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Campanile A, Prota C, Tedeschi M, Giano A, Pianese B, Cristiano M, Pompa A, Sorrentino R, Vigorito F, Ravera A. Adding the value of the Charlson Comorbidity Index to the GRACE score for mortality prediction in acute coronary syndromes. J Cardiovasc Med (Hagerstown) 2024; 25:114-122. [PMID: 38051655 DOI: 10.2459/jcm.0000000000001579] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
BACKGROUND Scarce and conflicting data still exist about the role of the Charlson Comorbidity Index (CCI) when added to the traditional Global Registry of Acute Coronary Events (GRACE) risk score for outcome prediction in patients with acute coronary syndrome (ACS). METHODS All consecutive admissions due to ACS, from 1 January 2018 to 31 December 2020 were retrospectively reviewed from an internal database of a tertiary cardiac center in Salerno (Italy). Logistic and Cox proportional regression analyses were performed in order to assess the contribution of the CCI on 30-day and long-term mortality. The CCI adding value to the GRACE score was analyzed with several measures of improvement in discrimination: increase in the area under the receiver-operating characteristic curve (AUC), the integrated discrimination improvement (IDI), and the categorical and continuous net reclassification improvement (cNRI) more than 0. Robustness of the results was assessed through an internal validation procedure with bootstrapping. RESULTS One thousand three hundred and ten patients were identified. The median age was 68 (58-78) years. One hundred and twenty (9.2%) and 113 (9.5%) deaths occurred, respectively, during the first 30 days from admission and during long-term follow-up (median follow-up time: 13 months; interquartile range: 9-24). After multivariate regression analysis, the CCI was not associated with short-term mortality, while it was significantly and independently associated with long-term mortality along with the GRACE score (hazard ratio: 1.34, 95% confidence interval: 1.22-1.47; P < 0.001). An additive effect of CCI with the GRACE risk score was observed in predicting long-term mortality: AUC from 0.768 to 0.819 ( P = 0.003), category-based NRI: 0.215, cNRI>0: 0.669 ( P < 0.001), IDI: 0.066 ( P < 0.001). CONCLUSION The CCI is a predictor of long-term mortality and improves risk stratification of patients with ACS over the GRACE risk score.
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Affiliation(s)
- Alfonso Campanile
- Department of Cardiology, Intensive Cardiac Care Unit, Ruggi D' Aragona Hospital
| | - Costantina Prota
- Department of Cardiology, Intensive Cardiac Care Unit, Ruggi D' Aragona Hospital
| | - Michele Tedeschi
- Department of Medicine and Surgery, School of Cardiology, University of Salerno
| | - Angelo Giano
- Department of Medicine and Surgery, School of Cardiology, University of Salerno
| | | | - Mario Cristiano
- Department of Medicine and Surgery, School of Cardiology, University of Salerno
| | - Antonella Pompa
- Department of Medicine and Surgery, School of Cardiology, University of Salerno
| | - Rosanna Sorrentino
- Department of Cardiology, Intensive Cardiac Care Unit, Ruggi D' Aragona Hospital
| | | | - Amelia Ravera
- Department of Cardiology, Intensive Cardiac Care Unit, Ruggi D' Aragona Hospital
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Delvecchio A, Pavone G, Conticchio M, Piacente C, Varvara M, Ferraro V, Stasi M, Casella A, Filippo R, Tedeschi M, Pullano C, Inchingolo R, Delmonte V, Memeo R. Awake robotic liver surgery: A case report. World J Gastrointest Surg 2023; 15:2954-2961. [PMID: 38222022 PMCID: PMC10784833 DOI: 10.4240/wjgs.v15.i12.2954] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/30/2023] [Accepted: 12/06/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND In recent years, minimally invasive liver resection has become a standard of care for liver tumors. Considering the need to treat increasingly fragile patients, general anesthesia is sometimes avoided due to respiratory complications. Therefore, surgical treatment with curative intent is abandoned in favor of a less invasive and less radical approach. Epidural anesthesia has been shown to reduce respiratory complications, especially in elderly patients with pre-existing lung disease. CASE SUMMARY A 77-year-old man with hepatitis-C-virus-related chronic liver disease underwent robotic liver resection for hepatocellular carcinoma. The patient was suffering from hypertension, diabetes and chronic obstructive pulmonary disease. The National Surgical Quality Improvement Program score for developing pneumonia was 9.2%. We planned a combined spinal-epidural anesthesia with conscious sedation to avoid general anesthesia. No modification of the standard surgical technique was necessary. Hemodynamics were stable and bleeding was minimal. The postoperative course was uneventful. CONCLUSION Robotic surgery in locoregional anesthesia with conscious sedation could be considered a safe and suitable approach in specialized centers and in selected patients.
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Affiliation(s)
- Antonella Delvecchio
- Unit of Hepato-Pancreatic-Biliary Surgery, “F. Miulli” Regional General Hospital, Bari 70021, Italy
| | - Gaetano Pavone
- Unit of Anesthesia and Perioperative Medicine, “F. Miulli” Regional General Hospital, Bari 70021, Italy
| | - Maria Conticchio
- Unit of Hepato-Pancreatic-Biliary Surgery, “F. Miulli” Regional General Hospital, Bari 70021, Italy
| | - Claudia Piacente
- Unit of Anesthesia and Perioperative Medicine, “F. Miulli” Regional General Hospital, Bari 70021, Italy
| | - Miriam Varvara
- Unit of Anesthesia and Perioperative Medicine, “F. Miulli” Regional General Hospital, Bari 70021, Italy
| | - Valentina Ferraro
- Unit of Hepato-Pancreatic-Biliary Surgery, “F. Miulli” Regional General Hospital, Bari 70021, Italy
| | - Matteo Stasi
- Unit of Hepato-Pancreatic-Biliary Surgery, “F. Miulli” Regional General Hospital, Bari 70021, Italy
| | - Annachiara Casella
- Unit of Hepato-Pancreatic-Biliary Surgery, “F. Miulli” Regional General Hospital, Bari 70021, Italy
| | - Rosalinda Filippo
- Unit of Hepato-Pancreatic-Biliary Surgery, “F. Miulli” Regional General Hospital, Bari 70021, Italy
| | - Michele Tedeschi
- Unit of Hepato-Pancreatic-Biliary Surgery, “F. Miulli” Regional General Hospital, Bari 70021, Italy
| | | | - Riccardo Inchingolo
- Unit of Interventional Radiology, “F. Miulli” Regional General Hospital, Bari 70021, Italy
| | - Vito Delmonte
- Unit of Anesthesia and Perioperative Medicine, “F. Miulli” Regional General Hospital, Bari 70021, Italy
| | - Riccardo Memeo
- Unit of Hepato-Pancreatic-Biliary Surgery, “F. Miulli” Regional General Hospital, Bari 70021, Italy
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Bertaina M, Morici N, Frea S, Garatti L, Briani M, Sorini C, Villanova L, Corrada E, Sacco A, Moltrasio M, Ravera A, Tedeschi M, Bertoldi L, Lettino M, Saia F, Corsini A, Camporotondo R, Colombo CNJ, Bertolin S, Rota M, Oliva F, Iannaccone M, Valente S, Pagnesi M, Metra M, Sionis A, Marini M, De Ferrari GM, Kapur NK, Pappalardo F, Tavazzi G. Differences between cardiogenic shock related to acute decompensated heart failure and acute myocardial infarction. ESC Heart Fail 2023; 10:3472-3482. [PMID: 37723131 PMCID: PMC10682868 DOI: 10.1002/ehf2.14510] [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] [Received: 09/01/2022] [Revised: 04/13/2023] [Accepted: 08/08/2023] [Indexed: 09/20/2023] Open
Abstract
AIMS The present analysis from the multicentre prospective Altshock-2 registry aims to better define clinical features, in-hospital course, and management of cardiogenic shock complicating acutely decompensated heart failure (ADHF-CS) as compared with that complicating acute myocardial infarction (AMI-CS). METHODS AND RESULTS All patients with AMI-CS or ADHF-CS enrolled in the Altshock-2 registry between March 2020 and February 2022 were selected. The primary objective was the characterization of ADHF-CS patients as compared with AMI-CS. In-hospital length of stay and mortality were secondary endpoints. One-hundred-ninety of the 238 CS patients enrolled in the aforementioned period were considered for the present analysis: 101 AMI-CS (80% ST-elevated myocardial infarction and 20% non-ST-elevated myocardial infarction) and 89 ADHF-CS. As compared with AMI-CS, ADHF-CS patients were younger [63 (IQR 59-76) vs. 67 (IQR 54-73) years, P = 0.01], but presented with higher creatinine [1.6 (IQR 1.0-2.6) vs. 1.2 (IQR 1.0-1.4) mg/dL, P < 0.001], bilirubin [1.3 (IQR 0.9-2.3) vs. 0.6 (IQR 0.4-1.1) mg/dL, P = 0.01], and central venous pressure values [14 mmHg (IQR 8-12) vs. 10 mmHg (IQR 7-14),P = 0.01]. Norepinephrine was the most common catecholamine used in AMI-CS (79.3%), whereas epinephrine was used more commonly in ADHF-CS (65.5%); 75.8% vs. 46.6% received a temporary mechanical support in AMI-CS and ADHF-CS, respectively (P < 0.001). Length of hospital stay was longer in the latter [28 (IQR 13-48) vs. 17 (IQR 9-29) days, P = 0.001]. Heart replacement therapies were more frequently used in the ADHF-CS group (heart transplantation 13.5% vs. 0% and left ventricular assist device 11% vs. 2%, P < 0.01 and 0.01, respectively). In-hospital mortality was 41.1% (38.6% AMI-CS vs. 43.8% ADHF-CS, P = 0.5). CONCLUSIONS ADHF-CS is characterized by a higher prevalence of end-organ and biventricular dysfunction at presentation, a longer hospital length of stay, and higher need of heart replacement therapies when compared with AMI-CS. In-hospital mortality was similar between the two aetiologies. Our data warrant development of new management protocols focused on CS aetiology.
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Affiliation(s)
- Maurizio Bertaina
- Division of CardiologySan Giovanni Bosco Hospital, ASL Città di TorinoTurinItaly
| | - Nuccia Morici
- IRCCS S. Maria Nascente—Fondazione Don Carlo Gnocchi ONLUSMilanItaly
| | - Simone Frea
- Intensive Cardiac Care UnitCittà della Salute e della Scienza di TorinoTurinItaly
| | - Laura Garatti
- Cardiology Department and De Gasperis Cardio CenterASST Grande Ospedale Metropolitano NiguardaMilanItaly
| | | | - Carlotta Sorini
- Division of Cardiology, Department of Medical BiotechnologiesUniversity of SienaSienaItaly
| | - Luca Villanova
- Cardiology Department and De Gasperis Cardio CenterASST Grande Ospedale Metropolitano NiguardaMilanItaly
| | - Elena Corrada
- Humanitas Research Hospital, IRCCS RozzanoMilanItaly
| | - Alice Sacco
- Cardiology Department and De Gasperis Cardio CenterASST Grande Ospedale Metropolitano NiguardaMilanItaly
| | | | - Amelia Ravera
- Cardiology Department, Intensive Care UnitS. Giovanni Di Dio e Ruggi D'Aragona HospitalSalernoItaly
| | - Michele Tedeschi
- Cardiology Department, Intensive Care UnitS. Giovanni Di Dio e Ruggi D'Aragona HospitalSalernoItaly
| | | | | | - Francesco Saia
- Cardiology UnitIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
| | - Anna Corsini
- Cardiology UnitIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
| | - Rita Camporotondo
- Intensive Cardiac Care UnitFondazione Policlinico San Matteo Hospital IRCCSPaviaItaly
| | | | - Stephanie Bertolin
- Cardiothoracic and Vascular Anesthesia and Intensive CareAO SS. Antonio e Biagio e Cesare ArrigoAlessandriaItaly
| | - Matteo Rota
- Units of Biostatistics and Biomathematics and Bioinformatics, Department of Molecular and Translational MedicineUniversity of BresciaBresciaItaly
| | - Fabrizio Oliva
- Cardiology Department and De Gasperis Cardio CenterASST Grande Ospedale Metropolitano NiguardaMilanItaly
| | - Mario Iannaccone
- Division of CardiologySan Giovanni Bosco Hospital, ASL Città di TorinoTurinItaly
| | - Serafina Valente
- Division of Cardiology, Department of Medical BiotechnologiesUniversity of SienaSienaItaly
| | - Matteo Pagnesi
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of Brescia, Cardiothoracic Department, Civil HospitalsBresciaItaly
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of Brescia, Cardiothoracic Department, Civil HospitalsBresciaItaly
| | - Alessandro Sionis
- Intensive Cardiac Care Unit, Cardiology DepartmentHospital de la Santa Creu i Sant PauBarcelonaSpain
| | - Marco Marini
- Division of Cardiology and ICCU, Department of Cardiovascular SciencesOspedali RiunitiAnconaItaly
| | - Gaetano Maria De Ferrari
- Intensive Cardiac Care UnitCittà della Salute e della Scienza di TorinoTurinItaly
- Department of Medical SciencesUniversity of TorinoTurinItaly
| | | | - Federico Pappalardo
- Cardiothoracic and Vascular Anesthesia and Intensive CareAO SS. Antonio e Biagio e Cesare ArrigoAlessandriaItaly
| | - Guido Tavazzi
- Department of Clinical‐Surgical, Diagnostic and Paediatric SciencesUniversity of Pavia ItalyPaviaItaly
- Anesthesia and Intensive CareFondazione Policlinico San Matteo Hospital IRCCS, Anestesia e Rianimazione IPaviaItaly
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Conticchio M, Delvecchio A, Ferraro V, Stasi M, Casella A, Filippo R, Tedeschi M, Memeo R. Standardization of robotic right liver mobilization. Int J Med Robot 2023; 19:e2551. [PMID: 37462233 DOI: 10.1002/rcs.2551] [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] [Received: 02/19/2023] [Revised: 05/28/2023] [Accepted: 07/06/2023] [Indexed: 11/05/2023]
Abstract
BACKGROUND Since its introduction 2 decades ago, robotics has been increasingly used for resection of benign and malignant liver lesions. The robotic platform seems to preserve minimally invasive approach benefits, overcoming laparoscopy limitations. Robotic right liver mobilisation represents a key step for many robotic resections from non-anatomical resections of posterosuperior segments to right hepatectomy. METHODS We present here a standardized technique of right hepatic lobe mobilisation including technical steps and videos. Robotic resection provide all benefits of minimally invasive approaches in terms of preserving abdominal wall, early alimentation, reduced respiratory stress, associated with more ergonomic conditions for surgeon. RESULTS We present our standardized and feasible right liver lobe mobilisation needed for posterosuperior resections to the right hepatectomy. CONCLUSIONS The standardisation of right liver lobe represented our aim to provide a safe and reproducible initial step for many procedures to reduce the conversion rate and to improve the learning curve in young surgeons.
