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Simonini A, Brogi E, Mazzei O, Paraboschi I, Mattioli G, Conti G, D'Agostino R. Airway Fire during Laser Surgery of the Vocal Cords in Children: A Case Report. Turk J Anaesthesiol Reanim 2022; 49:257-260. [PMID: 35110148 DOI: 10.5152/tjar.2021.22] [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: 11/22/2022] Open
Abstract
OBJECTIVES Fire in the operating theater is a potential source of important morbidity for the patient. Laser surgery of the head and neck district presents a particularly high risk of fire due to the presence of all three elements of the 'fire triad,' necessary to cause combustive or explosive events: an oxidiser, a fuel, and a heat source. The aim of the present study is to emphasise the need of new prevention tools and greater adherence to the recommendations available in the literature. METHODS The sudden occurrence of combustion within the airway of an infant undergoing laryngeal laser surgery was presented along with his management. RESULTS An infant underwent CO2 laser surgery for the treatment of the laryngeal stenosis. Unfortunately, the endoscopic procedure was complicated by a fire of the tracheal tube. The tube was immediately removed, the saline was flushed down the trachea and the ventilation was maintained through a face mask. Subsequently, a fiberoscopy was performed and showed a vocal cord burn. CONCLUSIONS Since operating room fires are still an underreported occurrence, we believe that this present work might raise awareness about this potential complication and give useful suggestions for the management of airway fires in paediatric anaesthesia.
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Affiliation(s)
- Alessandro Simonini
- Department of Anesthesiology and Intensive Care, Istituto G. Gaslini, Genoa, Italy
| | - Etrusca Brogi
- Department of Anesthesiology and Intensive Care, University of Pisa, Pisa, Italy
| | - Oscar Mazzei
- Department of Paediatric Surgery, Policlinico Umberto I, Rome, Italy
| | - Irene Paraboschi
- Department of Paediatric Surgery, Istituto G. Gaslini, Genoa, Italy;DINOGMI, University of Genoa, Genoa, Italy
| | - Girolamo Mattioli
- Department of Paediatric Surgery, Istituto G. Gaslini, Genoa, Italy;DINOGMI, University of Genoa, Genoa, Italy
| | - Giorgio Conti
- Department of Anesthesiology and Intensive Care, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Universita` Cattolica Del Sacro Cuore, Rome, Italy
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Paraboschi I, Fati F, Rizzo F, Sacco O, Stagnaro N, Mattioli G, Simonini A, Mazzei O, Torre M. Ectopic Thymus: An Unusual Case of Subglottic Mass. Ann Otol Rhinol Laryngol 2019; 128:1182-1188. [DOI: 10.1177/0003489419863828] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: The aim of our study is to report a case of a child with subglottic thymus that was suspected during diagnostic work-up for severe airway obstruction, excised surgically and confirmed with final histopathological examination. Moreover, we performed a narrative literature review to outline clinical and diagnostic features of this rare condition and to report suggestions for the management of subglottic masses. Methods: We report the case of a 7-month-old boy who was admitted to our Pediatric Airway Team Unit due to a history of worsening biphasic stridor and recurrent episodes of upper airway obstruction. The successful diagnostic work-up and a narrative literature of analogous cases of subglottic thymus were reported. Results: Ectopic thymus is a very rare condition in which thymic tissue is found outside the normal pathway of its embryonic migration. It usually presents as a cystic or, more rarely, solid mass, showing an indolent course toward spontaneous involution. In some cases, however, it becomes symptomatic exerting compression on surrounding vital structures. Due to its rarity, the initial diagnosis is normally mistaken with inflammatory diseases or malignancies and the definitive diagnosis is only achieved after histological examination of the excised specimen. To our knowledge, only four other cases of subglottic ectopic thymic tissue have been reported in the English literature so far and the diagnosis has never been suspected preoperatively. Conclusion: It is mandatory to consider ectopic thymic tissue in the differential diagnosis in children presenting with airways obstruction in order to prevent unnecessary, extensive, and exploratory surgery.
