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Kennedy CJ, Chiu C, Chapman AC, Gologorskaya O, Farhan H, Han M, Hodgson M, Lazzareschi D, Ashana D, Lee S, Smith AK, Espejo E, Boscardin J, Pirracchio R, Cobert J. Negativity and Positivity in the ICU: Exploratory Development of Automated Sentiment Capture in the Electronic Health Record. Crit Care Explor 2023; 5:e0960. [PMID: 37753238 PMCID: PMC10519480 DOI: 10.1097/cce.0000000000000960] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023] Open
Abstract
OBJECTIVES To develop proof-of-concept algorithms using alternative approaches to capture provider sentiment in ICU notes. DESIGN Retrospective observational cohort study. SETTING The Multiparameter Intelligent Monitoring of Intensive Care III (MIMIC-III) and the University of California, San Francisco (UCSF) deidentified notes databases. PATIENTS Adult (≥18 yr old) patients admitted to the ICU. MEASUREMENTS AND MAIN RESULTS We developed two sentiment models: 1) a keywords-based approach using a consensus-based clinical sentiment lexicon comprised of 72 positive and 103 negative phrases, including negations and 2) a Decoding-enhanced Bidirectional Encoder Representations from Transformers with disentangled attention-v3-based deep learning model (keywords-independent) trained on clinical sentiment labels. We applied the models to 198,944 notes across 52,997 ICU admissions in the MIMIC-III database. Analyses were replicated on an external sample of patients admitted to a UCSF ICU from 2018 to 2019. We also labeled sentiment in 1,493 note fragments and compared the predictive accuracy of our tools to three popular sentiment classifiers. Clinical sentiment terms were found in 99% of patient visits across 88% of notes. Our two sentiment tools were substantially more predictive (Spearman correlations of 0.62-0.84, p values < 0.00001) of labeled sentiment compared with general language algorithms (0.28-0.46). CONCLUSION Our exploratory healthcare-specific sentiment models can more accurately detect positivity and negativity in clinical notes compared with general sentiment tools not designed for clinical usage.
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Affiliation(s)
- Chris J Kennedy
- Department of Psychiatry, Harvard Medical School, Boston, MA
- Center for Precision Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Catherine Chiu
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA
| | - Allyson Cook Chapman
- Critical Care and Palliative Medicine, Department of Internal Medicine, University of California San Francisco, San Francisco, CA
- Department of Surgery, University of California San Francisco, San Francisco, CA
| | - Oksana Gologorskaya
- Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, CA
| | - Hassan Farhan
- Department of Anesthesiology, Perioperative and Pain Management, Stanford University, Stanford, CA
| | - Mary Han
- Center for Precision Psychiatry, Massachusetts General Hospital, Boston, MA
| | - MacGregor Hodgson
- Center for Precision Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Daniel Lazzareschi
- Center for Precision Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Deepshikha Ashana
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University, Durham, NC
| | - Sei Lee
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, CA
- Geriatrics, Palliative, and Extended Care, Veterans Affairs Medical Center, San Francisco, CA
| | - Alexander K Smith
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, CA
- Geriatrics, Palliative, and Extended Care, Veterans Affairs Medical Center, San Francisco, CA
| | - Edie Espejo
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, CA
| | - John Boscardin
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, CA
- Geriatrics, Palliative, and Extended Care, Veterans Affairs Medical Center, San Francisco, CA
| | - Romain Pirracchio
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA
| | - Julien Cobert
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA
- Department of Anesthesia, Anesthesia Service, San Francisco VA Health Care System, San Francisco, CA
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Lazzareschi D, Mehta RL, Dember LM, Bernholz J, Turan A, Sharma A, Kheterpal S, Parikh CR, Ali O, Schulman IH, Ryan A, Feng J, Simon N, Pirracchio R, Rossignol P, Legrand M. Overcoming barriers in the design and implementation of clinical trials for acute kidney injury: a report from the 2020 Kidney Disease Clinical Trialists meeting. Nephrol Dial Transplant 2023; 38:834-844. [PMID: 35022767 PMCID: PMC10064977 DOI: 10.1093/ndt/gfac003] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Indexed: 12/15/2022] Open
Abstract
Acute kidney injury (AKI) is a growing epidemic and is independently associated with increased risk of death, chronic kidney disease (CKD) and cardiovascular events. Randomized-controlled trials (RCTs) in this domain are notoriously challenging and many clinical studies in AKI have yielded inconclusive findings. Underlying this conundrum is the inherent heterogeneity of AKI in its etiology, presentation and course. AKI is best understood as a syndrome and identification of AKI subphenotypes is needed to elucidate the disease's myriad etiologies and to tailor effective prevention and treatment strategies. Conventional RCTs are logistically cumbersome and often feature highly selected patient populations that limit external generalizability and thus alternative trial designs should be considered when appropriate. In this narrative review of recent developments in AKI trials based on the Kidney Disease Clinical Trialists (KDCT) 2020 meeting, we discuss barriers to and strategies for improved design and implementation of clinical trials for AKI patients, including predictive and prognostic enrichment techniques, the use of pragmatic trials and adaptive trials.