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Affiliation(s)
- Maria Conticchio
- Unit of Hepato-Biliary and Pancreatic Surgery, "F. Miulli" General Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Antonella Delvecchio
- Unit of Hepato-Biliary and Pancreatic Surgery, "F. Miulli" General Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Valentina Ferraro
- Unit of Hepato-Biliary and Pancreatic Surgery, "F. Miulli" General Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Matteo Stasi
- Unit of Hepato-Biliary and Pancreatic Surgery, "F. Miulli" General Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Annachiara Casella
- Unit of Hepato-Biliary and Pancreatic Surgery, "F. Miulli" General Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Rosalinda Filippo
- Unit of Hepato-Biliary and Pancreatic Surgery, "F. Miulli" General Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Michele Tedeschi
- Unit of Hepato-Biliary and Pancreatic Surgery, "F. Miulli" General Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Riccardo Memeo
- Unit of Hepato-Biliary and Pancreatic Surgery, "F. Miulli" General Hospital, Acquaviva delle Fonti, Bari, Italy
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5
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Conticchio M, Delvecchio A, Ferraro V, Stasi M, Casella A, Chetta N, De Marinis E, Madaro A, Raele M, Filippo R, Ammendola M, Tedeschi M, dèAngelis N, Memeo R. Robotic emergency liver resection of ruptured hepatocellular carcinoma. Int J Med Robot 2023; 19:e2537. [PMID: 37222177 DOI: 10.1002/rcs.2537] [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] [Received: 11/11/2022] [Revised: 04/14/2023] [Accepted: 05/12/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND The spontaneous rupture of hepatocellular carcinoma (HCC) is a rare complication. The management of this complication needs a stepwise, multidisciplinary approach which considers first of all clinical conditions of the patient and also the possibility of the best curative treatment. METHODS We report our experience of an emergency robotic liver resection for a ruptured HCC in an elderly patient. Minimally invasive liver resection is currently recognised as a safe and feasible approach to the treatment of HCC in elderly patients. RESULTS Our patient presented haemodynamic stability, which allows us to perform a robotic resection of segment 3. To our knowledge, this is the first report of the application of a robotic platform in an emergency setting for liver resection. CONCLUSIONS Rupture of HCC is an uncommon complication, burdened by a high rate of mortality. Its management still remains controversial. Treatment should be individualised taking into consideration the clinical status of the patient, tumour features and possibility of centre therapeutic strategy.
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Affiliation(s)
- Maria Conticchio
- Unit of Hepato-Biliary and Pancreatic Surgery, "F. Miulli" General Hospital, Bari, Italy
| | - Antonella Delvecchio
- Unit of Hepato-Biliary and Pancreatic Surgery, "F. Miulli" General Hospital, Bari, Italy
| | - Valentina Ferraro
- Unit of Hepato-Biliary and Pancreatic Surgery, "F. Miulli" General Hospital, Bari, Italy
| | - Matteo Stasi
- Unit of Hepato-Biliary and Pancreatic Surgery, "F. Miulli" General Hospital, Bari, Italy
| | - Annachiara Casella
- Unit of Hepato-Biliary and Pancreatic Surgery, "F. Miulli" General Hospital, Bari, Italy
| | - Nicola Chetta
- Unit of Hepato-Biliary and Pancreatic Surgery, "F. Miulli" General Hospital, Bari, Italy
| | - Emma De Marinis
- Unit of Hepato-Biliary and Pancreatic Surgery, "F. Miulli" General Hospital, Bari, Italy
| | - Andrea Madaro
- Unit of Hepato-Biliary and Pancreatic Surgery, "F. Miulli" General Hospital, Bari, Italy
| | - Margherita Raele
- Unit of Hepato-Biliary and Pancreatic Surgery, "F. Miulli" General Hospital, Bari, Italy
| | - Rosalinda Filippo
- Unit of Hepato-Biliary and Pancreatic Surgery, "F. Miulli" General Hospital, Bari, Italy
| | - Michele Ammendola
- Department of Medical and Surgical Sciences, Clinical Surgery Unit, University of 'Magna Graecia' Medical School, Germaneto Campus, Catanzaro, Italy
| | - Michele Tedeschi
- Unit of Hepato-Biliary and Pancreatic Surgery, "F. Miulli" General Hospital, Bari, Italy
| | - Nicola dèAngelis
- UCARE Department, Unit of Digestive, Hepatobiliary, and Pancreatic Surgery, Henri Mondor University Hospital (AP-HP), Créteil, France
| | - Riccardo Memeo
- Unit of Hepato-Biliary and Pancreatic Surgery, "F. Miulli" General Hospital, Bari, Italy
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Bellino M, Galasso G, Silverio A, Tedeschi M, Formisano C, Romei S, Esposito L, Cancro FP, Vassallo MG, Accarino G, Verdoia M, Di Muro FM, Vecchione C, De Luca G. Soluble PCSK9 Inhibition: Indications, Clinical Impact, New Molecular Insights and Practical Approach-Where Do We Stand? J Clin Med 2023; 12:jcm12082922. [PMID: 37109259 PMCID: PMC10146045 DOI: 10.3390/jcm12082922] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/12/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
Current research on cardiovascular prevention predominantly focuses on risk-stratification and management of patients with coronary artery disease (CAD) to optimize their prognosis. Several basic, translational and clinical research efforts aim to determine the etiological mechanisms underlying CAD pathogenesis and to identify lifestyle-dependent metabolic risk factors or genetic and epigenetic parameters responsible for CAD occurrence and/or progression. A log-linear association between the absolute exposure of LDL cholesterol (LDL-C) and the risk of atherosclerotic cardio-vascular disease (ASCVD) was well documented over the year. LDL-C was identified as the principal enemy to fight against, and soluble proprotein convertase subtilisin kexin type 9 (PCSK9) was attributed the role of a powerful regulator of blood LDL-C levels. The two currently available antibodies (alirocumab and evolocumab) against PCSK9 are fully human engineered IgG that bind to soluble PCSK9 and avoid its interaction with the LDLR. As documented by modern and dedicated "game-changer" trials, antibodies against soluble PCSK9 reduce LDL-C levels by at least 60 percent when used alone and up to 85 percent when used in combination with high-intensity statins and/or other hypolipidemic therapies, including ezetimibe. Their clinical indications are well established, but new areas of use are advocated. Several clues suggest that regulation of PCSK9 represents a cornerstone of cardiovascular prevention, partly because of some pleiotropic effects attributed to these newly developed drugs. New mechanisms of PCSK9 regulation are being explored, and further efforts need to be put in place to reach patients with these new therapies. The aim of this manuscript is to perform a narrative review of the literature on soluble PCSK9 inhibitor drugs, with a focus on their indications and clinical impact.
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Affiliation(s)
- Michele Bellino
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Angelo Silverio
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Michele Tedeschi
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Ciro Formisano
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Stefano Romei
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Luca Esposito
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Francesco Paolo Cancro
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Maria Giovanna Vassallo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Giulio Accarino
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Monica Verdoia
- Division of Cardiology, Ospedale Degli Infermi, ASL Biella, 13900 Biella, Italy
| | - Francesca Maria Di Muro
- Structural Interventional Cardiology, Department of Clinical and Experimental Medicine, Clinica Medica, Careggi University Hospital, 50139 Florence, Italy
| | - Carmine Vecchione
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
- Vascular Physiopathology Unit, IRCCS Neuromed Mediterranean Neurological Institute, 86077 Pozzilli, Italy
| | - Giuseppe De Luca
- Division of Cardiology, AOU "Policlinico G. Martino", Department of Clinical and Experimental Medicine, University of Messina, 98166 Messina, Italy
- Division of Cardiology, IRCCS Hospital Galeazzi-Sant'Ambrogio, 20161 Milan, Italy
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7
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Visco V, Izzo C, Mancusi C, Rispoli A, Tedeschi M, Virtuoso N, Giano A, Gioia R, Melfi A, Serio B, Rusciano MR, Di Pietro P, Bramanti A, Galasso G, D’Angelo G, Carrizzo A, Vecchione C, Ciccarelli M. Artificial Intelligence in Hypertension Management: An Ace up Your Sleeve. J Cardiovasc Dev Dis 2023; 10:jcdd10020074. [PMID: 36826570 PMCID: PMC9963880 DOI: 10.3390/jcdd10020074] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/05/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023] Open
Abstract
Arterial hypertension (AH) is a progressive issue that grows in importance with the increased average age of the world population. The potential role of artificial intelligence (AI) in its prevention and treatment is firmly recognized. Indeed, AI application allows personalized medicine and tailored treatment for each patient. Specifically, this article reviews the benefits of AI in AH management, pointing out diagnostic and therapeutic improvements without ignoring the limitations of this innovative scientific approach. Consequently, we conducted a detailed search on AI applications in AH: the articles (quantitative and qualitative) reviewed in this paper were obtained by searching journal databases such as PubMed and subject-specific professional websites, including Google Scholar. The search terms included artificial intelligence, artificial neural network, deep learning, machine learning, big data, arterial hypertension, blood pressure, blood pressure measurement, cardiovascular disease, and personalized medicine. Specifically, AI-based systems could help continuously monitor BP using wearable technologies; in particular, BP can be estimated from a photoplethysmograph (PPG) signal obtained from a smartphone or a smartwatch using DL. Furthermore, thanks to ML algorithms, it is possible to identify new hypertension genes for the early diagnosis of AH and the prevention of complications. Moreover, integrating AI with omics-based technologies will lead to the definition of the trajectory of the hypertensive patient and the use of the most appropriate drug. However, AI is not free from technical issues and biases, such as over/underfitting, the "black-box" nature of many ML algorithms, and patient data privacy. In conclusion, AI-based systems will change clinical practice for AH by identifying patient trajectories for new, personalized care plans and predicting patients' risks and necessary therapy adjustments due to changes in disease progression and/or therapy response.
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Affiliation(s)
- Valeria Visco
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Carmine Izzo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Costantino Mancusi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, 80138 Naples, Italy
| | - Antonella Rispoli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Michele Tedeschi
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Nicola Virtuoso
- Cardiology Unit, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84131 Salerno, Italy
| | - Angelo Giano
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Renato Gioia
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Americo Melfi
- Cardiology Unit, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84131 Salerno, Italy
| | - Bianca Serio
- Hematology and Transplant Center, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84131 Salerno, Italy
| | - Maria Rosaria Rusciano
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Paola Di Pietro
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Alessia Bramanti
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Gianni D’Angelo
- Department of Computer Science, University of Salerno, 84084 Fisciano, Italy
| | - Albino Carrizzo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
- Vascular Physiopathology Unit, IRCCS Neuromed, 86077 Pozzilli, Italy
| | - Carmine Vecchione
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
- Vascular Physiopathology Unit, IRCCS Neuromed, 86077 Pozzilli, Italy
| | - Michele Ciccarelli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
- Correspondence:
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8
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Conticchio M, Maggialetti N, Rescigno M, Brunese MC, Vaschetti R, Inchingolo R, Calbi R, Ferraro V, Tedeschi M, Fantozzi MR, Avella P, Calabrese A, Memeo R, Scardapane A. Hepatocellular Carcinoma with Bile Duct Tumor Thrombus: A Case Report and Literature Review of 890 Patients Affected by Uncommon Primary Liver Tumor Presentation. J Clin Med 2023; 12:jcm12020423. [PMID: 36675352 PMCID: PMC9861411 DOI: 10.3390/jcm12020423] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/13/2022] [Accepted: 12/29/2022] [Indexed: 01/06/2023] Open
Abstract
Bile duct tumor thrombus (BDTT) is an uncommon finding in hepatocellular carcinoma (HCC), potentially mimicking cholangiocarcinoma (CCA). Recent studies have suggested that HCC with BDTT could represent a prognostic factor. We report the case of a 47-year-old male patient admitted to the University Hospital of Bari with abdominal pain. Blood tests revealed the presence of an untreated hepatitis B virus infection (HBV), with normal liver function and without jaundice. Abdominal ultrasonography revealed a cirrhotic liver with a segmental dilatation of the third bile duct segment, confirmed by a CT scan and liver MRI, which also identified a heterologous mass. No other focal hepatic lesions were identified. A percutaneous ultrasound-guided needle biopsy was then performed, detecting a moderately differentiated HCC. Finally, the patient underwent a third hepatic segmentectomy, and the histopathological analysis confirmed the endobiliary localization of HCC. Subsequently, the patient experienced a nodular recurrence in the fourth hepatic segment, which was treated with ultrasound-guided percutaneous radiofrequency ablation (RFA). This case shows that HCC with BDTT can mimic different types of tumors. It also indicates the value of an early multidisciplinary patient assessment to obtain an accurate diagnosis of HCC with BDTT, which may have prognostic value that has not been recognized until now.
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Affiliation(s)
- Maria Conticchio
- Unit of Hepatobiliary Surgery, Miulli Hospital, 70124 Acquaviva Delle Fonti, Italy
| | - Nicola Maggialetti
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Marco Rescigno
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Maria Chiara Brunese
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy
- Correspondence:
| | - Roberto Vaschetti
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | | | - Roberto Calbi
- Radiology Unit, Miulli Hospital, 70124 Acquaviva Delle Fonti, Italy
| | - Valentina Ferraro
- Unit of Hepatobiliary Surgery, Miulli Hospital, 70124 Acquaviva Delle Fonti, Italy
| | - Michele Tedeschi
- Unit of Hepatobiliary Surgery, Miulli Hospital, 70124 Acquaviva Delle Fonti, Italy
| | | | - Pasquale Avella
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, 80131 Naples, Italy
| | | | - Riccardo Memeo
- Unit of Hepatobiliary Surgery, Miulli Hospital, 70124 Acquaviva Delle Fonti, Italy
| | - Arnaldo Scardapane
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy
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9
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Morici N, Frea S, Bertaina M, Sacco A, Corrada E, Dini CS, Briani M, Tedeschi M, Saia F, Colombo C, Rota M, Oliva F, Iannaccone M, De Ferrari GM, Sionis A, Kapur NK, Tavazzi G, Pappalardo F. SCAI stage reclassification at 24 h predicts outcome of cardiogenic shock: Insights from the Altshock-2 registry. Catheter Cardiovasc Interv 2023; 101:22-32. [PMID: 36378673 PMCID: PMC10100478 DOI: 10.1002/ccd.30484] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/27/2022] [Accepted: 11/02/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cardiogenic shock (CS) includes several phenotypes with heterogenous hemodynamic features. Timely prognostication is warranted to identify patients requiring treatment escalation. We explored the association of the updated Society for Cardiovascular Angiography and Interventions (SCAI) stages classification with in-hospital mortality using a prospective national registry. METHODS Between March 2020 and February 2022 the Altshock-2 Registry has included 237 patients with CS of all etiologies at 11 Italian Centers. Patients were classified according to their admission SCAI stage (assigned prospectively and independently updated according to the recently released version). In-hospital mortality was evaluated for association with both admission and 24-h SCAI stages. RESULTS The overall in-hospital mortality was 38%. Of the 237 patients included and staged according to the updated SCAI classification, 20 (8%) had SCAI shock stage B, 131 (55%) SCAI stage C, 61 (26%) SCAI stage D and 25 (11%) SCAI stage E. In-hospital mortality stratified according to the SCAI classification at 24 h was 18% for patients in SCAI stage B, 27% for SCAI stage C, 63% for SCAI stage D and 100% for SCAI stage E. Both the revised SCAI stages on admission and at 24 h were associated with in-hospital mortality, but the classification potential slightly increased at 24-h. After adjusting for age, sex, lactate level, eGFR, CVP, inotropic score and mechanical circulatory support [MCS], SCAI classification at 24 h was an independent predictor of in-hospital mortality. CONCLUSIONS In the Altshock-2 registry the utility of SCAI shock stages to identify risk of in-hospital mortality increased at 24 h after admission. Escalation of treatment (either pharmacological or with MCS) should be tailored to achieve prompt clinical improvement within the first 24 h after admission. Registration: http://www. CLINICALTRIALS gov; Unique identifier: NCT04295252.
