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Mandarano M, Pelliccia C, Tomasello L, Caselli E, Floridi C, Loreti E, Barberini F, Rulli A, Gili A, Potenza R, Puma F, Rosati E, Donini A, Petrina A, Baccari P, Del Sordo R, Colella R, Bellezza G, Sidoni A. A New Medium (HistoCold) for Surgical Specimens Preserving to Improve the Preanalytic Issues in Histopathological Samples Handling: Morphologic and Antigenic Analysis. Biopreserv Biobank 2023; 21:610-623. [PMID: 37192479 DOI: 10.1089/bio.2022.0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023] Open
Abstract
Introduction: The onset of precision medicine has led to the integration of traditional morphologic tissues evaluation with biochemical and molecular data for a more appropriate pathological diagnosis. The preanalytic phase and, particularly, timing of cold ischemia are crucial to guarantee high-quality biorepositories of formalin-fixed paraffin-embedded (FFPE) tissues for patients' needs and scientific research. However, delayed fixation using the gold-standard and carcinogenic fixative neutral-buffered formalin (NBF) can be a significant limitation to diagnosis and biopathological characterization. HistoCold (patented; Bio-Optica Milano S.p.A., Milano, Italy) is a nontoxic, stable, and refrigerated preservative solution for tissue handling. This study examined HistoCold's potential role in improving the preanalytic phase of the pathological diagnostic process. Materials and Methods: Breast, lung, or colorectal cancers (20, 25, and 10 cases, respectively) that were to be surgically resected were recruited between 2019 and 2021. Once specimens were surgically removed, three residual samples for each patient were first promptly immersed into HistoCold for 24, 48, and 72 hours and then FFPE. These were compared with routine specimens regarding morphologic features (hematoxylin and eosin) and tissue antigenicity (immunohistochemical stains). Results: Good concordance regarding both the morphologic characteristics of the neoplasms and their proteins expression between the routine and HistoCold handled tissues were found. The tissue handling with the solution never affected the histopathological diagnosis. Conclusions: The use of HistoCold for samples transporting is easy, allows for improving the management of cold ischemia time, and monitoring the fixation times in NBF, resulting in good quality tissue blocks for biobanking. Moreover, it could be a candidate to eliminate formalin from operating theaters. HistoCold looks very promising for the preanalytic phase of human tissues handling in the era of precision medicine, to provide the best service to patients, and to scientific research.
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Affiliation(s)
- Martina Mandarano
- Section of Anatomic Pathology and Histology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Cristina Pelliccia
- Section of Anatomic Pathology and Histology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Laura Tomasello
- Section of Anatomic Pathology and Histology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Emanuele Caselli
- Section of Anatomic Pathology and Histology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Claudia Floridi
- Section of Anatomic Pathology and Histology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Elisabetta Loreti
- Section of Anatomic Pathology and Histology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Francesco Barberini
- Breast Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Antonio Rulli
- Breast Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Alessio Gili
- Section of Public Health, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Rossella Potenza
- Thoracic Surgery Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Francesco Puma
- Thoracic Surgery Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Emanuele Rosati
- Section of General and Emergency Surgery, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Annibale Donini
- Section of General and Emergency Surgery, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Adolfo Petrina
- General Surgery Unit, S.M. Misericordia Hospital, Perugia, Italy
| | - Paolo Baccari
- General Surgery Unit, S.M. Misericordia Hospital, Perugia, Italy
| | - Rachele Del Sordo
- Section of Anatomic Pathology and Histology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Renato Colella
- Section of Anatomic Pathology and Histology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Guido Bellezza
- Section of Anatomic Pathology and Histology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Angelo Sidoni
- Section of Anatomic Pathology and Histology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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Bertelli M, Foa´ A, Broccoli A, Zinzani PL, Stefoni V, Semprini F, Nanni S, Barberini F, Corsini A, Battistini P, Galie´ N. 665 THE UNFORSEEN MECHANISM: A CASE OF DISTRIBUTIVE SHOCK SECONDARY TO REACTIVE HAEMOPHAGOCYTIC SYNDROME LEADING TO SEVERE REVERSIBLE BIVENTRICULAR DYSFUNCTION. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.430] [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: 12/23/2022]
Abstract
Abstract
Distributive shock comprises a variety of processes causing dysregulated vasodilation with consequent life-threatening end-organ dysfunction. While sepsis constitutes by far its most common aetiology, other pathological mechanisms with different therapeutic targets may lead to a similar haemodynamic picture.
We hereby present the case of a 35-year-old male with no past cardiological history and a recent diagnosis of stage IVsB Hodgkin's lymphoma relapse 10 years after effective disease eradication with first-line chemotherapy. Shortly after a single cycle of second-line chemotherapy, the patient presented with high fever, acute chest pain and dyspnea associated with marked hypotension and sinus tachycardia. Laboratory tests revealed pancytopenia and raised inflammatory markers as well as evidence of acute kidney injury and hepatocellular damage. Urgent thoracic CT revealed no signs of pneumonia while echocardiography demonstrated severe biventricular dysfunction with 25% left ventricular ejection fraction and severe functional mitral regurgitation. Due to worsening tachypnea and desaturation the patient was intubated and transferred to our Intensive Cardiac Care Unit where urgent instatement of circulatory support with iv fluids, blood transfusions, adrenaline and intra-aortic balloon pump were performed and empirical broad-spectrum antibiotic therapy was started after performing blood cultures from peripheral and central veins. Concurrent right ventricular catheterisation demonstrated high-output cardiac failure (Qs Fick 7.89 Qp/m2, Qs thermodilution 8.0 Qp/m2) with mild increase in biventricular filling pressures and post-capillary pulmonary hypertension. Endomyocardial biopsy in turn revealed only mild subendocardial fibrosis and oedema thus excluding myocarditis as a potential cause for the severe biventricular dysfunction. Due to worsening of renal function with persistent anuria despite circulatory support the patient required continuous veno-venous haemofiltration. Notably, over the coming days no pathogen was isolated from any of the cultures with haemodynamic and respiratory parameters gradually improving, allowing for weaning from circulatory and respiratory support. On further examination of blood tests on admission, hypertriglyceridemia, raised ferritin levels and thrombin consumption were noted. These biochemical features, together with the history of Hodgkin's lymphoma relapse, recent chemotherapy, pancytopenia and splenomegaly, suggestive of natural killer cell dysfunction-related haemophagocytosis, pointed to reactive haemophagocytic syndrome as a potential aetiology of the severe distributive shock (> 99% probability on recently published “HS Score” for Reactive Haemophagocytic Syndrome). This hypothesis was further corroborated by the gradual albeit not complete regression of the severe biventricular dysfunction after haemodynamic support suggesting that this may have represented a byproduct of the patient's high-output state. Unfortunately, due to lymphoma progression with severe multiorgan involvement the patient was admitted shortly after discharge and deceased thereafter.
This case provides an example of the diversity of potential disease mechanisms underlying distributive shock where biventricular dysfunction may represent a reversible albeit severe bystander rather than the true driving factor of its life-threatening haemodynamic compromise.
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Affiliation(s)
- Michele Bertelli
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Unità Operativa Di Cardiologia
| | - Alberto Foa´
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Unità Operativa Di Cardiologia
| | - Alessandro Broccoli
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Istituto Di Ematologia ”Seragnoli”
| | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Istituto Di Ematologia ”Seragnoli”
| | - Vittorio Stefoni
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Istituto Di Ematologia ”Seragnoli”
| | - Franco Semprini
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Unità Operativa Di Cardiologia
| | - Samuele Nanni
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Unità Operativa Di Cardiologia
| | - Francesco Barberini
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Unità Operativa Di Cardiologia
| | - Anna Corsini
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Unità Operativa Di Cardiologia
| | - Paola Battistini
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Unità Operativa Di Cardiologia
| | - Nazzareno Galie´
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Unità Operativa Di Cardiologia
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Nanni S, Garofalo M, Schinzari M, Nardi E, Semprini F, Battistini P, Barberini F, Foà A, Baiocchi M, Castelli A, Folesani G, Pacini D, Galiè N, Corsini A. Prognostic value of high-sensitivity cardiac troponin I early after coronary artery bypass graft surgery. J Cardiothorac Surg 2022; 17:280. [PMID: 36319986 PMCID: PMC9628166 DOI: 10.1186/s13019-022-02027-x] [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] [Received: 05/20/2022] [Accepted: 09/24/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The diagnosis of periprocedural myocardial infarction (PMI) after coronary artery bypass graft (CABG) is based on biochemical markers along with clinical and instrumental findings. However, there is not a clear cutoff value of high-sensitivity cardiac troponin (hs-cTn) to identify PMI. We hypothesized that isolated hs-cTn concentrations in the first 24 h following CABG could predict cardiac adverse events (in-hospital death and PMI) and/or left ventricular ejection fraction (LVEF) decrease. METHODS We retrospectively enrolled all consecutive adult patients undergoing CABG, alone or in association with other cardiac surgery procedures, over 1 year. Hs-cTn I concentrations (Access, Beckman Coulter) were serially measured in the post-operative period and analyzed according to post-operative outcomes. RESULTS 300 patients were enrolled; 71.3% underwent CABG alone, 33.7% for acute coronary syndrome. Most patients showed hs-cTn I values superior to the limit required by the latest guidelines for the diagnosis of PMI. Five patients (1.7%) died, 8% developed a PMI, 10.6% showed a LVEF decrease ≥ 10%. Hs-cTn I concentrations did not significantly differ with respect to death and/or PMI whereas they were associated with LVEF decrease ≥ 10% (p value < 0.005 at any time interval), in particular hs-cTn I values at 9-12 h post-operatively. A hs-cTn I cutoff of 5556 ng/L, a value 281 (for males) and 479 (for females) times higher than the URL, at 9-12 h post-operatively was identified, representing the best balance between sensitivity (55%) and specificity (79%) in predicting LVEF decrease ≥ 10%. CONCLUSIONS Hs-cTn I at 9-12 h post-CABG may be useful to early identify patients at risk for LVEF decrease and to guide early investigation and management of possible post-operative complications.
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Affiliation(s)
- Samuele Nanni
- grid.6292.f0000 0004 1757 1758Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Mattia Garofalo
- grid.6292.f0000 0004 1757 1758Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy ,grid.6292.f0000 0004 1757 1758Department of Specialist, Diagnostic, and Experimental Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Matteo Schinzari
- grid.6292.f0000 0004 1757 1758Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy ,grid.6292.f0000 0004 1757 1758Department of Specialist, Diagnostic, and Experimental Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Elena Nardi
- grid.6292.f0000 0004 1757 1758Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy ,grid.6292.f0000 0004 1757 1758Department of Specialist, Diagnostic, and Experimental Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Franco Semprini
- grid.6292.f0000 0004 1757 1758Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Paola Battistini
- grid.6292.f0000 0004 1757 1758Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Barberini
- grid.6292.f0000 0004 1757 1758Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alberto Foà
- grid.6292.f0000 0004 1757 1758Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy ,grid.6292.f0000 0004 1757 1758Department of Specialist, Diagnostic, and Experimental Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Massimo Baiocchi
- grid.6292.f0000 0004 1757 1758Cardiothoracic and Vascular Anesthesia and Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea Castelli
- grid.6292.f0000 0004 1757 1758Cardiothoracic and Vascular Anesthesia and Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Gianluca Folesani
- grid.6292.f0000 0004 1757 1758Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Davide Pacini
- grid.6292.f0000 0004 1757 1758Department of Specialist, Diagnostic, and Experimental Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy ,grid.6292.f0000 0004 1757 1758Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Nazzareno Galiè
- grid.6292.f0000 0004 1757 1758Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy ,grid.6292.f0000 0004 1757 1758Department of Specialist, Diagnostic, and Experimental Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Anna Corsini
- grid.6292.f0000 0004 1757 1758Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Garofalo M, Corsini A, Potena L, Schinzari M, Nardi E, Barberini F, Gargiulo C, Malaguti M, Sabatino M, Semprini F, Galie N, Nanni S. Clinical profile and in-hospital outcome of patients supported by intra-aortic balloon pump in the clinical setting of cardiogenic shock according to aetiology. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1101] [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: 11/14/2022] Open
Abstract
Abstract
Background
Despite controversial evidence, intra-aortic balloon pump (IABP) is still the most used temporary mechanical support in cardiogenic shock (CS), as a bridge to recovery or to more advanced mechanical support and/or heart transplantation [1]. Indeed, the available evidence, which is mainly restricted to the context of acute coronary syndromes (ACS) and is limited by the variability of CS definitions, shows no benefit in terms of mortality [2]. Randomized controlled trials on IABP in the setting of non-ACS CS are still missing. As a result, European guidelines do not recommend the routine use of IABP, which may be considered in refractory CS [3].
