Italy
| | - A Stuto
- University of Milano-Bicocca, General Surgery Department, Istituti Clinici Zucchi-Monza, Italy
| | - A Renzi
- University of Milano-Bicocca, General Surgery Department, Istituti Clinici Zucchi-Monza, Italy
| | - L Ripamonti
- University of Milano-Bicocca, General Surgery Department, Istituti Clinici Zucchi-Monza, Italy
| | - C Bottini
- University of Milano-Bicocca, General Surgery Department, Istituti Clinici Zucchi-Monza, Italy
| | - R Nudo
- University of Milano-Bicocca, General Surgery Department, Istituti Clinici Zucchi-Monza, Italy
| | - L Del Re
- University of Milano-Bicocca, General Surgery Department, Istituti Clinici Zucchi-Monza, Italy
| | - F Gabrielli
- University of Milano-Bicocca, General Surgery Department, Istituti Clinici Zucchi-Monza, Italy
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Giordano P, Sileri P, Buntzen S, Nunoo-Mensah J, Lenisa L, Singh B, Thorlacius-Ussing O, Griffiths B, Vujovic Z, Stuto A. Final results of a European, multicentre, prospective, observational study of Permacol™ collagen paste injection for the treatment of anal fistula. Colorectal Dis 2018; 20:243-251. [PMID: 28493393 DOI: 10.1111/codi.13715] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 07/14/2016] [Accepted: 12/07/2016] [Indexed: 12/22/2022]
Abstract
AIM Permacol™ collagen paste (Permacol™ paste) is an acellular cross-linked porcine dermal collagen matrix suspension for use in soft-tissue repair. The use of Permacol™ paste in the filling of anorectal fistula tract is a new sphincter-preserving method for fistula repair. The MASERATI100 study was a prospective, observational clinical study with the objective to assess the efficacy of Permacol™ collagen paste for anal fistula repair in 100 patients. METHOD Patients (n = 100) with anal fistula were treated, at 10 European surgical sites, with a sphincter-preserving technique using Permacol™ paste. Fistula healing was assessed at 1, 3, 6 and 12 months post-treatment, with the primary end-point being healing at 6 months. Faecal continence and patient satisfaction were surveyed at each follow-up; adverse events (AEs) were monitored throughout the follow-up. RESULTS At 6 months postsurgery, 56.7% of patients were healed and the percentage healed was largely maintained, with 53.5% healed at 12 months. Regarding AEs, 29.0% of patients had at least one AE, and 16.0% of patients had one or more procedure-related AE. Most AEs reported were minor and similar to those commonly observed after fistula treatment, and the incidence of serious adverse events was low (4.0% of patients). Regardless of treatment outcome, 73.0% of patients were satisfied or very satisfied with the procedure. CONCLUSION Permacol™ paste is a promising sphincter-preserving treatment for anal fistulae and has minimal adverse side-effects.
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Affiliation(s)
- P Giordano
- Colorectal Department, Whipps Cross University Hospital, Barts Health, London, UK
| | - P Sileri
- Surgery, University of Rome Tor Vergata, Rome, Italy
| | - S Buntzen
- Colorectal Surgery, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - J Nunoo-Mensah
- Department of Colorectal Surgery, King's College Hospital, London, UK
| | - L Lenisa
- General Surgery Unit, Casa di Cura Humanitas San Pio X, Milan, Italy
| | - B Singh
- Leicester General Hospital, Leicester, UK
| | - O Thorlacius-Ussing
- Department of Gastrointestinal Surgery, Aalborg University Hospital, Aalborg, Denmark
| | | | - Z Vujovic
- Ninewells Hospital & Medical School, Dundee, Scotland, UK
| | - A Stuto
- Coloproctology and Pelvic Floor Surgery, Policlinico Abano Terme, Padova, Italy
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Giordano P, Sileri P, Buntzen S, Stuto A, Nunoo-Mensah J, Lenisa L, Singh B, Thorlacius-Ussing O, Griffiths B, Ziyaie D. A prospective multicentre observational study of Permacol collagen paste for anorectal fistula: preliminary results. Colorectal Dis 2016; 18:286-94. [PMID: 26355641 DOI: 10.1111/codi.13112] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [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: 04/01/2015] [Accepted: 07/03/2015] [Indexed: 02/08/2023]
Abstract