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Affiliation(s)
- Nuccia Morici
- IRCCS S. Maria Nascente - Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Simone Frea
- Intensive Cardiac Care Unit, Città della Salute e della Scienza di Torino, Torino, Italy
| | - Maurizio Bertaina
- Division of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Torino, Italy
| | - Alice Sacco
- Cardiology Department and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Elena Corrada
- Humanitas Research Hospital IRCCS Rozzano, Milan, Italy
| | - Carlotta Sorini Dini
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | | | - Michele Tedeschi
- Cardiology Department, Intensive Care Unit, S. Giovanni Di Dio e Ruggi D'Aragona Hospital, Salerno, Italy
| | - Francesco Saia
- Cardiology Unit, Cardio-Thoraco-Vascular Department, University Hospital of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Costanza Colombo
- Intensive Cardiac Care Unit, Fondazione Policlinico San Matteo Hospital IRCCS, Pavia, Italy
| | - Matteo Rota
- Department of Molecular and Translational Medicine, Units of Biostatistics and Biomathematics and Bioinformatics, University of Brescia, Brescia, Italy
| | - Fabrizio Oliva
- Cardiology Department and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Mario Iannaccone
- Division of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Torino, Italy
| | - Gaetano M De Ferrari
- Intensive Cardiac Care Unit, Città della Salute e della Scienza di Torino, Torino, Italy.,Department of Medical Sciences, University of Torino, Torino, Italy
| | - Alessandro Sionis
- Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Navin K Kapur
- The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Guido Tavazzi
- Department of Clinical-Surgical, Diagnostic and Paediatric Sciences, Unit of Anaesthesia and Intensive Care, University of Pavia Italy.,Anesthesia and Intensive Care, Fondazione Policlinico San Matteo Hospital IRCCS, Anestesia e Rianimazione I, Pavia, Italy
| | - Federico Pappalardo
- Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
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10
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Esposito L, Cancro FP, Silverio A, Di Maio M, Bellino M, Romei S, Tedeschi M, Ciccarelli M, Vecchione C, Galasso G. Lipoprotein(a) levels and risk of adverse events after myocardial infarction in patients with and without diabetes. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
There is a positive continuous association between Lipoprotein(a) (Lp[a]) levels and the risk of recurrent ischemic events in patients with recent myocardial infarction (MI). However, the prognostic significance of the association between high Lp(a) levels and diabetes has been poorly investigated after MI.
Purpose
The aim of this study was to evaluate the association of Lp(a) levels with the long-term risk of adverse events in post-MI patients, and to investigate whether diabetes may influence this association.
Methods
Consecutive MI patients who underwent urgent/emergent coronary angiography at our Institution from February 2013 to June 2019 were prospectively collected. Lp(a) serum concentrations was expressed for increasing range values (≤10, >10–30, >30–50, >50–70, and ≥70 mg/dL). The primary outcome was the recurrence of MI; the secondary outcome was all-cause death. The propensity score weighting technique was used to account for potential confounding between patients with and without diabetes.
Results
The study population consisted of 1018 post-MI patients (median age: 63 years; 76% males). Diabetes was reported in 280 patients (27.5%). The median value of Lp(a) was 10 mg/dL, and patients with diabetes showed significantly lower Lp(a) levels than patients without diabetes (p=0.025). At a median follow-up of 1121 days, the primary outcome was reported in 109 patients (10.7%), and the secondary outcome in 100 (9.8%). After propensity score weighting, there was a significant association between increasing Lp(a) range values and the primary outcome both in the overall population (p trend = 0.030) and in non-diabetic patients (p trend = 0.009), but not in diabetics.
Conversely, no significant association with the risk of all-cause mortality across increasing Lp(a) categories both in the overall population and in the study groups according to the presence or not of diabetes was found.
Compared with the lowest Lp(a) category, Lp(a) plasma levels >70 mg/dL were independently associated with the risk of recurrent MI (HR: 3.222; 95% CI, 1.225–8.478, p=0.018) and all-cause death (HR: 2.656; 95% CI, 1.009–6.991, p=0.048) in non-diabetic patients, but not in diabetics.
Conclusions
In this real-world post-MI population, Lp(a) serum levels were lower in diabetic than in non-diabetic patients. Increasing Lp(a) levels were significantly associated with the risk of recurrent MI, and very high Lp(a) serum concentration (>70 mg/dL) independently predicted recurrent MI and death in non-diabetic patients, but not in diabetics. These results reinforce the importance of routine assessment of Lp(a) levels after MI, particularly in patients without diabetes.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- L Esposito
- University of Salerno School of Medicine , Salerno , Italy
| | - F P Cancro
- University of Salerno School of Medicine , Salerno , Italy
| | - A Silverio
- University of Salerno School of Medicine , Salerno , Italy
| | - M Di Maio
- University of Salerno School of Medicine , Salerno , Italy
| | - M Bellino
- University of Salerno School of Medicine , Salerno , Italy
| | - S Romei
- University of Salerno School of Medicine , Salerno , Italy
| | - M Tedeschi
- University of Salerno School of Medicine , Salerno , Italy
| | - M Ciccarelli
- University of Salerno School of Medicine , Salerno , Italy
| | - C Vecchione
- University of Salerno School of Medicine , Salerno , Italy
| | - G Galasso
- University of Salerno School of Medicine , Salerno , Italy
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11
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Cancro F, Baldi C, Silverio A, Di Maio M, Esposito L, Tedeschi M, Cristiano M, Sabatino M, Romei S, Vecchione C, Galasso G. P192 LONG TERM PROGNOSTIC EFFECT OF LIPROTEIN(A) IN PATIENTS WITH AND WITHOUT DIABETES MELLITUS AFTER MYOCARDIAL INFARCTION. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.184] [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: 11/12/2022]
Abstract
Abstract
Aims
To describe the baseline clinical, laboratory and angiographic characteristics of patients with acute myocardial infarction (MI) according to the presence or not of diabetes mellitus (DM), and to evaluate if DM may influence the effect of lipoprotein(a) [Lp(a)] serum level on long–term outcome in this very high–risk population.
Methods
This was a retrospective, single–center, study including consecutive patients admitted with MI diagnosis between January 1, 2017, and December 31, 2020. The availability of data on baseline Lp(a) serum level was considered as an inclusion criterion. The study population was divided into two groups according to the presence or not of DM. The Lp(a) value of 50 mg/dL was used to test the hypothesis of a different effect of Lp(a) on the clinical outcome of patients with or without DM. The primary study outcome was all–cause death at 3–year follow–up.
Results
The study population included 997 patients (mean age 63.7±13.5 years; 75.7% were males). Diabetes was reported in 280 (28.1%) patients. DM patients were older than those without DM (67.8±12.1 vs. 62.0±13.7 years, p < 0.001) and showed a significantly higher prevalence of dyslipidemia, hypertension, obesity, prior MI and prior coronary revascularization (p < 0.001). DM patients showed higher SYNTAX score value (19.8 vs. 15.1, p < 0.001) and a higher prevalence of left main involvement (6.3 vs. 3.1, p = 0.023). At Kaplan–Meier analysis, in the group without DM, patients with Lp(a)≥50 mg/dL showed a significantly lower long–term survival compared with those with Lp(a)<50 mg/dL (Log–Rank=0.004). In DM patients DM, conversely, no survival difference was found between patients with Lp(a)≥50 mg/dL vs. those with Lp(a)<50 mg/dL. At multivariable Cox regression analysis, in patients without DM, Lp(a) serum level (HR: 2.68, 95% CI 1.23–5.83; p = 0.013) and age (HR: 1.06, 95% CI 1.04–1.09; p < 0.001) were independent predictors of mortality at 3–year follow–up. Among DM patients, only age was independently associated with 3–year mortality (HR: 1.07, 95% CI 1.03–1.10; p < 0.001) (Table).
Conclusion
In this MI population, Lp(a) was independently associated with long–term mortality in patients without DM, but not in patients with DM. Whether DM can modify the effect of Lp(a) on clinical outcome after MI requires confirmation by larger prospective studies.
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Affiliation(s)
- F Cancro
- AOU S. GIOVANNI DI DIO–RUGGI D‘ARAGONA, SALERNO; VILLA DEI FIORI SRL, ACERRA; OSPEDALE MARIA SS. ADDOLORATA, EBOLI; DEPARTMENT OF MEDICINE, SURGERY AND DENTISTRY, UNIVERSITY OF SALERNO, SALERNO
| | - C Baldi
- AOU S. GIOVANNI DI DIO–RUGGI D‘ARAGONA, SALERNO; VILLA DEI FIORI SRL, ACERRA; OSPEDALE MARIA SS. ADDOLORATA, EBOLI; DEPARTMENT OF MEDICINE, SURGERY AND DENTISTRY, UNIVERSITY OF SALERNO, SALERNO
| | - A Silverio
- AOU S. GIOVANNI DI DIO–RUGGI D‘ARAGONA, SALERNO; VILLA DEI FIORI SRL, ACERRA; OSPEDALE MARIA SS. ADDOLORATA, EBOLI; DEPARTMENT OF MEDICINE, SURGERY AND DENTISTRY, UNIVERSITY OF SALERNO, SALERNO
| | - M Di Maio
- AOU S. GIOVANNI DI DIO–RUGGI D‘ARAGONA, SALERNO; VILLA DEI FIORI SRL, ACERRA; OSPEDALE MARIA SS. ADDOLORATA, EBOLI; DEPARTMENT OF MEDICINE, SURGERY AND DENTISTRY, UNIVERSITY OF SALERNO, SALERNO
| | - L Esposito
- AOU S. GIOVANNI DI DIO–RUGGI D‘ARAGONA, SALERNO; VILLA DEI FIORI SRL, ACERRA; OSPEDALE MARIA SS. ADDOLORATA, EBOLI; DEPARTMENT OF MEDICINE, SURGERY AND DENTISTRY, UNIVERSITY OF SALERNO, SALERNO
| | - M Tedeschi
- AOU S. GIOVANNI DI DIO–RUGGI D‘ARAGONA, SALERNO; VILLA DEI FIORI SRL, ACERRA; OSPEDALE MARIA SS. ADDOLORATA, EBOLI; DEPARTMENT OF MEDICINE, SURGERY AND DENTISTRY, UNIVERSITY OF SALERNO, SALERNO
| | - M Cristiano
- AOU S. GIOVANNI DI DIO–RUGGI D‘ARAGONA, SALERNO; VILLA DEI FIORI SRL, ACERRA; OSPEDALE MARIA SS. ADDOLORATA, EBOLI; DEPARTMENT OF MEDICINE, SURGERY AND DENTISTRY, UNIVERSITY OF SALERNO, SALERNO
| | - M Sabatino
- AOU S. GIOVANNI DI DIO–RUGGI D‘ARAGONA, SALERNO; VILLA DEI FIORI SRL, ACERRA; OSPEDALE MARIA SS. ADDOLORATA, EBOLI; DEPARTMENT OF MEDICINE, SURGERY AND DENTISTRY, UNIVERSITY OF SALERNO, SALERNO
| | - S Romei
- AOU S. GIOVANNI DI DIO–RUGGI D‘ARAGONA, SALERNO; VILLA DEI FIORI SRL, ACERRA; OSPEDALE MARIA SS. ADDOLORATA, EBOLI; DEPARTMENT OF MEDICINE, SURGERY AND DENTISTRY, UNIVERSITY OF SALERNO, SALERNO
| | - C Vecchione
- AOU S. GIOVANNI DI DIO–RUGGI D‘ARAGONA, SALERNO; VILLA DEI FIORI SRL, ACERRA; OSPEDALE MARIA SS. ADDOLORATA, EBOLI; DEPARTMENT OF MEDICINE, SURGERY AND DENTISTRY, UNIVERSITY OF SALERNO, SALERNO
| | - G Galasso
- AOU S. GIOVANNI DI DIO–RUGGI D‘ARAGONA, SALERNO; VILLA DEI FIORI SRL, ACERRA; OSPEDALE MARIA SS. ADDOLORATA, EBOLI; DEPARTMENT OF MEDICINE, SURGERY AND DENTISTRY, UNIVERSITY OF SALERNO, SALERNO
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12
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Belloni S, Caruso R, Cattani D, Mandelli G, Donizetti D, Mazzoleni B, Tedeschi M. Occurrence rate and risk factors for long-term central line-associated bloodstream infections in patients with cancer: A systematic review. Worldviews Evid Based Nurs 2022; 19:100-111. [PMID: 35262257 DOI: 10.1111/wvn.12574] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 07/23/2021] [Accepted: 08/02/2021] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Central line-associated bloodstream infection (CLABSI) is a public health problem that harms patients' outcomes and healthcare costs, especially in susceptible populations such as patients with cancer. Overall, systematic queries about etiology, risks, and epidemiology are explained by data from observational studies, which better underline the relationship between factors and incidence of disease. However, no recent systematic reviews of observational studies on adult patients with cancer have been conducted on this topic, considering the wide range of all potential factors which can contribute to the increase in infection rate in the hospitalized adults with cancer. This study systematically reviewed observational studies investigating the occurrence rate of CLABSI and its risk factors for long-term inserted central catheter-related infections in hospitalized adult cancer patients. METHODS A systematic review was performed on four databases from the earliest available date until December 2020. Retrospective and prospective cohort studies focused on the occurrence rate of CLABSI and its risk factors in hospitalized adult cancer patients. The pooled occurrence rate of CLABSI (95% CI) was calculated by applying a random-effects model. RESULTS Of 1712 studies, 8 were eligible, and the data of device-related infection rate were meta-analyzed. The pooled occurrence rate of CLABSI was roughly 8% (95% CI [4%, 14%]). The device characteristics, device's management aspects, therapies administration, and select patients' clinical conditions represent the main risk factors for long-term catheter-related infection in cancer patients. LINKING EVIDENCE TO ACTION Considering the substantial infection rate among cancer patients, identifying risk rate factors is pivotal to support evidence-grounded preventive strategies and maximize cancer patient safety. This study's results could guide policymakers and healthcare leaders and future research studies to disseminate appropriate risk-reducing management culture and implement standardized research and clinical approach to the investigated phenomenon as an infection surveillance strategy.
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Affiliation(s)
- Silvia Belloni
- Educational and Research Unit, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Rosario Caruso
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Daniela Cattani
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Giorgia Mandelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Daniela Donizetti
- Educational and Research Unit, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Beatrice Mazzoleni
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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13
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Tedeschi M, Cancro FP, Busiello MM, Butrico V, Torre M, Cristiano M, Sabatino M, Romei S, Settembre E, Alfano A, Vecchione C, Galasso G. 634 Long term prognostic effect of lipoprotein in patients with and without diabetes mellitus after myocardial infarction. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab140.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
The aim is to describe the baseline clinical, laboratory, and angiographic characteristics of patients with acute myocardial infarction (MI) according to the presence or not of diabetes mellitus (DM), and to evaluate if DM may influence the effect of lipoproteina [Lpa] serum level on long-term outcome in this very high-risk population.
