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Nasi G, Tursi A, Di Mario F, Lammert F, Poskus T, Reichert MC, Regula J, Bonovas S, Sapienza M, Brandimarte G. Combined Overview on Diverticular Assessment:a new score for the management of diverticular disease. Eur J Public Health 2022. [PMCID: PMC9594387 DOI: 10.1093/eurpub/ckac131.134] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Diverticulosis is increasing worldwide as a public health problem. The Combined Overview on Diverticular Assessment (CODA) score, merging Diverticular Inflammation and Complication Assessment (DICA) and few clinical parameters, may reliably predict the occurrence of acute diverticulitis and surgery due to complications. Thus, the aim of the study is to confirm the value of DICA classification and to develop and validate the CODA endoscopic-clinical score. Methods A number of 2198 patients, at the first diagnosis of diverticulosis/diverticular disease were enrolled in a multicentre, prospective, international cohort study. Participants were scored according to DICA classifications. A 3-year follow-up was performed. Survival methods for censored observation were used to develop and validate the CODA score for predicting diverticulitis and surgery. Results The 3-year cumulative probability of diverticulitis and surgery was ≤4%, and ≤0.7% in CODA A; <10%and <2.5% in CODA B; >10%and >2.5% in CODA C, respectively. The 3-year cumulative probability of diverticulitis and surgery was of 3.3% (95% CI 2.5% to 4.5%) in DICA 1, 11.6% (95% CI 9.2% to 14.5%) in DICA 2 and 22.0% (95% CI 17.2% to 28.0%) in DICA 3 (p < 0.001), and 0.15% (95% CI 0.04% to 0.59%) in DICA 1, 3.0% (95% CI 1.9% to 4.7%) in DICA 2 and 11.0% (95% CI 7.5% to 16.0%) in DICA 3 (p < 0.001), respectively. The CODA score showed optimal discrimination capacity in predicting the risk of surgery in the development (cstatistic: 0.829; 95%CI 0.811 to 0.846) and validation cohort (c-statistic: 0.943; 95% CI 0.905 to 0.981). Conclusions DICA endoscopic classification was confirmed to have a significant predictive value in terms of acute diverticulitis occurence/recurrence and risk of surgery. CODA score could provide a new risk stratification tool useful for everyday clinical practice and also with a significant public health impact in terms of treatment effectiveness and decision making. Key messages • DICA endoscopic classification of diverticular disease is a clear predictor of the outcome of diverticulosis/diverticular disease. • The CODA score, combining DICA and few clinical parameters, may reliably predict the occurence of acute diverticulitis and surgery due to complications.
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Affiliation(s)
- G Nasi
- Direction of Health Management, Cristo Re Hospital , Rome, Italy
| | - A Tursi
- Territorial Gastroenterology Service, ASL BAT , Andria, Italy
| | - F Di Mario
- Maggiore Hospital Gastroenterology, , Parma, Italy
| | - F Lammert
- Department of Medicine II, Saarland University Medical Center , Homburg, Germany
| | - T Poskus
- Institute of Clinical Medicine, Vilnius University Hospital , Vilnius, Lithuania
| | - MC Reichert
- Department of Medicine II, Saarland University Medical Center , Homburg, Germany
| | - J Regula
- Medical Centre for Postgraduate Education Gastroenterology, , Warsaw, Poland
- Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology Gastroenterology, , Warsaw, Poland
| | - S Bonovas
- Department of Biomedical Sciences, Humanitas University , Rozzano, Italy
| | - M Sapienza
- Direction of Health Management, Cristo Re Hospital , Rome, Italy
- Department of Life Sciences and Public Health, Catholic University , Rome, Italy
| | - G Brandimarte
- Internal Medicine and Gastroenterology, Cristo Re Hospital , Rome, Italy