Purpose
The aim of our study was to analyse the use of IABP in the context of CS, providing insights into its indications, outcomes, and complications in relation to the aetiology (ACS vs non-ACS) of CS.
Methods
We retrospectively enrolled all consecutive adult patients receiving IABP for refractory CS at our tertiary referral Hospital between 2009 and 2018, and analysed data focusing on in-hospital outcomes, including death, recovery, heart transplantation, and escalation to more advanced mechanical support such as venoarterial extracorporeal membrane oxygenation (VA-ECMO) or left ventricular assist device (LVAD), and on IABP-related complications.
Results
403 patients received IABP, 75.2% (n=303) for ACS CS and 24.8% (n=100) for non-ACS CS. With respect to ACS patients, non-ACS patients were younger (age 59±18.3 vs 73.1±12.6 years old, p<0.001), had a lower left ventricular ejection fraction (LVEF) [25% (IR 18–35%) vs 38% (IR 25–45%), p<0.001], were supported by IABP for longer time [6 (IR 2–18) vs 2 (IR 1–4) days, p<0.001], required more use of inotropes/vasoconstrictors [80.0% (n=80) vs 33.8% (n=102), p<0.001], and needed more often escalation to VA-ECMO [23.0% (n=23) vs 1.3% (n=4), p<0.001]. Non-ACS patients showed higher in-hospital mortality than ACS patients [46.0% (n=46) vs 33.9% (n=103), p=0.042]. Non-ACS patients were more frequently bridged to heart transplantation [20.0% (n=20) vs 0.3% (n=1), p<0.001] or LVAD [4.0% (n=4) vs 0.6% (n=2), p=0.055] than ACS patients; mortality after transplantation/LVAD did not significantly differ between the two groups [12.5% (n=3/24) vs 66.7% (n=2/3), p>0.05]. The incidence of IABP-related overall and major complications (including ischemic stroke, major bleeding, and peripheral or visceral ischemia) was not different with respect to the non-ACS vs ACS aetiology [major complications: 8.0% (n=8) vs 5.0% (n=15), p>0.05].
Conclusions
In our experience, in the clinical setting of CS treated with IABP, non-ACS patients show a worse clinical profile and prognosis than ACS patients, and more often require escalation to more advanced mechanical support and/or heart transplantation, while the incidence of IABP-related complications appears similar independently of the aetiology.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Garofalo
- Policlinico IRCCS Sant'Orsola-Malpighi - Alma Mater Studiorum Università di Bologna, Dipartimento Cardio-Toraco-Vascolare - Medicina Specialistica, Diagnostica e Sperimentale , Bologna , Italy
| | - A Corsini
- Policlinico IRCCS Sant'Orsola-Malpighi, Dipartimento Cardio-Toraco-Vascolare , Bologna , Italy
| | - L Potena
- Policlinico IRCCS Sant'Orsola-Malpighi, Dipartimento Cardio-Toraco-Vascolare , Bologna , Italy
| | - M Schinzari
- Policlinico IRCCS Sant'Orsola-Malpighi - Alma Mater Studiorum Università di Bologna, Dipartimento Cardio-Toraco-Vascolare - Medicina Specialistica, Diagnostica e Sperimentale , Bologna , Italy
| | - E Nardi
- Policlinico IRCCS Sant'Orsola-Malpighi - Alma Mater Studiorum Università di Bologna, Dipartimento Cardio-Toraco-Vascolare - Medicina Specialistica, Diagnostica e Sperimentale , Bologna , Italy
| | - F Barberini
- Policlinico IRCCS Sant'Orsola-Malpighi, Dipartimento Cardio-Toraco-Vascolare , Bologna , Italy
| | - C Gargiulo
- Policlinico IRCCS Sant'Orsola-Malpighi - Alma Mater Studiorum Università di Bologna, Dipartimento Cardio-Toraco-Vascolare - Medicina Specialistica, Diagnostica e Sperimentale , Bologna , Italy
| | - M Malaguti
- Alma Mater Studiorum Università di Bologna, Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale , Bologna , Italy
| | - M Sabatino
- Policlinico IRCCS Sant'Orsola-Malpighi, Dipartimento Cardio-Toraco-Vascolare , Bologna , Italy
| | - F Semprini
- Policlinico IRCCS Sant'Orsola-Malpighi, Dipartimento Cardio-Toraco-Vascolare , Bologna , Italy
| | - N Galie
- Policlinico IRCCS Sant'Orsola-Malpighi - Alma Mater Studiorum Università di Bologna, Dipartimento Cardio-Toraco-Vascolare - Medicina Specialistica, Diagnostica e Sperimentale , Bologna , Italy
| | - S Nanni
- Policlinico IRCCS Sant'Orsola-Malpighi, Dipartimento Cardio-Toraco-Vascolare , Bologna , Italy
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Corsini A, Potena L, Barberini F, Foà A, Gargiulo C, Malaguti M, Schinzari M, Garofalo M, Nardi E, Sabatino M, Semprini F, Galiè N, Nanni S. Clinical profile and in-hospital outcome of patients supported by intra-aortic balloon pump in the clinical setting of cardiogenic shock. Am Heart J Plus 2022; 17:100145. [PMID: 38559877 PMCID: PMC10978365 DOI: 10.1016/j.ahjo.2022.100145] [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] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/17/2022] [Accepted: 05/19/2022] [Indexed: 04/04/2024]
Abstract
Background Despite controversial evidences, intra-aortic balloon pump (IABP) is still the most widely used temporary mechanical support device in cardiogenic shock (CS), as a bridge to recovery or to more invasive mechanical supports/heart transplantation. Methods We analyzed retrospectively data of all patients receiving IABP for CS from 2009 to 2018 in a referral centre for advanced heart failure and heart transplantation; we included CS following acute coronary syndrome (ACS) and other CS etiologies different from ACS. We excluded patients in which IABP was implanted as a support following cardiac surgery, non-cardiac surgery in patients with severe chronic heart failure, or in elective high risk or complicated Cath Lab procedures.We focused on in-hospital outcomes (including death, recovery, heart transplantation, LVAD) and IABP complications. Results 403 patients received IABP, 303 (75.2%) following ACS and 100 (24.8%) in non-ACS CS. Non-ACS patients were younger (59 ± 18.3 vs 73.1 ± 12.6 years, p < 0.001), had lower median left ventricular ejection fraction (LVEF) (25% [18-35] vs 38% [25-45], p < 0.001). In patients with non-ACS etiologies IABP was more frequently a bridge to heart transplantation [20% (n = 20) vs 0.3% (n = 1), P < 0.001] or LVAD [4% (n = 4) vs 0.6% (n = 2), P = 0.055], while ACS patients were more frequently discharged without transplantation/LVAD [65.7% (n = 199) vs 33% (n = 33), P < 0.001]. Non-ACS patients showed higher in-hospital mortality [46% (n = 46) vs 33.9% (n = 103), P = 0.042]. Post-transplant/LVAD outcome in non-ACS subgroup was favorable (21 out of 24 patients were discharged). Serious IABP-related adverse events occurred in 21 patients (5.2%). Ischemic/hemorrhagic complications, infections and thrombocytopenia were more frequent with longer IABP stay. Conclusions Despite therapy including percutaneous circulatory support, mortality in CS is still high. In our experience, in the clinical setting of refractory CS an IABP support represents a relatively safe circulatory support, associated with a low rate of serious complications in complex clinical scenarios.
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Affiliation(s)
- Anna Corsini
- IRCCS Azienda Ospedaliero-Universitaria di Bologna
| | | | | | - Alberto Foà
- IRCCS Azienda Ospedaliero-Universitaria di Bologna
| | - Caterina Gargiulo
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Mattia Malaguti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Matteo Schinzari
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Mattia Garofalo
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Elena Nardi
- IRCCS Azienda Ospedaliero-Universitaria di Bologna
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | | | | | - Nazzareno Galiè
- IRCCS Azienda Ospedaliero-Universitaria di Bologna
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
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Cirocchi R, Nascimbeni R, Burini G, Boselli C, Barberini F, Davies J, Di Saverio S, Cassini D, Amato B, Binda GA, Bassotti G. The Management of Acute Colonic Diverticulitis in the COVID-19 Era: A Scoping Review. Medicina (Kaunas) 2021; 57:medicina57101127. [PMID: 34684164 PMCID: PMC8538273 DOI: 10.3390/medicina57101127] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 02/07/2023]
Abstract
Background and Objective: During the COVID-19 pandemic, health systems worldwide made major changes to their organization, delaying diagnosis and treatment across a broad spectrum of pathologies. Concerning surgery, there was an evident reduction in all elective and emergency activities, particularly for benign pathologies such as acute diverticulitis, for which we have identified a reduction in emergency room presentation with mild forms and an increase with more severe forms. The aim of our review was to discover new data on emergency presentation for patients with acute diverticulitis during the Covid-19 pandemic and their current management, and to define a better methodology for surgical decision-making. Method: We conducted a scoping review on 25 trials, analyzing five points: reduced hospital access for patients with diverticulitis, the preferred treatment for non-complicated diverticulitis, the role of CT scanning in primary evaluation and percutaneous drainage as a treatment, and changes in surgical decision-making and preferred treatment strategies for complicated diverticulitis. Results: We found a decrease in emergency access for patients with diverticular disease, with an increased incidence of complicated diverticulitis. The preferred treatment was conservative for non-complicated forms and in patients with COVID-related pneumonia, percutaneous drainage for abscess, or with surgery delayed or reserved for diffuse peritonitis or sepsis. Conclusion: During the COVID-19 pandemic we observed an increased number of complicated forms of diverticulitis, while the total number decreased, possibly due to delay in hospital or ambulatory presentation because of the fear of contracting COVID-19. We observed a greater tendency to treat these more severe forms by conservative means or drainage. When surgery was necessary, there was a preference for an open approach or a delayed operation.