Methods and results
This was a retrospective, single-centre, study including consecutive patients admitted with MI diagnosis between 1 January 2017 and 31 December 2020. The availability of data on baseline Lpa serum level was considered as an inclusion criterion. The study population was divided into two groups according to the presence or not of DM. The Lpa value of 50 mg/dl was used to test the hypothesis of a different effect of Lpa on the clinical outcome of patients with or without DM. The primary study outcome was all-cause death at 3-year follow-up. The study population included 997 patients (mean age 63.7 ± 13.5 years; 75.7% were males). Diabetes was reported in 280 (28.1%) patients. DM patients were older than those without DM (67.8 ± 12.1 vs. 62.0 ± 13.7 years, P < 0.001) and showed a significantly higher prevalence of dyslipidaemia, hypertension, obesity, prior MI, and prior coronary revascularization (P < 0.001). DM patients showed higher SYNTAX score value (19.8 vs. 15.1, P < 0.001) and a higher prevalence of left main involvement (6.3 vs. 3.1, P = 0.023). At Kaplan–Meier analysis, in the group without DM, patients with Lpa ≥ 50 mg/dl showed a significantly lower long-term survival compared with those with Lpa < 50 mg/dl (Log-Rank = 0.004). In DM patients, conversely, no survival difference was found between patients with Lpa ≥ 50 mg/dl vs. those with Lpa < 50 mg/dl. At multivariable Cox regression analysis, in patients without DM, Lpa serum level (HR: 2.68, 95% CI: 1.23–5.83; P = 0.013) and age (HR: 1.06, 95% CI: 1.04–1.09; P < 0.001) were independent predictors of mortality at 3-year follow-up. Among DM patients, only age was independently associated with 3-year mortality (HR: 1.07, 95% CI: 1.03–1.10; P < 0.001) (Table).
Conclusions
In this MI population, Lpa was independently associated with long-term mortality in patients without DM, but not in patients with DM. Whether DM can modify the effect of Lpa on clinical outcome after MI requires confirmation by larger prospective studies.
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Affiliation(s)
- Michele Tedeschi
- Department of Medicine, Surgery and Dentistry, ‘Scuola Medica Salernitana’, University of Salerno, Baronissi, Salerno, Italy
| | - Francesco Paolo Cancro
- Department of Medicine, Surgery and Dentistry, ‘Scuola Medica Salernitana’, University of Salerno, Baronissi, Salerno, Italy
| | - Marco Maria Busiello
- Department of Medicine, Surgery and Dentistry, ‘Scuola Medica Salernitana’, University of Salerno, Baronissi, Salerno, Italy
| | - Valentina Butrico
- Department of Medicine, Surgery and Dentistry, ‘Scuola Medica Salernitana’, University of Salerno, Baronissi, Salerno, Italy
| | - Marco Torre
- Department of Medicine, Surgery and Dentistry, ‘Scuola Medica Salernitana’, University of Salerno, Baronissi, Salerno, Italy
| | - Mario Cristiano
- Department of Medicine, Surgery and Dentistry, ‘Scuola Medica Salernitana’, University of Salerno, Baronissi, Salerno, Italy
| | - Mariano Sabatino
- Department of Medicine, Surgery and Dentistry, ‘Scuola Medica Salernitana’, University of Salerno, Baronissi, Salerno, Italy
| | - Stefano Romei
- Department of Medicine, Surgery and Dentistry, ‘Scuola Medica Salernitana’, University of Salerno, Baronissi, Salerno, Italy
| | - Emanuela Settembre
- Department of Medicine, Surgery and Dentistry, ‘Scuola Medica Salernitana’, University of Salerno, Baronissi, Salerno, Italy
| | - Antonia Alfano
- Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital ‘San Giovanni di Dio e Ruggi D’Aragona’, Salerno, Italy
| | - Carmine Vecchione
- Department of Medicine, Surgery and Dentistry, ‘Scuola Medica Salernitana’, University of Salerno, Baronissi, Salerno, Italy
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry, ‘Scuola Medica Salernitana’, University of Salerno, Baronissi, Salerno, Italy
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Campanile A, Procaccini C, Dell' Aquila F, Tedeschi M, Rispoli A, Sorrentino R, Ravera A. Frailty assessment in an unselected population admitted to an intensive cardiac care unit. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Although interest in frailty has expanded among cardiology experts over the past 2 decades, its integration, as part of cardiovascular disease management, is still lacking, above all in the acute cardiac care setting. The Clinical Frailty Scale (CFS) is a brief guided tool to assess frailty in hospital settings without specialist equipment.
Purpose
Our objective was to test the performance of the CFS in an older, unselected population, admitted to an Intensive Cardiac Care Unit (ICCU) during the year 2019.
Methods
The study sample included 431 patients ≥65 years old, admitted to an ICCU of a tertiary cardiac center in Italy. The CFS ranged from “very fit: 1” to “terminally ill: 9”, but it was considered present at a score ≥5. Our primary endpoint was defined by a combination of severe complications requiring critical care and in-hospital death. The data were collected from the hospital discharge summary and the electronic chart records.
Results
158 patients (36.7%) were frail. These individuals had greater comorbidity and higher in-hospital mortality (Table 1). After a multivariable logistic regression analysis, 4 predictors were identified: signs of congestive heart failure (OR: 8.51, 95% Confidence Interval-CI: 4.63–14.6; p<0,001), systolic blood pressure (OR per 1 mmHg increasing: 0.98, 95% CI: 0.97–0.99; p<0,001), smoking habit (OR: 0.49, 95% CI: 0.22–1.11; p=0.09) and the CFS ≥5 (OR: 1.86, 95% CI: 1.08–3.23: p=0,026).
Conclusions
The CFS is a simple guided frailty tool that may enhance outcome prediction in the acute cardiac care setting. These findings merit evaluation in larger cohorts of unselected patients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Campanile
- AOU S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - C Procaccini
- AOU S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - F Dell' Aquila
- AOU S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - M Tedeschi
- University of Salerno School of Medicine, Cardiology, Salerno, Italy
| | - A Rispoli
- University of Salerno School of Medicine, Cardiology, Salerno, Italy
| | - R Sorrentino
- AOU S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - A Ravera
- AOU S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
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15
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Inchingolo R, Acquafredda F, Tedeschi M, Laera L, Surico G, Surgo A, Fiorentino A, Spiliopoulos S, de’Angelis N, Memeo R. Worldwide management of hepatocellular carcinoma during the COVID-19 pandemic. World J Gastroenterol 2021; 27:3780-3789. [PMID: 34321843 PMCID: PMC8291009 DOI: 10.3748/wjg.v27.i25.3780] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/15/2021] [Accepted: 04/13/2021] [Indexed: 02/06/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has impacted hospital organization, with the necessity to quickly react to face the pandemic. The management of the oncological patient has been modified by necessity due to different allocation of nurses and doctors, requiring new strategies to guarantee the correct assistance to the patients. Hepatocellular carcinoma, considered as one of the most aggressive types of liver cancer, has also required a different management during this period in order to optimize the management of patients at risk for and with this cancer. The aim of this document is to review recommendations on hepatocellular carcinoma surveillance and management, including surgery, liver transplantation, interventional radiology, oncology, and radiotherapy. Publications and guidelines from the main scientific societies worldwide regarding the management of hepatocellular carcinoma during the COVID-19 pandemic were reviewed.
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Affiliation(s)
- Riccardo Inchingolo
- Department of Interventional Radiology Unit, “F. Miulli” General Regional Hospital, Acquaviva delle Fonti 70021, Bari, Italy
| | - Fabrizio Acquafredda
- Department of Interventional Radiology Unit, “F. Miulli” General Regional Hospital, Acquaviva delle Fonti 70021, Bari, Italy
| | - Michele Tedeschi
- Unit of Hepato-Pancreatic-Biliary Surgery, “F. Miulli” General Regional Hospital, Acquaviva delle Fonti 70124, Bari, Italy
| | - Letizia Laera
- Department of Oncology, “F. Miulli” General Regional Hospital, Acquaviva delle Fonti 70021, Bari, Italy
| | - Gianmarco Surico
- Department of Oncology, “F. Miulli” General Regional Hospital, Acquaviva delle Fonti 70021, Bari, Italy
| | - Alessia Surgo
- Department of Radiation Oncology, “F. Miulli” General Regional Hospital, Acquaviva delle Fonti 70021, Bari, Italy
| | - Alba Fiorentino
- Department of Radiation Oncology, “F. Miulli” General Regional Hospital, Acquaviva delle Fonti 70021, Bari, Italy
| | - Stavros Spiliopoulos
- Department of 2nd Radiology, National and Kapodistrian University of Athens, Athens 12461, Greece
| | - Nicola de’Angelis
- Unit of Minimally Invasive and Robotic Digestive Surgery, “F. Miulli” General Regional Hospital, Acquaviva delle Fonti 70021, Bari, Italy
| | - Riccardo Memeo
- Unit of Hepato-Pancreatic-Biliary Surgery, “F. Miulli” General Regional Hospital, Acquaviva delle Fonti 70124, Bari, Italy
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16
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Sandri MT, Azzolini E, Torri V, Carloni S, Pozzi C, Salvatici M, Tedeschi M, Castoldi M, Mantovani A, Rescigno M. SARS-CoV-2 serology in 4000 health care and administrative staff across seven sites in Lombardy, Italy. Sci Rep 2021; 11:12312. [PMID: 34112899 PMCID: PMC8192543 DOI: 10.1038/s41598-021-91773-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 05/17/2021] [Indexed: 02/06/2023] Open
Abstract
Lombardy is the Italian region most affected by COVID-19. We tested the presence of plasma anti-SARS-CoV-2 IgG antibodies in 3985 employees across 7 healthcare facilities in areas of Lombardy with different exposure to the SARS-CoV-2 epidemic. Subjects filled a questionnaire to self-report on COVID-19 symptoms, comorbidities, smoking, regular or remote working, and the exposure to COVID-infected individuals. We show that the number of individuals exposed to the virus depended on the geographical location of the facility, ranging between 3 and 43%, consistent with the spatial variation of COVID-19 incidence in Lombardy, and correlated with family interactions. We observed a higher prevalence of females than males positive for IgG, however the level of antibodies was similar, suggesting a comparable magnitude of the anti-spike antibody response. IgG positivity among smokers was lower (7.4% vs 13.5%) although without difference in IgG plasma levels. We observed 11.9% of IgG positive asymptomatic individuals and another 23.1% with one or two symptoms. Interestingly, among the IgG positive population, 81.2% of subjects with anosmia/dysgeusia and fever were SARS-CoV-2 infected, indicating that these symptoms are strongly associated to COVID-19. In conclusion, the frequency of IgG positivity and SARS-CoV-2 infection is dependent on the geographical exposure to the virus and primarily to family rather than hospital exposure.
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Affiliation(s)
| | - Elena Azzolini
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Valter Torri
- Istituto Di Ricerche Farmacologiche, Mario Negri" - IRCCS, Milan, Italy
| | - Sara Carloni
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Chiara Pozzi
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | | | | | - Alberto Mantovani
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- The William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Maria Rescigno
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
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17
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Ferraro V, Tedeschi M, Laera L, Ammendola M, Riccelli U, Silvestris N, Fiorentino A, Surico G, Inchingolo R, Decembrino F, de Angelis N, Memeo R. Correction to: The Role of Laparoscopic Surgery in Localized Pancreatic Neuroendocrine Tumours. Curr Treat Options Oncol 2021; 22:36. [PMID: 33738586 DOI: 10.1007/s11864-021-00842-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Valentina Ferraro
- Hepato-Pancreato-Biliary Surgery Unit, Miulli Hospital, Acquaviva delle Fonti, Bari, Italy.
| | - Michele Tedeschi
- Hepato-Pancreato-Biliary Surgery Unit, Miulli Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Letizia Laera
- Medical Oncology Unit, Miulli Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Michele Ammendola
- Department of Health Sciences, General Surgery, Magna Græcia University, Medicine School of Germaneto, Catanzaro, Italy
| | - Umberto Riccelli
- Department of Reconstructive Surgery, "Pugliese Ciaccio" Hospital, Catanzaro, Italy
| | - Nicola Silvestris
- Medical Oncology Unit, IRCCS Cancer Institute "Giovanni Paolo II", Bari, Italy
| | - Alba Fiorentino
- Radiotherapy Unit, Miulli Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Giammarco Surico
- Medical Oncology Unit, Miulli Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Riccardo Inchingolo
- Interventional Radiology Unit, Miulli Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Francesco Decembrino
- Gastroenterology and Endoscopy Unit, Miulli Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Nicola de Angelis
- Minimally invasive and Robotic Gastrointestinal Surgery, Acquaviva delle Fonti, Bari, Italy
| | - Riccardo Memeo
- Hepato-Pancreato-Biliary Surgery Unit, Miulli Hospital, Acquaviva delle Fonti, Bari, Italy
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18
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Libia A, Ferraro V, Tedeschi M, de'Angelis N, Torzilli G, Aldrighetti L, Pessaux P, Cherqui D, Memeo R. ASO Visual Abstract: Laparoscopic R1 Vascular Hepatectomy for Hepatocellular Carcinoma (With Video). Ann Surg Oncol 2021. [PMID: 33665714 DOI: 10.1245/s10434-021-09758-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Annarita Libia
- Department of Surgical Science, University of Rome "Sapienza", Rome, Italy. .,Department of Hepatobiliary and Pancreatic Surgery, Ecclesiastical Entity General Regional Hospital F. Miulli, Acquaviva delle Fonti, Italy.
| | - Valentina Ferraro
- Department of Hepatobiliary and Pancreatic Surgery, Ecclesiastical Entity General Regional Hospital F. Miulli, Acquaviva delle Fonti, Italy
| | - Michele Tedeschi
- Department of Hepatobiliary and Pancreatic Surgery, Ecclesiastical Entity General Regional Hospital F. Miulli, Acquaviva delle Fonti, Italy
| | - Nicola de'Angelis
- Minimal Invasive and Robotic Gastrointestinal Surgery, Ecclesiastical Entity General Regional Hospital F. Miulli, Acquaviva delle Fonti, Italy
| | - Guido Torzilli
- Department of Surgery, Division of Hepatobiliary and General Surgery, Humanitas Clinical and Research Center, Humanitas University, Milan, Italy
| | - Luca Aldrighetti
- Department of Surgery-Liver Unit, Scientific Institute San Raffaele, Milan, Italy
| | - Patrick Pessaux
- Hepatobiliary Surgery and Transplantation, Hautepierre Hospital, Strasbourg, France
| | - Daniel Cherqui
- Centre Hepato-Biliaire, AP-HP Hopital Paul Brousse, Villejuif, France
| | - Riccardo Memeo
- Department of Hepatobiliary and Pancreatic Surgery, Ecclesiastical Entity General Regional Hospital F. Miulli, Acquaviva delle Fonti, Italy
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19
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Ferraro V, Tedeschi M, Laera L, Ammendola M, Riccelli U, Silvestris N, Fiorentino A, Surico G, Inchingolo R, Decembrino F, de Angelis N, Memeo R. The Role of Laparoscopic Surgery in Localized Pancreatic Neuroendocrine Tumours. Curr Treat Options Oncol 2021; 22:27. [PMID: 33641016 DOI: 10.1007/s11864-021-00824-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Accepted: 01/18/2021] [Indexed: 02/05/2023]
Abstract
Pancreatic neuroendocrine tumours (PNETs) are a rare and heterogeneous group of tumours with various clinical manifestations and biological behaviours. They represent approximately 2-4% of all pancreatic tumours, with an incidence of 2-3 cases per million people. PNETs are classified clinically as non-functional or functional, and pancreatic resection is recommended for lesions greater than 2 cm. The surgical approach can involve "typical" and "atypical" resections depending on the number, size and location of the tumour. Typical resections include pancreaticoduodenectomy, distal pancreatectomy enucleation and, rarely, total pancreatectomy. Atypical resections comprise central pancreatectomies or enucleations. Minimally invasive pancreatic resection has been proven to be technically feasible and safe in high-volume and specialized centres with highly skilled laparoscopic surgeons, with consolidated benefits for patients in the postoperative course. However, open and minimally invasive pancreatic surgery remains to have a high rate of complications; there is no specific technical contraindication to minimally invasive pancreatic surgery, but an appropriate patient selection is crucial to obtain satisfactory clinical and oncological outcomes.