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Nasi G, Brandimarte G, Marrone R, Sponzilli A, Sorbara D, Benedetti P, Grande D, Brando C, D'Avino A, Parrocchia S. Benchmarking between two different hospitals on health risk management in the covid-19 emergency. Eur J Public Health 2021. [PMCID: PMC8574661 DOI: 10.1093/eurpub/ckab165.362] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Iusse The strategies adopted during COVID19 emergencies by two different hospitals in the Lazio Region are presented: S. Maria Goretti Hospital (SMGH) directly managed by the ASL Latina, hub and centre of the Emergency Department, and Cristo Re Classified Hospital (CRH), accredited in the territory of the ASL Roma1. Description of the problem SMGH has been identified as COVID19 Intervention Hospital. CRH initially was a No-COVID support structure, then included in the COVID19 network. During the COVID19 emergency, the directors of both hospitals had to simultaneously ensure activity as usual, COVID19 recovery and risk management. Results SMGH, while continuing the emergency, oncological, pregnancy, paediatrics and outpatient activities, COVID19 patients was isolated on 7 different floors/areas. Moreover was defined: chain of command; clinical admission criteria; COVID19 multi-professional and support teams, roles, skills and specific training; health surveillance; environmental hygiene, safety paths/procedures, vaccinal center and much more. CRH, while continuing minimum programmed activities to reduce waiting lists, in the first epidemic phase was created 4 tensile structures for Pre-triage and COVID pathways, respiratory isolation area for supsected patient; transfer admission for emergency networks, clean-dirty pathway. Moreover in the second phase, was activated beds of COVID19 network and 4 technical beds OBI; the ‘Walk-in' for antigenic testing, with molecular confirmation <24h and infectious counselling; multi-disciplinary and specialist support teams, training courses, health surveillance, vaccinal center and much more. Lessons During COVID19 pandemic, risk management skills linked to the technical-organisational strategy of hospital directors, making it possible to reprogramme their structure in a short period of time with flexibility and resilience of the whole organization. Key messages Specific skills and roles, both hygienic and organizational, are essential to risk management in hospitals during epidemic emergencies. The multidisciplinarity, flexibility and modularity of the hospital structure are the organizational bases in cases of pandemics.
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Affiliation(s)
- G Nasi
- Department of Health Management, Cristo Re Hospital, Rome, Italy
| | - G Brandimarte
- Division of Internal Medicine and Gastroenterology, Cristo Re Hospital, Rome, Italy
| | - R Marrone
- Department of Health Management, S.M. Goretti Hospital, Latina, Italy
| | - A Sponzilli
- Operation Management, Cristo Re Hospital, Rome, Italy
| | - D Sorbara
- Department of Health Management, S.M. Goretti Hospital, Latina, Italy
| | - P Benedetti
- Department of Health Management, Cristo Re Hospital, Rome, Italy
| | - D Grande
- Department of Health Management, Cristo Re Hospital, Rome, Italy
| | - C Brando
- Division of Internal Medicine and Gastroenterology, Cristo Re Hospital, Rome, Italy
| | - A D'Avino
- Division of Internal Medicine and Gastroenterology, Cristo Re Hospital, Rome, Italy
| | - S Parrocchia
- Department of Health Management, S.M. Goretti Hospital, Latina, Italy
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Giorgetti G, Fabiocchi F, D'Avino A, Tursi A, Brandimarte MA, Paoloni A, Meucci T, Parrocchia S, Brandimarte G, Nasi G. Assessment of the nutritional status in patients with acute diverticulitis. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.206] [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: 11/13/2022] Open
Abstract
Abstract
Background
The study evaluated the implementation of a screening strategy on all hospitalizations for diverticular disease (DD) of the colon with particular reference to acute diverticulitis (AD) regarding nutritional status.
Methods
The Nutritional Risk Security (NRS2002) system, was used, preselecting those with AD by the nurses of the nutrition team on the same day of admission from 1/01 to 31/12/2017 at the S. Eugenio Hospital in Rome. Patients (pts) with positive pre-screening were referred for additional evaluation performed by a dietician.
