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Altomare M. Multi-centric study on organ donation after trauma: a cluster analysis. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02488-w. [PMID: 38592467 DOI: 10.1007/s00068-024-02488-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/24/2024] [Indexed: 04/10/2024]
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Bettoni G, Gheda S, Altomare M, Cioffi SPB, Ferrazzi D, Cazzaniga M, Bonacchini L, Cimbanassi S, Aseni P. Successful Needle Aspiration of a Traumatic Pneumothorax: A Case Report and Literature Review. Medicina (Kaunas) 2024; 60:548. [PMID: 38674194 PMCID: PMC11051943 DOI: 10.3390/medicina60040548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/20/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024]
Abstract
Traumatic pneumothorax (PTX) occurs in up to 50% of patients with severe polytrauma and chest injuries. Patients with a traumatic PTX with clinical signs of tension physiology and hemodynamic instability are typically treated with an urgent decompressive thoracostomy, tube thoracostomy, or needle decompression. There is recent evidence that non-breathless patients with a hemodynamically stable traumatic PTX can be managed conservatively through observation or a percutaneous pigtail catheter. We present here a 52-year-old woman who presented to the emergency department with a 55 mm traumatic PTX. Following aspiration of 1500 mL of air, a clinical improvement was immediately observed, allowing the patient to be discharged shortly thereafter. In hemodynamically stable patients with a post-traumatic PTX, without specific risk factors or oxygen desaturation, observation or simple needle aspiration can be a reasonable approach. Although the recent medical literature supports conservative management of small traumatic PTXs, guidelines are lacking for hemodynamically stable patients with a significantly large PTX. This case report documents our successful experience with needle aspiration in such a setting of large traumatic PTX. We aimed in this article to review the available literature on needle aspiration and conservative treatment of traumatic pneumothorax. A total of 12 studies were selected out of 190 articles on traumatic PTX where conservative treatment and chest tube decompression were compared. Our case report offers a novel contribution by illustrating the successful resolution of a sizable pneumothorax through needle aspiration, suggesting that even a large PTX in a hemodynamically stable patient, without other risk conditions, can be successfully treated conservatively with simple needle aspiration in order to avoid tube thoracostomy complications.
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Affiliation(s)
- Giuseppe Bettoni
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (G.B.); (S.G.); (D.F.); (M.C.); (L.B.)
| | - Silvia Gheda
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (G.B.); (S.G.); (D.F.); (M.C.); (L.B.)
| | - Michele Altomare
- Advanced Technologies in Surgery, Department of Surgical Sciences, University of Rome Sapienza, 00185 Rome, Italy; (M.A.); (S.P.B.C.)
- General Surgery Trauma Team, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy;
| | - Stefano Piero Bernardo Cioffi
- Advanced Technologies in Surgery, Department of Surgical Sciences, University of Rome Sapienza, 00185 Rome, Italy; (M.A.); (S.P.B.C.)
- General Surgery Trauma Team, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy;
| | - Davide Ferrazzi
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (G.B.); (S.G.); (D.F.); (M.C.); (L.B.)
| | - Michela Cazzaniga
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (G.B.); (S.G.); (D.F.); (M.C.); (L.B.)
| | - Luca Bonacchini
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (G.B.); (S.G.); (D.F.); (M.C.); (L.B.)
| | - Stefania Cimbanassi
- General Surgery Trauma Team, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy;
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Paolo Aseni
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (G.B.); (S.G.); (D.F.); (M.C.); (L.B.)
- Department of Biomedical and Clinical Sciences “L. Sacco”, Università degli Studi di Milano, 20157 Milan, Italy
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Spota A, Granieri S, Ferrario L, Zamburlini B, Frassini S, Reitano E, Cioffi SP, Altomare M, Bini R, Virdis F, Chiara O, Cimbanassi S. Injury Patterns of Electric-Scooter Related Trauma: A Systematic Review With Proportion Meta-Analysis. Am Surg 2024:31348241241682. [PMID: 38532248 DOI: 10.1177/00031348241241682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
Electric scooter (ES)-related injuries are increasing but poorly described. Clinicians need more information to be prepared for these patients. We supposed two prevalent patterns of patients: mildly injured (predominant upper-limb injuries) and severely injured (predominant head trauma). This study aims to understand the frequency of ES-related injuries and patients' characteristics despite the heterogeneity of data currently available. A systematic review with a proportion meta-analysis was conducted on studies with a multidisciplinary description of ES-related injuries in adult patients (PROSPERO-ID: CRD42022341241). Articles from inception to April 2023 were identified in MEDLINE, Embase, and Cochrane's databases. The risk of bias was evaluated using ROBINS-I. Twenty-five observational studies with 5387 patients were included in the meta-analysis, depending on reported data. Upper-limb (31.8%) and head (19.5%) injuries are the most frequent (25/25 studies included). When injured while riding, 19.5% of patients are intoxicated with drugs/alcohol, and only 3.9% use a helmet, increasing the possibility of severe injuries. About 80% of patients are victims of spontaneous falls. Half of the patients self-present to the ED, and 69.4% of cases are discharged directly from the ED. Studies' limitations include an overall moderate risk of bias and high heterogeneity. Electric scooter-related accidents are commonly associated with upper-limb injuries but often involve the head. Spontaneous falls are the most common mechanism of injury, probably related to frequent substance abuse and helmet misuse. This hot topic is not adequately investigated due to a lack of data. A prospective registry could fill this gap.