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Affiliation(s)
- Valentina Ferraro
- Hepato-Pancreato-Biliary Surgery Unit, Miulli Hospital, Acquaviva delle Fonti, Bari, Italy.
| | - Michele Tedeschi
- Hepato-Pancreato-Biliary Surgery Unit, Miulli Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Letizia Laera
- Medical Oncology Unit, Miulli Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Michele Ammendola
- Department of Health Sciences, General Surgery, Magna Græcia University, Medicine School of Germaneto, Catanzaro, Italy
| | - Umberto Riccelli
- Department of Reconstructive Surgery, "Pugliese Ciaccio" Hospital, Catanzaro, Italy
| | - Nicola Silvestris
- Medical Oncology Unit, IRCCS Cancer Institute "Giovanni Paolo II", Bari, Italy
| | - Alba Fiorentino
- Radiotherapy Unit, Miulli Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Giammarco Surico
- Medical Oncology Unit, Miulli Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Riccardo Inchingolo
- Interventional Radiology Unit, Miulli Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Francesco Decembrino
- Gastroenterology and Endoscopy Unit, Miulli Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Nicola de Angelis
- Minimally invasive and Robotic Gastrointestinal Surgery, Acquaviva delle Fonti, Bari, Italy
| | - Riccardo Memeo
- Hepato-Pancreato-Biliary Surgery Unit, Miulli Hospital, Acquaviva delle Fonti, Bari, Italy
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20
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Libia A, Ferraro V, Tedeschi M, de'Angelis N, Torzilli G, Aldrighetti L, Pessaux P, Cherqui D, Memeo R. Laparoscopic R1 Vascular Hepatectomy for Hepatocellular Carcinoma (with Video). Ann Surg Oncol 2021; 28:3699-3700. [PMID: 33547513 DOI: 10.1245/s10434-020-09582-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 12/24/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Annarita Libia
- Department of Surgical Science, University of Rome La Sapienza, Rome, Italy.
| | - Valentina Ferraro
- Department of Hepato-Biliary and Pancreatic Surgery, Ecclesiastical Entity General Regional Hospital Francesco Miulli, Acquaviva delle Fonti, Italy
| | - Michele Tedeschi
- Department of Hepato-Biliary and Pancreatic Surgery, Ecclesiastical Entity General Regional Hospital Francesco Miulli, Acquaviva delle Fonti, Italy
| | - Nicola de'Angelis
- Unit of Digestive, Hepato-Pancreato-Biliary Surgery, Henri Mondor Hospital Public Health Service, Universite Paris-Est Creteil Val de Marne, Créteil, France
| | - Guido Torzilli
- Department of Surgery, Division of Hepatobiliary and General Surgery, Humanitas Clinical and Research Center, Humanitas University, Milan, Italy
| | - Luca Aldrighetti
- Department of Surgery-Liver Unit, Scientific Institute San Raffaele, Milan, Italy
| | - Patrick Pessaux
- Hepato-Biliary Surgery and Transplantation, Hautepierre Hospital, Strasbourg, France
| | - Daniel Cherqui
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Villejuif, France
| | - Riccardo Memeo
- Department of Hepato-Pancreatic-Biliary Surgery, Miulli Hospital, Bari, Italy
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21
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Ielpo B, Pittau G, Ciacio O, Tedeschi M, Pietrasz D, Torrent L, Sa Cunha A, Cherqui D. Standardized laparoscopic right hepatic lobe mobilization. J Hepatobiliary Pancreat Sci 2020; 29:e30-e32. [PMID: 32506772 DOI: 10.1002/jhbp.782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 04/17/2020] [Accepted: 04/28/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Benedetto Ielpo
- Department of General and Digestive Surgery, HPB Unit, University Hospital of León, León, Spain
| | - Gabriella Pittau
- Centre Hepato-Biliaire, Hôpital Paul-Brousse, Villejuif, Paris, France
| | - Oriana Ciacio
- Centre Hepato-Biliaire, Hôpital Paul-Brousse, Villejuif, Paris, France
| | - Michele Tedeschi
- Centre Hepato-Biliaire, Hôpital Paul-Brousse, Villejuif, Paris, France
| | - Daniel Pietrasz
- Centre Hepato-Biliaire, Hôpital Paul-Brousse, Villejuif, Paris, France
| | - Laia Torrent
- Department of General and Digestive Surgery, Hospital del Mar, Barcelona, Spain
| | - Antonio Sa Cunha
- Centre Hepato-Biliaire, Hôpital Paul-Brousse, Villejuif, Paris, France
| | - Daniel Cherqui
- Centre Hepato-Biliaire, Hôpital Paul-Brousse, Villejuif, Paris, France
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22
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Hobeika C, Fuks D, Cauchy F, Goumard C, Soubrane O, Gayet B, Salamé E, Cherqui D, Vibert E, Scatton O, Nomi T, Oudafal N, Kawai T, Komatsu S, Okumura S, Petrucciani N, Laurent A, Bucur P, Barbier L, Trechot B, Nunèz J, Tedeschi M, Allard MA, Golse N, Ciacio O, Pittau G, Cunha AS, Adam R, Laurent C, Chiche L, Leourier P, Rebibo L, Regimbeau JM, Ferre L, Souche FR, Chauvat J, Fabre JM, Jehaes F, Mohkam K, Lesurtel M, Ducerf C, Mabrut JY, Hor T, Paye F, Balladur P, Suc B, Muscari F, Millet G, El Amrani M, Ratajczak C, Lecolle K, Boleslawski E, Truant S, Pruvot FR, Kianmanesh AR, Codjia T, Schwarz L, Girard E, Abba J, Letoublon C, Chirica M, Carmelo A, VanBrugghe C, Cherkaoui Z, Unterteiner X, Memeo R, Pessaux P, Buc E, Lermite E, Barbieux J, Bougard M, Marchese U, Ewald J, Turini O, Thobie A, Menahem B, Mulliri A, Lubrano J, Zemour J, Fagot H, Passot G, Gregoire E, Hardwigsen J, le Treut YP, Patrice D. Impact of cirrhosis in patients undergoing laparoscopic liver resection in a nationwide multicentre survey. Br J Surg 2020; 107:268-277. [PMID: 31916594 DOI: 10.1002/bjs.11406] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 09/21/2019] [Accepted: 09/27/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The aim was to analyse the impact of cirrhosis on short-term outcomes after laparoscopic liver resection (LLR) in a multicentre national cohort study. METHODS This retrospective study included all patients undergoing LLR in 27 centres between 2000 and 2017. Cirrhosis was defined as F4 fibrosis on pathological examination. Short-term outcomes of patients with and without liver cirrhosis were compared after propensity score matching by centre volume, demographic and tumour characteristics, and extent of resection. RESULTS Among 3150 patients included, LLR was performed in 774 patients with (24·6 per cent) and 2376 (75·4 per cent) without cirrhosis. Severe complication and mortality rates in patients with cirrhosis were 10·6 and 2·6 per cent respectively. Posthepatectomy liver failure (PHLF) developed in 3·6 per cent of patients with cirrhosis and was the major cause of death (11 of 20 patients). After matching, patients with cirrhosis tended to have higher rates of severe complications (odds ratio (OR) 1·74, 95 per cent c.i. 0·92 to 3·41; P = 0·096) and PHLF (OR 7·13, 0·91 to 323·10; P = 0·068) than those without cirrhosis. They also had a higher risk of death (OR 5·13, 1·08 to 48·61; P = 0·039). Rates of cardiorespiratory complications (P = 0·338), bile leakage (P = 0·286) and reoperation (P = 0·352) were similar in the two groups. Patients with cirrhosis had a longer hospital stay than those without (11 versus 8 days; P = 0·018). Centre expertise was an independent protective factor against PHLF in patients with cirrhosis (OR 0·33, 0·14 to 0·76; P = 0·010). CONCLUSION Underlying cirrhosis remains an independent risk factor for impaired outcomes in patients undergoing LLR, even in expert centres.
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Affiliation(s)
- C Hobeika
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Sorbonne Université, Centre de Recherche Scientifique Saint Antoine, Hôpital Pitié Salpétrière, Paris, France
| | - D Fuks
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, University Paris Descartes, Paris, France
| | - F Cauchy
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Hôpital Beaujon, Clichy, France
| | - C Goumard
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Sorbonne Université, Centre de Recherche Scientifique Saint Antoine, Hôpital Pitié Salpétrière, Paris, France
| | - O Soubrane
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Hôpital Beaujon, Clichy, France
| | - B Gayet
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, University Paris Descartes, Paris, France
| | - E Salamé
- Department of Digestive Surgery and Liver Transplantation, Trousseau University Hospital, Tours University, Tours, France
| | - D Cherqui
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Centre Hépato-biliaire de Paul Brousse, Villejuif, France
| | - E Vibert
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Centre Hépato-biliaire de Paul Brousse, Villejuif, France
| | - O Scatton
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Sorbonne Université, Centre de Recherche Scientifique Saint Antoine, Hôpital Pitié Salpétrière, Paris, France
| | | | - T Nomi
- Nara Medical University, Nara, Japan
| | - N Oudafal
- Institut Mutualiste Montsouris, Paris, France
| | - T Kawai
- Pitié Salpétrière Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - S Komatsu
- Pitié Salpétrière Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - S Okumura
- Pitié Salpétrière Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | | | - A Laurent
- Hôpital Henri Mondor, APHP, Creteil, France
| | - P Bucur
- Trousseau Hospital, University Hospital Centre of Tours, Tours, France
| | - L Barbier
- Trousseau Hospital, University Hospital Centre of Tours, Tours, France
| | - B Trechot
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - J Nunèz
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - M Tedeschi
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - M-A Allard
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - N Golse
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - O Ciacio
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - G Pittau
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - A Sa Cunha
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - R Adam
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - C Laurent
- Hospital University Centre of Bordeaux, Bordeaux, France
| | - L Chiche
- Hospital University Centre of Bordeaux, Bordeaux, France
| | - P Leourier
- Hospital University Centre of Amiens-Picardie, Amiens, France
| | - L Rebibo
- Hospital University Centre of Amiens-Picardie, Amiens, France
| | - J-M Regimbeau
- Hospital University Centre of Amiens-Picardie, Amiens, France
| | - L Ferre
- Saint Eloi Hospital, Hospital University Centre of Montpellier, Montpellier, France
| | - F R Souche
- Saint Eloi Hospital, Hospital University Centre of Montpellier, Montpellier, France
| | - J Chauvat
- Saint Eloi Hospital, Hospital University Centre of Montpellier, Montpellier, France
| | - J-M Fabre
- Saint Eloi Hospital, Hospital University Centre of Montpellier, Montpellier, France
| | - F Jehaes
- Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - K Mohkam
- Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - M Lesurtel
- Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - C Ducerf
- Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - J-Y Mabrut
- Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - T Hor
- St Antoine Hospital, APHP, Paris, France
| | - F Paye
- St Antoine Hospital, APHP, Paris, France
| | - P Balladur
- St Antoine Hospital, APHP, Paris, France
| | - B Suc
- Rangueil Hospital, Hospital University Centre of Toulouse, Toulouse, France
| | - F Muscari
- Rangueil Hospital, Hospital University Centre of Toulouse, Toulouse, France
| | - G Millet
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - M El Amrani
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - C Ratajczak
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - K Lecolle
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - E Boleslawski
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - S Truant
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - F-R Pruvot
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - A-R Kianmanesh
- Robert Debré Hospital, Hospital University Centre of Reims, Reims, France
| | - T Codjia
- Charles Nicolle Hospital, Hospital University Centre of Rouen, Rouen, France
| | - L Schwarz
- Charles Nicolle Hospital, Hospital University Centre of Rouen, Rouen, France
| | - E Girard
- Michalon Hospital, Hospital University Centre of Grenoble, Grebnoble, France
| | - J Abba
- Michalon Hospital, Hospital University Centre of Grenoble, Grebnoble, France
| | - C Letoublon
- Michalon Hospital, Hospital University Centre of Grenoble, Grebnoble, France
| | - M Chirica
- Michalon Hospital, Hospital University Centre of Grenoble, Grebnoble, France
| | | | | | - Z Cherkaoui
- Nouvel Hôpital Civil, Hospital University Centre of Strasbourg, Strasbourg, France
| | - X Unterteiner
- Nouvel Hôpital Civil, Hospital University Centre of Strasbourg, Strasbourg, France
| | - R Memeo
- Nouvel Hôpital Civil, Hospital University Centre of Strasbourg, Strasbourg, France
| | - P Pessaux
- Nouvel Hôpital Civil, Hospital University Centre of Strasbourg, Strasbourg, France
| | - E Buc
- Hospital University Centre of Clermont-Ferrand, Clermont-Ferrand, France
| | - E Lermite
- Hospital University Centre of Angers, Angers, France
| | - J Barbieux
- Hospital University Centre of Angers, Angers, France
| | - M Bougard
- Hospital University Centre of Angers, Angers, France
| | - U Marchese
- Institut Paoli-Calmettes, Marseille, France
| | - J Ewald
- Institut Paoli-Calmettes, Marseille, France
| | - O Turini
- Institut Paoli-Calmettes, Marseille, France
| | - A Thobie
- Hospital University Centre of Caen Normandie, Caen, France
| | - B Menahem
- Hospital University Centre of Caen Normandie, Caen, France
| | - A Mulliri
- Hospital University Centre of Caen Normandie, Caen, France
| | - J Lubrano
- Hospital University Centre of Caen Normandie, Caen, France
| | - J Zemour
- Hospital University Centre of Saint-Pierre, Saint Pierre, Department of Réunion, France
| | - H Fagot
- Hospital University Centre of Saint-Pierre, Saint Pierre, Department of Réunion, France
| | - G Passot
- Hospital University Centre of Lyon Sud, Lyon, France
| | - E Gregoire
- La Timone Hospital, Hospital University Centre of Marseille, Marseille, France
| | - J Hardwigsen
- La Timone Hospital, Hospital University Centre of Marseille, Marseille, France
| | - Y-P le Treut
- La Timone Hospital, Hospital University Centre of Marseille, Marseille, France
| | - D Patrice
- Louis Pasteur Hospital, Colmar, France
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23
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Golse N, Cosse C, Allard MA, Laurenzi A, Tedeschi M, Guglielmo N, Fernandez-Sevilla E, Robert M, Tréchot B, Pietrasz D, Pittau G, Ciacio O, Sa Cunha A, Castaing D, Cherqui D, Adam R, Samuel D, Sebagh M, Vibert E. Evaluation of a micro-spectrometer for the real-time assessment of liver graft with mild-to-moderate macrosteatosis: A proof of concept study. J Hepatol 2019; 70:423-430. [PMID: 30399385 DOI: 10.1016/j.jhep.2018.10.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 08/31/2018] [Revised: 10/24/2018] [Accepted: 10/27/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS Liver macrosteatosis (MS) is a major predictor of graft dysfunction after transplantation. However, frozen section techniques to quantify steatosis are often unavailable in the context of procurements, and the findings of preoperative imaging techniques correlate poorly with those of permanent sections, so that the surgeon is ultimately responsible for the decision. Our aim was to assess the accuracy of a non-invasive pocket-sized micro-spectrometer (PSM) for the real-time estimation of MS. METHODS We prospectively evaluated a commercial PSM by scanning the liver capsule. A double pathological quantification of MS was performed on permanent sections. Initial calibration (training cohort) was performed on 35 livers (MS ≤60%) and an algorithm was created to correlate the estimated (PSM) and known (pathological) MS values. A second assessment (validation cohort) was then performed on 154 grafts. RESULTS Our algorithm achieved a coefficient of determination R2 = 0.81. Its validation on the second cohort demonstrated a Lin's concordance coefficient of 0.78. Accuracy reached 0.91%, with reproducibility of 86.3%. The sensitivity, specificity, positive and negative predictive values for MS ≥30% were 66.7%, 100%, 100% and 98%, respectively. The PSM could predict the absence (<30%)/presence (≥30%) of MS with a kappa coefficient of 0.79. Neither graft weight nor height, donor body mass index nor the CT-scan liver-to-spleen attenuation ratio could accurately predict MS. CONCLUSION We demonstrated that a PSM can reliably and reproducibly assess mild-to-moderate MS. Its low cost and the immediacy of results may offer considerable added-value decision support for surgeons. This tool could avoid the detrimental and prolonged ischaemia caused by the pathological examination of (potentially) marginal grafts. This device now needs to be assessed in the context of a large-scale multicentre study. LAY SUMMARY Macro-vacuolar liver steatosis is a major prognostic factor for outcomes after liver transplantation. However, it is often difficult for logistical reasons to get this estimation during procurement. Therefore, we developed an algorithm for a commercial, portable and affordable spectrometer to accurately estimate this content in a real-time fashion. This device could be of great interest for clinical decision-making to accept or discard a potential human liver graft.