Results
AD was observed in 133 pts, 58% women, out of a total sample of 4667. The NRS2002 was applied to all, finding a positive screening test in 97 (72.9%) pts of whom a severely compromised nutritional status (NRS2002 score>3) in 61 pts (62.9%). Each patient tested positive was given initial nutritional support: oral supplements (17 pts, 17.52%), enteral nutrition (22 pts 22.68%), total parenteral nutrition (58 pts 59.8%). The mean length of hospital stay was 6.9 days, although was significantly longer for pts with NRS2002 positive (mean of 18 day). NRS2002 score can be a significant predictor of disease severity and outcome, operating independently of BMI, since a total score ≥3 can predict length of hospital stay.
Conclusions
The study confirmed that NRS2002 is a useful screening tool for identifying nutritional risk AD pts in hospital wards and allowed to select pts who needed a more careful monitoring program, diet therapy and possibly nutrition artificial. Furthermore, it showed an increasing and underestimated risk of malnutrition in a large number of pts hospitalized and that NRS2002 screening is a good predictor of some socio-health indicators such as hospital stay.
Key messages
There is an increasing and underestimated risk of malnutrition in a large number of patients hospitalized. NRS2002 is a useful screening tool for identifying nutritional risk and a good predictor of some socio-health indicators such as hospital stay.
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Affiliation(s)
- G Giorgetti
- Digestive Endoscopy and Nutrition Unit, S. Eugenio Hospital, Rome, Italy
| | - F Fabiocchi
- Digestive Endoscopy and Nutrition Unit, S. Eugenio Hospital, Rome, Italy
| | - A D'Avino
- Division of Internal Medicine and Gastroenterology, Cristo Re Hospital, Rome, Italy
| | - A Tursi
- Territorial Gastroenterology Service, ASL BAT, Andria (BT), Italy
| | | | - A Paoloni
- Division of Internal Medicine and Gastroenterology, Cristo Re Hospital, Rome, Italy
- Endocrinology and Diabetology Service, Cristo Re Hospital, Rome, Italy
| | - T Meucci
- Endocrinology and Diabetology Service, Cristo Re Hospital, Rome, Italy
| | - S Parrocchia
- Department of Health Management, S.M. Goretti Hospital, Latina, Italy
| | - G Brandimarte
- Division of Internal Medicine and Gastroenterology, Cristo Re Hospital, Rome, Italy
| | - G Nasi
- Department of Health Management, Cristo Re Hospital, Rome, Italy
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Cassieri C, Mastromatteo AM, Pica R, Zippi M, Corazziari ES, Paoluzi P, Lecca GP, Vernia P, Brandimarte G, Nasi G. Azathioprine in the maintainance remission in inflammatory bowel disease patients: 7-year follow up. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] Open
Abstract
Abstract
Background
Azathioprine (AZA) and thiopurine are widely used for induction and maintenance of remission in steroid dependent patients with inflammatory bowel disease (IBD).
Methods
Aim of this study has been to investigate its efficacy and safety in maintaining steroid-free remission in steroid dependent IBD patients seven year after the institution of treatment. Data from consecutive IBD outpatients referred in our Institution, between 1985-2016, were reviewed and all patients treated with AZA were included in this retrospective study. AZA was administered at the recommended dose of 2-2.5 mg/kg.
Results
Out of 2802 consecutive IBD outpatients visited in the index period, AZA was prescribed to 433 patients, 236 (54.5%) were affected by Crohn's disease (CD) and 197 (45.5%) by ulcerative colitis (UC). One hundred and seventy-nine patients with a follow-up < 84 months were excluded from the study. Two hundred and fifty-four patients were evaluated, 141 (55.5%) with CD and 113 (44.5%) with UC. One hundred and thirty-nine (54.7%) were male and 115 (45.3%) female (average age of 35.62 ± 14.20 SD years, range 14-74 y.). Seven year after the institution of treatment, 127 (50%) patients still were in steroid-free remission (83 CD vs 44 UC, 58.8% and 38.9%, respectively, p = 0.0024), 71 (27.9%) had a relapse requiring retreatment with steroids (29 CD vs 42 UC, 20.6% and 37.2%, respectively, p = 0.0047), 56 (22.1%) discontinued the treatment due to side effects (29 CD vs 27 UC, 20.6% and 23.9%, respectively). Loss of response from 1st to 7th year of follow-up was low, about 20%.