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Affiliation(s)
- Daniel Lazzareschi
- Department of Anesthesia & Perioperative Care, Division of Critical Care Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Ravindra L Mehta
- Department of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Laura M Dember
- Renal-Electrolyte and Hypertension Division, Department of Medicine, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Pennsylvania, PA, USA
| | | | - Alparslan Turan
- Department of Anesthesiology, Lerner College of Medicine of Case Western University, Cleveland, OH, USA
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA
| | | | - Sachin Kheterpal
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Chirag R Parikh
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Omar Ali
- Verpora Ltd, Nottingham, UK
- University of Portsmouth, UK
| | - Ivonne H Schulman
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Abigail Ryan
- Division of Chronic Care Management, Centers for Medicare & Medicaid Services, Woodlawn, MD, USA
| | - Jean Feng
- Department of Epidemiology and Biostatistics, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Noah Simon
- Department of Biostatistics, University of Washington (UW), Seattle, WA, USA
| | - Romain Pirracchio
- Department of Anesthesia & Perioperative Care, Division of Critical Care Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Patrick Rossignol
- INI-CRCT Network, Nancy, France
- University of Lorraine, Inserm 1433 CIC-P CHRU de Nancy, Inserm U1116, Nancy, France
| | - Matthieu Legrand
- Department of Anesthesia & Perioperative Care, Division of Critical Care Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
- INI-CRCT Network, Nancy, France
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Chiu C, Fong N, Lazzareschi D, Mavrothalassitis O, Kothari R, Chen LL, Pirracchio R, Kheterpal S, Domino KB, Mathis M, Legrand M. Fluids, vasopressors, and acute kidney injury after major abdominal surgery between 2015 and 2019: a multicentre retrospective analysis. Br J Anaesth 2022; 129:317-326. [PMID: 35688657 DOI: 10.1016/j.bja.2022.05.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [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: 03/17/2022] [Revised: 04/28/2022] [Accepted: 05/05/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Practice patterns related to intraoperative fluid administration and vasopressor use have potentially evolved over recent years. However, the extent of such changes and their association with perioperative outcomes, such as the development of acute kidney injury (AKI), have not been studied. METHODS We performed a retrospective analysis of major abdominal surgeries in adults across 26 US hospitals between 2015 and 2019. The primary outcome was AKI as defined by the Kidney Disease Improving Global Outcomes definition (KDIGO) using only serum creatinine criteria. Univariable linear predictive additive models were used to describe the dose-dependent risk of AKI given fluid administration or vasopressor use. RESULTS Over the study period, we observed a decrease in the volume of crystalloid administered, a decrease in the proportion of patients receiving more than 10 ml kg-1 h-1 of crystalloid, an increase in the amount of norepinephrine equivalents administered, and a decreased duration of hypotension. The incidence of AKI increased between 2016 and 2019. An increase of crystalloid administration from 1 to 10 ml kg-1 h-1 was associated with a 58% decreased risk of AKI. CONCLUSIONS Despite decreased duration of hypotension during the study period, decreased fluid administration and increased vasopressor use were associated with increased incidence of AKI. Crystalloid administration below 10 ml kg-1 h-1 was associated with an increased risk of AKI. Although no causality can be concluded, these data suggest that prevention and treatment of hypotension during abdominal surgery with liberal use of vasopressors at the expense of fluid administration is associated with an increased risk of postoperative AKI.
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Affiliation(s)
- Catherine Chiu
- Department of Anesthesia & Perioperative Care, University of California, San Francisco, San Francisco, CA, USA
| | - Nicholas Fong
- Department of Anesthesia & Perioperative Care, University of California, San Francisco, San Francisco, CA, USA
| | - Daniel Lazzareschi
- Department of Anesthesia & Perioperative Care, University of California, San Francisco, San Francisco, CA, USA
| | - Orestes Mavrothalassitis
- Department of Anesthesia & Perioperative Care, University of California, San Francisco, San Francisco, CA, USA
| | - Rishi Kothari
- Department of Anesthesia & Perioperative Care, University of California, San Francisco, San Francisco, CA, USA
| | - Lee-Lynn Chen
- Department of Anesthesia & Perioperative Care, University of California, San Francisco, San Francisco, CA, USA
| | - Romain Pirracchio
- Department of Anesthesia & Perioperative Care, University of California, San Francisco, San Francisco, CA, USA
| | - Sachin Kheterpal
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Karen B Domino
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, USA
| | - Michael Mathis
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Matthieu Legrand
- Department of Anesthesia & Perioperative Care, University of California, San Francisco, San Francisco, CA, USA.