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Affiliation(s)
- Roberto Cirocchi
- Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy; (R.C.); (C.B.); (F.B.); (G.B.)
| | - Riccardo Nascimbeni
- Department of Molecular and Translational Medicine, University of Brescia, 25121 Brescia, Italy;
| | - Gloria Burini
- General & Emergency Surgical Clinic, University of Ancona, Hospital “Ospedali Riuniti di Ancona”, 60126 Ancona, Italy
- Correspondence: ; Tel.: +39-34-6570-0300
| | - Carlo Boselli
- Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy; (R.C.); (C.B.); (F.B.); (G.B.)
| | - Francesco Barberini
- Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy; (R.C.); (C.B.); (F.B.); (G.B.)
| | - Justin Davies
- Colorectal Unit, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK; (J.D.); (S.D.S.)
| | - Salomone Di Saverio
- Colorectal Unit, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK; (J.D.); (S.D.S.)
| | - Diletta Cassini
- General and Laparoscopic Surgery, ASST Nord Milano, Sesto San Giovanni, 20099 Milano, Italy;
| | - Bruno Amato
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80138 Naples, Italy;
| | | | - Gabrio Bassotti
- Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy; (R.C.); (C.B.); (F.B.); (G.B.)
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Rulli A, Covarelli P, Servoli A, Saracini A, Panzarola P, Colella R, Boselli C, Barberini F. Accuracy and feasibility of SentiMag technique for localization of non-palpable breast lesions. MINERVA CHIR 2020; 75:255-259. [PMID: 32456397 DOI: 10.23736/s0026-4733.20.08303-0] [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: 11/08/2022]
Abstract
BACKGROUND Non-palpable breast lesions are more frequent now than in the past due to the attention toward the mammary pathology and the screening diffusion; the marking of such lesions is very important for a successful surgery. The SentiMag System uses a magnetic marker that is inoculated transdermal in the breast through an 18-gauge needle. METHODS Between April 1<sup>st</sup> and June 30<sup>th</sup>, 2018, 16 patients with non-palpable breast lesions were selected and subjected to surgery using the SentiMag System in our Unit. They were women with a mean age of 52 years (range 30-84 years). Seven of 16 (43.7%) had a borderline preoperative histological or cytological diagnosis (C3/B3), and nine (56.3%) a diagnosis of carcinoma (C5/B5). Six (37.5%) were marked on ultrasound guidance and 10 (62.5%) on a mammography stereotaxic guide. RESULTS The time for the marker positioning ranged from 2 to 10 minutes. The radiological control of the surgical specimen always showed the presence of both the lesion and the marker, both centered within the specimen and intact. The pathology revealed seven benign lesions, one in-situ, and eight infiltrating carcinomas. CONCLUSIONS The SentiMag represents a fast and safe preoperative marking system of non-palpable breast lesions, cutting the radio exposure for personnel and patients. The marker is not displaced over time and it is rapid to place and easy to locate intraoperatively, allowing a clear dissection plane around the lesion. Thus, this reduces the amount of gland removed, improving the aesthetic result mostly in small breasts.
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Affiliation(s)
- Antonio Rulli
- Department of Surgical Oncology, University of Perugia, Perugia, Italy
| | - Piero Covarelli
- Department of Surgical Oncology, University of Perugia, Perugia, Italy -
| | | | - Andrea Saracini
- Department of Radiology, Perugia General Hospital, Perugia, Italy
| | - Paola Panzarola
- Department of Radiology, Perugia General Hospital, Perugia, Italy
| | - Renato Colella
- Department of Pathology, University of Perugia, Perugia, Italy
| | - Carlo Boselli
- Department of Surgical Oncology, University of Perugia, Perugia, Italy
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Soror T, Lancellotta V, Kovács G, Lanzotti V, Tagliaferri L, Casà C, Aristei C, Barberini F, Mahmoud M, Badakhshi H. kOBCS ©: a novel software calculator program of the Objective Breast Cosmesis Scale (OBCS). Breast Cancer 2020; 27:179-185. [PMID: 31452014 DOI: 10.1007/s12282-019-01006-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 01/29/2019] [Accepted: 08/17/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE The Objective Breast Cosmesis Scale (OBCS) is an objective method that documents the aesthetic changes in breast cancer patients. This work evaluates the kOBCS© software (http://www.kobcs.info) which simplifies the estimation of the OBCS values. METHODS Five schematic drawings were photographed and imported into the kOBCS©. Thirty photos of breast cancer patients were imported into kOBCS©; 20 users (experts and non-experts) evaluated the photographs on two different settings. Subjective evaluation was performed using the Harvard breast cosmesis scale. RESULTS There was a highly significant correlation between the OBCS values based on hand measurements and the values estimated by kOBCS© (r = 0.997, P < 0.001). Agreement among the users using the kOBCS© was strong with high statistical significance (ICC = 0.846, P < 0.001, 95% CI 0.774-0.910, Cronbach's alpha = 0.991). Results of the subjective analyses and mean OBCS values as estimated by kOBCS© correlated significantly (r = 0.961, P < 0.001). CONCLUSIONS The kOBCS© is a reliable and reproducible easy-to-use software for reporting breast cosmesis following breast-conserving therapy.
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Affiliation(s)
- Tamer Soror
- Department of Clinical Radiation Oncology, Ernst Von Bergmann Medical Center, Academic Teaching Hospital of Humboldt University Berlin (Charité), Potsdam, Germany.
- Radiation Oncology Department, National Cancer Institute (NCI), Cairo University, Cairo, Egypt.
| | - Valentina Lancellotta
- Radiation Oncology Section, Department of Surgery and Biomedical Sciences, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - György Kovács
- Interdisciplinary Brachytherapy Unit, University of Luebeck/UKSH-CL, Lübeck, Germany
| | | | - Luca Tagliaferri
- Fondazione Policlinico Universitario A. Gemelli IRCCS-UOC Radioterapia, Rome, Italy
| | - Calogero Casà
- Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica Del Sacro Cuore, Istituto di Radiologia, Rome, Italy
| | - Cynthia Aristei
- Interdisciplinary Brachytherapy Unit, University of Luebeck/UKSH-CL, Lübeck, Germany
| | - Francesco Barberini
- Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy
| | - Mohamed Mahmoud
- Radiation Oncology Section, Department of Surgery and Biomedical Sciences, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Harun Badakhshi
- Department of Clinical Radiation Oncology, Ernst Von Bergmann Medical Center, Academic Teaching Hospital of Humboldt University Berlin (Charité), Potsdam, Germany
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Covarelli P, Barberini F, Cannavicci D, Cirocchi R, Rulli A, Boselli C, De Giorgi V. Reduction of postoperative lymphorrhoea in patients undergoing radical lymphadenectomy for stage III melanoma: prospective study using collagen-fibrin patches. MINERVA CHIR 2019; 75:111-116. [PMID: 31820617 DOI: 10.23736/s0026-4733.19.08114-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Radical lymph nodes dissection (RLND) is the standard procedure for regional control of disease in patients with metastatic melanoma (stage III). Because of its aggressiveness, lymphorrhoea is a constant problem in postoperative. METHODS In this prospective nonrandomized study with a retrospective analysis of data, patients undergoing surgical treatment of axillary or iliac-inguinal RLND received standard treatment plus a collagen-fibrin sealant patch (TachoSil) (N.=50) or standard treatment alone (N.=50). The first endpoint was the comparison between the treated population and the control group, in terms of persistence of drainage and average daily volume of lymphorrhoea. The second aim was to relate patients' BMI, volume of lymphorrhoea and time of drainage in the two groups. RESULTS In the comparison between the two groups receiving or not the treatment with collagen-fibrin patch, we found an average difference both in the volume of daily lymphorrhoea (42.91±6.61 cc) and in the persistence of drainage (9.292±1.644 days) with P value <0.0001. Besides, the collagen-fibrin patch was actually effective in reducing lymphorrhoea and time of drainage, regardless of patients' BMI. CONCLUSIONS The results of this study confirm and support the starting thesis: TachoSil is an effective tissue sealant able to reduce lymphorrhoea and drainage removal times following a radical lymphadenectomy, independently from the BMI.
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Affiliation(s)
- Piero Covarelli
- Department of Oncologic Surgery, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy -
| | - Francesco Barberini
- Department of Oncologic Surgery, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Daniele Cannavicci
- Department of Oncologic Surgery, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Roberto Cirocchi
- Department of Oncologic Surgery, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Antonio Rulli
- Department of Oncologic Surgery, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Carlo Boselli
- Department of Oncologic Surgery, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
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Gioia S, Lancia M, Cirocchi R, Suadoni F, Franceschetto L, Santoro A, Palumbo P, Boselli C, Barberini F, Covarelli P, Renzi C, Carlini L. Retained sponges in abdomen: an analysis of the judgments of the Italian Supreme Court. G Chir 2019; 40:290-297. [PMID: 32011979] [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: 06/10/2023]
Abstract
The administration of justice in Italy includes first, second and third instance. The first and second instances are represented by the Court of First Instance and the Court of Appeal: these are judgment of Romamerit. The court of last appeal for both the civil and the criminal jurisdiction is the Court of Cassation, the Italian Supreme Court. It is a court of legitimacy that should provide for a consistent and uniform interpretation of the law and that only on points of law, not on factual evidence. The Court of Cassation can confirm the sentence of second instance, can dismiss it without referral, can deciding and closing the trial definitively, or dismiss it referring the case to the judge of merit that must decide according to the principles set out in the legitimacy. The aim of this study is to analyze the Supreme Cassation Court's judgments on the legal proceedings about retained sponges in abdomen.
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Popivanov G, Tabakov M, Mantese G, Cirocchi R, Piccinini I, D'Andrea V, Covarelli P, Boselli C, Barberini F, Tabola R, Pietro U, Cavaliere D. Surgical treatment of gastrointestinal stromal tumors of the duodenum: a literature review. Transl Gastroenterol Hepatol 2018; 3:71. [PMID: 30363779 DOI: 10.21037/tgh.2018.09.04] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 02/25/2018] [Accepted: 09/04/2018] [Indexed: 01/10/2023] Open
Abstract
Background Gastrointestinal stromal tumors (GIST) are the most frequent mesenchymal tumours in the digestive tract. The duodenal GIST (dGIST) is the rarest subtype, representing only 4-5% of all GIST, but up to 21% of the resected ones. The diagnostic and therapeutic management of dGIST may be difficult due to the rarity of this tumor, its anatomical location, and the clinical behavior that often mimic a variety of conditions; moreover, there is lack of consent for their treatment. This study has evaluated the scientific literature to provide consensus on the diagnosis of dGIST and to outline possible options for surgical treatment. Methods An extensive research has been carried out on the electronic databases MEDLINE, Scopus, EMBASE and Cochrane to identify all clinical trials that report an event or case series of dGIST. Results Eighty-six studies that met the inclusion criteria were identified with five hundred forty-nine patients with dGIST: twenty-seven patients were treated with pancreatoduodenectomy and ninety-six with only local resection (segmental/wedge resections); in four hundred twenty-six patients it is not possible identify the type of treatment performed (pancreatoduodenectomy or segmental/wedge resections). Conclusions dGISTs are a very rare subset of GISTs. They may be asymptomatic or may involve symptoms of upper GI bleeding and abdominal pain at presentation. Because of the misleading clinical presentation the differential diagnosis may be difficult. Tumours smaller than 2 cm have a low biological aggressiveness and can be followed annually by endoscopic ultrasound. The biggest ones should undergo radical surgical resection (R0). In dGIST there is no uniformly adopted surgical strategy because of the low incidence, lack of experience, and the complex anatomy of the duodenum. Therefore, individually tailored surgical approach is recommended. R0 resection with 1-2 cm clear margin is required. Lymph node dissection is not recommended due to the low incidence of lymphatic metastases. Tumor rupture should be avoided.