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Affiliation(s)
- Irene Paraboschi
- DINOGMI University of Genoa, Genoa, Italy
- Paediatric Surgery Unit, Giannina Gaslini Research Institute and Children Hospital, Genoa, Italy
| | | | - Francesca Rizzo
- Radiology Unit, Giannina Gaslini Research Institute and Children Hospital, Genoa, Italy
| | - Oliviero Sacco
- Pediatric Airway Team Unit, Giannina Gaslini Research Institute and Children Hospital, Genoa, Italy
| | - Nicola Stagnaro
- Radiology Unit, Giannina Gaslini Research Institute and Children Hospital, Genoa, Italy
| | - Girolamo Mattioli
- DINOGMI University of Genoa, Genoa, Italy
- Paediatric Surgery Unit, Giannina Gaslini Research Institute and Children Hospital, Genoa, Italy
| | - Alessandro Simonini
- Anesthesia and Intensive Care, Neonatal and Pediatric Intensive Care Unit, Giannina Gaslini Research Institute and Children Hospital, Genoa, Italy
| | | | - Michele Torre
- Pediatric Airway Team Unit, Giannina Gaslini Research Institute and Children Hospital, Genoa, Italy
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Torre M, Paraboschi I, Loy A, Mesini A, Pistorio A, Simonini A, Mattioli G, Mazzei O, Piro L, Bandettini R, Castagnola E. Prolonged antibiotic administration for surgical site infection in pediatric laryngotracheal surgery. Laryngoscope 2018; 129:2634-2639. [PMID: 30589074 DOI: 10.1002/lary.27699] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 03/30/2018] [Revised: 10/12/2018] [Accepted: 10/22/2018] [Indexed: 11/05/2022]
Abstract
OBJECTIVES/HYPOTHESIS Incidence of surgical site infection (SSI) after laryngotracheal (LT) surgery is relatively high, especially in children. STUDY DESIGN Retrospective and prospective cohort study. METHODS Clinical records of children who underwent open LT surgery at the Istituto Giannina Gaslini Children's Hospital from January 2008 to August 2017 were reviewed for development of SSI. Standard antibiotic prophylaxis was administered until February 2015. In March 2015, an antibiotic treatment tailored on pathogens isolated from surveillance cultures and prolonged until extubation was introduced. Incidence and risk factors for SSI before and after the new protocol implementation were analyzed by means of univariate and multivariable analyses. RESULTS A total of 57 procedures were analyzed. SSI incidence was 36% in patients receiving standard prophylaxis and 4% in those treated with the new strategy (P = .004), with an absolute benefit increase of 32% (95% confidence interval: 11%-52%), in absence of any difference in clinical conditions between the two groups. CONCLUSIONS The new management protocol had a highly favorable impact on the development of an SSI. LEVEL OF EVIDENCE 2b Laryngoscope, 129:2634-2639, 2019.
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Affiliation(s)
- Michele Torre
- Pediatric Surgery and Airway Team Unit, Scientific Institute for Research, Hospitalization, and Health Care, Istituto Giannina Gaslini, Genoa, Italy
| | - Irene Paraboschi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Science, University of Genoa, Genoa, Italy
| | - Anna Loy
- Infectious Diseases Unit, Scientific Institute for Research, Hospitalization, and Health Care, Istituto Giannina Gaslini, Genoa, Italy
| | - Alessio Mesini
- Infectious Diseases Unit, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Angela Pistorio
- Epidemiology and Biostatistics Unit, Scientific Institute for Research, Hospitalization, and Health Care, Istituto Giannina Gaslini, Genoa, Italy
| | - Alessandro Simonini
- Anesthesia and Neonatal and Pediatric Intensive Care Unit, Scientific Institute for Research, Hospitalization, and Health Care, Istituto Giannina Gaslini, Genoa, Italy
| | - Girolamo Mattioli
- Pediatric Surgery and Airway Team Unit, Scientific Institute for Research, Hospitalization, and Health Care, Istituto Giannina Gaslini, Genoa, Italy.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Science, University of Genoa, Genoa, Italy
| | - Oscar Mazzei
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Science, University of Genoa, Genoa, Italy
| | - Liliana Piro
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Science, University of Genoa, Genoa, Italy
| | - Roberto Bandettini
- Laboratory of Microbiology, Scientific Institute for Research, Hospitalization, and Health Care, Istituto Giannina Gaslini, Genoa, Italy
| | - Elio Castagnola
- Infectious Diseases Unit, Scientific Institute for Research, Hospitalization, and Health Care, Istituto Giannina Gaslini, Genoa, Italy
