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Viganò L, Cimino M, Aldrighetti L, Ferrero A, Cillo U, Guglielmi A, Ettorre GM, Giuliante F, Dalla Valle R, Mazzaferro V, Jovine E, De Carlis L, Calise F, Torzilli G, Ratti F, Gringeri E, Russolillo N, Levi Sandri GB, Ardito F, Boggi U, Gruttadauria S, Di Benedetto F, Rossi GE, Berti S, Ceccarelli G, Vincenti L, Belli G, Zamboni F, Coratti A, Mezzatesta P, Santambrogio R, Navarra G, Giuliani A, Pinna AD, Parisi A, Colledan M, Slim A, Antonucci A, Grazi GL, Frena A, Sgroi G, Brolese A, Morelli L, Floridi A, Patriti A, Veneroni L, Boni L, Maida P, Griseri G, Filauro M, Guerriero S, Tisone G, Romito R, Tedeschi U, Zimmitti G. Multicentre evaluation of case volume in minimally invasive hepatectomy. Br J Surg 2019; 107:443-451. [PMID: 32167174 DOI: 10.1002/bjs.11369] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 06/11/2019] [Accepted: 08/23/2019] [Indexed: 02/05/2023]
Abstract
Abstract
Background
Surgical outcomes may be associated with hospital volume and the influence of volume on minimally invasive liver surgery (MILS) is not known.
Methods
Patients entered into the prospective registry of the Italian Group of MILS from 2014 to 2018 were considered. Only centres with an accrual period of at least 12 months and stable MILS activity during the enrolment period were included. Case volume was defined by the mean number of minimally invasive liver resections performed per month (MILS/month).
Results
A total of 2225 MILS operations were undertaken by 46 centres; nine centres performed more than two MILS/month (1376 patients) and 37 centres carried out two or fewer MILS/month (849 patients). The proportion of resections of anterolateral segments decreased with case volume, whereas that of major hepatectomies increased. Left lateral sectionectomies and resections of anterolateral segments had similar outcome in the two groups. Resections of posterosuperior segments and major hepatectomies had higher overall and severe morbidity rates in centres performing two or fewer MILS/month than in those undertaking a larger number (posterosuperior segments resections: overall morbidity 30·4 versus 18·7 per cent respectively, and severe morbidity 9·9 versus 4·0 per cent; left hepatectomy: 46 versus 22 per cent, and 19 versus 5 per cent; right hepatectomy: 42 versus 34 per cent, and 25 versus 15 per cent).
Conclusion
A volume–outcome association existed for minimally invasive hepatectomy. Complex and major resections may be best managed in high-volume centres.
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Affiliation(s)
- L Viganò
- Department of Hepatobiliary and General Surgery, Humanitas Clinical and Research Centre, Humanitas University, Rozzano, Italy
| | - M Cimino
- Department of Hepatobiliary and General Surgery, Humanitas Clinical and Research Centre, Humanitas University, Rozzano, Italy
| | - L Aldrighetti
- Department of Surgery, Ospedale San Raffaele, Milan, Italy
| | - A Ferrero
- Department of Digestive and Hepatobiliary Surgery, Mauriziano Umberto I Hospital, Turin, Italy
| | - U Cillo
- Hepato-Biliary and Liver Transplantation Unit, University of Padua, Padua, Italy
| | - A Guglielmi
- Department of Surgery, Division of General and Hepatobiliary Surgery, G.B. Rossi University Hospital, University of Verona, Verona, Italy
| | - G M Ettorre
- Division of General Surgery and Liver Transplantation, San Camillo Hospital, Rome, Italy
| | - F Giuliante
- Hepatobiliary Surgery Unit, A. Gemelli Hospital, Università Cattolica del Sacro Cuore, Rome, Italy
| | - R Dalla Valle
- Department of Surgery, University Hospital of Parma, Parma, Italy
| | - V Mazzaferro
- Department of Gastrointestinal Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori, University of Milan, Milan, Italy
| | - E Jovine
- Department of Surgery, Maggiore Hospital, Bologna, Italy
| | - L De Carlis
- Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - F Calise
- Department of Hepatopancreatobiliary Surgery, Pinetagrande Hospital, Castelvolturno, Italy
| | - G Torzilli
- Department of Hepatobiliary and General Surgery, Humanitas Clinical and Research Centre, Humanitas University, Rozzano, Italy
| | - F Ratti
- Ospedale San Raffaele, Milan
| | | | | | | | | | - U Boggi
- Azienda Ospedaliero Universitaria (AOU) Pisana, Pisa
| | - S Gruttadauria
- Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo
| | | | - G E Rossi
- Ospedale Maggiore Policlinico, Milan
| | - S Berti
- Ospedale Civile S. Andrea, La Spezia
| | | | | | - G Belli