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Affiliation(s)
- Georgi Popivanov
- Military Medical Academy, Clinic of Endoscopic, Endocrine surgery and Coloproctology, Sofia, Bulgaria
| | - Mihail Tabakov
- University Hospital Sv. Ivan Rilski, Surgical Clinic, Sofia, Bulgaria
| | - George Mantese
- Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy
| | - Roberto Cirocchi
- Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy
| | - Irene Piccinini
- Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy
| | - Vito D'Andrea
- Department of Surgical and Biomedical Sciences, University of Perugia, Italy
| | - Piero Covarelli
- Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy
| | - Carlo Boselli
- Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy
| | - Francesco Barberini
- Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy
| | - Renata Tabola
- Department and Clinic of Gastrointestinal and General Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Ursi Pietro
- Department of Surgical and Biomedical Sciences, University of Perugia, Italy
| | - Davide Cavaliere
- General Surgery and Surgical Oncology, Morgagni-Pierantoni Hospital, Forlì, Italy
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Abstract
PURPOSE OF REVIEW Despite the improvement in medical therapy for heart failure and the advancements in mechanical circulatory support, heart transplantation (HT) still remains the best therapeutic option to improve survival and quality of life in patients with advanced heart failure. Nevertheless, HT recipients are exposed to the risk of several potential complications that may impair their outcomes. In this article, we aim to provide a practical and scholarly framework for clinicians approaching heart transplant medicine, as well as a concise update for the experienced readers on the most relevant post-HT complications. RECENT FINDINGS While recognizing that most of the treatments herein discussed are based more on experience than on solid scientific evidence, significant step forward has been made in particular in the recognition and management of primary graft dysfunction, antibody-mediated rejection, and renal dysfunction. Complications after HT may vary according to the time from surgery and can be related to graft function and pathology or to diseases and dysfunctions occurring in other organs or systems, mainly as side effects of immunosuppressive drugs and progression of pre-existing conditions. Future research needs to focus on improving precision diagnostics of causes of graft dysfunction and on reaching an optimal and customized balance between efficacy and toxicities of immunosuppressive strategies.
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Affiliation(s)
- Luciano Potena
- Heart Transplant Program, Bologna Academic Hospital, Policlinico S. Orsola-Malpighi, Building 25, Via Massarenti, 9, 40138, Bologna, Italy.
| | - Andreas Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Francesco Barberini
- Heart Transplant Program, Bologna Academic Hospital, Policlinico S. Orsola-Malpighi, Building 25, Via Massarenti, 9, 40138, Bologna, Italy
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Scialpi M, Rondoni V, Recchia N, Barberini F, Baccari P, Antonietta Mazzei M, Manganaro L, Roncati L, Pusiol T, Palumbo B. Value of split-bolus multidetector-row CT technique in the quantitative assessment of pancreatic enhancement. Medeni Med J 2017. [DOI: 10.5222/mmj.2017.180] [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: 11/05/2022] Open
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14
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Grigioni F, Russo A, Pasquale F, Biagini E, Barberini F, Ferlito M, Leone O, Rapezzi C. Clinical Use of Doppler Echocardiography in Organic Mitral Regurgitation: From Diagnosis to Patients' Management. J Cardiovasc Ultrasound 2015; 23:121-33. [PMID: 26448820 PMCID: PMC4595698 DOI: 10.4250/jcu.2015.23.3.121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 09/06/2015] [Accepted: 09/07/2015] [Indexed: 01/11/2023] Open
Abstract
Knowledge of mitral regurgitation (MR) is essential for any care provider, and not only for those directly involved in the management of cardiovascular diseases. This happens because MR is the most frequent valvular lesion in North America and the second most common form of valve disease requiring surgery in Europe. Furthermore, due to the ageing of the general population and the reduced mortality from acute cardiovascular events, the prevalence of MR is expected to increase further. Doppler echocardiography is essential both for the diagnosis and the clinical management of MR. In the present article, we sought to provide a practical step-by-step approach to help either performing a Doppler echocardiography or interpreting its findings in light of contemporary knowledge on organic (but not only) MR.
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Affiliation(s)
- Francesco Grigioni
- Department of Experimental Diagnostic and Specialty Medicine, Cardiology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Antonio Russo
- Department of Experimental Diagnostic and Specialty Medicine, Cardiology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Ferdinando Pasquale
- Department of Experimental Diagnostic and Specialty Medicine, Cardiology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Elena Biagini
- Department of Experimental Diagnostic and Specialty Medicine, Cardiology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Francesco Barberini
- Department of Experimental Diagnostic and Specialty Medicine, Cardiology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Marinella Ferlito
- Department of Experimental Diagnostic and Specialty Medicine, Cardiology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Ornella Leone
- Pathology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Claudio Rapezzi
- Department of Experimental Diagnostic and Specialty Medicine, Cardiology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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15
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Rulli A, Listorti C, Foglietta J, Burattini M, Caracappa D, Palumbo I, Barberini F, Covarelli P, Boselli C. Impact of genetic signature on breast cancer therapy: preliminary experience. Minerva Med 2015; 106:309-313. [PMID: 26649813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- A Rulli
- Breast Unit, Department of Surgical Oncology, University of Perugia, Perugia, Italy -
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16
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Boselli C, Barberini F, Listorti C, Castellani E, Renzi C, Corsi A, Grassi V, Cacurri A, Desiderio J, Trastulli S, Santoro A, Pironi D, Burattini F, Cirocchi R, Avenia N, Noya G, Parisi A. Distal pancreatectomy with splenic preservation: A short-term outcome analysis of the Warshaw technique. Int J Surg 2015; 21 Suppl 1:S40-3. [DOI: 10.1016/j.ijsu.2015.06.051] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 03/23/2015] [Accepted: 04/10/2015] [Indexed: 01/15/2023]
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Masetti M, Malossi M, Potena L, Prestinenzi P, Manfredini V, Barberini F, Borgese L, Sabatino M, Magnani G, Grigioni F, Rapezzi C. Everolimus (EVE) vs. Mycophenolate (MMF) De Novo After Heart Transplantation (HTx): Does It Matter for Long Term Outcomes? J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.356] [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: 11/25/2022] Open
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18
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Parisi A, Desiderio J, Cirocchi R, Grassi V, Trastulli S, Barberini F, Corsi A, Cacurri A, Renzi C, Anastasio F, Battista F, Pucci G, Noya G, Schillaci G. Road accident due to a pancreatic insulinoma: a case report. Medicine (Baltimore) 2015; 94:e537. [PMID: 25816027 PMCID: PMC4554003 DOI: 10.1097/md.0000000000000537] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Insulinoma is a rare pancreatic endocrine tumor, typically sporadic and solitary. Although the Whipple triad, consisting of hypoglycemia, neuroglycopenic symptoms, and symptoms relief with glucose administration, is often present, the diagnosis may be challenging when symptoms are less typical. We report a case of road accident due to an episode of loss of consciousness in a patient with pancreatic insulinoma. In the previous months, the patient had occasionally reported nonspecific symptoms. During hospitalization, endocrine examinations were compatible with an insulin-producing tumor. Abdominal computerized tomography and magnetic resonance imaging allowed us to identify and localize the tumor. The patient underwent a robotic distal pancreatectomy with partial omentectomy and splenectomy. Insulin-producing tumors may go undetected for a long period due to nonspecific clinical symptoms, and may cause episodes of loss of consciousness with potentially lethal consequences. Robot-assisted procedures can be performed with the same techniques of the traditional surgery, reducing surgical trauma, intraoperative blood loss, and hospital stays.
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Affiliation(s)
- Amilcare Parisi
- From the Unit of Digestive and Liver Surgery (AP, JD, VG, ST, AC), Santa Maria Hospital, Terni; Department of General and Oncologic Surgery (RC, FB, AC, CR, GN), University of Perugia, Perugia; Unit of Internal Medicine (FA, FB, GP, GS), Santa Maria Hospital, Terni; and Department of Medicine (FA, FB, GP, GS), University of Perugia, Perugia, Italy
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Parisi A, Desiderio J, Trastulli S, Grassi V, Ricci F, Farinacci F, Cacurri A, Castellani E, Corsi A, Renzi C, Barberini F, D'Andrea V, Santoro A, Cirocchi R. Robotic pancreaticoduodenectomy in a case of duodenal gastrointestinal stromal tumor. World J Surg Oncol 2014; 12:372. [PMID: 25475024 PMCID: PMC4289318 DOI: 10.1186/1477-7819-12-372] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 11/18/2014] [Indexed: 11/30/2022] Open
Abstract
Background Laparoscopic pancreaticoduodenectomy is rarely performed, and it has not been particularly successful due to its technical complexity. The objective of this study is to highlight how robotic surgery could improve a minimally invasive approach and to expose the usefulness of robotic surgery even in complex surgical procedures. Case presentation The surgical technique employed in our center to perform a pancreaticoduodenectomy, which was by means of the da Vinci™ robotic system in order to remove a duodenal gastrointestinal stromal tumor, is reported. Conclusions Robotic technology has improved significantly over the traditional laparoscopic approach, representing an evolution of minimally invasive techniques, allowing procedures to be safely performed that are still considered to be scarcely feasible or reproducible.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Claudio Renzi
- Department of General and Oncologic Surgery, University of Perugia, Piazzale Gambuli 1, Perugia, 06157, Italy.
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20
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Cirocchi R, Arezzo A, Vettoretto N, Cavaliere D, Farinella E, Renzi C, Cannata G, Desiderio J, Farinacci F, Barberini F, Trastulli S, Parisi A, Fingerhut A. Role of damage control surgery in the treatment of Hinchey III and IV sigmoid diverticulitis: a tailored strategy. Medicine (Baltimore) 2014; 93:e184. [PMID: 25437034 PMCID: PMC4616377 DOI: 10.1097/md.0000000000000184] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Many of the treatment strategies for sigmoid diverticulitis are actually focusing on nonoperative and minimally invasive approaches. The aim of this systematic review was to evaluate the actual role of damage control surgery (DCS) in the treatment of generalized peritonitis caused by perforated sigmoid diverticulitis.A literature search was performed in PubMed and Google Scholar for articles published from 1960 to July 2013. Comparative and noncomparative studies that included patients who underwent DCS for complicated diverticulitis were considered.Acute Physiology and Chronic Health Evaluation score, duration of open abdomen, intensive care unit length of stay, reoperation, bowel resection performed at first operation, fecal diversion, method, and timing of closure of abdominal wall were the main outcomes of interest.According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses algorithm for the literature search and review, 10 studies were included in this systematic review. DCS was exclusively performed in diverticulitis patients with septic shock or requiring vasopressors intraoperatively. Two surgical different approaches were highlighted: limited resection of the diseased colonic segment with or without stoma or reconstruction in situ, and laparoscopic washing and drainage without colonic resection.Despite the heterogeneity of patient groups, clinical settings, and interventions included in this review, DCS appears to be a promising strategy for the treatment of Hinchey III and IV diverticulitis, complicated by septic shock. A tailored approach to each patient seems to be appropriate.