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Brandigi E, Torino G, Messina M, Molinaro F, Mazzei O, Matucci T, López Gutiérrez JC. Combined capillary-venous-lymphatic malformations without overgrowth in patients with Klippel-Trénaunay syndrome. J Vasc Surg Venous Lymphat Disord 2017; 6:230-236. [PMID: 29233587 DOI: 10.1016/j.jvsv.2017.09.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 09/22/2017] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Klippel-Trénaunay syndrome (KTS) is described in the literature as a complex syndrome characterized by various combinations of capillary, venous, and lymphatic malformations associated with limb overgrowth. In the first description by Maurice Klippel and Paul Trénaunay, tridimensional bone hypertrophy was believed to be the cause of limb enlargement. The purpose of this study was primarily to assess the presence of real bone hypertrophy as a cause of enlargement of the limb and to underline the rare presence of undergrowth of the affected limb in patients with KTS. METHODS A two-center retrospective review including 17 KTS patients with various combinations of capillary, venous, and lymphatic malformation affecting the lower limb was performed. Differences in limb dimension were evaluated clinically. Width and length discrepancy of the affected limb was measured with radiologic imaging. RESULTS We found an increase of length in the affected limb in 80% of the patients. The leg length discrepancy varied from 0.2 to 2.6 cm. The median leg length discrepancy was found to be 1.4 cm. Three patients had a reduced length of the affected limb. Girth enlargement of the affected extremity was noticed in 60% of the patients, and 2 of 17 patients had hypotrophy of the involved limb. Hypertrophy (an increase in both length and width) of the bone was found in none of our cases, and the circumferential enlargement of the affected extremity was related only to soft tissue enlargement. CONCLUSIONS In the literature, KTS is considered the prototype of overgrowth syndromes associated with complex vascular malformations. The majority of our patients showed limb length increase associated with soft tissue enlargement without an increase of bone width; there were also two patients with limb undergrowth. A real bone overgrowth (an increase in both length and width) was not present in our patients. Therefore, we could consider the absence of real bone hypertrophy as probably a new aspect of such confusing and controversial definitions of KTS. In addition, it would be more accurate to classify KTS patients on the basis of their phenotypic features (type of vascular malformation, types of overgrown tissue) rather than by use of an outdated eponym.
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Affiliation(s)
- Elisa Brandigi
- Paediatric Surgery Unit, Salesi Children's Hospital, Ancona, Italy.
| | - Giovanni Torino
- Paediatric Surgery Unit, Salesi Children's Hospital, Ancona, Italy
| | - Mario Messina
- Paediatric Surgery Unit, Santa Maria alle Scotte University Hospital, Siena, Italy
| | - Francesco Molinaro
- Paediatric Surgery Unit, Santa Maria alle Scotte University Hospital, Siena, Italy
| | - Oscar Mazzei
- Paediatric Surgery Unit, Santa Maria alle Scotte University Hospital, Siena, Italy
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Angotti R, Molinaro F, Sica M, Mariscoli F, Bindi E, Mazzei O, Ferrara F, Messina M. Association of Duodenal Atresia, Malrotation, and Atrial Septal Defect in a Down-Syndrome Patient. APSP J Case Rep 2016; 7:16. [PMID: 27170921 PMCID: PMC4852059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 04/18/2016] [Indexed: 11/26/2022] Open
Abstract
Duodenal atresia is the frequent cause of neonatal intestinal obstruction. The association between duodenal atresia, intestinal malrotation, cardiac anomalies and Down syndrome is infrequently reported. We present a prenatally suspected case of duodenal atresia which was associated with malrotation and atrial septal defect in a patient of Down syndrome. Duodenotomy and resection of web was performed in addition to Ladd's procedure. Postoperative course remained uneventful.
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Benassai G, Perrotta S, Desiato V, Benassai GL, Mazzei O, Quarto G. TEM in the treatment of recurrent rectal cancer in the elderly. BMC Geriatr 2011. [PMCID: PMC3194378 DOI: 10.1186/1471-2318-11-s1-a5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Perrotta S, Desiato V, Mazzei O, Benassai GL, Quarto G, Benassai G. Laparoscopy in bilio-pancreatic surgery in elderly. BMC Geriatr 2011. [PMCID: PMC3194374 DOI: 10.1186/1471-2318-11-s1-a46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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