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Affiliation(s)
- Nicolas Golse
- Department of Surgery, Paul-Brousse Hospital Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif 94800, France; DHU Hepatinov, Villejuif 94800, France; INSERM, Unit 1193, Villejuif 94800, France; Univ Paris-Sud, UMR-S 1193, Villejuif 94800, France.
| | - Cyril Cosse
- Faculty of Medicine Paris V, Paris 75020, France
| | - Marc-Antoine Allard
- Department of Surgery, Paul-Brousse Hospital Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif 94800, France
| | - Andrea Laurenzi
- Department of Surgery, Paul-Brousse Hospital Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif 94800, France
| | - Michele Tedeschi
- Department of Surgery, Paul-Brousse Hospital Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif 94800, France
| | - Nicola Guglielmo
- Department of Surgery, Paul-Brousse Hospital Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif 94800, France
| | - Elena Fernandez-Sevilla
- Department of Surgery, Paul-Brousse Hospital Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif 94800, France
| | - Maud Robert
- Department of General Surgery and Bariatric Surgery, Edouard Herriot Hospital, Hospices Civils de Lyon-Claude Bernard Lyon 1 University, France
| | - Boris Tréchot
- Department of Surgery, Paul-Brousse Hospital Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif 94800, France
| | - Daniel Pietrasz
- Department of Surgery, Paul-Brousse Hospital Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif 94800, France
| | - Gabriella Pittau
- Department of Surgery, Paul-Brousse Hospital Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif 94800, France
| | - Oriana Ciacio
- Department of Surgery, Paul-Brousse Hospital Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif 94800, France
| | - Antonio Sa Cunha
- Department of Surgery, Paul-Brousse Hospital Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif 94800, France; DHU Hepatinov, Villejuif 94800, France; INSERM, Unit 1193, Villejuif 94800, France; Univ Paris-Sud, UMR-S 1193, Villejuif 94800, France
| | - Denis Castaing
- Department of Surgery, Paul-Brousse Hospital Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif 94800, France; DHU Hepatinov, Villejuif 94800, France; INSERM, Unit 1193, Villejuif 94800, France; Univ Paris-Sud, UMR-S 1193, Villejuif 94800, France
| | - Daniel Cherqui
- Department of Surgery, Paul-Brousse Hospital Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif 94800, France; DHU Hepatinov, Villejuif 94800, France; INSERM, Unit 1193, Villejuif 94800, France; Univ Paris-Sud, UMR-S 1193, Villejuif 94800, France
| | - René Adam
- Department of Surgery, Paul-Brousse Hospital Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif 94800, France; DHU Hepatinov, Villejuif 94800, France; INSERM, Unit 776, Villejuif F-94800, France; Univ Paris-Sud, UMR-S 776, Villejuif 94800, France
| | - Didier Samuel
- DHU Hepatinov, Villejuif 94800, France; INSERM, Unit 1193, Villejuif 94800, France; Univ Paris-Sud, UMR-S 1193, Villejuif 94800, France; Department of Hepatology, Paul-Brousse Hospital Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif 94800, France
| | - Mylene Sebagh
- Department of Pathology, Paul-Brousse Hospital Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif 94800, France
| | - Eric Vibert
- Department of Surgery, Paul-Brousse Hospital Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif 94800, France; DHU Hepatinov, Villejuif 94800, France; INSERM, Unit 1193, Villejuif 94800, France; Univ Paris-Sud, UMR-S 1193, Villejuif 94800, France
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Nobile MT, Vidili MG, Benasso M, Venturini M, Tedeschi M, Zunino F, Rosso R. A Preliminary Clinical Study of Cyclophosphamide with Reduced Glutathione Asc Uroprotector. Tumori 2018; 75:257-8. [PMID: 2773078 DOI: 10.1177/030089168907500313] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Reduced glutathione (GSH) has been reported to be an effective protector against cyclophosphamide-induced urotoxicity in experimental models, providing protection comparable to that of mesna. This paper describes our preliminary results of the clinical use of GSH in combination with cyclophosphamide. GSH was administered i.v. in two divided doses of 2.5 g, 15 min before and 30 min after escalating doses of cyclophosphamide ranging from 1.2 up to 1.6 g/m2 (1-h infusion). GSH was well tolerated and did not produce unexpected toxicity. The lack of bladder damage, including microscopic hematuria, supports the protective role of this thiol compound.
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Affiliation(s)
- M T Nobile
- Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
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25
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Locatelli MC, D'Antona A, Labianca R, Vinci M, Tedeschi M, Carcione R, Corbo A, Venturino P, Luporini G. A Phase II Study of Combination Chemotherapy in Advanced Ovarian Carcinoma with Cisplatin and Cyclophosphamide plus Reduced Glutathione as Potential Protective Agent against Cisplatin Toxicity. Tumori 2018; 79:37-9. [PMID: 8497920 DOI: 10.1177/030089169307900108] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and Backgroud The clinical use of cisplatin (CDDP)„ one of the most active agents in advanced ovarian cancer, is limited by nephrotoxicity and cumulative neurotoxicity. In preclinical studies, reduced glutathione (GSH) demonstrated a protective action against CDDP nephrotoxicity. We treated 20 patients with advanced ovarian carcinoma, with polichemotherapy containing CDDP + GSH, to assess the protective action of GSH against CDDP nephrotoxicity. Methods Between January 1988 and December 1989, 20 patients, with advanced ovarian carcinoma (St. III-IV-FIGO), not pretreated received CDDP: 45 mg/m2 i.v., on day 1-2, + cyclophosphamide (CPA): 900 mg/m2 i.v. on day 2 + GSH 2500 mg i.v. in normal saline 100 ml (in 15 min), before CDDP, every 21-28 days. Results A pathologic complete response rate (PCR) of 55 % (11/20) was observed (7/14 patients with bulky disease). Median survival was 26.5 months and 5 patients were still alive and disease free at 35 months. Toxicity was limited, without any case of nephrotoxicity. Conclusions On the basis of our previous experience with the same regimen without GSH, this study suggests that also in the clinical setting, GSH has no negative interference on CDDP activity and that GSH might improve the therapeutic index of CDDP. However, our data need to be confirmed by large randomized clinical studies.
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Affiliation(s)
- M C Locatelli
- Medical Oncology Dept., San Carlo Borromeo Hospital, Milan, Italy
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26
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Giorgakis E, Tedeschi M, Bonaccorsi-Riani E, Khorsandi SE, Menon K, Vilca-Melendez H, Jassem W, Srinivasan P, Prachalias A, Heaton N. The Effect of Recipient Body Mass Index and Its Extremes on Survival and Graft Vascular and Biliary Complications After Liver Transplantation: A Single Center Retrospective Study. Ann Transplant 2017; 22:611-621. [PMID: 29026064 DOI: 10.12659/aot.903475] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND This is the largest UK-based study on the effect of recipient body mass index (BMI) and its extremes (BMI <18.5 and BMI ≥35 kg/m²) on liver transplant (LT) outcomes. Its purpose was to analyze the BMI effect on post-LT mortality, graft loss, primary non-function (PNF), and graft vascular and biliary complications. MATERIAL AND METHODS Data were retrieved from a single-center LT database of 2,115 consecutive patients receiving first LT during period February 2004 to September 2015. Survivals were compared across the BMI groups; the effects of recipient BMI on survival, PNF, and graft vascular and biliary complications were analyzed via regression. RESULTS Autoimmune disease and nonalcoholic steatohepatitis were prevalent among underweight and morbidly obese adults, respectively. Graft survival was similar across BMI classes at 30 days and in 1, 2, 5, and 10 years (p=0.75) and on obese versus non-obese (p=0.33). BMI <35 kg/m² versus BMI ≥35 kg/m² mean graft survival was similar (p=0.84). BMI <18.5 kg/m² recipients tended to have inferior mean graft and patient survivals; however, the difference was non-significant (p=0.09 and p=0.1 respectively). BMI <18.5 kg/m² recipients were at higher risk of hepatic artery thrombosis (HR, 1.73, 95% CI 1.73-3, p<0.05). Adult underweight status was an independent HAT risk factor (HR 3, 95% CI 1-8.6, p=0.046). BMI class did not affect ischemic cholangiopathy risk (p=0.84). However, the overall biliary complication risk increased by 3% for every 1 kg/m² BMI rise. CONCLUSIONS Post-LT survival is independent of recipient BMI. Underweight status is linked to higher HAT risk. Biliary complication risk increases with rising recipient BMI. After appropriate recipient selection, recipient BMI extremes are not a contraindication for LT.
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Affiliation(s)
- Emmanouil Giorgakis
- Institute of Liver Studies, King's College Hospital, London, United Kingdom.,Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Michele Tedeschi
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | | | | | - Krishna Menon
- Institute of Liver Studies, King's College Hospital , London, United Kingdom
| | | | - Wayel Jassem
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Parthi Srinivasan
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Andreas Prachalias
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Nigel Heaton
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
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27
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Ricci F, Parravano M, Regine F, Sciamanna M, Tedeschi M, Missiroli F, Varano M. Aflibercept in persistent neovascular AMD: comparison of different treatment strategies in switching therapy. Eye (Lond) 2017; 31:163-164. [DOI: 10.1038/eye.2016.215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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28
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Giorgakis E, Tedeschi M, Bonaccorsi-Riani E, Khorsandi SE, Vilca-Melendez H, Heaton N. Primum Non Nocere: Organ Donation After Electrocution and Transplantation of Electricity-Damaged Livers: Report of 2 Cases. Transplant Proc 2016; 48:2596-2600. [PMID: 27788788 DOI: 10.1016/j.transproceed.2016.08.012] [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] [Received: 06/09/2016] [Accepted: 08/03/2016] [Indexed: 11/29/2022]
Abstract
Liver transplantation remains the treatment of choice for patients with end-stage liver disease. However, allograft availability continues to be a problem, and extending the criteria for organ acceptance is key. Deceased donors after electrical accidents, as well as electricity-traumatized allografts, are not common but should be considered suitable. This study describes 2 cases of heart-beating organ donors with electrical injury to the liver. In 1 case, the electric shock was the cause of death; in the second case, the injury was caused by defibrillation at organ procurement. Both allografts had sustained sizeable electrical injury, and both resulted in excellent early posttransplant outcomes. These cases demonstrate that electrocution is not a contraindication to donation and that electricity-traumatized allografts may remain transplantable after careful assessment. Education of all staff in the management of such donors can optimize utility of such allografts.
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Affiliation(s)
- E Giorgakis
- Institute of Liver Studies, King's College Hospital, London, United Kingdom.
| | - M Tedeschi
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - E Bonaccorsi-Riani
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - S E Khorsandi
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - H Vilca-Melendez
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - N Heaton
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
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29
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Ricci F, Parravano M, Regine F, Sciamanna M, Tedeschi M, Missiroli F, Varano M. Aflibercept in persistent neovascular AMD: comparison of different treatment strategies in switching therapy. Eye (Lond) 2016; 30:1077-83. [PMID: 27229701 DOI: 10.1038/eye.2016.95] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 02/25/2016] [Indexed: 11/09/2022] Open
Abstract
PurposeTo evaluate the effects of aflibercept administered according to a pro re nata (PRN) or Fixed Regimen to patients with neovascular AMD and persistent intraretinal/subretinal fluid (IRF/SRF) despite three consecutive ranibizumab injections.MethodsPatients were switched to aflibercept injection (IVA) administered according to a PRN or to a fixed regimen for 1 year in two different retina centers. At baseline each patient underwent a complete ophthalmologic evaluation, including best-corrected visual acuity assessment (BCVA ETDRS chart), fluorescein, and indocyanine green angiography and OCT.ResultsEach group included 36 eyes. After 1 year the PRN group showed BCVA stabilization (63 vs 60 letters, P=0.33), whereas fixed regimen group showed significant BCVA improvement (68 vs 71, P=0.008). The median central retinal thickness decreased by 94 μm in the PRN (P=0.002) and by 148 μm in the fixed regimen group (P≤0.001). Complete IRF/SRF reabsorption was found in 58% of eyes in the PRN and in 42% of eyes in the fixed regimen group. At 1-year visit, the percentage of eyes with pigment epithelium detachment did not significantly decrease, but a height reduction was recorded in both groups. The median number of IVA was 3.5 in the PRN and 7 in the fixed regimen group.ConclusionThe switch to aflibercept with both treatment strategies enabled improvement in morphological parameters and stabilization of visual acuity. BCVA improvement and reduction in vision loss with reduction in retinal thickness, fluid and PED height was achieved with the fixed regimen in previously treated nAMD after 1 year.
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Affiliation(s)
- F Ricci
- Ophthalmology Department, University of Rome Tor Vergata, Rome, Italy
| | - M Parravano
- Ophthalmology Department, Fondazione G.B. Bietti-IRCCS, Rome, Italy
| | - F Regine
- Ophthalmology Department, University of Rome Tor Vergata, Rome, Italy
| | - M Sciamanna
- Ophthalmology Department, Fondazione G.B. Bietti-IRCCS, Rome, Italy
| | - M Tedeschi
- Ophthalmology Department, Fondazione G.B. Bietti-IRCCS, Rome, Italy
| | - F Missiroli
- Ophthalmology Department, University of Rome Tor Vergata, Rome, Italy
| | - M Varano
- Ophthalmology Department, Fondazione G.B. Bietti-IRCCS, Rome, Italy
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30
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Testini M, Piccinni G, Lissidini G, Gurrado A, Tedeschi M, Franco IF, Di Meo G, Pasculli A, De Luca GM, Ribezzi M, Falconi M. Surgical management of the pancreatic stump following pancreato-duodenectomy. J Visc Surg 2016; 153:193-202. [PMID: 27130693 DOI: 10.1016/j.jviscsurg.2016.04.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Pancreato-duodenectomy (PD) is the treatment of choice for periampullary tumors, and currently, indications have been extended to benign disease, including symptomatic chronic pancreatitis, paraduodenal pancreatitis, and benign periampullary tumors that are not amenable to conservative surgery. In spite of a significant decrease in mortality in high volume centers over the last three decades (from>20% in the 1980s to<5% today), morbidity remains high, ranging from 30% to 50%. The most common complications are related to the pancreatic remnant, such as postoperative pancreatic fistula, anastomotic dehiscence, abscess, and hemorrhage, and are among the highest of all surgical complications following intra-abdominal gastro-intestinal anastomoses. Moreover, pancreatico-enteric anastomotic breakdown remains a life-threatening complication. For these reasons, the management of the pancreatic stump following resection is still one of the most hotly debated issues in digestive surgery; more than 80 different methods of pancreatico-enteric reconstructions having been described, and no gold standard has yet been defined. In this review, we analyzed the current trends in the surgical management of the pancreatic remnant after PD.