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4
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Mavrothalassitis O, Pirracchio R, Fong N, Lazzareschi D, Sharma A, Vaughn MT, Mathis M, Legrand M. Outcome of surgical patients during the first wave of the COVID-19 pandemic in US hospitals. Br J Anaesth 2021; 128:e35-e37. [PMID: 34689990 PMCID: PMC8484076 DOI: 10.1016/j.bja.2021.09.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 09/16/2021] [Accepted: 09/16/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
| | - Romain Pirracchio
- Department of Anesthesia and Perioperative Care, UCSF, San Francisco, CA, USA
| | - Nicholas Fong
- Department of Anesthesia and Perioperative Care, UCSF, San Francisco, CA, USA
| | - Daniel Lazzareschi
- Department of Anesthesia and Perioperative Care, UCSF, San Francisco, CA, USA
| | - Anshuman Sharma
- Department of Anesthesia and Perioperative Care, UCSF, San Francisco, CA, USA
| | - Michelle T Vaughn
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Michael Mathis
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Matthieu Legrand
- Department of Anesthesia and Perioperative Care, UCSF, San Francisco, CA, USA; INI-CRCT Network, Nancy, France.
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5
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Vallicelli C, Catena F, Ghermandi C, Amaduzzi A, Coccolini F, Cipolat L, Martignani M, Lazzareschi D, Cucchi M, Schiavina R, Di Pinna A. Extensive cytoreductive surgery in a Jehovah's Witness patient. A case report. Ann Ital Chir 2015; 86:S2239253X1501960X. [PMID: 25777965] [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
Jehovah's Witnesses are a well-known patient demographic in medicine because of their religious-based refusal of blood transfusion. This case report outlines the treatment of a Jehovah's Witness patient in need of an extensive cytoreductive surgery due to a peritoneal carcinomatosis of ovarian origin. The surgeons carried out all the recommended surgical and anaesthetic measures concluding that extensive cytoreductive surgery on a Jehovah's Witness is possible and that a complete cytoreduction can be safely performed.
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Catena F, Di Saverio S, Ansaloni L, Coccolini F, Sartelli M, Vallicelli C, Cucchi M, Tarasconi A, Catena R, De' Angelis G, Abongwa HK, Lazzareschi D, Pinna A. The HAC trial (harmonic for acute cholecystitis): a randomized, double-blind, controlled trial comparing the use of harmonic scalpel to monopolar diathermy for laparoscopic cholecystectomy in cases of acute cholecystitis. World J Emerg Surg 2014; 9:53. [PMID: 25383091 PMCID: PMC4223749 DOI: 10.1186/1749-7922-9-53] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 09/29/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The HARMONIC SCALPEL (H) is an advanced ultrasonic cutting and coagulating surgical device with important clinical advantages, such as: reduced ligature demand; greater precision due to minimal lateral thermal tissue damage; minimal smoke production; absence of electric corrents running through the patient. However, there are no prospective RCTs demonstrating the advantages of H compared to the conventional monopolar diathermy (MD) during laparoscopic cholecystectomy (LC) in cases of acute cholecystitis (AC). METHODS This study was a prospective, single-center, randomized trial (Trial Registration Number: NCT00746850) designed to investigate whether the use of H can reduce the incidence of intra-operative conversion during LC in cases of AC, compared to the use of MD. Patients were divided into two groups: both groups underwent early LC, within 72 hours of diagnosis, using H and MD respectively (H = experimental/study group, MD = control group). The study was designed and conducted in accordance with the regulations of Good Clinical Practice. RESULTS 42 patients were randomly assigned the use of H (21 patients) or MD (21 patients) during LC. The two groups were comparable in terms of basic patient characteristics. Mean operating time in the H group was 101.3 minutes compared to 106.4 minutes in the control group (p=ns); overall blood loss was significantly lower in the H group. Conversion rate was 4.7% for the H group, which was significantly lower than the 33% conversion rate for the control group (p<0.05). Post-operative morbidity rates differed slightly: 19% and 23% in the H and control groups, respectively (p=ns). Average post-operative hospitalization lasted 5.2 days in the H group compared to 5.4 days in the control group (p=ns). CONCLUSIONS The use of H appears to correlate with reduced rates of laparoscopic-open conversion. Given this evidence, H may be more suitable than MD for technically demanding cases of AC.