Conclusions
Seven year after the onset of treatment 50% of patients did not require further steroid courses. After the first year loss of response was low in six subsequent years. In the present series the maintenance of steroid-free remission was significantly higher in CD than in UC patients. The occurrence of side effects leading to the withdrawal of AZA treatment has been low.
Key messages
An important therapeutic moment of IBD is mantaining remission in steroid dipendent patients. AZA can be a viable and inexpensive alternative to treath these patients.
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Affiliation(s)
- C Cassieri
- Internal Medicine and Gastroenterology, “Cristo Re” Hospital, Rome, Italy
| | | | - R Pica
- Unit of Gastronterology and Digestive Endoscopy, Sandro Pertini Hospital, Rome, Italy
| | - M Zippi
- Unit of Gastronterology and Digestive Endoscopy, Sandro Pertini Hospital, Rome, Italy
| | - E S Corazziari
- Internal Medicine and Medical Specialties, Sapienza University, Rome, Italy
| | - P Paoluzi
- Internal Medicine and Medical Specialties, Sapienza University, Rome, Italy
| | - G P Lecca
- Internal Medicine and Gastroenterology, “Cristo Re” Hospital, Rome, Italy
| | - P Vernia
- Internal Medicine and Medical Specialties, Sapienza University, Rome, Italy
| | - G Brandimarte
- Internal Medicine and Gastroenterology, “Cristo Re” Hospital, Rome, Italy
| | - G Nasi
- Health Department, “Cristo Re” Hospital, Rome, Italy
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Nasi G, Tursi A, Di Mario F, Elisei W, Picchio M, Bafutto M, Dumitrascu D, Regula J, Mastromatteo AM, Brandimarte G. DICA endoscopic classification: 2-year analysis from an international, multicenter prospective study. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1157] [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] Open
Abstract
Abstract
Background
Diverticulosis of the colon is the most frequent anatomical alteration detected during colonoscopy. The endoscopic classification “DICA”(Diverticular Inflammation and Complication Assessment) has been recently developed in order to have an objective endoscopic description of the colon harbouring diverticula. Aim of this multicentre, international, prospective study was to assess the predictive value of this classification in term of acute diverticulitis and surgery occurrence on a 2-year observational follow-up period.
Methods
2215 prospective patients at the first diagnosis of diverticular disease were enrolled after exclusion of radiological signs of acute diverticulitis; inflammatory bowel diseases; ischemic colitis; prior colonic resection; patients with severe liver failure (Child-Pugh C) or severe kidney failure; pregnant women; patients who are currently using or who have received any laxative agents or mesalazine or probiotics or antibiotics < 2 weeks prior to the enrollment; inability to comply with study protocol; patients with or history of cancer, of any origin, within 5 years before enrollment; history of alcohol, drug, or chemical abuse.
Results
1377(62.15%) patients were classified as DICA 1, 599(27,04%) as DICA 2 and 239(10.80%) as DICA 3. The risk of acute diverticulitis occurrence/recurrence, as well as the risk of surgery, were significantly linked to the severity of DICA score at entry. Overall, acute diverticulitis occurred in 123 (5,5%) patients: it occurred in 32 (2,3%) DICA 1, 53 (8,9%) DICA 2 and 32 (16.4%) DICA 3 patients respectively (p < 0,0001). Overall, surgery occurred in 35 (1,6%) patients: it occurred in 2 (0.1%) DICA1, 15 (2,5%) DICA 2 and 18 (7,6%) DICA 3 patients respectively (p < 0,0001).
Conclusions
The 2-year results of this prospective study seems to confirm that DICA endoscopic classification has a significant prognostic role on the risk of acute diverticulitis occurrence/recurrence and surgery in these patients.
Key messages
DICA is the first endoscopic classification of diverticular disease. The risk of occurrence/recurrence of acute diverticulitis and the risk of surgery are strictly linked to the severity of DICA score.