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Affiliation(s)
- M Testini
- Endocrine, Digestive, and Emergency Surgery Unit, Department of Biomedical Sciences and Human Oncology, University Medical School of Bari, Policlinico, Piazza Giulio Cesare 11, 70121 Bari, Italy.
| | - G Piccinni
- Endocrine, Digestive, and Emergency Surgery Unit, Department of Biomedical Sciences and Human Oncology, University Medical School of Bari, Policlinico, Piazza Giulio Cesare 11, 70121 Bari, Italy
| | - G Lissidini
- Endocrine, Digestive, and Emergency Surgery Unit, Department of Biomedical Sciences and Human Oncology, University Medical School of Bari, Policlinico, Piazza Giulio Cesare 11, 70121 Bari, Italy
| | - A Gurrado
- Endocrine, Digestive, and Emergency Surgery Unit, Department of Biomedical Sciences and Human Oncology, University Medical School of Bari, Policlinico, Piazza Giulio Cesare 11, 70121 Bari, Italy
| | - M Tedeschi
- Endocrine, Digestive, and Emergency Surgery Unit, Department of Biomedical Sciences and Human Oncology, University Medical School of Bari, Policlinico, Piazza Giulio Cesare 11, 70121 Bari, Italy
| | - I F Franco
- Endocrine, Digestive, and Emergency Surgery Unit, Department of Biomedical Sciences and Human Oncology, University Medical School of Bari, Policlinico, Piazza Giulio Cesare 11, 70121 Bari, Italy
| | - G Di Meo
- Endocrine, Digestive, and Emergency Surgery Unit, Department of Biomedical Sciences and Human Oncology, University Medical School of Bari, Policlinico, Piazza Giulio Cesare 11, 70121 Bari, Italy
| | - A Pasculli
- Endocrine, Digestive, and Emergency Surgery Unit, Department of Biomedical Sciences and Human Oncology, University Medical School of Bari, Policlinico, Piazza Giulio Cesare 11, 70121 Bari, Italy
| | - G M De Luca
- Endocrine, Digestive, and Emergency Surgery Unit, Department of Biomedical Sciences and Human Oncology, University Medical School of Bari, Policlinico, Piazza Giulio Cesare 11, 70121 Bari, Italy
| | - M Ribezzi
- Anesthesiology Unit, Department of Emergency Surgery and Organs Transplantation, University Medical School of Bari, Policlinico, Piazza Giulio Cesare 11, 70121 Bari, Italy
| | - M Falconi
- Pancreatic Surgery Unit, San Raffaele Hospital IRCCS, University Vita e Salute, Milan, Italy
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Tedeschi M, Vittore F, Di Fronzo P, Gurrado A, Piccinni G, Testini M. Autoimmune pancreatitis or pancreatic cancer? A dilemma in a pregnant woman. Ann Ital Chir 2015; 86:66-69. [PMID: 25624427] [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: 06/04/2023]
Abstract
INTRODUCTION Autoimmune pancreatitis is now a defined entity and it could mimic a pancreatic malignancy. True oncological emergencies in pregnant patients are rare. CASE REPORT A 39 years-old pregnant woman was admitted to our emergency unit due to right upper quadrant abdominal pain and evidence of obstructive jaundice. Since computed tomography-scan and endoscopic retrograde cholangiopancreatography are contraindicated in pregnant woman, a cholangio-Nuclear Magnetic Resonance was performed, confirming the biliary tract dilatation with stenosis of the intrapancreatic portion of the common bile duct and a shaded image of a mass in the pancreatic head. An endoscopic ultrasound with fine needle aspiration biopsy were performed. US-guided external percutaneous trans-hepatic biliary drainage was successfully performed. The cytological examination showed the presence of erythrocytes, granulocytes, histiocytes and rare lymphocytes; a diagnosis of AIP was supposed, and steroid therapy with metilprednisolone was started. Laboratory tests and jaundice were normalized within 15 days, and the fetus was born in very good health, 22 weeks after. The follow-up was uneventful and a CT-scan confirmed the complete normalization of the pancreatic gland, 12 months after hospital discharge. CONCLUSION Autoimmune pancreatitis should be taken into account in the differential diagnosis of a not well defined pancreatic mass; in the event of pancreatic mass-forming disease in pregnancy, the differential diagnosis should be early and accurate, because destructive surgery involves an high rate of morbidity and may interrupt pregnancy. A US-guided FNAB and the response to the corticosteroid therapy should lead to a correct diagnosis.
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Vavallo A, Lucarelli G, Bettocchi C, Tedeschi M, Palazzo S, Losappio V, Gesualdo L, Grandaliano G, Selvaggi FP, Battaglia M, Ditonno P. Allograft nephrectomy: what is the best surgical technique? Transplant Proc 2013; 44:1922-5. [PMID: 22974872 DOI: 10.1016/j.transproceed.2012.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The objective of this study was to evaluate differences in outcomes of allograft nephrectomies performed by extracapsular versus intracapsular techniques. METHODS From 1993 to 2010, we performed 89 allograft nephrectomies, including 57 by extracapsular techniques and 32 by intracapsular, chosen according to feasibility at the beginning of the surgery. Fisher exact test and logistic regression were used for statistical analysis. Survival estimates after allograft nephrectomy were calculated according to the Kaplan-Meier method. RESULTS After a mean graft survival of 49.7 months, the indications for transplant nephrectomy were chronic rejection (39.3%), acute rejection (22.5%), infection/sepsis (19.1%), gross hematuria (6.7%), renal vein thrombosis (6.7%), renal artery thrombosis (3.4%), and graft rupture (2.3%). Mean operative time, blood loss, transfusions, and complications were similar between the extracapsular and intracapsular groups. The only difference in surgical aspects between the 2 groups was the mean hospital stay, which was longer for the extracapsular group (13.8 vs 7.6 days; P = .01), a result that was confirmed by multivariate analysis (odds ratio, 1.05; 95% confidence interval, 1.0-1.1; P = .03). CONCLUSIONS Our experience showed no significant advantages in favor of the intracapsular technique except for a shorter length of hospital stay than after the extracapsular procedure.
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Affiliation(s)
- A Vavallo
- Urology, Andrology, and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.
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Impedovo SV, Martino P, Palazzo S, Ditonno P, Tedeschi M, Giangrande F, Miacola C, Forte S, Selvaggi FP, Battaglia M. Value of the resistive index in patient and graft survival after kidney transplant. Arch Ital Urol Androl 2012; 84:279-282. [PMID: 23427764] [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: 06/01/2023] Open
Abstract
INTRODUCTION The resistive index (RI) obtained by performing doppler sonography is a hemodynamic index commonly used to measure flow resistance within an organ to assess if there is a vascular disease associated with that organ. It is a well-known predictor of kidney transplant outcome. The purpose of this study was to analyze the impact of RI values on patient and graft survival, as well as kidney graft function during 5-year follow-up. MATERIALS AND METHODS We retrospectively investigated 761 kidney transplant recipients from cadaveric donors performed between 1998 to 2011. RI was measured at hospital discharge after the kidney transplant. All the patients were divided into tertiles, according to the baseline RI value (group 1: RI < 0.70, group 2: RI between 0.70 and 0.79 and group 3: RI > 0.80). RESULTS Patients with a low RI (<0.70) showed the lowest incidence of delayed graft function (DGF) compared to the other two groups (20.2% vs. 32.2% vs. 33%). Recipients with low RI values displayed significantly better creatinine clearance (70 vs. 55 vs 35 ml/min, respectively) than those with medium or high RI values at 5-year follow-up. Kaplan-Meier estimates of cumulative graft survival were significantly worse in patients who had a RI of 0.70 or more than in patients with a RI of less than 0.70 (p = 0.02). Cumulative patient survival showed the same behavior (0.01) CONCLUSIONS Low RI values measured in segmental arteries in the very early post-transplant period predict better kidney graft function and reduce the risk of all-cause graft loss, including patient death in a 5-year follow-up period.
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Affiliation(s)
- Stefano Vittorio Impedovo
- Urology, Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.
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Impedovo SV, Martino P, Palazzo S, Ditonno P, Tedeschi M, Palumbo F, Tafa A, Matera M, Selvaggi FP, Battaglia M. Ultrasonographic findings in dual kidney transplantation. Arch Ital Urol Androl 2012; 84:245-248. [PMID: 23427755] [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: 06/01/2023] Open
Abstract
INTRODUCTION Organ shortage has led to using grafts from expanded criteria donors (ECD). Double kidney transplantation is an accepted strategy to increase the donor pool, using organs from an ECD which are not acceptable for single kidney transplantation (SKT). Aim of this retrospective study was to analyse the role of colour Doppler ultrasound (CDUS) in the diagnosis of major surgical complications in DKT, performed with unilateral or bilateral placement. MATERIALS AND METHODS From 2000 to 2011 we performed 54 DKT. Unilateral placement of both kidneys was done in 26 patients and bilateral DKT in 28, through two separate Gibson incisions (18) or one midline incision (10). Each patient underwent at least 3 CDUS before hospital discharge. The main surgical complications, discovered initially thanks to ultrasound (US), were hydronephrosis from ureteral obstruction, lymphocele and deep venous thrombosis (DVT). RESULTS Mean follow-up was 42.7 months. Good postoperative renalfunction was demonstrated in 25 patients (46.3%), while delayed graft function occurred in 29 (53.7%). US showed ureteral obstruction requiring surgery in 5 unilateral DKT while no patient subjected to bilateral DKT developed severe hydronephrosis. Lymphoocele, surgically drained, was demonstrated in 6 bilateral DKT with a midline incision, 2 bilateral DKT with two separate incisions and 3 unilateral DKT. CDUS also enabled diagnosis of 2 cases of DVT in ipsilateral DKTs. CONCLUSIONS CDUS provides useful information in patients with DKT, allowing the detection of clinically unsuspected unilateral diseases. US study of our patients demonstrated that unilateral DKTs are more susceptible to the development of DVT and ureteral stricture, while the incidence of voluminous lymphocele is more frequent in bilateral DKT through a single midline incision. In this scenario, all patients undergoing DKT should be carefully monitored by US after surgery.
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Affiliation(s)
- Stefano Vittorio Impedovo
- Urology, Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.
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Martino P, Impedovo SV, Palazzo S, Ditonno P, Ricapito V, Saracino GA, Lucarelli G, Tedeschi M, Bettocchi C, Battaglia M. Ureteral strictures after kidney transplantation: risk factors. Arch Ital Urol Androl 2012; 84:287-290. [PMID: 23427766] [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: 06/01/2023] Open
Abstract
INTRODUCTION Ureteral obstruction is one of the most commonly reported urological complications after kidney transplantation often occurring within the first 3 months after surgery. Ischemia is the most frequent cause of ureteral stenosis and is the result of excessive hilar dissection and a poor anastomotic technique. Aim of this study was to identify the main risk factors for ureteral stenosis after kidney transplantation from cadaveric donors and to assess their impact on both graft survival and patient. MATERIALS AND METHODS We retrospectively investigated 761 kidney transplants from cadaveric donors performed between 1998 to 2011. In all the patients, the ureteroneocystostomy was stented with a double J stent 4.7Ch x 12 cm held in place for an average time of 4-6 weeks post-operatively. Each patient underwent at least 3 ultrasound scans during hospital stay and subsequently during follow-up. All patients with severe hydronephrosis were followed by sequential renal scintigraphy with MAG3 and diuretic stimulus. RESULTS After a mean follow-up of 60.1 (+/- 38.5) months, severe ureteral stenosis was discovered in 21 patients (2.76%), with exclusive involvement of the vesicoureteral junction. No statistically significant correlation was found with donor age and the incidence of delayed graft function, whereas a significant correlation between ureteral obstruction and unilateral placement of both grafts in dual kidney transplantation (DKT) (p < 0.001) was found. These patients had a longer mean hospital stay than the control group, but there was no influence on survival of the organ or patient. CONCLUSIONS ureteral obstruction after renal transplantation often features subtle and late symptoms. Early ultrasound monitoring is therefore essential and in the presence of severe hydronephrosis, scintigraphic confirmation of the obstruction. In fact. early resolution of the stenosis appears to provide optimal graft and patient survival.
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Affiliation(s)
- Pasquale Martino
- Urology, Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.
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Tedeschi M, Cuccia F, Angarano E, Piscitelli D, Gigante G, Altomare DF. Solitary schwannoma of the rectum mimicking rectal cancer. Report of a case and review of the literature. Ann Ital Chir 2011; 82:309-312. [PMID: 21834483] [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
A case of a submucosal tumor bulging into the rectum in an old female patient is reported. It proved to be a very rare case of rectal schwannoma, whose differential diagnosis is difficult to obtain preoperatively and optimal treatment and prognosis still uncertain. The mass was removed by means of an ultrasound device after an open anterior rectotomy. The operation was uneventful and the patient is disease free 18 months after.
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Affiliation(s)
- Michele Tedeschi
- Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Bari, Italy
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Pino MS, Fabi A, Tedeschi M, Mottolese M, Papaldo P, Vici P, Ferretti G, Nisticò C, Russillo M, Cuppone F, Di Benedetto A, Botti C, Giannarelli D, Cognetti F. Biological markers to predict response to neoadjuvant chemotherapy (NCT) in patients with locally advanced breast cancer (LABC): Ready for prime time? J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e11073] [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: 11/20/2022] Open
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Altomare DF, Tedeschi M, Rotelli MT, Bocale D, Piscitelli D, Rinaldi M. Lack of prognostic role of pre- and postoperative peritoneal cytology and cytokeratin PCR-expression on local recurrence after curative anterior resection for mid-low rectal cancer. Updates Surg 2011; 63:109-13. [PMID: 21509696 DOI: 10.1007/s13304-011-0071-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2010] [Accepted: 04/08/2011] [Indexed: 12/16/2022]
Abstract
Local recurrence continues to be a major problem in rectal cancer. After cancer removal, detection of viable cancer cells could be useful to identify patients at risk for local recurrence. Thus, aim of the study was the detection of residual peritoneal cancer cells with a possible prognostic role for local recurrence. Twenty-nine patients were operated (R0) for low (extraperitoneal) rectal cancer, without neoadjuvant radiochemotherapy. Before and immediately after cancer removal, a peritoneal lavage was done to evaluate by RT-PCR the cytokeratin 20 mRNA on isolated cells and in order to detect cancer cells by the Thin-prep test. After a median follow-up of 39 months, 5 patients died (17%), one for non-cancer-related disease, two (7%) for local recurrence and peritoneal carcinosis, and two for distant metastases. Preoperative cytology with Thin-prep test was positive in 4 patients (14%), while postoperative peritoneal cytology was positive only in 1 patient, different from the previous. No patient developed local or distal recurrence and all were disease-free at the end of the follow-up. RT-PCR analysis was positive on the peritoneal lavage after cancer removal in 11 patients. One died for unrelated cause and no one developed local recurrences. Local recurrence occurred in only 1 of the 2 patients with positive RT-PCR analysis on the first lavage and negative on the second lavage. Our study demonstrates a not important prognostic role of Thin-prep test and RT-PCR of cytokeratin 20 mRNA on the detection of patients at risk for local recurrence after curative resection of rectal cancer.