- Ospedale Santa Maria di Loreto Nuovo, Naples
| | | | | | | | | | | | | | - A D Pinna
- Policlinico Sant'Orsola Malpighi, Bologne
| | | | | | - A Slim
- AO Desio e Vimercate, Vimercate
| | | | - G L Grazi
- Istituto Nazionale Tumori Regina Elena, Rome
| | | | - G Sgroi
- AO Treviglio-Caravaggio, Treviglio
| | | | | | | | - A Patriti
- Ospedale San Matteo degli Infermi, Spoleto
| | | | - L Boni
- AOU Fondazione Macchi, Varese
| | - P Maida
- Ospedale Villa Betania, Naples
| | | | | | | | | | - R Romito
- AOU Maggiore della Carità, Novara
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Clerici CA, Giacon B, Veneroni L, Ferrari A, Luksch R, Meazza C, Polastri D, Simonetti F, Massimino M. [Psycho-organic diseases in children and adolescents affected by pediatric neoplasms]. Minerva Pediatr 2013; 65:651-667. [PMID: 24217634] [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
At Pediatric Oncology Centers, psychological intervention and psychotherapy are generally offered to children and adolescents for supporting their adjustment to disease and treatment. The clinical practice, however, point out that cognitive and emotional symptoms, such as psychic distortions, fatigue, anxiety, irritability and depression, are sustained by biological mechanisms connected with disease and treatment and not respondent to psychological consultation and to other psychosocial resources. These manifestations could interfere with treatment or with the long-term adjustment and call for psychopharmacological treatments. Biological factors able to cause these alterations are not yet studied in depth in clinical tradition and scientific literature on the integration of psychological and psychopharmacological intervention in pediatric oncology is still poor. In this paper organic components of psychic and behavioral alterations in the course of disease are illustrated, considering the symptoms, causes and possible remedies in the light of the most recent interdisciplinary views. The main mechanism connected with oncologic treatments - chemotherapy, surgery, radiotherapy - and responsible for psycho-organic alterations in children and adolescent with cancer are also described.
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Affiliation(s)
- C A Clerici
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti Università degli Studi di Milano, Milano, Italia2 SSD Psicologia Clinica, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milano, Italia -
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3
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Imola M, Mianulli AM, Pasini G, Santelmo C, Drudi F, Fantini M, Corso V, Veneroni L, Ravaioli A. Emergency hemicolectomy for intestinal primary aspergillosis in acute myeloid leukemia. G Chir 2012; 33:74-76. [PMID: 22525550] [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: 05/31/2023]
Abstract
Intestinal aspergillosis is an infection with a very high death rate especially in leukemic patients. Here we describe a case of a 46 years old woman with acute myeloid leukemia (LAM M5) who developed intestinal primary aspergillosis. This patient was diagnosed with LAM M5 through bone marrow aspiration and bone biopsy in March 2004. Symptoms of the disease were slight persistent fever, weight loss, asthenia, anemia, thrombocytopenia,and leukocytosis with high number of blasts in peripheral blood. After induction chemotherapy with ICE (Ifosfamide, Carboplatin, Etoposide), she developed neutropenia and high fever without apparent infective foci. She was treated with empiric antibiotic therapy, nevertheless she developed an intense diarrhea and ileo-cecal distention. Diagnostic exams didn't show signs of a focal lesion. Despite the change in antibiotic treatment and the transfusions of granulocytes and blood cells, the patient developed extremely critical conditions with persistence of neutropenia and abdominal distention. A surgical treatment was decided at the time. We treated the patient with a two steps surgical procedure. The first step was a right abdominal ileostomy followed by improvement of general conditions and then the second step a right colectomy. The histological morphology confirmed necrotizing colitis with Aspergillus ife. At that time , treatment with voriconazole was started. The general conditions of the patient improved rapidly and we were able to treat the patient with other medical anti-leukemic therapies. The patient is now cured and in healthy state. We obtained a good clinical result as only in other few cases described in literature.