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Affiliation(s)
- G Nasi
- Health Department, “Cristo Re” Hospital, Rome, Italy
| | - A Tursi
- Territorial Gastroenterology Service, ASL BAT, Andria (BT), Italy
| | - F Di Mario
- Department of Medical and Surgical Sciences, University of Parma, Parma, Italy
| | - W Elisei
- Division of Gastroenterology, San Camillo Forlanini, Rome, Italy
| | - M Picchio
- Division of Surgery, “P. Colombo” Hospital, ASL RM6, Velletri (RM), Italy
| | - M Bafutto
- Institute of Gastroenterology and Digestive Endoscopy, Goiânia University, Goiás, Brazil
| | - D Dumitrascu
- 2nd Medical Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - J Regula
- Department of Gastroenterology-Hepatology-Clinical Oncology, “Maria Sklodowska-Curie” Clinical Oncology Institute, Warsaw, Poland
| | | | - G Brandimarte
- Division of Internal Medicine and Gastroenterology, “Cristo Re” Hospital, Rome, Italy
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6
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Nasi G, Parrocchia S, Mastromatteo AM, Triggiani A, Miraglia BA, Ferrazzani S, Moscato U, Metastasio P, Piscicelli C, Distefano FA. VBAC or not VBAC? Improvement of performance and outcome indexes with the promotion of care safety. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.184] [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: 11/13/2022] Open
Abstract
Abstract
Background
In a multidisciplinary approach to Quality Management System and humanization of care, we aimed at evaluating the characteristics that influence the request of women to carry out Vaginal Birth after Cesarean (VBAC).
Methods
Skills have been improved, with the use of tests on dummies and case by case assessments. For the psychological-motivational study we have adopted: Informed consent, Semi-structured interview and Big Five Questionnaire. The women were recruited by both Gemelli and Cristo Re Hospital: the women following the counseling decided to undergo a second Caesarean Section (CS) (41, control group) and women who decided to complete a VBAC (22, experimental group).
Results
The analysis of the data shows that the women of the VBAC group are in the average between 31-35 years (57%), 80% has an education = or > at the 3rd level and the choice of the VBAC was conditioned by the partner (64%). The women of the control group are in average > 35 years (51%), 60% have a higher average education and the influence on the choice is oriented by the gynecologist/obstetrician (64%). From the personality test a statistically significant difference emerges between the dimensions Energy and Mental Opening. Past experience influences the choice of the next birth: women who are inclined to a second CS considered the previous CS as a positive event (66%) while only 36% in the VBAC group; 64% of this was the recovery of the painful post-surgery and a certain type of difficulty in the care of the child, in breastfeeding, of having suffered from post-partum mood alterations, which is why they chose to undertake a Trial of Labor After Cesarean.
Conclusions
The deeper knowledge of women as well as the preparation and safety of the same operators has shown that it is possible to perform a greater number of VBACs, with the sharing, participation and satisfaction of women and the entire team, leading to an improvement in outcomes and performance indexes.
Key messages
The promotion of care safety also improves the performance indexes through continuous training to the operators and the study of psychological aspects that lead to the choice to carry out a VBAC. Good Clinical Practice shown that it is possible to perform a greater number of VBACs, with the sharing, participation and satisfaction of women and the entire team.
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Affiliation(s)
- G Nasi
- Health Medical Direction, Cristo Re Hospital - GIOMI, Rome, Italy
| | - S Parrocchia
- Health Medical Direction, Santa Maria Goretti Hospital, Latina, Italy
| | - A M Mastromatteo
- Health Medical Direction, Cristo Re Hospital - GIOMI, Rome, Italy
| | - A Triggiani
- Division of Obstetrics and Gynecology, Cristo Re Hospital - GIOMI, Rome, Italy
| | - B A Miraglia
- Health Medical Direction, Cristo Re Hospital - GIOMI, Rome, Italy
| | - S Ferrazzani
- Division of Obstetrics and Gynecology, Fondazione Policlinico A. Gemelli - IRCCS Catholic University of Rome, Rome, Italy
| | - U Moscato
- Department of Public Health, Fondazione Policlinico A. Gemelli - IRCCS Catholic University of Rome, Rome, Italy
| | - P Metastasio
- Division of Obstetrics and Gynecology, Cristo Re Hospital - GIOMI, Rome, Italy
| | - C Piscicelli
- Division of Obstetrics and Gynecology, Cristo Re Hospital - GIOMI, Rome, Italy
| | - F A Distefano
- Division of Obstetrics and Gynecology, Cristo Re Hospital - GIOMI, Rome, Italy
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Nasi G, Mastromatteo AM, Cambiè G, Di Mario F, Elisei W, Franceschi M, Nouvenne A, Tursi A, Violi A, Brandimarte G. Prognostic value of the Diverticular Inflammation and Complication Assessment (DICA) classification. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.221] [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] Open
Abstract
Abstract
Colonic Diverticulosis is one of the most common anatomic alterations found in the clinical practice. This condition has 60% incidence in the population over 60 years old. About 20% of patients with this condition will develop Diverticular Disease, and 5% of them will evolve into Diverticulitis. The aim of the study is to analyse the validation of the classification considering the distribution of the severity DICA score between the patients with diagnosis of colonic Diverticulosis.