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Affiliation(s)
- Donato F Altomare
- General Surgery and Liver Transplantation Unit, Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Policlinico, Piazza G Cesare, 11-70124 Bari, Italy.
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Vavallo A, Lucarelli G, Tedeschi M, Impedovo S, Rutigliano M, Bettocchi C, Selvaggi F, Battaglia M, Ditonno P. 397 DIABETES MELLITUS IS A RISK FACTOR FOR RECURRENCE AND MORTALITY IN PATIENTS WITH RENAL CELL CARCINOMA. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/s1569-9056(11)60391-6] [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] [Indexed: 11/24/2022]
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Martino P, Palazzo S, Crudele V, Benedetto G, Tedeschi M, Bettocchi C, Ditonno P, Lucarelli G, Selvaggi FP. Echoguided treatment of simple renal cysts: our experience from 1995 to 2010. Arch Ital Urol Androl 2010; 82:284-286. [PMID: 21341583] [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: 05/30/2023] Open
Abstract
UNLABELLED The simple renal cysts are the most frequent lesions of kidney in adults. Approximately 30% of subjects older than 70 years presents a simple renal cysts. It is well accepted that a simple renal cyst without symptoms does not require any treatment. OBJECTIVE Evaluate the efficacy of the echoguided treatment of simple renal cysts with a single sclerotherapy. MATERIAL AND METHODS Since 1995 to March 2010 in our clinic 329 patients underwent percutaneous drainages of simple renal cysts. In 56 cases (17% of patients) it was a simple aspiration, in 69 cases (21%) a drainage was placed for 24 hour continuous draining and in 204 cases (62%) lesions were treated by sclerotherapy. After aspiration of fluid we injected inside the cyst 99% ethanol in the amount equal to 30% of aspirated volume and never exceeding 60 ml. After 40 minutes we aspirated ethanol and removed the drainage. RESULTS The outcome was considered good if the size of the cyst was less of 50% of the primary size. Percutaneous drainage with sclerotherapy showed a success rate of almost 100% using 99% ethanol. However, this method is not completely free from complications. CONCLUSIONS The long-term results and the mini-invasive modality of treatment without hospedalization are the most important advantages of this procedure. Furthermore our experience showed a good success rate with a single sclerotherapy with benefit to the patient and lower costs of procedure.
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Affiliation(s)
- Pasquale Martino
- Department of Emergency and Organ Transplantation - Urology I, University of Bari "Aldo Moro", Italy.
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Martino P, Lucarelli G, Palazzo S, Tedeschi M, Impedovo SV, Di Lorenzo V, Ditonno P, Battaglia M, Selvaggi FP. Surgical complications of renal transplantation: ultrasound diagnosis. Arch Ital Urol Androl 2010; 82:221-225. [PMID: 21341568] [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: 05/30/2023] Open
Abstract
OBJECTIVE Ultrasound is the principal imaging technique for the evaluation of a renal allograft; it is a safe imaging technique to assess the structure of the graft and its perfusion without the need for intravenous contrast or ionizing radiation. The evaluation of kidney transplant complications is easy due to its presence in the iliac fossa lying anterior to the external iliac vessels. Complications may be classified as medical and surgical; the latter are classified in urologic, vascular and general surgical complications. MATERIALS AND METHODS Our experience on surgical complications in kidney recipients from donors, on the role of ultrasound in the diagnosis of these complications and their impact on the graft and patient survival rates is reported. RESULTS Ultrasonography represents a safe imaging technique to assess the structure of the graft and its perfusion without the use of ionizing radiation and iodinated contrast medium, and a quick, accurate method for the evaluation of complications. CONCLUSIONS Although it possesses limitations and is ultimately operator dependent, ultrasound is considered an excellent tool for the assessment of the kidney transplant and in our experience it represents the main imaging technique used in the evaluation of graft complications.
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Affiliation(s)
- Pasquale Martino
- Department of Emergency and Organ Transplantation - Urology, Andrology and Kidney Transplantation Unit - University of Bari, Italy.
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Grilli E, Messina M, Tedeschi M, Piva A. Feeding a microencapsulated blend of organic acids and nature identical compounds to weaning pigs improved growth performance and intestinal metabolism. Livest Sci 2010. [DOI: 10.1016/j.livsci.2010.06.056] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Greco LG, Tedeschi M, Stasolla S, Gentile A, Gentile A, Piscitelli D. Abdominal nodal localization of Castleman's disease: report of a case. Int J Surg 2010; 8:620-2. [PMID: 20674810 DOI: 10.1016/j.ijsu.2010.06.019] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Revised: 06/22/2010] [Accepted: 06/28/2010] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Castleman's disease (CD) is a rare benign disorder that may grow in any area where lymphoid tissue is normally present but the most frequent site is mediastinum (67%); the abdomen is rarely affected by this pathology. In the pathogenesis of CD an important role could be played by HHV-8. Diagnosis is difficult and the diagnostic certainty is obtained only by histological examination. For this disease there is no gold-standard treatment. CASE REPORT We report the case of a woman of 33 years of age affected by a rare form of abdominal nodal localization of Castleman's Disease for which the patient underwent surgery. CONCLUSION CD must be included in the differential diagnosis of retroperitoneal tumors even though the definitive diagnosis can only be achieved by histological and immunohistochemical examination. In the case of single location, the treatment of choice is surgical removal.
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Affiliation(s)
- L G Greco
- Department of Emergency and Organ Transplantation, Section of General Surgery and Liver Transplantation, University of Bari, Italy
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Catalano G, Puglisi F, De Fazio M, Tedeschi M, Gentile A, Memeo R, Memeo V. Mucinous cystic neoplasm of the pancreas: a case report. Chir Ital 2009; 61:375-379. [PMID: 19694242] [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
Cystic neoplasms of the pancreas account for only a small percentage of pancreatic tumours. They include mucinous cystic tumours, which have a higher incidence in females in their forties or fifties. Cystic neoplasms of the pancreas can present in a benign, borderline or malignant form. These tumours have a natural evolution from a benign (mucinous cystadenoma) to a malignant form (cystadenocarcinoma). It is not always easy to diagnose cystic tumours, including mucinous cystic tumours of the pancreas, and the final diagnosis is often reached only after the surgical procedure, which is the gold standard treatment of this disease. We present the case of a 56-year-old woman affected by a mucinous cystic tumour of the body-tail of the pancreas, who underwent distal splenopancreasectomy. She was discharged on postoperative day 12. After an 18-month followup, she is in good general condition and disease-free.
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Affiliation(s)
- Giorgio Catalano
- General Surgery and Liver Transplantation, DETO, University of Bari
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Tedeschi M, Varano M, Schiano Lomoriello D, Scassa C, Parisi V. Photodynamic therapy outcomes in a case of macular choroidal neovascularization secondary to Candida endophthalmitis. Eur J Ophthalmol 2007; 17:124-7. [PMID: 17294393 DOI: 10.1177/112067210701700118] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the effects on visual function and choroidal neovascularization (CNV) progression in a case of subretinal CNV due to Candida endophthalmitis treated with a combination of photodynamic therapy (PDT) and drugs. METHODS A 28-year-old one-eyed woman with CNV in the right eye came to our observation. The CNV developed as a consequence of Candida endophthalmitis. The CNV was treated with six PDT treatments with verteporfin in association with systemic steroid therapy with prednisone (100 mg/day to reduce) and fluconazole (800 mg/day to reduce). Visual acuity (VA) was assessed in pre-PDT conditions and after six PDT treatments (24 months of follow-up). RESULTS Pre-PDT VA was 20/125; after 24 months of follow-up, six PDT re-treatments, and pharmacologic therapy, VA was stabilized at 20/100. CONCLUSIONS In our case, associated PDT and drug therapies were safe and useful to maintain VA and to arrest CNV progression in the foveal region after 2 years of follow-up.
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Affiliation(s)
- M Tedeschi
- G.B. Bietti Eye Foundation, IRCCS, Roma, Italy.
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Piermarocchi S, Sartore M, Bandello F, Lanzetta P, Brancato R, Garattini L, Lumbroso B, Rispoli M, Pece A, Isola V, Pulazzini A, Menchini U, Virgili G, Tedeschi M, Varano M. Quality of vision: A consensus building initiative for a new ophthalmologic concept. Eur J Ophthalmol 2007; 16:851-60. [PMID: 17191192 DOI: 10.1177/112067210601600611] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Many studies have addressed the quantification of visual acuity, and the conventional method of measuring it has so far demonstrated serious limitations. Vision testing requires new methods that can more precisely express the quality of vision as perceived by the patient. METHODS This study employed the Delphi method of consensus building. Concepts associated with quality of vision (QoV) were identified by a board of experts and proposed to participating specialists in two subsequent questionnaires. Upon receipt of the completed questionnaires, the replies were classified to determine the building blocks of a consensus. RESULTS By analyzing the replies to the two questionnaires, the authors determined the key elements of QoV on which a consensus was found among the respondents. CONCLUSIONS A consensus was reached on the opinion that the quantification of visual acuity by traditional means is inadequate for investigating QoV. Although visual acuity is still a basic element for testing, the experts believe that contrast sensitivity, reading speed, and microperimetry are additional parameters necessary for quantifying QoV. The use of a psychometric questionnaire on visual function could allow a better interpretation of visual impairment.
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Affiliation(s)
- S Piermarocchi
- Department of Neurosciences, Section of Ophthalmology, University of Padova, Padova, Italy.
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Dubois RW, Aguilar D, Fass R, Orr WC, Elfant AB, Dean BB, Harper AS, Yu HT, Melmed GY, Lynn R, Singh A, Tedeschi M. Consequences of frequent nocturnal gastro-oesophageal reflux disease among employed adults: symptom severity, quality of life and work productivity. Aliment Pharmacol Ther 2007; 25:487-500. [PMID: 17270005 DOI: 10.1111/j.1365-2036.2006.03189.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Effects of frequent nocturnal symptoms of gastro-oesophageal reflux disease (GERD-FNS) on health-related quality of life (HRQOL) and work productivity are not well documented. AIM To assess symptom severity, production loss, and HRQOL among employed adults with and without GERD-FNS. METHODS Using several validated outcome measures in a web survey design, GERD was pre-specified as GERD Symptom and Medication Questionnaire score >9, and > or =1 episode of heartburn or acid regurgitation during the preceding week. GERD-FNS patients were those reporting > or =2 symptom-nights during the previous week; their outcomes were compared with those of patients having minimal or no nocturnal symptoms (GERD-NNS) and vs. non-GERD controls. RESULTS Data were collected from 1002 GERD patients (476 GERD-FNS, 526 GERD-NNS) and 513 controls. Severe symptoms were more common, sleep abnormalities were more frequent (P < 0.0001) and SF-36 scores lower (P < 0.05, all scores) among GERD-FNS patients vs. GERD-NNS patients. GERD-related work loss was greater among those with GERD-FNS vs. GERD-NNS (P < 0.0001). Work loss and functional limitations were more pronounced when comparing GERD-FNS cases vs. non-GERD controls. CONCLUSION Employed adults with frequent nocturnal GERD report more severe symptoms, and are associated with impaired sleep, HRQOL and work productivity compared with controls and patients with minimal or no nocturnal symptoms.
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Affiliation(s)
- R W Dubois
- Cerner LifeSciences, Los Angeles, CA, USA
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Piva A, Pizzamiglio V, Morlacchini M, Tedeschi M, Piva G. Lipid microencapsulation allows slow release of organic acids and natural identical flavors along the swine intestine1,2. J Anim Sci 2007; 85:486-93. [PMID: 17040943 DOI: 10.2527/jas.2006-323] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The purpose of the present work was to investigate the in vivo concentrations of sorbic acid and vanillin as markers of the fate of organic acids (OA) and natural identical flavors (NIF) from a microencapsulated mixture and from the same mixture non-microencapsulated, and the possible consequences on the intestinal microbial fermentation. Fifteen weaned pigs were selected from 3 dietary groups and were slaughtered at 29.5 +/- 0.27 kg of BW. Diets were (1) control; (2) control supplemented with a blend of OA and NIF microencapsulated with hydrogenated vegetable lipids (protected blend, PB); and (3) control supplemented with the same blend of OA and NIF mixed with the same protective matrix in powdered form but without the active ingredient coating (non-protected blend, NPB). Stomach, cranial jejunum, caudal jejunum, ileum, cecum, and colon were sampled to determine the concentrations of sorbic acid and vanillin contained in the blend and used as tracers. Sorbic acid and vanillin were not detectable in pigs fed the control, and their concentrations were not different in the stomach of PB and NPB treatments. Pigs fed PB showed a gradual decrease of the tracer concentrations along the intestinal tract, whereas pigs fed NPB showed a decline of tracer concentration in the cranial jejunum and onwards, compared with the stomach concentrations. Sorbic acid and vanillin concentrations along the intestinal tract were greater (P = 0.02) in pigs fed PB compared with pigs fed NPB. Pigs fed PB had lower (P = 0.03) coliforms in the caudal jejunum and the cecum than pigs fed the control or NPB. Pigs fed the control or PB had a greater (P = 0.03) lactic acid bacteria plate count in the cecum than pigs fed NPB, which showed a reduction (P = 0.02) of lactic acid concentrations and greater (P = 0.02) pH values in the caudal jejunum. The protective lipid matrix used for microencapsulation of the OA and NIF blend allowed slow-release of both active ingredients and prevented the immediate disappearance of such compounds upon exiting the stomach.
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Affiliation(s)
- A Piva
- DIMORFIPA, Università di Bologna, 40064 Ozzano Emilia, Bologna, Italy.
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Ravera L, Colombo I, Tedeschi M, Ravera A. Security and privacy at the private multispecialty hospital Istituto Clinico Humanitas: strategy and reality. Int J Med Inform 2004; 73:321-4. [PMID: 15066566 DOI: 10.1016/j.ijmedinf.2003.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Tedeschi M. Naltrexone and acamprosate. Using new drugs for alcohol dependence. Aust Fam Physician 2001; 30:447-50. [PMID: 11432017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
BACKGROUND Two new drugs for the treatment of alcohol dependence have recently become available in Australia. Both naltrexone and acamprosate have an 'anticraving' action, but act on different pathways and have different properties. OBJECTIVE This article aims to give an outline of the major pharmacological features of the two new drugs and some guidelines on their use for general practitioners. DISCUSSION The past 50 years have seen major advances in almost all medical disciplines. A notable exception has been the alcohol and drug field. The arrival of methadone to Australia in the 1960s was, until lately, the most recent advance in the field. Over the past 18 months, several new drugs have become available for use in alcohol and drug (A&D) clinics. These drugs have also become available to the GP, but their use by this group remains relatively small.
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Affiliation(s)
- M Tedeschi
- ACT Alcohol and Drug Program, Canberra Hospital, ACT
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