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Affiliation(s)
- Roberto Cirocchi
- From the Department of Digestive Surgery (RC, JD, ST, AP), St. Maria Hospital, University of Perugia, Terni; Department of Surgical Sciences (AA), University of Turin, Turin; Laparoscopic Surgical Unit (NV), M. Mellini Hospital, Chiari; Department of Surgical Oncology (DC), Forlì; Department of HPB and Digestive Surgery (EF), Ospedale Mauriziano Umberto I, Turin; Department of General and Oncologic Surgery (CR, GC, FB), University of Perugia, Perugia; Department of Mininvasive and Robotic Surgery (FF), St. Maria Hospital, University of Perugia, Terni, Italy; Athens First Department of Surgery (Prof Leandros) (AF), Hippokration University Hospital, University of Athens, Athens, Greece; and Section for Surgical Research (Prof Uranues) (AF), Department of Surgery, Medical University of Graz, Graz, Austria
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Boselli C, Burini G, Covarelli P, Barberini F, Gemini A, Castellani E, Noya G, Cirocchi R. A rare nosological entity: the perforated solitary cecal diverticulum. Research article. Ann Ital Chir 2014; 85:397-403. [PMID: 25264076] [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: 06/03/2023]
Abstract
AIM To describe three cases of solitary cecal diverticulum, and trying to evaluate the better method of diagnosis and treatment with analysis of the literature. MATERIAL OF STUDY Description of three cases of solitary cecal diverticulum's perforation admitted in the Department of General and Oncologic Surgery, Santa Maria della Misericordia Hospital, Perugia, during the period January 2011 - January 2012. RESULTS In all patients the clinical presentation was very similar to that of acute appendicitis. Preoperative diagnosis was achieved in one case through abdominal CT scan, other two cases were identified at final pathology. At one year from the treatment all patient are still alive. DISCUSSION Cecal diverticulum is a rare condition, often diagnosed either casually or because of inflammatory or perforative complications. The highest incidence is found in Western population. Because of the clinical presentation, very similar to the appendicitis, and the inflammatory reaction involving the colon and its surrounding tissues, the pre- and intra-operative diagnosis are very difficult. The diagnosis is almost always histological. The treatment may vary from simple expectant medical management, carried out with bowel rest, parenteral support and antibiotics as for left-sided diverticulitis, to surgical approach, performed through simple diverticulectomy or by classical right hemicolectomy. CONCLUSION Pre-surgical and, also intra-operative, diagnosis of perforated solitary cecal diverticulum is clearly difficult. CT scan represents the gold standard for the differential diagnosis. Right hemicolectomy is an effective and safe approach, allowing accurate control, preventing complications and recurrences, and it represents the optimal management of the disease.
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Cirocchi R, Corsi A, Castellani E, Barberini F, Renzi C, Cagini L, Boselli C, Noya G. A comparison of case series comparing Non Operative Management vs Operative Management of splenic injury after blunt trauma. ULUS TRAVMA ACIL CER 2014; 20:91-6. [DOI: 10.5505/tjtes.2014.99442] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Pusiol T, Franceschetti I, Bonfioli F, Barberini F, Scalera GB, Piscioli I. Middle ear metastasis from dormant breast cancer as the initial sign of disseminated disease 20 years after quadrantectomy. Ear Nose Throat J 2013; 92:121-4. [PMID: 23532648 DOI: 10.1177/014556131309200310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
We describe an unusual case of breast cancer metastatic to the middle ear in a 71-year-old woman. The metastasis was the initial sign of disseminated disease 20 years after the patient had undergone a quadrantectomy for her primary disease. Computed tomography (CT) demonstrated the presence of an intratympanic mass with a soft-tissue density that was suggestive of chronic inflammation. The patient underwent a canal-wall-down tympanoplasty. When a brownish mass was found around the ossicles, a mastoidectomy with posterior tympanotomy was carried out. However, exposure of the tumor was insufficient, and therefore the posterior wall of the ear canal had to be removed en bloc. Some tumor was left on the round window membrane so that we would not leave the patient with a total hearing loss. Our case highlights the limitations of CT and magnetic resonance imaging in differentiating inflammatory and neoplastic lesions.
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Affiliation(s)
- Teresa Pusiol
- Institute of Pathology, S. Maria del Carmine Hospital, Piazzale S. Maria 6, 38068 Rovereto (TN), Italy
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Covarelli P, Burini G, Barberini F, Caracappa D, Boselli C, Noya G, Castellani E, Rulli A. The integrated role of ultrasonography in the diagnosis of soft tissue metastases from melanoma: preliminary report of a single-center experience and literature review. In Vivo 2013; 27:827-833. [PMID: 24292589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Currently melanoma has the fastest growing incidence of all cancers in men and the second in women (after lung cancer) in Western countries. Since prognosis of skin melanoma is excellent in early stages but dramatically worsens in advanced stages, an early diagnosis is fundamental in granting patients a favorable outcome. Sentinel node (SN) biopsy represents the gold standard for accurately staging melanoma, but other tests are commonly endorsed both in the initial staging work-up and in the follow-up, such as ultrasonography, computed tomography (CT)-scan and positron emission tomography (PET)-CT. PET-CT, among others, has high sensitivity and specificity for the study of distant metastases, the assessment of soft tissues and lymph node involvement, and for the guidance of surgical biopsies. Ultrasonography (US) is a non-invasive procedure whose use has recently expanded in our service, both preoperatively, intraoperatively and postoperatively, thanks to its wide availability, low costs and easy and fast reproducibility; ultrasonography even surpassed the reliability of PET-CT or CT-scan in the seven cases presented herein. US is operator-dependent, and this is probably the major limitation of the procedure, together with lack of prospective studies validating its strength, but our preliminary study demonstrates that ultrasound can assume an important role in melanoma, both for staging and the follow-up of patients, especially with lymph nodal or subcutaneous involvement.
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Potena L, Bontadini A, Iannelli S, Fruet F, Leone O, Barberini F, Borgese L, Manfredini V, Masetti M, Magnani G, Fallani F, Grigioni F, Branzi A. Occurrence of Fatal and Nonfatal Adverse Outcomes after Heart Transplantation in Patients with Pretransplant Noncytotoxic HLA Antibodies. J Transplant 2013; 2013:519680. [PMID: 23984043 PMCID: PMC3745955 DOI: 10.1155/2013/519680] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 06/09/2013] [Indexed: 11/17/2022] Open
Abstract
HLA antibodies (HLA ab) in transplant candidates have been associated with poor outcome. However, clinical relevance of noncytotoxic antibodies after heart transplant (HT) is controversial. By using a Luminex-based HLA screening, we retested pretransplant sera from HT recipients testing negative for cytotoxic HLA ab and for prospective crossmatch. Out of the 173 consecutive patients assayed (52 ± 13y; 16% females; 47% ischemic etiology), 32 (18%) showed pretransplant HLA ab, and 12 (7%) tested positive against both class I and class II HLA. Recipients with any HLA ab had poorer survival than those without (65 ± 9 versus 82 ± 3%; P = 0.02), accounting for a doubled independent mortality risk (P = 0.04). In addition, HLA-ab detection was associated with increased prevalence of early graft failure (35 versus 15%; P = 0.05) and late cellular rejection (29 versus 11%; P = 0.03). Of the subgroup of 37 patients suspected for antibody mediated rejection (AMR), the 9 with pretransplant HLA ab were more likely to display pathological AMR grade 2 (P = 0.04). By an inexpensive, luminex-based, HLA-screening assay, we were able to detect non-cytotoxic HLA ab predicting fatal and nonfatal adverse outcomes after heart transplant. Allocation strategies and desensitization protocols need to be developed and prospectively tested in these patients.
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Affiliation(s)
- Luciano Potena
- Cardiovascular Department, Academic Hospital S. Orsola-Malpighi, University of Bologna, Building 21, Via Massarenti 9, 40138 Bologna, Italy
| | - Andrea Bontadini
- Immunogenetics Unit, Transfusion Service, Academic Hospital S. Orsola-Malpighi, University of Bologna, Italy
| | - Sandra Iannelli
- Immunogenetics Unit, Transfusion Service, Academic Hospital S. Orsola-Malpighi, University of Bologna, Italy
| | - Fiorenza Fruet
- Immunogenetics Unit, Transfusion Service, Academic Hospital S. Orsola-Malpighi, University of Bologna, Italy
| | - Ornella Leone
- Pathology Department, Academic Hospital S. Orsola-Malpighi, University of Bologna, Italy
| | - Francesco Barberini
- Cardiovascular Department, Academic Hospital S. Orsola-Malpighi, University of Bologna, Building 21, Via Massarenti 9, 40138 Bologna, Italy
| | - Laura Borgese
- Cardiovascular Department, Academic Hospital S. Orsola-Malpighi, University of Bologna, Building 21, Via Massarenti 9, 40138 Bologna, Italy
| | - Valentina Manfredini
- Cardiovascular Department, Academic Hospital S. Orsola-Malpighi, University of Bologna, Building 21, Via Massarenti 9, 40138 Bologna, Italy
| | - Marco Masetti
- Cardiovascular Department, Academic Hospital S. Orsola-Malpighi, University of Bologna, Building 21, Via Massarenti 9, 40138 Bologna, Italy
| | - Gaia Magnani
- Cardiovascular Department, Academic Hospital S. Orsola-Malpighi, University of Bologna, Building 21, Via Massarenti 9, 40138 Bologna, Italy
| | - Francesco Fallani
- Cardiovascular Department, Academic Hospital S. Orsola-Malpighi, University of Bologna, Building 21, Via Massarenti 9, 40138 Bologna, Italy
| | - Francesco Grigioni
- Cardiovascular Department, Academic Hospital S. Orsola-Malpighi, University of Bologna, Building 21, Via Massarenti 9, 40138 Bologna, Italy
| | - Angelo Branzi
- Cardiovascular Department, Academic Hospital S. Orsola-Malpighi, University of Bologna, Building 21, Via Massarenti 9, 40138 Bologna, Italy
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Rulli A, Caracappa D, Barberini F, Boselli C, Cirocchi R, Castellani E, Noya G, Covarelli P. Oncologic reliability of nipple-sparing mastectomy for selected patients with breast cancer. In Vivo 2013; 27:387-394. [PMID: 23606696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Nipple sparing mastectomy (NSM) is the current surgical alternative to conventional techniques, when mastectomy is required. This less invasive procedure safeguards the integrity of the nipple areola complex (NAC), whose removal is recognized as a factor that exacerbates the patient's feeling of mutilation, however ensuring oncological radicality for women with breast cancer. PATIENTS AND METHODS From January 2003 to January 2011, 77 patients underwent Nipple Sparing Mastectomy (NSM). Patients were carefully selected according to specific criteria. When requested, postoperative radiotherapy on the residual glandular tissue was performed within 6 months of surgery. Patients were on close clinical and instrumental follow-up every 4 months for 2 years and every 6 months for the remaining 3 years. RESULTS Of the 77 patients who underwent NSM, 10 suffering from bilateral cancer were subjected to bilateral procedure, for a total of 87 performed procedures. Furthermore, in the same group, 13 NSMs were carried out for preventive purposes. The average diameter of resected tumors was 13.5 mm, with a range of 2 to 25 mm. During the follow-up (range 23-115 months, mean 50.33 months) 2 locoregional recurrences in the NAC were observed, identified through instrumental check, and surgically treated by NAC removal after 33 and 37 months respectively. CONCLUSION According to the litterature data and confirmed by our experience, we consider NSM as an oncologically safe technique that, in the respect of inclusion criteria may be performed in any patient with indication to mastectomy. A careful selection of patients by a multidisciplinary team according to strict criteria is the key in determining feasibility as well as oncological safety and should lead the general acceptance and widespread use of such surgical technique.