We analysed and classified with DICA 5635 colonoscopies in the period between January 2012 and April 2018 and we obtained the Hospital Discharge Form from all the patients that had been admitted to the hospital in the same time period. The results showed that 69.9% of the patients were assigned to the score DICA1, 21% to DICA2 and 9.1% to DICA3. Ageing increased both the diagnosis of Diverticular Disease and the severity score. The severity was higher in female patients (DICA1=44.6%,DICA2=50.8%,DICA3=57.8%). The occurrence of complications overall was 5.4% and specifically: not complicated Diverticular Disease (DICA1=1%, DICA2=1.8%, DICA3=3.5%); not complicated Diverticulitis (DICA1=2.1%, DICA2=4.7%, DICA3=6.4%); Bleeding in Diverticulitis (DICA1=0.4%, DICA2=1.2%, DICA3=4.5%); Diverticular Perforation (DICA1=0.0%, DICA2=0.1%, DICA3=0.4%). The complications that needed a surgical procedure were for DICA1 about 0.2%, for DICA2 0.8% and for DICA3 2.5%. As well the average of the occupant days in the hospital and the cost, respectively, was for DICA1:8.5 days and 2300 €; for DICA2:9.5 days and 3080 €; for DICA 3:13 days and 4090 €.
The majority of the patients with Diverticular Disease belonged to the severity score DICA1 and the patients classified with DICA3 were mainly female and older than 69 years old. The study confirmed the prognostic value of the endoscopic classification DICA since the occurrence of complication resulted in a statistically significant relation with the score DICA3.
Key messages
DICA classification was able to discriminate, based on endoscopic records, the patients that could develop complications for Diverticular Disease. DICA classification is a valid parameter to predict the outcome of the disease, with great impact on public health improving the effectiveness of treatment.
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Affiliation(s)
- G Nasi
- Health Medical Direction, Cristo Re Hospital - GIOMI, Rome, Italy
| | - A M Mastromatteo
- Health Medical Direction, Cristo Re Hospital - GIOMI, Rome, Italy
| | - G Cambiè
- Department of Medicine and Surgery, Gastroenterology Unit, University of Parma, Parma, Italy
| | - F Di Mario
- Department of Medicine and Surgery, Gastroenterology Unit, University of Parma, Parma, Italy
| | - W Elisei
- Division of Gastroenterology, ASL Roma 6, Albano Laziale (Rome), Italy
| | - M Franceschi
- Digestive Endoscopy Unit, ULSS 7 Alto Vicentino, Santorso (VI), Italy
| | - A Nouvenne
- Department of Medicine and Surgery, Gastroenterology Unit, University of Parma, Parma, Italy
| | - A Tursi
- Territorial Gastroenterology Service, ASL BAT, Andria (BT), Italy
| | - A Violi
- Department of Medicine and Surgery, Gastroenterology Unit, University of Parma, Parma, Italy
| | - G Brandimarte
- Division of Internal Medicine and Gastroenterology, Cristo Re Hospital - GIOMI, Rome, Italy
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Brandimarte G, Nasi G, Di Mario F, Nonis M, Tursi A. Impact of new endoscopic classification on public health: an international study. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv175.175] [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: 11/13/2022] Open
Affiliation(s)
- G Brandimarte
- Division of Internal Medicine, “Cristo Re” Hospital, Rome, Italy
| | - G Nasi
- Health Department “Cristo Re” Hospital, Rome, Italy
| | - F Di Mario
- Department of Clinical & Exparimental Medicine, Gastroenterology Unit, University of Parma
| | - M Nonis
- Health Department “Cristo Re” Hospital, Rome, Italy
| | - A Tursi
- Gastroenterology Service, ASL BAT, Andria (BT, Italy
