The use of biological membranes for correction of congenital malformations

Many congenital malformations often require a multidisciplinary and multistep surgical treatment, including the use of biological membranes. Aims of the study were to describe the use of these membranes for the correction of malformations, their clinical performance at follow-up, and patient's tolerance to them. The study included patients treated between 2009 and November 2020 in two referral centers. They were affected by abdominal wall defects (AWD), esophageal atresia/tracheo-esophageal fistula (EA/TEF), diaphragmatic hernia (CDH), spinal defects (SD), and anorectal malformations (ARM). The human origin membranes used during surgery were amniotic membrane, fascia lata, and pericardium provided by the local tissue bank and the porcine-derived membrane available on the market. Thirty-one patients were retrieved. The sample included 10 AWD, 7 EA/TEF, 5 CDH, 4 SD, 2 ARM, and 3 miscellaneous defects. The median age at repair was 139 days (range: 10,5–1494). The median follow-up was 1021 days (range: 485,5–1535). Two patients were lost at follow-up. The defects were successfully repaired and the membranes perfectly tolerated in 28/29 cases. In 1 case of CDH the fascia lata was replaced with a Goretex patch due to recurrence of the defect. This is the largest series on the use of biological membranes in congenital malformations. The variety of tissues allows to choose the best material for each malformation. The excellent tolerance and performance of this first series of patients encourage the use of these membranes to correct different type of malformations at any age.

Gender-specific violence and/or abuse: strategy for dealing with a hidden phenomenon

Background

Exposing episodes of violence against women or hate crimes was extremely difficult in the past, due to a lack of awareness in emergency departments, the absence of a social, institutional and health network, and poor communication by Anti-Violence Centers. Until about 10 years ago, professional skills employed to address this kind of episodes were strictly related to the specificity of the trauma reported (gynecological, orthopedic, surgical and psychiatric).

Purpose

introduce a necessary holistic approach, that takes into account all aspects of the issue that normally are completely overlooked.

Methods

The “Codice Rosa” project began in the Grosseto Health Department (Tuscany) on 2009. It ensured reserved access to the emergency room for victims of violence, in particular women, children and discriminated persons. Later, it evolved into a regional network for women who have suffered from gender-based violence and for victims of hate crime violence. The project currently includes all victims, no matter whether they access the sanitary service through the emergency room, ambulatory or ordinary hospitalization. It follows a precise alert procedure triggering subsequent steps over the territory, with the goal to ensure ongoing support and a global care scheme.

Results

from 2010 up to July 2019 in the Grosseto Health Department 3483 “Codice Rosa” (mistreatment, abuse, stalking) have been admitted, 3088 adults and 395 minors respectively. In Tuscany from 2012 up to July 2019, the Codice Rosa patients were 20162, 17305 adults and 2857 minors respectively.

Conclusions

The program operates synergistically with other entities, institutions and overall with the local network of Anti-Violence Centers and Social Services, in line with national and international directives. It has provided a strong contribution to the development of current national guidelines in Italy.

Key messages

Gender specific violence and hate crimes phenomenon have to be specifically addressed. Improving the regional/national networks among the various actors involved in the fight against gender violence and hate crimes.

Health and Gender Medicine Clinic: 2 years of multidisclipinary team experience

Background

Cardiovascular disease (CVD) is the leading cause of mortality in western countries and the first cause of mortality in women.

Purpose

Women generally do not concern about CVD and that represents the main risk for them.

Methods

Misericordia Hospital, Grosseto, started a Clinic of Health and Gender Medicine on 2017. On the first and third Monday of every month, we evaluate < 60 years patients who are at risk for traditional CVD, depression, early menopause, polycystic ovary, autoimmune and rheumatic disease. On the first visit, medical history, arterial pressure, electrocardiogram, body mass index, waist circumference and lipid profile, were collected. We also supply questionnaires to evaluate diabetes and depression risk by Generalized Anxiety Disorder (GAD-7), Patient Health Questionnaire (PHQ-9) and food diary. Two weeks later, a multidisciplinary team (cardiologist-diabetologist-nutritionist-gynecologist-psychiatrist and a nurse) evaluates the patients defining the personal risk profile.

Results

From 2017 to December 2019, 74 females and 7 males belonging to the target population were examined. Age group: <45(61%), 46-50(26%), 51-60(48%), >60(19%). Clinical characteristics: Hypertension: 64%; Obesity 5%; Unknown dyslipidemia 44%; Risk of diabetes: 39%; Gestational diabetes: 5%; Gestational hypertension: 5% CVD risk: 42%; Depression: 33% Autoimmune disease: 30%. From them 60.5% have needed further investigation. Follow-up is going on.

Conclusions

according with the literature, more than 50% of the cohort was unconsciously at high risk of CVD. So a multidisciplinary approach is needed in order to frame a complex health status. Thus we established collaboration with patients to improve lifestyles as CVD-prevention's tool.

Key messages

Cardiovascular disease represent often an hidden health problem, especially in women. Multidisciplinary approach is needed to face CVD.