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Affiliation(s)
- Fausto Catena
- Department of Emergency Surgery, Parma University Hospital, Parma, Italy
| | | | | | | | | | | | - Michele Cucchi
- St. Orsola - Malpighi University Hospital, Bologna, Italy
| | - Antonio Tarasconi
- Department of Emergency Surgery, Parma University Hospital, Parma, Italy
| | - Rodolfo Catena
- Department of Emergency Surgery, Parma University Hospital, Parma, Italy
| | | | | | | | - Antonio Pinna
- St. Orsola - Malpighi University Hospital, Bologna, Italy
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7
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Sabbatani S, Catena F, Neri F, Vallicelli C, Ansaloni L, Sartelli M, Coccolini F, Di Saverio S, Catena R, Lazzareschi D, Tarasconi A, Abongwa HK, De Simone B, Pinna A. The Bolognese surgeon Giuseppe Ruggi: how and why the aseptic surgery was introduced in Bologna in the middle half of the XIX century. J Surg Res 2014; 192:555-63. [PMID: 25240285 DOI: 10.1016/j.jss.2014.04.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 01/21/2014] [Accepted: 04/09/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND The first reliable statistic data about perioperatory mortality were published in 1841 by the French Joseph-Francois Malgaigne (1806-1863): he referred to a mean mortality of 60% for amputations and this bad result was to be attributed mainly to hospital acquired diseases. The idea of "hospital acquired disease" although vague, included five infective nosologic entities, which at that time were diagnosed more frequently: erysipelas, tetan, pyemia, septicemia, and gangrene. Nonetheless, the suppuration with pus production was considered from most of the surgeons and doctors of that time as a necessary and unavoidable step in the process of wound healing. During the end of the eighteenth century, hospitals of the main European cities were transforming into aggregations of several wards, where the high concentration of patients created poor sanitary conditions and a consistent increase of perioperatory mortality. In 1865, Lister applied his first antiseptic dressing on the surface of an exposed fracture. These experimental attempts lead to an effective reduction of wound infections respect to the dressing with strings used previously. DISCUSSION Lister's innovations in the field of wound treatment were based on two brand new concepts: germs causing rot were ubiquitarious and the wound infection was not a normal step in the process of wound healing. The concept of antisepsis was hardly accepted in the European surgical world: "Of all countries, Italy is the most indifferent and uninterested in experimenting this method, which has been so favorably judged from the greatest surgical societies in Germany". This quotation from the young surgeon Giuseppe Ruggi (1844-1925) from Bologna comes from his article where he presented his first experiences on aseptic medications started the previous year in the Surgical Department of Maggiore Hospital in Bologna. In his report, Ruggi described the adopted technique and suggested that the medication should be extended to all the surgical patients of the hospital:"… this is needed to totally remove from the hospital all those elements of infection which grow in the wounds dressed with the old method". The experimentation of this new dressing for the few treated cases was rigorous and concerned both the sterilization of surgical tools with the fenic acid (5%) and the shaving of the skin. Ruggi also observed that there was no correlation between the seriousness of the wound and its extension or way of healing: when "simple" cases that "should heal without complication" showed fever he often realized that "it was often due to a medication performed without following the rules for an accurate disinfection and dressing". Ruggi thought that the fever was connected to "reabsorption of pyrogenic substances, which can be removed cleaning and disinfecting the wound" in cases of wounds not accurately dressed and rarely medicated. Frequent postoperative medications of the wound were able to eliminate the fever within 2 h. Ruggi's attitude toward the fine reasoning lead him to introduce the concept of immunodeficiency related to physical deterioration: "… patients treated for surgical disease may sometimes suffer from complications of medical conditions, which initially escape the most accurate investigations… The surgical operation could, in some cases, hold the balance of power". CONCLUSIONS The obtained results, published in 1879, appear extremely interesting. As he wrote in 1898, for the presentation of his case record of more than 1000 laparotomies, he had started "… operating as a young surgeon without any tutor, helped only by his mind and what he could deduce from publications existing at the moment …".
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Affiliation(s)
- Sergio Sabbatani
- Department of Infectious Diseases, St. Orsola - Malpighi University Hospital, Bologna, Italy
| | - Fausto Catena
- Department of Surgery, St. Orsola - Malpighi University Hospital, Bologna, Italy.