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Affiliation(s)
- Antonio Rulli
- General and Oncologic Surgery Unit, Department of Surgical, Radiological and Odontostomatological Sciences, University of Perugia, S. Maria della Misericordia Hospital, S. Andrea delle Fratte, Perugia, Italy.
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Rulli A, Caracappa D, Castellani E, Arcuri G, Barberini F, Sanguinetti A, Noya G, Pataia E, Covarelli P. Optimizing therapeutic timing in patients undergoing mastectomy through use of the Tiloop® synthetic mesh: single-step surgery. In Vivo 2013; 27:383-386. [PMID: 23606695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Patients undergoing mastectomy for breast cancer have to face a long and elaborated therapeutic path, very often burdened by reoperation to replace the temporary expander, used to enlarge the submuscular pouch, with a definitive implant. Postoperative planning represents a critical moment of care, as it requires the integration of multiple treatments (chemotherapy, radiotherapy, hormonotherapy) each with a specific deadline. We believe that in such a complex multidisciplinary approach, coordination among the different therapeutic phases should be the key to success. The aim of the Breast Unit is to manage rapidly the ad hoc paths set out for each patient in order to guarantee compliance with adequate therapeutic timing. With this purpose in mind we tested the advantage of immediate reconstruction with definitive implants, by using a polypropylene mesh which, prolonging the inferolateral profile of the pectoralis major muscle (PMM), allows for direct accommodation of the desired implant volume. This leads to a single-step surgical approach, guaranteeing at the same time reduced interference with adjuvant therapies and good aesthetic results. We applied this technique to 4 patients, one of which was bilateral and, in spite of the restricted number of cases, our results seem to be promising.
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Affiliation(s)
- Antonio Rulli
- Breast Unit, Department of Surgery, Section of Plastic andReconstructive Surgery, University of Perugia, Perugia General Hospital, Via degli Olivi 18, Perugia, Italy
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Potena L, Barberini F, Boffini M, Amarelli C, Pellegrini C, Livi U, Masciocco G, Faggian G, Gerosa G, Lilla P, Marraudino N, Porcu M, Guarisco R, Maccherini M. Safety of Early Everolimus in De Novo Heart Transplant Recipients: Interim Analysis of the Randomized Study EVERHEART. J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.303] [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] Open
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Boselli C, Renzi C, Gemini A, Castellani E, Trastulli S, Desiderio J, Corsi A, Barberini F, Cirocchi R, Santoro A, Parisi A, Redler A, Noya G. Surgery in asymptomatic patients with colorectal cancer and unresectable liver metastases: the authors' experience. Onco Targets Ther 2013; 6:267-72. [PMID: 23569390 PMCID: PMC3615897 DOI: 10.2147/ott.s39448] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [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: 01/22/2023] Open
Abstract
PURPOSE In asymptomatic patients with Stage IV colorectal cancer, the debate continues over the efficacy of primary resection compared to chemotherapy alone. The aim of this study was to define the optimal management for asymptomatic patients with colorectal cancer and unresectable liver metastases. PATIENTS AND METHODS Patients receiving elective surgery (n = 17) were compared to patients receiving chemotherapy only (n = 31). Data concerning patients' demographics, location of primary tumor, comorbidities, performance status, Child-Pugh score, extension of liver metastases, size of primary, and other secondary locations were collected. RESULTS Thirty-day mortality after chemotherapy was lower than that after surgical resection (19.3% versus 29.4%; not significant). In patients with >75% hepatic involvement, mortality at 1 month was higher after receiving surgical treatment than after chemotherapy alone (50% versus 25%). In patients with <75% hepatic involvement, 30-day mortality was similar in both groups (not significant). Thirty-day mortality in patients with Stage T3 was lower in those receiving chemotherapy (16.7% versus 30%; not significant). Overall survival was similar in both groups. The risk of all-cause death after elective surgery (2.1) was significantly higher than in patients receiving chemotherapy only (P = 0.035). CONCLUSION This study demonstrated that in palliative treatment of asymptomatic unresectable Stage IV colorectal cancer, the overall risk of death was significantly higher after elective surgery compared to patients receiving chemotherapy alone. However, in the literature, there is no substantial difference between these treatments. New studies are required to better evaluate outcomes.
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Affiliation(s)
- Carlo Boselli
- Department of General and Oncologic Surgery, University of Perugia, Perugia
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Rebonato A, Pierotti L, Barberini F, Rosi G, Macarini L, Scialpi M. [Small renal cell carcinoma (≤ 4 cm): enhancement patterns on triphasic spiral CT]. Recenti Prog Med 2013; 103:471-6. [PMID: 23096734 DOI: 10.1701/1166.12891] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aim of this study was to define enhancement patterns of small renal cell carcinoma (RCC) (≤4 cm) by triphasic spiral CT. In 24 patients with RCC, hypervascularity and hypovascularity were identified in 12 and 12 RO, respectively, in the cortico-medullary phase (CMP). Hypervascular RCC showed increased density in the CMP (170,7±46,3 UH) and a gradual wash-out in the nephrographic phase (NP) (152,5±41 UH) and pielographic phase (PF) (99,2±38 UH). Hypovascular RCC showed increased density in the CMP (52,9±24,7 UH) and a gradual wash-out in NP (64,5±16,9 UH) and PP phases (55,0±17,3 UH).
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Scialpi M, Franzini C, Piscioli I, Barberini F, Pusiol T, Rondelli F, Nicolanti V, Rulli A, Izzo P, Merlin G, Forcione AR, Pugliese F, Di Cello P, Paliotta A, Izzo L. Synchronous primary lung cancer. Critical review of diagnostic criteria. Ann Ital Chir 2013; 84:33-40. [PMID: 23235125] [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: 06/01/2023]
Abstract
QUESTION OF THE STUDY Synchronous primary lung cancers (SPLCs) may pose a radiologic-pathologic and therapeutic dilemma in according to recent WHO classification. PATIENTS AND METHODS Two cases of surgically treated SPLCs are reported. RESULTS In the first case two nodules were detected by Computed Tomography (CT) in the upper right lobe. The patient underwent lobectomy and histological diagnosis was adenocarcinoma and squamous cell carcinoma. The second patient presented at CT one nodule in the upper left lobe and another nodule in the upper right lobe. Sternotomic access was chosen for bilateral removal of the lesions. The diagnosis was sarcomatoid carcinoma and large cell neuroendocrine adenocarcinoma. DISCUSSION The criteria of Martini and Melamed are inadequate for the diagnosis of SPLCs. The use of TTF-1 (thyroid transcription factor-1) is necessary to establish the diagnosis of SPLC in patients with adenocarcinoma of other sites. Bronchioloalveolar carcinomas must be excluded because of their multicentricity. When histology of two tumors found in the same lobe is identical and histotype is adenocarcinoma, large cell carcinoma or sarcomatoid carcinoma, the diagnosis of SPLCs must be excluded and those lesions must be considered as metastatic disease. The prognosis and treatment of SPLCs are discussed after critical review of the literature.
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Castellani E, Covarelli P, Boselli C, Cirocchi R, Rulli A, Barberini F, Caracappa D, Cini C, Desiderio J, Burini G, Noya G. Spontaneous splenic rupture in patient with metastatic melanoma treated with vemurafenib. World J Surg Oncol 2012; 10:155. [PMID: 22846499 PMCID: PMC3502264 DOI: 10.1186/1477-7819-10-155] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 06/08/2012] [Indexed: 01/20/2023] Open
Abstract
Background BRAF inhibitors such as vemurafenib are a new family of biological drugs, recently available to treat metastatic malignant melanoma. Methods We present the case of a 38-year-old man affected by metastatic melanoma who had been under treatment with vemurafenib for a few days. The patient suffered from sudden onset of abdominal pain due to intra-abdominal hemorrhage with profuse hemoperitoneum. An emergency abdominal sonography confirmed the clinical suspicion of a splenic rupture. Results The intraoperative finding was hemoperitoneum due to splenic two-step rupture and splenectomy was therefore performed. Histopathology confirmed splenic hematoma and capsule laceration, in the absence of metastasis. Conclusions This report describes the occurrence of a previously unreported adverse event in a patient with stage IV melanoma receiving vemurafenib.
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Affiliation(s)
- Elisa Castellani
- Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy
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Petrisli E, Potena L, Bianchi I, Chiereghin A, Masetti M, Prestinenzi P, Barberini F, Angeli F, Magnani G, Lazzarotto T, Grigioni F, Branzi A. 402 Reconstitution of CMV-Specific Immunity after Heart Transplantation Is Modulated by mTOR Inhibition, but Not by Antiviral Strategy. J Heart Lung Transplant 2012. [DOI: 10.1016/j.healun.2012.01.412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Cirocchi R, Farinella E, Trastulli S, Cavaliere D, Covarelli P, Listorti C, Desiderio J, Barberini F, Avenia N, Rulli A, Verdecchia GM, Noya G, Boselli C. Surgical treatment of primitive gastro-intestinal lymphomas: a systematic review. World J Surg Oncol 2011; 9:145. [PMID: 22059926 PMCID: PMC3229478 DOI: 10.1186/1477-7819-9-145] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 11/07/2011] [Indexed: 02/07/2023] Open
Abstract
Primitive Gastrointestinal Lymphomas (PGIL) are uncommon tumours, although time-trend analyses have demonstrated an increase. The role of surgery in the management of lymphoproliferative diseases has changed over the past 40 years. Nowadays their management is centred on systemic treatments as chemo-/radio- therapy. Surgery is restricted to very selected indications, always discussed in a multidisciplinary setting. The aim of this systematic review is to evaluate the actual role of surgery in the treatment of PGIL. A systematic review of literature was conducted according to the recommendations of The Cochrane Collaboration. Main outcomes analysed were overall survival (OS) and disease free survival (DFS). There are currently 1 RCT and 4 non-randomised prospective controlled studies comparing surgical versus medical treatment for PGIL. Seven hundred and one patients were analysed, divided into two groups: 318 who underwent to surgery alone or associated with chemotherapy and/or radiotherapy (surgical group) versus 383 who were treated with chemotherapy and/or radiotherapy (medical group). Despite the OS at 10 years between surgical and medical groups did not show relevant differences, the DFS was significantly better in the medical group (P = 0.00001). Accordingly a trend was noticed in the recurrence rate, which was lower in the medical group (6.06 vs. 8.57%); and an higher mortality was revealed in the surgical group (4.51% vs. 1.50%). The chemotherapy confirms its primary role in the management of PGIL as part of systemic treatment in the medical group. Surgery remains the treatment of choice in case of PGIL acutely complicated, although there is no evidence in literature regarding the utility of preventive surgery.