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Affiliation(s)
- M Imola
- Department of Oncology (Instituto Ondologico Romagnolo), General Surgery, Infermi Hospital, Rimini, Italy
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Clerici CA, Invernizzi R, Veneroni L, de'Micheli A. [Firearms related suicide/homicide rate among the security guards population in Italy]. G Ital Med Lav Ergon 2009; 31:A10-A15. [PMID: 19621533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The main aim of this study is evaluating the suicide/homicide rate of the Italian security guards population compared to other armed and general populations during a recent period. METHODS The authors reviewed the incidence of suicides and homicides among security guards from 1996 to 2006 and, where information was available, a comparison was made with Italian population adapted by age. Comparisons with the general population were also made. RESULTS The average rate of firearms related suicide among the security guards population during the established period was 11.7 per 100,000 persons-years (95% CI = 6.6-16.7) compared to a guns-related suicide rate of 0.7 per 100,000 person-years, (95% CI = 0.6-0.7) and a non-guns related rate of 5.5 per 100,000 persons-years, (95% CI = 5.2-5.9) for the general population adjusted for age. The overall homicide rate among security guards during the period was 11.4 per 100,000 person-years (95% CI = 6.2-15.4) compared with the homicide rate for the Italian population of 5.4 per 100,000 persons-years, (95% CI = 7.3-15.4). CONCLUSION The rate of suicide and homicide among the Italian security guards population was higher than the suicide/homicide rate in the general population. These results show that the phenomenon we have described needs attention and specific prevention activities.
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Affiliation(s)
- C A Clerici
- Dipartimento di Scienze e Tecnologie Biomediche, Sezione di Psicologia, Facoltà di Medicina, Università degli Studi di Milano, Italy.
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Raimoldi A, Berti GL, Canclini L, Giola V, Leidi GL, Maccaroni A, Sironi M, Veneroni L, Bacchioni AM, Assi A. [Papillary cystadenoma of the epididymis. 2 case reports]. Arch Ital Urol Androl 1997; 69:309-11. [PMID: 9477616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Tumors of the epididymis are very rare. They are benign tumors in 75 per cent of the cases. Papillary cystadenoma represents 4-9 per cent of epididymal benign tumors. Often associated with the syndrome of von Hippel Lindau and infertility, histologically it can be confused with metastatic renal cell carcinoma. We report two cases of papillary cystadenoma located in the head of the right epididymis, with no concomitance with the syndrome of von Hippel Lindau, cured by the removal of the neoplastic nodule. There was no recidivation, in confirmation of the neoplastic benignity.
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Affiliation(s)
- A Raimoldi
- Divisione di Urologia, Ospedale Civile di Legnano, Milano
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6
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Veneroni L, Canclini L, Berti GL, Giola V, Leidi GL, Maccaroni A, Raimoldi A, Sironi M, Assi A, Bacchioni AM. [Renal oncocytoma in the single kidney after previous surgery of renal carcinoma. Apropos of 2 cases]. Arch Ital Urol Androl 1997; 69:303-7. [PMID: 9477615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Renal oncocytoma is a neoplasm which rarely occurs in patients with solitary kidney, the other being absent because of a previous nephrectomy performed for renal cancer. We present two case reports and a literature review. We have studied some important problems such as the histogenesis, the potential for malignancy, the diagnosis, the treatment and the follow up. The high incidence of coexistence of renal oncocytoma and renal cell carcinoma has important clinical implications. We would like to emphasize the importance of preoperatory FNAB, nephron sparing surgery and very careful follow up.