| | - Flavia Neri
- Department of Infectious Diseases, St. Orsola - Malpighi University Hospital, Bologna, Italy; Department of Surgery, St. Orsola - Malpighi University Hospital, Bologna, Italy
| | - Carlo Vallicelli
- Department of Infectious Diseases, St. Orsola - Malpighi University Hospital, Bologna, Italy; Department of Surgery, St. Orsola - Malpighi University Hospital, Bologna, Italy
| | - Luca Ansaloni
- Department of Surgery, Bergamo Hospital, Bergamo, Italy
| | | | | | - Salomone Di Saverio
- Department of Surgery, St. Orsola - Malpighi University Hospital, Bologna, Italy
| | - Rodolfo Catena
- Department of Surgery, St. Orsola - Malpighi University Hospital, Bologna, Italy
| | - Daniel Lazzareschi
- Department of Surgery, St. Orsola - Malpighi University Hospital, Bologna, Italy
| | | | | | | | - Antonio Pinna
- Department of Surgery, St. Orsola - Malpighi University Hospital, Bologna, Italy
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8
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Catena F, Ansaloni L, Bianchi E, Di Saverio S, Coccolini F, Vallicelli C, Lazzareschi D, Sartelli M, Amaduzzi A, Amaduzz A, Pinna AD. The ACTIVE (Acute Cholecystitis Trial Invasive Versus Endoscopic) Study: multicenter randomized, double-blind, controlled trial of laparoscopic versus open surgery for acute cholecystitis. Hepatogastroenterology 2013; 60:1552-1556. [PMID: 24634923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND/AIMS In some randomized controlled trials laparoscopic cholecystectomy (LC) for acute cholecystitis was associated with a shorter hospital stay when compared with open cholecystectomy (OC). These studies were not double blinded and without intention to treat purpose. METHODOLOGY The present study project was a prospective, randomized investigation. The study was performed in the Department of General, Emergency and Transplant Surgery St Orsola-Malpighi University Hospital (Bologna, Italy). Subjects were divided in two groups: in the first group the patient was submitted to LC while in the second group was submitted to OC. RESULTS Of 164 consecutive patients, 20 were excluded from the study. The two groups were similar in demographic and clinical characteristics. Seven (9.7%) patients in the LC group required conversion to OC. There were no deaths or bile duct lesions in either group, and the postoperative complication rate was similar (p=n.s.). The mean postoperative hospital stay was also comparable. CONCLUSIONS Even though LC for acute and gangrenous cholecystitis is technically demanding, in experienced hands it is safe and effective. It does not increase the mortality and the morbidity rate with a low conversion rate and no difference in hospital stay.
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9
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Catena F, Vallicelli C, Ansaloni L, Sartelli M, Di Saverio S, Schiavina R, Pasqualini E, Amaduzzi A, Coccolini F, Cucchi M, Lazzareschi D, Baiocchi GL, Pinna AD. T.E.A. Study: three-day ertapenem versus three-day Ampicillin-Sulbactam. BMC Gastroenterol 2013; 13:76. [PMID: 23631512 PMCID: PMC3660242 DOI: 10.1186/1471-230x-13-76] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2011] [Accepted: 12/19/2012] [Indexed: 11/10/2022] Open
Abstract
Background Intra-abdominal infections are one of the most common infections encountered by a general surgeon. However, despite this prevalence, standardized guidelines outlining the proper use of antibiotic therapy are poorly defined due to a lack of clinical trials investigating the ideal duration of antibiotic treatment. The aim of this study is to compare the efficacy and safety of a three-day treatment regimen of Ampicillin-Sulbactam to that of a three-day regimen of Ertapenem in patients with localized peritonitis ranging from mild to moderate severity. Methods This study is a prospective, multi-center, randomized investigation performed in the Department of General, Emergency, and Transplant Surgery of St. Orsola-Malpighi University Hospital in Bologna, Italy. Discrete data were analyzed using the Chi-squared and Fisher exact tests. Differences between the two study groups were considered statistically significant for p-values less than 0.05. Results 71 patients were treated with Ertapenem and 71 patients were treated with Ampicillin-Sulbactam. The two groups were comparable in terms of age and gender as well as the site of abdominal infection. Post-operative infection was identified in 12 patients: 10 with wound infections and 2 with intra-abdominal infections. In the Ertapenem group, 69 of the 71 patients (97%) were treated successfully, while the therapy failed in 2 cases (3%). Therapy failures were more frequent in the Unasyn group, amounting to 10 of 71 cases (p = 0.03). Conclusion According to these preliminary findings, the authors conclude that a three-day Ertapenem treatment regimen is the most effective antibiotic therapy for patients with localized intra-abdominal infections ranging from mild to moderate severity. Trial registration Trial registration: ClinicalTrials.gov:
NCT00630513
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Affiliation(s)
- Fausto Catena
- Emergency Surgery Department, Parma University Hospital, Parma, Italy.