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Cirocchi R, Trastulli S, Sanguinetti A, Cattorini L, Covarelli P, Giannotti D, Di Rocco G, Rondelli F, Barberini F, Boselli C, Santoro A, Gullà N, Redler A, Avenia N. Recurrent differentiated thyroid cancer: to cut or burn. World J Surg Oncol 2011; 9:89. [PMID: 21838904 PMCID: PMC3169481 DOI: 10.1186/1477-7819-9-89] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Accepted: 08/12/2011] [Indexed: 11/22/2022] Open
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Scialpi M, Benagiano G, Frati S, Piscioli I, Barberini F, Lupattelli L. Magnetic resonance imaging features of myxoid leiomyoma of the vagina: A case report. Indian J Radiol Imaging 2011; 19:238-41. [PMID: 19881095 PMCID: PMC2766875 DOI: 10.4103/0971-3026.54880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We report a rare case of a voluminous vaginal myxoid leiomyoma in a 27-year-old nulliparous woman. Magnetic Resonance Imaging (MRI) revealed a mass arising from the vagina, with inhomogeneous signal intensity on spin-echo T1W and T2W images. MRI accurately defined the tissue planes between the lesion and the adjacent structures and suggested its benign nature. The mass was completely resected by means of transvaginal approach and the diagnosis of myxoid leiomyoma was confirmed histologically. To the best of our knowledge, this is the first report describing the MRI features of vaginal myxoid leiomyoma.
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Affiliation(s)
- Michele Scialpi
- Department of Surgical, Radiological and Odontostomatological Sciences, Section of Diagnostic and Interventional Radiology, University of Perugia, S. Maria della Misericordia Hospital, S. Andrea delle Fratte, 06134 Perugia, Italy
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Scialpi M, Cardone G, Barberini F, Piscioli I, Rotondo A. Renal oncocytoma: misleading diagnosis of benignancy by using angular interface sign at MR imaging. Radiology 2010; 257:587-8; author reply 588. [PMID: 20959552 DOI: 10.1148/radiol.101035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Rulli A, Barberini F, Scialpi M, Izzo L, D'Angeli I, Gori S, Sidoni A, Rondelli F, Noya G, Aristei C. Interstitial high-dose-rate brachytherapy after breast conserving surgery. Oncol Rep 2010; 24:417-22. [PMID: 20596628 DOI: 10.3892/or_00000874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We evaluated local recurrence, toxicity rate and cosmetic outcome in 72 patients treated with high-dose-rate (HDR) brachytherapy after breast conserving surgery. HDR brachytherapy was administered: i) as partial breast irradiation (PBI) in 64 patients with low-risk early stage breast cancer, enrolled in a phase II prospective study; ii) as PBI after a second conservative surgery as treatment of local relapse in 3 patients; iii) for delivering a boost after whole breast external beam radiotherapy in 5 patients. Implantation was done during surgery (breast conserving or re-excision to achieve adequate surgical margins), with the wound open, or postoperatively. The implant was well tolerated in all patients, so no premature catheter removal was required. At a median follow-up of 32 months (range 5-52) no local recurrence has been observed. Toxicity was very low. Cosmetic outcome was excellent/good in a high percentage of patients. Our results suggest that PBI administered with HDR brachytherapy is feasible in selected patients with low risk early stage breast carcinoma. PBI seems feasible to repeat radiotherapy after a salvage breast conserving surgery for local relapse in a second attempt to preserve the breast.
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Affiliation(s)
- Antonio Rulli
- Breast Unit, Perugia General Hospital, Perugia, Italy
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Avenia N, Sanguinetti A, Cirocchi R, Bistoni G, Trastulli S, D'Ajello F, Barberini F, Cavallaro G, Rulli A, Sidoni A, Noya G, De Toma G, Sciannameo F. Primary breast lymphomas: a multicentric experience. World J Surg Oncol 2010; 8:53. [PMID: 20584320 PMCID: PMC2903594 DOI: 10.1186/1477-7819-8-53] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Accepted: 06/28/2010] [Indexed: 11/23/2022] Open
Abstract
Background The Primary Breast Lymphomas (PBL) represent 0,38-0,70% of all non-Hodgkin lymphomas (NHL), 1,7-2,2% of all extranodal NHL and only 0,04-0,5% of all breast cancer. Most frequent PBLs are the diffuse large B cell lymphomas; in any case-reports MALT lymphomas lack or are a rare occurrence. Their incidence is growing. From 1880 (first breast resection for "lymphadenoid sarcoma" carried out by Gross) to the recent past the gold standard treatment for such diseases was surgery. At present such role has lost some of its importance, and it is matter of debate. Methods Twenty-three women affected by PBL underwent surgery. Average age was 63 years (range: 39-83). Seven suffered of hypothyroidism secondary to autoimmune thyroiditis. Fourteen patients underwent mastectomy, nine patients received quadrantectomy (average neoplasm diameter: 1,85 cm, range: 1,1-2,6 cm). In 10 cases axillary dissection was carried out. Pathologic examination revealed 16 diffuse large B cell lymphomas and 7 MALT lymphomas. Results Seven patients in the mastectomy group had a recurrence (50%), and all of them with diffuse large B cell lymphomas at stage II. Two of these had not received chemotherapy. No patient undergoing quadrantectomy had recurrence. In the mastectomy group disease free survival (DFS) at 5 and 10 years was 57 and 50%. Overall survival (OS) at 5 and 10 years was 71.4% and 57.1% respectively. All recurrences were systemic. DFS and OS at 5 and 10 years was 100% in the quadrantectomy group. In the patients with recurrence mortality was 85.7%. For stage IE DFS and OS at 5 and 10 years were 100%. For stage II DFS at 10 years was 62.5% and 56.2% respectively; OS at 5 and 10 years was 75% and 62.5% respectively. For MALT lymphomas DFS and OS at 5 and 10 years were 100%. For diffuse large B cell lymphomas DFS at 5 and 10 years was 62.5% and 56.2% respectively; OS at 5 and 10 years was 75% and 62,5% respectively. Conclusions The role of surgery in this disease should be limited to get a definitive diagnosis while for the staging and the treatment CT scan and chemio/radioterapy are repectively mandatory. MALT PBLs have a definitely better prognosis compared to large B cell lymphomas. The surgical treatment must always be oncologically radical (R0); mastectomy must not be carried out as a rule, but only when tissue sparing procedures are not feasible. Axillary dissection must always be performed for staging purposes, so avoiding the risk of under-staging II o IE, due to the possibility of clinically silent axillary node involvement.
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Affiliation(s)
- Nicola Avenia
- Department of General Surgery, University of Perugia, Perugia, Italy
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Scialpi M, Cappabianca S, Rotondo A, Scalera GB, Barberini F, Cagini L, Donato S, Brunese L, Piscioli I, Lupattelli L. Pulmonary congenital cystic disease in adults. Spiral computed tomography findings with pathologic correlation and management. Radiol Med 2010; 115:539-50. [PMID: 20058095 DOI: 10.1007/s11547-010-0467-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Accepted: 04/03/2009] [Indexed: 12/19/2022]
Abstract
PURPOSE The aim of this study was to assess the computed tomography (CT) features of intrapulmonary congenital cystic diseases in adults and to correlate the imaging features with the pathological findings, with emphasis on the oncogenic potential of the lesions. MATERIALS AND METHODS We retrospectively reviewed the CT scans in three institutions from August 1996 to December 2008, of nine patients (six men, three women; mean age 48.6 years; range 26-75 years) who had histological diagnosis of pulmonary cystic disease after surgery. Six patients had a diagnosis of intrapulmonary bronchogenic cyst (IBC), and three had a type-I cystic adenomatoid malformation (CAM). In one case, intralobar sequestration (ILS) was associated with type-I CAM. RESULTS Three patients were symptomatic and six were asymptomatic. On CT scans, IBCs showed homogeneous fluid attenuation (n=2), air-fluid level (n=2), air attenuation (n=1) or soft-tissue attenuation (n=1). The surrounding lung tissue showed areas of band-like linear attenuation in three IBCs, atelectasia in two and mucocele-like areas in one. On CT, type-I CAM appeared as a unilocular cystic lesion with air-fluid level (n=1) or air content (n=1). Both cases had thin walls surrounded by normal lung parenchyma. ILS appeared as a fluid-filled cyst with afferent and efferent vessels. Of the six IBCs, one occurred in the upper right lobe, two in the middle lobe and three in the lower right lobe. Of the three type-I CAMs, one was in the upper left lobe and one in the middle lobe. The type-I CAM associated with ILS was located in the left lower lobe. CONCLUSIONS The similar CT patterns preclude differentiation between IBC and type-I CAM. Surgical resection of all intrapulmonary cystic lesions detected in adults is mandatory because type-I CAM is a precursor of mucinous bronchioloalveolar carcinoma.
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Affiliation(s)
- M Scialpi
- Department of Surgical, Radiologic and Odontostomatologic Sciences, Section of Diagnostic and Interventional Radiology, University of Perugia, S. Maria della Misericordia Hospital, S. Andrea delle Fratte, 06156, Perugia, Italy.
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Avenia N, Sanguinetti A, Cirocchi R, Docimo G, Ragusa M, Ruggiero R, Procaccini E, Boselli C, D'Ajello F, Barberini F, Parmeggiani D, Rosato L, Sciannameo F, De Toma G, Noya G. Antibiotic prophylaxis in thyroid surgery: a preliminary multicentric Italian experience. Ann Surg Innov Res 2009; 3:10. [PMID: 19656389 PMCID: PMC2731779 DOI: 10.1186/1750-1164-3-10] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Accepted: 08/05/2009] [Indexed: 12/27/2022]
Abstract
Post-operatory wound infections are a very uncommon finding after thyroidectomy. For these reasons international guidelines do not routinely recommend systemic antibiotic prophylaxis. The benefits of this antibiotic prophylaxis is not supported by clinical evidence in the literature. We have conducted a multicentric randomized double-blind trial on 500 patients who had undergone thyroidectomy for goitre or thyroid carcinoma. The 500 patients enrolled in the study (mean age 47 years) were randomized in two subgroups of 250 patients. 250 patients were treated with standard antibiotic prophylaxis with sulbactam/ampicillin 1 fl (3 gr.) 30 min before surgery. No antibiotic prophylaxis was instituted in the remainder 250 patients. Our RCT showed that prophylactic antibiotic treatment is not beneficial in patients younger than eighty years old, with no concomitant metabolic, infective and hematologic disease, with no cardiac valvulopathies, not under steroidal or immunosuppressive treatment, and not severely obese. Our study should be regarded only as a preliminary RCT, and should be followed by a study in which a larger number of patients should be enrolled so that statistically significant data can be obtained.
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Affiliation(s)
- Nicola Avenia
- Endocrine Surgical Unit, University of Perugia, Italy
| | | | | | | | - Mark Ragusa
- Thoracic Surgical Unit, University of Perugia, Italy
| | | | | | | | | | | | | | | | | | - Giorgio De Toma
- Department of Surgery "P. Valdoni", University of Rome, Italy
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Scialpi M, Volterrani L, Mazzei M, Cappabianca S, Barberini F, Piscioli I, Brunese L, Lupattelli L. Small (≤2 cm) atypical hepatic haemangiomas in the non-cirrhotic patient: pattern-based classification scheme for enhancement at triple-phase helical CT. Radiol Med 2009; 114:935-47. [DOI: 10.1007/s11547-009-0427-1] [Citation(s) in RCA: 10] [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] [Received: 12/03/2007] [Accepted: 06/10/2008] [Indexed: 01/26/2023]
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Sanguinetti A, Rosato L, Cirocchi R, Barberini F, Pezzolla A, Cavallaro G, Parmeggiani D, Ruggiero R, Docimo G, Procaccini E, Santoriello A, Rulli A, Gubitosi A, Canonico S, Taffurelli M, Sciannameo F, Barbarisi A, Docimo L, Agresti M, De Toma G, Noya G, Parmeggiani U, Avenia N. [Antibiotic prophylaxis in breast surgery. Preliminary resuls of a multicenter randomized study on 1400 cases]. Ann Ital Chir 2009; 80:275-279. [PMID: 19967885] [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: 05/28/2023]
Abstract
UNLABELLED Breast surgery is classified among the procedures performed in clean surgery and is associated with a low incidence of wound infection (3-15%). The objective of this study was to evaluate the advantages antibiotic prophylaxis in patients undergoing breast surgery. A multicenter randomized controlled study was performed between January 2008 and November 2008. One thousand four hundred patients were enrolled in prospective randomized study; surgical wound infection was found in 41 patients (2.93%). In our RCT we have shown that in breast surgery antibiotic prophylaxis does not present significant advantages in patients with potential risk of infection (17 patients, 2.42%, subjected to antibiotic prophylaxis vs 24 patients, 3.43%, without antibiotic prophylaxis) (P = 0.27). In patients with drainage there is a significant minor incidence of wound infections in patients receiving antibiotic prophylaxis (5 patients, 0.92%, subjected to antibiotic prophylaxis vs 14 patients, 3.09%, without antibiotic prophylaxis) (P = 0.02). CONCLUSION This study is only a preliminary RCT to be followed by a study which should be enrolled more patients in order to get the results as statistically significant.