AIM Permacol collagen paste (Permacol paste) is a new option for the treatment of anorectal fistula. It functions by filling the fistula tract with an acellular crosslinked porcine dermal collagen matrix suspension. The MASERATI 100 study group was set up to evaluate the clinical outcome of Permacol paste in the treatment of anorectal fistula. This paper reports the results from the initial 30 patients enrolled in the MASERATI 100 prospective, observational clinical trial. METHOD Patients (N = 30) with anal fistula presenting to 10 European academic surgical units were treated with a sphincter-preserving technique using Permacol paste. Fistula healing was assessed at 1, 3, 6 and 12 months after treatment, with the primary end-point of fistula healing at 6 months post-surgery. Faecal continence and patient satisfaction were recorded at each follow-up visit and adverse events were monitored throughout the follow-up. RESULTS Of the 28 patients with data at 6 months post-surgery, 15 (54%) were healed, and the healing rate was maintained at 12 months. Healing after treatment with Permacol paste was similar for intersphincteric to transsphincteric fistulae and primary or recurrent fistulae. Only one patient exhibited an adverse event (perianal abscess) that was possibly related to the treatment. At the last outpatient visit, over 60% of patients were satisfied or very satisfied with the operation. CONCLUSION Permacol paste is shown to be effective in treating primary and recurrent cryptoglandular anorectal fistula with minimal unwanted side effects.
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Affiliation(s)
- P Giordano
- Colorectal Department, Whipps Cross University Hospital, Barts Health, London, UK
| | - P Sileri
- University of Rome Tor Vergata, Rome, Italy
| | - S Buntzen
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - A Stuto
- General Surgery Department, Ospedale Santa Maria degli Angeli, Pordenone, Italy
| | - J Nunoo-Mensah
- Department of Colorectal Surgery, King's College Hospital, London, UK
| | - L Lenisa
- Surgery Unit, San Pio X Hospital, Milan, Italy
| | - B Singh
- Leicester General Hospital, Leicester, UK
| | - O Thorlacius-Ussing
- Department of Gastrointestinal Surgery, Aalborg University Hospital, Aalborg, Denmark
| | | | - D Ziyaie
- Ninewells Hospital and Medical School, Dundee, Scotland, UK
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Van Geluwe B, Stuto A, DaPozzo F, Fieuws S, Meurette G, Lehur P, D’Hoore A. Relief of obstructed defecation syndrome after stapled transanal rectal resection (STARR): a meta-analysis. Acta Chir Belg 2014; 114:189-97. [PMID: 25102709 DOI: 10.1080/00015458.2014.11681007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Stapled transanal rectal resection (STARR) is a promising new treatment for obstructed defecation syndrome (ODS) associated with rectal intussusception and/or rectocele. The aim of this work was to assess the efficacy of STARR to treat ODS. METHODS Outcome data after STARR for ODS were pooled according to the used constipation score. As different types of constipation scores were reported, and standardized effect sizes were calculated before performing a meta-analysis. RESULTS Twenty-six publications were identified with a median follow-up of 12 months (range: 3-42). In total 1298 patients were included. Six different scoring systems were used. In total 43 estimates of the effect STARR were analyzed. All studies showed a significant improvement in ODS yielding a combined standardized effect size of 3.8 (95% CI : 3.2-4.5). Although a very high degree of heterogeneity between effect sizes has been observed (I2 = 93.3%), suggesting an overestimation of this improvement. This is partially due to the use of various instruments, but largely originating from (unmeasured) study characteristics. CONCLUSIONS The consistent finding of a decrease in the various ODS-scores confirms that STARR can reduce ODS but the effect is overestimated. This meta-analysis clearly highlights some methodological shortcomings in published data. Heterogeneity in ODS scoring implies the need for standard effect size calculation to compare published results, and underlines the urgent need for a more uniform and accurate data reporting.