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10
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Coccolini F, Ansaloni L, Manfredi R, Campanati L, Poiasina E, Bertoli P, Capponi MG, Sartelli M, Di Saverio S, Cucchi M, Lazzareschi D, Pisano M, Catena F. Peritoneal adhesion index (PAI): proposal of a score for the "ignored iceberg" of medicine and surgery. World J Emerg Surg 2013; 8:6. [PMID: 23369320 PMCID: PMC3573980 DOI: 10.1186/1749-7922-8-6] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 01/29/2013] [Indexed: 12/24/2022] Open
Abstract
Peritoneal adhesions describe a condition in which pathological bonds form between the omentum, the small and large bowels, the abdominal wall, and other intra-abdominal organs. Different classification systems have been proposed, but they do not resolve the underlying problem of ambiguity in the quantification and definition of adhesions. We therefore propose a standardized classification system of adhesions to universalize their definition based on the macroscopic appearance of adhesions and their diffusion to different regions of the abdomen. By scoring with these criteria, the peritoneal adhesion index (PAI) can range from 0 to 30, unambiguously specifying precise adhesion scenarios. The standardized classification and quantification of adhesions would enable different studies to more meaningfully integrate their results, thereby facilitating a more comprehensive approach to the treatment and management of this pathology.
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Affiliation(s)
- Federico Coccolini
- General and Emergency Surgery department, Papa Giovanni XXIII hospital, Piazza OMS-Organizzazione Mondiale della Sanità 1, 24128, Bergamo, Italy.
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11
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Catena F, Di Battista M, Ansaloni L, Pantaleo M, Fusaroli P, Di Scioscio V, Santini D, Nannini M, Saponara M, Ponti G, Persiani R, Delrio P, Coccolini F, Di Saverio S, Biasco G, Lazzareschi D, Pinna A. Microscopic margins of resection influence primary gastrointestinal stromal tumor survival. Oncol Res Treat 2012; 35:645-8. [PMID: 23147540 DOI: 10.1159/000343585] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Primary gastrointestinal stromal tumors (GISTs) are stromal tumors that arise from the gastrointestinal tract. Both surgical resection and molecular therapy are crucial in the treatment of these tumors. This study analyzes the outcomes of 151 patients with GIST treated at 3 institutions. These institutions comprise the GISTologist Study Group and provided follow-up data. PATIENTS AND METHODS 151 patients with primary GIST were admitted and treated at the St. Orsola-Malpighi University Hospital in Bologna, Italy, the Catholic University Hospital in Rome, Italy, and the Modena University Hospital and National Cancer Institute in Naples, Italy, over the past 11 years. Patient data as well as tumor and therapy variables were studied to identify factors predicting survival with a focus on the microscopic margins of resection. RESULTS All 151 patients had primary disease without metastasis and underwent complete resection of gross disease. The 5-year disease-free survival rate was 77%. Disease-free survival was predicted by tumor size, mitotic count, and margins of resection. Recurrence of disease after resection was predominantly intra-abdominal. CONCLUSIONS Tumor size, mitotic count, and microscopic margins of resection predict disease-free survival in patients with primary GIST.
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Affiliation(s)
- Fausto Catena
- MaTransplant, General and Emergency Surgery Department, St Orsola-Malpighi University Hospital Bologna, Italy.
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12
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Coccolini F, Manfredi R, Catena F, Vallicelli C, De Iaco PA, Martoni A, Lazzareschi D, Ansaloni L. Peritoneal cystic mesothelioma: are surgery and HIPEC optimal first-line treatments? ACTA ACUST UNITED AC 2012; 35:200-2. [PMID: 22488091 DOI: 10.1159/000337414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Peritoneal cystic mesothelioma (PCM) is an uncommon clinical pathology. Its high rate of recurrence following partial or total resection as well as its spontaneous onset of malignancy have been well documented in a series of case studies. The medical community has yet to define standardized treatment guidelines for PCM. CASE REPORTS This study reviews the case of 2 patients admitted and treated for PCM. Recent studies have reported improved recurrence and survival rates achieved by means of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), especially when used as first-line treatments. However, whether or not the use of CRS and HIPEC is more effective than a surgical regimen of multiple debulking procedures, is still the subject of debate. CONCLUSION CRS and HIPEC as first-line treatments have lower morbidity and mortality rates than regimens of multiple back-to-back surgical procedures, and as such, the CRS/HIPEC method appears to be the more successful approach.
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Affiliation(s)
- Federico Coccolini
- Dept. of General and Emergency Surgery, Ospedali Riuniti, Bergamo, Italy.