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Aristei C, Stracci F, Guerrieri P, Anselmo P, Armellini R, Rulli A, Barberini F, Latini P, Menghini AR. Frequency of sister chromatid exchanges and micronuclei monitored over time in patients with early-stage breast cancer: results of an observational study. ACTA ACUST UNITED AC 2009; 192:24-9. [PMID: 19480933 DOI: 10.1016/j.cancergencyto.2009.02.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Revised: 02/16/2009] [Accepted: 02/26/2009] [Indexed: 10/20/2022]
Abstract
Spontaneous chromosomal instability correlates with a high risk of cancer. The frequency of spontaneous sister chromatid exchanges (SCE) and micronuclei (MN) in peripheral blood lymphocytes was used for evaluation of spontaneous chromosomal instability in early-stage breast cancer patients to determine whether SCE and MN frequencies are biomarkers of damage from chemotherapy and radiotherapy. In 20 stage I-II breast cancer patients, SCE and MN were measured before surgery and at 4 weeks after. In patients who received adjuvant chemotherapy (CTx), they were also determined before starting radiotherapy (RTx). Other assessments were done 2, 6, and 12 months after RTx in almost all patients and at 18 months in 4 patients. Generalized estimating equations (GEE) were used to estimate population averaged effects at the different treatment and follow-up time points. Moreover, SCE and MN baseline values in patients were compared with those of a control group of 12 healthy women. A significant difference emerged between patients and healthy controls (P<0.0001 for SCE and P<0.0003 for MN; Mann-Whitney test); SCE increased significantly after CTx and MN increased significantly after RTx. In the GEE model, the smoking habit was associated with increased SCE in patients treated with CTx; age significantly affected MN frequencies. Both MN and SCE frequencies are increased in breast cancer patients and are indicators of CTx and RTx damage, respectively. The increased SCE levels in patients treated with CTx may be due to a synergic effect of smoking and chemotherapy.
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Affiliation(s)
- Cynthia Aristei
- Department of Radiation Oncology, University of Perugia, Policlinico Monteluce, Perugia, Italy.
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Rondelli F, Reboldi P, Rulli A, Barberini F, Guerrisi A, Izzo L, Bolognese A, Covarelli P, Boselli C, Becattini C, Noya G. Loop ileostomy versus loop colostomy for fecal diversion after colorectal or coloanal anastomosis: a meta-analysis. Int J Colorectal Dis 2009; 24:479-88. [PMID: 19219439 DOI: 10.1007/s00384-009-0662-x] [Citation(s) in RCA: 143] [Impact Index Per Article: 9.5] [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] [Accepted: 01/20/2009] [Indexed: 02/04/2023]
Abstract
BACKGROUND Sphincter-saving surgery for the treatment of middle and low rectal cancer has spread considerably when total mesorectal excision became standard treatment. In order to reduce leakage-related complications, surgeons often perform a derivative stoma, a loop ileostomy (LI), or a loop colostomy (LC), but to date, there is no evidence on which is the better technique to adopt. METHODS We performed a systematic review and meta-analysis of all randomized controlled trials until 2007 and observational studies comparing temporary LI and LC for temporary decompression of colorectal and/or coloanal anastomoses. Clinically relevant events were grouped into four study outcomes: general outcome measures: dehydratation and wound infection GOM construction of the stoma outcome measures: parastomal hernia, stenosis, sepsis, prolapse, retraction, necrosis, and hemorrhage closure of the stoma outcome measures: anastomotic leak or fistula, wound infection COM, occlusion and hernia functioning of the stoma outcome measures: occlusion and skin irritation. RESULTS Twelve comparative studies were included in this analysis, five randomized controlled trials and seven observational studies. Overall, the included studies reported on 1,529 patients, 894 (58.5%) undergoing defunctioning LI. LI reduced the risk of construction of the stoma outcome measure (odds ratio, OR = 0.47). Specifically, patients undergoing LI had a lower risk of prolapse (OR = 0.21) and sepsis (OR = 0.54). LI was associated with an excess risk of occlusion after stoma closure (OR = 2.13) and dehydratation (OR = 4.61). No other significant difference was found for outcomes. CONCLUSION Our overview shows that LI is associated with a lower risk of construction of the stoma outcome measures.
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Affiliation(s)
- F Rondelli
- Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy
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Antognelli C, Del Buono C, Ludovini V, Gori S, Talesa VN, Crinò L, Barberini F, Rulli A. CYP17, GSTP1, PON1 and GLO1 gene polymorphisms as risk factors for breast cancer: an Italian case-control study. BMC Cancer 2009; 9:115. [PMID: 19379515 PMCID: PMC2680904 DOI: 10.1186/1471-2407-9-115] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2008] [Accepted: 04/20/2009] [Indexed: 12/13/2022] Open
Abstract
Background Estrogens, environmental chemicals with carcinogenic potential, as well as oxidative and carbonyl stresses play a very important role in breast cancer (BC) genesis and progression. Therefore, polymorphisms of genes encoding enzymes involved in estrogen biosynthesis pathway and in the metabolic activation of pro-carcinogens to genotoxic intermediates, such as cytochrome P450C17α (CYP17), endogenous free-radical scavenging systems, such as glutathione S-transferase (GSTP1) and paraoxonase 1 (PON1), and anti-glycation defenses, such as glyoxalase I (GLO1), could influence individual susceptibility to BC. In the present case-control study, we investigated the possible association of CYP17 A1A2, GSTP1 ILE105VAL, PON1 Q192R or L55M, and GLO1 A111E polymorphisms with the risk of BC. Methods The above-said five polymorphisms were characterized in 547 patients with BC and in 544 healthy controls by PCR/RFLP methods, using DNA from whole blood. To estimate the relative risks, Odds ratios and 95% confidence intervals were calculated using unconditional logistic regression after adjusting for the known risk factors for BC. Results CYP17 polymorphism had no major effect in BC proneness in the overall population. However, it modified the risk of BC for certain subgroups of patients. In particular, among premenopausal women with the A1A1 genotype, a protective effect of later age at menarche and parity was observed. As to GSTP1 and PON1 192 polymorphisms, the mutant Val and R alleles, respectively, were associated with a decreased risk of developing BC, while polymorphisms in PON1 55 and GLO1 were associated with an increased risk of this neoplasia. However, these findings, while nominally significant, did not withstand correction for multiple testing. Conclusion Genetic polymorphisms in biotransformation enzymes CYP17, GSTP1, PON1 and GLO1 could be associated with the risk for BC. Although significances did not withstand correction for multiple testing, the results of our exploratory analysis warrant further studies on the above mentioned genes and BC.
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Affiliation(s)
- Cinzia Antognelli
- Department of Experimental Medicine, University of Perugia, Perugia, Italy.
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Palumbo I, Farneti A, Perrucci E, Barberini F, Rulli A, Aristei C. Partial breast irradiation with interstitial high dose-rate brachytherapy in elderly patients: results of a phase II prospective study. BMC Geriatr 2009. [PMCID: PMC4290975 DOI: 10.1186/1471-2318-9-s1-a6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Barberini F, Rulli A, Covarelli P, Badolato M, Gentile D, Boselli C, Rondelli F, Servoli A, Noya G. Breast cancer in older woman: can axillary dissection be omitted? BMC Geriatr 2009. [PMCID: PMC4290827 DOI: 10.1186/1471-2318-9-s1-a17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Scialpi M, Franzini C, Cavaliere A, Barberini F, Piscioli I, Franceschetti I, Lupattelli L. Clinical Outcome of High Risk Gastrointestinal Stromal Tumor in a Meckel's Diverticulum. Int J Biomed Sci 2009; 5:74-8. [PMID: 23675119 PMCID: PMC3614757] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2008] [Accepted: 12/01/2008] [Indexed: 11/22/2022]
Abstract
We describe a seven years follow-up of a high risk gastrointestinal stromal tumor in a Meckel's diverticulum in a 68-year-old man with abdominal pain and vomiting. The patient was operated in emergency for peritonitis due to perforation of small intestine and treated with imatinib mesylate. The metastatic progression of the disease demonstrated the value of prognostic indicators (mitotic rate >10/50 high power field, necrosis and 8 cm in maximum diameter) for assessing risk of aggressive behaviour. Computed tomography was a valuable procedure for detection of local recurrence, the distant metastases and for surveillance after surgery in the follow-up. The review of the literature shows that this case has the longest follow up and consents the comparisons of the same neoplasm in other sites most frequent and better described than Meckel's diverticulum.
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Affiliation(s)
- Michele Scialpi
- Department of Surgery Radiology, Odontostomatology Science, Section of Diagnostic and Interventional Radiology, University of Perugia, S. Maria della Misericordia Hospital, S. Andrea delle Fratte, 06156 Perugia, Italy;
| | - Christian Franzini
- Division of Surgery, Guastalla Hospital, Via Donatori di Sangue 1, 40016 Guastalla (RE), Italy;
| | - Antonio Cavaliere
- Department of Anatomic Pathology, University of Perugia, Via Brunamonti 51, 06100 Perugia, Italy;
| | - Francesco Barberini
- Oncological Surgical Unit, University of Perugia, Via Brunamonti 51, 06100 Perugia, Italy;
| | - Irene Piscioli
- Department of Radiology, Budrio Hospital, Via Benni 44, 44054 Budrio (BO), Italy;
| | - Ilaria Franceschetti
- Institute of Anatomic Pathology, S. Maria del Carmine Hospital, Piazzale S.Maria 6, 38068 Rovereto (TN), Italy
| | - Luciano Lupattelli
- Department of Surgery Radiology, Odontostomatology Science, Section of Diagnostic and Interventional Radiology, University of Perugia, S. Maria della Misericordia Hospital, S. Andrea delle Fratte, 06156 Perugia, Italy;
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Nigro M, Piscioli I, Franceschetti I, Barberini F, Lupattelli L, Scialpi M. Simultaneous Occurrence of Renal Oncocytoma and B Small Cell Lymphoma in the Same Kidney: Report of Two Cases. Urol Int 2009; 83:242-5. [DOI: 10.1159/000230033] [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] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Accepted: 02/20/2009] [Indexed: 11/19/2022]
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