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Affiliation(s)
- B. Van Geluwe
- Department of Abdominal Surgery, University Hospitals Gasthuisberg Leuven, Belgium
| | - A. Stuto
- Department of Surgery, Ospedale Santa Maria degli Angeli, Pordenone, Italy
| | - F. DaPozzo
- Department of Surgery, Ospedale Santa Maria degli Angeli, Pordenone, Italy
| | - S. Fieuws
- Interuniversity centre for Biostatistics and Statistical Bioinformatics, Leuven, Belgium
| | - G. Meurette
- Department of Digestive and Endocrine Surgery, University Hospital, Hotel Dieu, Nantes, France
| | - P.A. Lehur
- Department of Digestive and Endocrine Surgery, University Hospital, Hotel Dieu, Nantes, France
| | - A. D’Hoore
- Department of Abdominal Surgery, University Hospitals Gasthuisberg Leuven, Belgium
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Stuto A, Armaro B, Cosentino E, Ambu A, Bottaro G, Lo Giudice A, Canonico G, Vitale L, Carpenzano G, Basile G. Cardiopulmonary exercise stress testing vs standard exercise stress testing to estimate the actual changes in functional capacity after cardiac rehabilitation in older patients. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Stuto A, Armaro B, Cosentino E, Ambu A, Bottaro G, Lo Giudice A, Vasile L, Canonico G, Carpenzano G, Basile G. Functional capacity after cardiac rehabilitation in diabetic vs non diabetic cardiac patients. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p4261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Braini A, Narisetty P, Favero A, Calandra S, Calandra A, Caponnetto F, Digito F, Da Pozzo F, Marcotti E, Porebski E, Rovedo S, Terrosu G, Torricelli L, Stuto A. Double PPH technique for hemorrhoidal prolapse: a multicentric, prospective, and nonrandomized trial. Surg Innov 2013; 20:553-8. [PMID: 23339147 DOI: 10.1177/1553350612472988] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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: 11/15/2022]
Abstract
INTRODUCTION Longo's technique (or PPH technique) is well known worldwide. Meta-analysis suggests that the failure due to persistence or recurrence is close to 7.7%. One of the reasons for the recurrence is the treatment of the advanced hemorrhoidal prolapse with a single stapling device, which is not enough to resect the appropriate amount of prolapse. MATERIALS AND METHODS We describe the application of "Double PPH Technique" (D-PPH) to treat large hemorrhoidal prolapses. We performed a multicentric, prospective, and nonrandomized trial from July 2008 to July 2009, wherein 2 groups of patients with prolapse and hemorrhoids were treated with a single PPH or a D-PPH. Results were compared. The primary outcome was evaluation of safety and efficacy of the D-PPH procedure in selected patients with large hemorrhoidal prolapse. RESULTS In all, 281 consecutive patients suffering from hemorrhoidal prolapse underwent surgery, of whom 74 were assigned intraoperatively to D-PPH, whereas 207 underwent single PPH. Postoperative complications were 5% in both groups (P = .32), in particular: postoperative major bleeding 3.0% in PPH versus 4.1% D-PPH (P = .59); pain 37.9 % PPH versus 27.3% D-PPH (mean visual analog scale [VAS] = 2.5 vs 2.9, respectively; P = .72); and fecal urgency 2.1% PPH versus 5.7% D-PPH (P = .8). Persistence of hemorrhoidal prolapse at 12-month follow-up was 3.7% in the PPH group versus 5.9% in the D-PPH group (P = .5). CONCLUSIONS Our data support the hypothesis that an accurate intraoperative patient selection for single (PPH) or double (D-PPH) stapled technique will lower in a significant way the incidence of recurrence after Longo's procedure for hemorrhoidal prolapse.
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Affiliation(s)
- A Braini
- 1U.O. Chirurgia 2, Az. Ospedaliera S. Maria degli Angeli, Pordenone, Italy
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Stuto A, Favero A, Cerullo G, Braini A, Narisetty P, Tosolini G. Double stapled haemorrhoidopexy for haemorrhoidal prolapse: indications, feasibility and safety. Colorectal Dis 2012; 14:e386-9. [PMID: 22300355 DOI: 10.1111/j.1463-1318.2012.02965.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIM Selected patients with haemorrhoidal prolapse undergoing double stapled anopexy with the procedure for prolapse and haemorrhoids (PPH03) were studied. METHOD Between March 2007 and March 2010, 235 patients referred with haemorrhoids were included in the study. Patients with obstructed defaecation were excluded. At surgery intraoperative evaluation for double stapled anopexy was carried out based on the criteria of prolapse occupying half or more of the anal circumference and redundant prolapsed tissue determined by the circular anal dilator. Patients fulfilling these criteria were submitted for double stapled anopexy with the PPH03 stapler. All clinical and operative data were recorded in a prospectively maintained database. RESULTS Among the 142 patients with haemorrhoidal prolapse having surgery 91 had a single and 51 a double stapled technique. The mean operative time was 34.8 min with no major or minor intraoperative complications. Recurrence at 48 months was 1.9% and the mean satisfaction score was 8.9. CONCLUSION The double stapled PPH03 technique in selected cases was as safe and effective as a single stapling technique with a lower incidence of recurrence over a medium-term follow-up.