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13
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Catena F, Ansaloni L, Di Saverio S, Cocccolini F, Vallicelli C, Lazzareschi D, Campanelli G, Pinna A. Use of porcine small intestine submucosa prostheses in contaminated hernia repair. ANZ J Surg 2012; 81:576-7. [PMID: 22295421 DOI: 10.1111/j.1445-2197.2011.05798.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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14
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Coccolini F, Catena F, Ansaloni L, Neri F, Gazzotti F, Lazzareschi D, Pinna AD. An innovative abdominal wall repair technique for infected prosthesis: the Eskimo technique. ULUS TRAVMA ACIL CER 2011; 17:354-8. [PMID: 21935836 DOI: 10.5505/tjtes.2011.56767] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The use of meshes to repair incisional hernias has been shown to reduce the recurrence rate, though it may increase the risk of surgical site infection. This is one of the most feared and devastating complications of surgical abdominal wall repair. The aim of this work is to describe a new surgical technique that was used to treat two patients suffering from chronic prosthesis infection. Additionally, the outcome of this procedure will be analyzed in terms of its safety, subsequent site infection and recurrence prevention. Two case reports are presented. The procedure was based on a wide surgical excision of the infected prosthesis and the surrounding tissues, plus abdominal wall repair with biological prosthesis. Both patients experienced an uneventful postoperative course. Infection of the surgical site resolved following the procedure and, after a mean follow-up of 36 months, no recurrences of the incisional hernia had occurred. This unique surgical technique not only proved to be safe, but it also solved the chronic prosthesis infection through its use of radical excision, without any postoperative complications or recurrence. This technique confirmed that biological prostheses can be used safely and effectively for implantation in sites of infection.
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Affiliation(s)
- Federico Coccolini
- Department of General, Emergency and Transplant Surgery, SantOrsola-Malpighi University Hospital, Bologna, Italy.
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15
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Abstract
BACKGROUND The incidence of abdominal tuberculosis (TB) is increasing in western and developed countries. This pathology has several complications, including free intestinal perforation. The aim of this study was to analytically summarize all the pertinent literature discussing the various treatments for TB-related perforations. METHODS We reviewed the patient database of the Emergency Surgery Department of the Bologna University Hospital, checking the last 13 years. A retrospective review was conducted of all reported cases of intestinal perforation due to intestinal TB published through 3 March 2009. RESULTS 119 cases of abdominal TB presenting with intestinal perforation were published. There are no standardized guidelines regarding the surgical treatment. Of the 119 reported cases, 40 (33.6%) were treated with resection and anastomosis, 17 (14.2%) with direct sutures, 4 (3.3%) with a simple drain, and in 57, the treatment was not reported. CONCLUSION No clinical evidence has been available for analysis to discern the optimal surgical strategy for treating intestinal perforations induced by TB. The direct closure of the perforation typically correlates with poor morbidity and mortality results. The better treatment seems to be the surgical resection of the perforated part with anastomosis. However, pharmacological therapy remains the essential pillar of treatment.
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Affiliation(s)
- Federico Coccolini
- Department of Surgery, Bologna University, St. Orsola Hospital, Bologna, Italy.
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16
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Coccolini F, Catena F, Ansaloni L, Ercolani G, Di Saverio S, Gazzotti F, Lazzareschi D, Pinna AD. A prospective, multi centre, randomized clinical study to compare the efficacy and safety of Ertapenem 3 days versus Ampicillin-Sulbactam 3 days in the treatment of localized community acquired intra-abdominal infection. (T.E.A. Study: Three days Ertapenem vs three days Ampicillin-sulbactam). BMC Gastroenterol 2011; 11:42. [PMID: 21501482 PMCID: PMC3090366 DOI: 10.1186/1471-230x-11-42] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Accepted: 04/18/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The recommendations outlined in the latest guidelines published by the Surgical Infection Society (SIS) and the Infectious Disease Society of America (IDSA) regarding the proper duration of antibiotic therapy in patients with intra-abdominal infections are limited and non-specific. This ambiguity is due mainly to the lack of clinical trials on the topic of optimal duration of therapy. It is well known that the overuse of antibiotics has several important consequences such as increased treatment costs, reduced clinical efficacy, and above all, the increased emergence of antibiotic-resistant pathogens. Ampicillin-Sulbactam is a commonly used "first line" antibiotic for intra-abdominal infections. Ertapenem and Ampicillin-sulbactam are recommended as primary treatment agents for localized peritonitis by both the SIS and IDSA guidelines. METHODS/DESIGN This study is a prospective multi-center randomized investigation. The study will be performed in the Departments of General, Emergency, and Transplant Surgery of Sant'Orsola-Malpighi University Hospital in Bologna, Italy, in the General Surgery Department of the Ospedali Riuniti of Bergamo, Italy, and in the Trauma and Emergency Surgery Department of Maggiore Hospital in Bologna, Italy, and will be conducted by all surgeons willing to participate in the study. The inclusion period of the study will take approximately two years before the planned number of 142 enrolled patients is reached. DISCUSSION Ertapenem and Ampicillin-sulbactam are recommended both as primary treatment agents for localized peritonitis by both the SIS and IDSA guidelines. As one of the discussed topic is the optimal duration of the antibiotic therapy and this ambiguity is due mainly to the lack of clinical trials on the topic, the present study aims for obtain precise data. TRIAL REGISTRATION ClinicalTrials.gov: NCT00630513.