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MESH Headings
- Adenocarcinoma, Clear Cell/diagnosis
- Adenocarcinoma, Clear Cell/pathology
- Adenocarcinoma, Clear Cell/surgery
- Adenoma, Oxyphilic/diagnosis
- Adenoma, Oxyphilic/pathology
- Adenoma, Oxyphilic/surgery
- Aged
- Biopsy, Needle
- Humans
- Kidney/pathology
- Kidney Neoplasms/diagnosis
- Kidney Neoplasms/pathology
- Kidney Neoplasms/surgery
- Male
- Middle Aged
- Neoplasms, Second Primary/diagnosis
- Neoplasms, Second Primary/pathology
- Nephrectomy
- Time Factors
- Tomography, X-Ray Computed
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Affiliation(s)
- L Veneroni
- U.O. Urologia, Ospedale Civile di Legnano
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7
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Leidi GL, Berti GL, Canclini L, Giola V, Maccaroni A, Raimoldi A, Veneroni L, Bacchioni AM. Ureteroscopy and stone lithotripsy with lithoclast: personal experience. Arch Ital Urol Androl 1997; 69:181-3. [PMID: 9234563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Ureteroscopy has become a common technique in the diagnosis and treatment of ureteral pathologies, but this procedure is quite invasive and some complications have been reported in literature. In our Institute 49 patients underwent ureteroscopy and ballistic lithotripsy with lithoclast for ureteral stones. The stones were localized both in the middle and distal part of the ureter. We used a small caliber 7-8.5 Wolf ureteroscope. The treatments were performed under antibiotic prophylaxis. Direct access to the ureter without dilation of the meatus was obtained in 97.96% of patients. The stones were easily reached in 93.88% of the cases and satisfactory fragmentation was obtained in 90.7%. In 4 patients (9.3%) one or more large stone fragments escaped into the kidney, requiring the patients to be treated with ESWL. No major complications occurred: no ureteral perforations, no important bleeding and no severe or persistent infections. All patients were discharged in one to four days postoperatively. The authors conclude that ureteroscopy using small caliber instruments with Lithoclast is a safe and satisfactory alternative to ESWL in the treatment of ureteral stones.
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Affiliation(s)
- G L Leidi
- Department of Urology, Legnano Hospital
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8
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Berti G, Leidi G, Raimoldi A, Veneroni L, Giola V, Longoni E, Bacchioni A. Elettrovaporizzazione endoscopica della prostata (TVP): Esperienza su 112 casi. Urologia 1997. [DOI: 10.1177/039156039706401s22] [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: 11/16/2022]
Abstract
Transurethral electrovaporisation of the prostate (TVP) is one of the most recent techniques utilised as an alternative to TURP for the treatment of benign prostatic hyperplasia (BPH). This study reports our experience with TVP on 112 patients affected by BPH. All the patients had an adenoma equal or less than 40 grams in weight, maximum flow rate less than 10 ml per second or urine retention and PSA less than 4 mcg per litre. In all cases TVP was carried out without any complications during the operation (mean time 32 minutes) with no bleeding. 102 patients had the catheter removed after two days and 10 after 4 days. The maximum flow rate increased from 6.7 ml per second before the operation to 25.1 ml per second post operation. In 7 patients (6.2%) with unsatisfactory flow and/or with adenoma residue, it was necessary to perform a second TVP. 8 patients had temporary stress incontinence for 3 months after the operation, while one patient had permanent orthostatic incontinence. We can conclude that TVP is an easy technique to learn and has given the same clinical and urodynamic results as TURP, with negligible bleeding. The complication of temporary post operative incontinence in 7 patients and permanent incontinence in one patient, requires further studies to understand whether this is due to the surgical technique or to the actual method.
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Affiliation(s)
- G.L. Berti
- U.O. di Urologia - Ospedale di Legnano (Milano)
| | - G.L Leidi
- U.O. di Urologia - Ospedale di Legnano (Milano)
| | - A. Raimoldi
- U.O. di Urologia - Ospedale di Legnano (Milano)
| | - L. Veneroni
- U.O. di Urologia - Ospedale di Legnano (Milano)
| | - V. Giola
- U.O. di Urologia - Ospedale di Legnano (Milano)
| | - E. Longoni
- U.O. di Urologia - Ospedale di Legnano (Milano)
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