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Affiliation(s)
- A Stuto
- 2° Surgical Department, Azienda Ospedaliera Santa Maria Degli Angeli, Pordenone, Italy
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Lenisa L, Schwandner O, Stuto A, Jayne D, Pigot F, Tuech JJ, Scherer R, Nugent K, Corbisier F, Espin-Basany E, Hetzer FH. STARR with Contour Transtar: prospective multicentre European study. Colorectal Dis 2009; 11:821-7. [PMID: 19175625 PMCID: PMC2774156 DOI: 10.1111/j.1463-1318.2008.01714.x] [Citation(s) in RCA: 71] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The stapled transanal rectal resection (STARR) in patients with defecation disorders is limited by the shape and capacity of the circular stapler. A new device has been recently developed, the Contour Transtar stapler, in order to improve the safety and effectiveness of the STARR technique. The study has been designed to confirm this declaration. METHOD From January to June 2007 a prospective European multicentre study of consecutive patients with defecation disorder caused by internal rectal prolapse underwent the new STARR technique. The assessment of perioperative morbidity and functional outcome after 6 weeks, 3 and 12 months was documented by different scores. RESULTS In all 75 patients, median age 64, the Transtar procedure was performed with 9% intraoperative difficulties, 7% postoperative complications and no mortality. The mean reduction of the ODS score was -15.6 (95%-CI: -17.3 to -13.8, P < 0.0001), mean reduction of SSS was -12.6 (95%-CI: -14.2 to -11.2; P < 0.0001). 41% stated improvement of their continence status by CCF score, only 4 patients (5%) had deterioration. CONCLUSION The Transtar procedure is technically demanding, with good functional results similar to the conventional STARR.
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Affiliation(s)
- L Lenisa
- Department of Surgery, Casa di Cura San Pio XMilan, Italy
| | - O Schwandner
- Department of Surgery, Caritas-Krankenhaus St. JosefRegensburg, Germany
| | - A Stuto
- Department of Surgery, Ospedale S. Maria degli AngeliPordenone, Italy
| | - D Jayne
- Academic Surgical Unit, St James University HospitalLeeds, UK
| | - F Pigot
- Department of Proctology, Bagatelle-Maison de SanteTalence-Cedex, France
| | - JJ Tuech
- Department of Digestive Surgery, University HospitalRouen, France
| | - R Scherer
- Department of Surgery, Krankenhaus WaldfriedeBerlin, Germany
| | - K Nugent
- Department of Surgery, General HospitalSouthampton, UK
| | - F Corbisier
- Department of Surgery, C.H.N.D.R.F.Charleroi, Belgium
| | - E Espin-Basany
- Department of Surgery, Hospital Valle de HebronBarcelona, Spain
| | - F H Hetzer
- Department of Surgery, Cantonal HospitalSt Gallen, Switzerland
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Corman ML, Carriero A, Hager T, Herold A, Jayne DG, Lehur PA, Lomanto D, Longo A, Mellgren AF, Nicholls J, Nyström PO, Senagore AJ, Stuto A, Wexner SD. Consensus conference on the stapled transanal rectal resection (STARR) for disordered defaecation. Colorectal Dis 2006; 8:98-101. [PMID: 16412068 DOI: 10.1111/j.1463-1318.2005.00941.x] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.8] [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] [Indexed: 12/13/2022]
Abstract
An international working party was convened in Rome, Italy on 16-17 June, 2005, with the purpose of developing a consensus on the application of the circular stapling instrument to the treatment of certain rectal conditions, the so-called Stapled Transanal Rectal Resection (STARR). Since the procedure has been submitted to only limited objective analysis it was felt prudent to hold a meeting of interested individuals for the purpose of evaluating the current status and to make conclusions and recommendations concerning the applicability of this new approach.