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Affiliation(s)
- Federico Coccolini
- Unit of General, Emergency and Transplant Surgery, St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Fausto Catena
- Unit of General, Emergency and Transplant Surgery, St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Luca Ansaloni
- Unit of General Surgery, Ospedali Riuniti, Bergamo, Italy
| | - Giorgio Ercolani
- Unit of General, Emergency and Transplant Surgery, St. Orsola-Malpighi University Hospital, Bologna, Italy
| | | | - Filippo Gazzotti
- Unit of General, Emergency and Transplant Surgery, St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Daniel Lazzareschi
- Department of Integrative Biology, University of California, Berkeley, USA
| | - Antonio D Pinna
- Unit of General, Emergency and Transplant Surgery, St. Orsola-Malpighi University Hospital, Bologna, Italy
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17
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Abstract
Esophageal gastrointestinal stromal tumors (GISTs) are extremely uncommon, representing approximately 5% of GISTs with the majority of esophageal GISTs occurring at the esophagogastric junction (EGJ). The treatment options available for these GISTs are fairly controversial. Many different options are nowadays at our disposal. From surgery to the target therapies we have the possibility to treat the majority of GISTs, including those which are defined as unresectable. The EGJ GISTs represent a stimulating challenge for the surgeon. The anatomical location increases the possibility of post-operative complications. As the role of negative margins in GIST surgery is still controversial and the efficacy of target therapy has been demonstrated, why not treat EGJ GISTs with enucleation and, where indicated, adjuvant target therapy?
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18
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Abstract
Background Emergency surgery has become a neglected specialization in Europe and in many other parts of the world. In certain medical fields, emergency surgery isn't even considered an autonomous specialization. However every emergency surgeon must have a good formation in General Surgery but exist huge disparities between different European surgical formative systems. Methods An analysis of the main problems of the European surgical formative system was conducted. Results This discrepancy between formative systems is absolutely unacceptable and presents a notable hazard for the European Union, considering that surgical certifications are reciprocally recognized between programs within all European Union states. Conclusion Considering the increasing possibilities to move inside the European Union, is necessary to improve the European surgical formative system to warrant an uniform formation for all surgeons.
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Affiliation(s)
- Federico Coccolini
- General, Emergency and Transplant Unit, Sant'Orsola-Malpighi University Hospital, Bologna, Italy.
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Mincione G, Cirafici AM, Lazzareschi D, Pepe S, Ciardiello F, Colletta G. Loss of thyrotropin regulation and transforming growth factor beta-induced growth arrest in erbB-2 overexpressing rat thyroid cells. Cancer Res 1993; 53:5548-53. [PMID: 8106149] [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: 01/28/2023]
Abstract
Amplification of erbB-2 gene and overexpression of gp185erbB-2 gene product is found in approximately one-third of primary human breast and ovarian cancer. Overexpression of gp185erbB-2 was recently found in human papillary thyroid carcinomas, but not in thyroid follicular carcinomas or adenomas. The erbB-2 gene encodes a cell surface growth factor receptor with intrinsic tyrosine kinase activity. Wild type human erbB-2 has been shown to act as a potent oncogene when overexpressed in mouse fibroblasts. To test whether overexpression of normal human erbB-2 gene can transform epithelial differentiated rat thyroid cells, these cells were infected with a recombinant retroviral expression vector containing the erbB-2 protooncogene. Rat thyroid cells expressing high levels of gp185erbB-2 do not display a fully transformed and tumorigenic phenotype. However, the isolated cell clones that overexpress gp185erbB-2, show changes in their growth properties if compared to normal thyroid cells, since they can grow in absence of thyrotropin, the main growth factor controlling thyroid cell proliferation in vitro, and do not respond to the growth inhibitory effect of transforming growth factor beta.
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MESH Headings
- Animals
- Blotting, Western
- Cell Differentiation
- Cell Division/drug effects
- Cell Transformation, Neoplastic/genetics
- Cinnamates
- Drug Resistance
- Hygromycin B/analogs & derivatives
- Hygromycin B/pharmacology
- Mice
- Mice, Nude
- Neoplasm Transplantation
- Oncogene Proteins, Viral/analysis
- Oncogene Proteins, Viral/genetics
- Proto-Oncogenes
- RNA, Messenger/analysis
- RNA, Messenger/genetics
- Rats
- Rats, Inbred F344
- Receptor, ErbB-2
- Receptors, Thyrotropin/analysis
- Thyroid Gland/chemistry
- Thyroid Gland/pathology
- Transforming Growth Factor beta/pharmacology
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Affiliation(s)
- G Mincione
- Istituto di Patologia Umana e Medicina Sociale, Facoltà di Medicina e Chirurgia, Chieti, Italy
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