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Rossi C, Grassi A, Torchio B, Ravarino N, Nasi G, Gallone G, Fonzo D. [Pancreatic beta-cell hyperplasia in adults. A clinical case]. MINERVA ENDOCRINOL 1996; 21:73-8. [PMID: 9026684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The author describe a rare case of pancreatic beta-cell hyperplasia. The patient was referred to us because of serious hypoglycemic crises. During hospitalization, endogenous hyperinsulinism was confirmed by hematochemical and instrumental tests. AngioCT of the pancreas evidenced a small lesion of the corpus, suspected of insulinoma. The patient underwent a corpus caudalis pancreatectomy: a small nodule with histologic neuroendocrine traits was ablated. A few days after the operation, new symptomatic hypoglycemia appeared. The hormonal tests confirmed a recurrence of endogenous hyperinsulinism. The patient underwent a new operation for pancreaticoduodenectomy: histological examination confirmed a pancreatic beta-cells hyperplasia. This condition has to be taken into account in the differential diagnosis of post prandial hypoglycemia. Besides, the observation of an insulinoma doesn't exclude the presence of a diffused disorder of islet cells as in the case above described.
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Affiliation(s)
- C Rossi
- Divisione di Endocrinologia e Malattie del Ricambio, Ospedale Mauriziano Umberto I, Torino
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10
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Torricelli P, Puviani M, De Santis M, Nasi G, Pollastri C. [Magnetic resonance in the staging of renal carcinoma. The results compared with computed tomography in 42 cases]. Radiol Med 1992; 84:85-91. [PMID: 1509152] [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: 12/27/2022]
Abstract
In order to investigate the value of MRI in the staging of renal cell carcinoma and to compare the results of MRI and CT, the authors evaluated by means of MRI and CT 42 patients affected with renal cell carcinoma. All patients underwent surgery, and pathology of the surgical specimens was performed. A comparison was made between the surgical and pathologic data and MRI and CT results. Moreover, a comparative evaluation of MRI and CT findings was also made. From the comparison between pathologic data and CT and MRI results MRI was seen to have correctly staged 36 of 42 cases (85%), versus CT 33 of 42 cases (78%). Moreover, MRI proved to be superior to CT in evaluating venous involvement (stages III A and III C) and extra-fascial tumor spread (stage IVA). On the contrary, no significant differences were found between MRI and CT in the evaluation of perirenal involvement (stages I-II) and lymph node metastases (stage III B). MRI misdiagnosed 6 of 42 cases: 2 false negatives in evaluating extracapsular tumor spread, 1 false positive of mesenteric infiltration, 1 false positive of renal vein thrombosis, 1 false positive and 1 false negative in evaluating lymph node metastases. CT misdiagnoses (9 of 42 cases) were the same as those of MRI in 5 cases, while in the MRI false positive of renal vein thrombosis CT was correct. The extant 4 incorrect CT findings were: 2 false positive of renal vein thrombosis, 1 false negative of infiltration of diaphragm and psoas muscle, 1 false positive infiltration of the right liver lobe. As yet, therefore, MRI cannot be routinely employed to stage all renal cancer patients. On the contrary, MRI should be considered as a second-choice diagnostic tool to employ in selected cases when CT alone cannot solve all the problems relative to staging.