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Affiliation(s)
- M L Corman
- Stony Brook University, Stony Brook, NY, USA.
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13
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Tonin D, Scatà A, Stuto A, Rota G, Doffria E, Tosolini G. [Postoperative complications and local recurrence of mid-lower rectal carcinoma treated with neoadjuvant chemoradiotherapy and surgery. Preliminary results]. Tumori 2003; 89:149-51. [PMID: 12903576] [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: 03/04/2023]
Abstract
In our study we evaluate postoperative complications and local recurrence in local advanced rectal cancer after preoperative chemoradiation plus surgery. We treated 24 patients, 15 males and 9 females; in all cases the cancer was at stage II or III. Down-staging was observed in 14 patients (58.3%), 2 patients (8.3%) had no residual disease. We performed 2 APR, 20 low anterior resections (10 of which laparoscopic) and 2 transanal local excisions. In postoperative period we observed 8 complications, 4 minor and 4 major ones, with an over-all morbidity of 33.3% and of 16.6% if considering major complications. At present no local recurrence was registered.
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Affiliation(s)
- D Tonin
- Unità Operativa II Chirurgia, Azienda Ospedaliera S Maria degli Angeli, Pordenone
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14
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McKernan JB, Stuto A, Champion JK. New application of bipolar coagulation in laparoscopic surgery. Surg Laparosc Endosc Percutan Tech 1996; 6:335-40. [PMID: 8890416] [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: 02/02/2023]
Abstract
Bipolar electrocautery is associated with a lower risk of tissue injury from an inadvertent energy transfer compared with monopolar diathermy, and bipolar coagulation has been effectively employed in obstetric and gynecologic procedures. The present report describes the successful use of bipolar diathermy during general laparoscopic surgery. Hemostasis and closure of even large vessels was possible with the use of bipolar forceps during laparoscopic cholecystectomy, fundoplication, appendectomy, and highly selective vagotomy procedures. No intraoperative complications resulting from bleeding were apparent in this series of 296 laparoscopic operations, nor were any postoperative complications suggestive of inadvertent tissue damage, such as peritonitis, apparent. Thus, these results suggest that bipolar coagulation can be used safely and without difficulty in laparoscopic surgical procedures.
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Affiliation(s)
- J B McKernan
- Department of Surgery, Emory University, Atlanta, Georgia, USA
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15
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Bedin N, Tonin D, Stuto A. [Peritonitis yesterday and today: trends in diagnosis and therapy]. MINERVA CHIR 1996; 51:377-82. [PMID: 8992383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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16
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Grisolia GA, Pelli P, Pinzauti E, Panozzo G, Stuto A, Danti DA, Billi G, Pampaloni A. Skin substitutes in the treatment of deep partial skin thickness burns in children: clinical experience and long-term results. Burns 1991; 17:52-5. [PMID: 2031676 DOI: 10.1016/0305-4179(91)90012-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [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: 12/29/2022]
Abstract
This report describes the use of skin substitutes in the treatment of deep partial skin thickness burns in childhood. These are lesions that, if treated inadequately, can result in severe scarring. However, if treated appropriately, they can heal without any sequelae, which is obviously crucial for aesthetic and psychological reasons. This review contains children admitted to the authors' Burn Unit over a 5-year period (1984-88) with deep partial skin thickness lesions which were treated with synthetic and/or biosynthetic skin substitutes and without surgical procedures. This group of children has been compared with another group hospitalized for burns of the same depth and treated with conventional closed wound management. First, short-term results are presented, highlighting healing time, followed by the long-term results from an aesthetic and functional viewpoint.
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Affiliation(s)
- G A Grisolia
- Paediatric Surgery Department, A. Meyer Children Hospital, Florence, Italy
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17
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Aloisi B, Stuto A, Mossuti E, Brancati BM. [A case of the "long Q-T and peak-torsion syncope" syndrome caused by prenylamine]. Minerva Cardioangiol 1978; 26:687-92. [PMID: 750945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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