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11
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Lonardo A, Grisendi A, Pulvirenti M, Della Casa G, Melini L, Di Gregorio C, Nasi G, Sarti M, Tamborrino E, Lonardo F. Right colon adenocarcinoma presenting as Bacteroides fragilis liver abscesses. J Clin Gastroenterol 1992; 14:335-8. [PMID: 1607610 DOI: 10.1097/00004836-199206000-00013] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.4] [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: 12/27/2022]
Abstract
Pyogenic abscesses of the liver occur in association with a variety of diseases. Sometimes they are caused by anaerobic infections of liver metastases. Uncommonly, however, multiple hepatic abscesses caused by anaerobic bacteria are the presenting signs of unsuspected colonic cancer in the absence of liver metastases. We report a 60-year-old man who presented with febrile cholestatic liver disease initially thought to be metastases. Repeated ultrasound-directed liver biopsies yielded a diagnosis of multiple abscesses. Bacteroides fragilis was grown from the liver specimen and the patient responded well to metronidazole treatment. Two months later, however, overt symptoms of large bowel disease led to the diagnosis of colonic adenocarcinoma. After a 6-month postoperative follow-up, the patient is free of liver metastases. Anaerobic liver abscesses should always alert the clinician to possible silent colonic cancer.
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Affiliation(s)
- A Lonardo
- First Division of Internal Medicine, Ospedale Civile, Modena, Italy
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12
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Longo M, Nasi G, Burani A, Criscuolo M, Cocchi G. Bone pulsating metastasis due to hypernephroma. Chir Organi Mov 1991; 76:379-83. [PMID: 1800052] [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: 12/28/2022]
Abstract
Bone pulsating metastasis due to hypernephroma is an exceptional occurrence. The authors present one case of bone pulsating metastasis due to hypernephroma localized in the proximal tibia. The primary renal lesion was located by ultrasonography and confirmed by CT scan.
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Affiliation(s)
- M Longo
- Divisione di Ortopedia e Traumatologia, Ospedale Civile, Modena
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13
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Botti C, Olmi R, Filoni A, Oleari G, Nasi G, Zanetti GC. Trans-Uretero-Ureterostomia Percutanea « in Situ » Secondo Izquierdo. Urologia 1988. [DOI: 10.1177/039156038805500321] [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: 11/15/2022]
Affiliation(s)
| | | | | | | | | | - G. C. Zanetti
- U.L.S.S. n. 16 di Modena, Divisione di Urologia - Primario:
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14
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Botti C, Olmi R, Filoni A, Oleari G, Nasi G, Zanetti GC. Esito Morfologico Di Un Caso Trattato Con Una Nefrolitotomia Percutanea Renale. Urologia 1988. [DOI: 10.1177/039156038805500325] [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: 11/17/2022]
Affiliation(s)
| | | | | | | | | | - G. C. Zanetti
- U.L.S.S. ». 16. di Modena, Ospedale Civile, Divisione di Urologia - Primario:
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Affiliation(s)
| | | | | | | | | | - G.C. Zanetti
- U.L.S.S. n. 16 di Modena, Divisione di Urologia - Primario:
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16
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Botti C, Olmi R, Borelli A, Filoni A, Zanetti GC, Nasi G. Ricostruzione Del Collo Vescicale E Dell'Uretra in Una Donna Con Incontinenza Totale. Urologia 1984. [DOI: 10.1177/039156038405100222] [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: 11/15/2022]
Affiliation(s)
| | | | | | | | | | - G. Nasi
- Servizio di Radiologia e Fisioterapia
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17
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Berri G, Nasi G, Bertoni V, Olmi R, Zanetti GC. Prostatografia Trans-Uretrale. Urologia 1981. [DOI: 10.1177/039156038104800112] [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: 11/17/2022]
Affiliation(s)
| | | | | | | | - G. C. Zanetti
- (Ospedale Civile di Modena, Divisione Urologica - Primario: dott. G. C. Zanetti)
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Berri G, Bianchi M, Bertoni V, Nasi G, Zanetti G. A Proposito Dell'Intervento Di Devine Nell'Induratio Penis Plastica. Urologia 1979. [DOI: 10.1177/039156037904600217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Botti C, Berri G, Olmi R, Nasi G. Una Osservazione Di Uretere Retro-Cavale. Urologia 1978. [DOI: 10.1177/039156037804500516] [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: 11/15/2022]
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