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Affiliation(s)
- Andrea Spota
- Acute care surgery and trauma, ASST GOM Niguarda, Milan, Italy
- Tissue Bank and Therapy, ASST GOM Niguarda, Milan, Italy
| | - Stefano Granieri
- General Surgery Unit, ASST-Brianza, Vimercate Hospital, Vimercate, Italy
| | - Luca Ferrario
- General Surgery Department, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milano, Italy
- Department of Biomedical and Clinical Sciences "Luigi Sacco," Università Degli Studi di Milano, Milano, Italy
| | | | - Simone Frassini
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
- General Surgery Residency Program, University of Pavia, Pavia, Italy
| | - Elisa Reitano
- Department of General Surgery, Nouvel Hôpital Civil, CHRU-Strasbourg, Strasbourg, France
| | - Stefano Pb Cioffi
- Acute care surgery and trauma, ASST GOM Niguarda, Milan, Italy
- Department of Surgical Sciences, University of Rome Sapienza, Roma, Italy
| | - Michele Altomare
- Acute care surgery and trauma, ASST GOM Niguarda, Milan, Italy
- Department of Surgical Sciences, University of Rome Sapienza, Roma, Italy
| | - Roberto Bini
- Acute care surgery and trauma, ASST GOM Niguarda, Milan, Italy
| | | | - Osvaldo Chiara
- Acute care surgery and trauma, ASST GOM Niguarda, Milan, Italy
- Department of Pathophysiology and Transplantation, State University of Milan, Milano, Italy
| | - Stefania Cimbanassi
- Acute care surgery and trauma, ASST GOM Niguarda, Milan, Italy
- Department of Pathophysiology and Transplantation, State University of Milan, Milano, Italy
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Canzi G, De Ponti E, Spota A, Mangini G, De Simone E, Cioffi SPB, Altomare M, Bini R, Virdis F, Cimbanassi S, Chiara O, Sozzi D, Novelli G. Are severity and location of facial trauma risk factors for cervical spine injuries? 10-year analysis based on the use of the AO spine injury classification and the comprehensive facial injury (CFI) score. Eur Spine J 2024; 33:198-204. [PMID: 38006474 DOI: 10.1007/s00586-023-08037-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/12/2023] [Accepted: 10/29/2023] [Indexed: 11/27/2023]
Abstract
PURPOSE This study aims to demonstrate a correlation between cervical spine injury and location and severity of facial trauma. METHODS We did a 10-year retrospective analysis of prospectively collected patients with at least one facial and/or cervical spine injury. We classified facial injuries using the Comprehensive Facial Injury (CFI) score, and stratified patients into mild (CFI < 4), moderate (4 ≤ CFI < 10) and severe facial trauma (CFI ≥ 10). The primary outcome was to recognize the severity and topography of the facial trauma which predict the probability of associated cervical spine injuries. RESULTS We included 1197 patients: 78% with facial injuries, 16% with spine injuries and 6% with both. According to the CFI score, 48% of patients sustained a mild facial trauma, 35% a moderate one and 17% a severe one. The midface was involved in 45% of cases, then the upper facial third (13%) and the lower one (10%). The multivariate analysis showed multiple independent risk factors for associated facial and cervical spine injuries, among them an injury of the middle facial third (OR 1.11 p 0.004) and the facial trauma severity, having every increasing point of CFI score a 6% increasing risk (OR 1.06 p 0.004). CONCLUSIONS Facial trauma is a risk factor for a concomitant cervical spine injury. Among multiple risk factors, severe midfacial trauma is an important red flag. The stratification of facial injuries based on the CFI score through CT-scan images could be a turning point in the management of patients at risk for cervical spine injuries before imaging is available.
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Affiliation(s)
- G Canzi
- Maxillofacial Surgery Unit, Department of Neuroscience - Head & Neck, ASST GOM Niguarda, Milan, Italy
| | - E De Ponti
- Medical Physics Department, Foundation IRCCS San Gerardo Hospital, 20900, Monza, Italy
| | - A Spota
- Acute Care Surgery and Trauma, ASST GOM Niguarda, Milan, Italy.
- Tissue Bank and Therapy, ASST GOM Niguarda, Milan, Italy.
| | - G Mangini
- School of Medicine, University of Milano Bicocca, Milan, Italy
| | - E De Simone
- Postgraduate School of Maxillo-Facial Surgery, University of Milan, Milan, Italy
| | - S P B Cioffi
- Acute Care Surgery and Trauma, ASST GOM Niguarda, Milan, Italy
- Department of Surgical Sciences, University of Rome Sapienza, Rome, Italy
| | - M Altomare
- Acute Care Surgery and Trauma, ASST GOM Niguarda, Milan, Italy
- Department of Surgical Sciences, University of Rome Sapienza, Rome, Italy
| | - R Bini
- Acute Care Surgery and Trauma, ASST GOM Niguarda, Milan, Italy
| | - F Virdis
- Acute Care Surgery and Trauma, ASST GOM Niguarda, Milan, Italy
| | - S Cimbanassi
- Acute Care Surgery and Trauma, ASST GOM Niguarda, Milan, Italy
- Department of Pathophysiology and Transplantation, Università Degli Studi Di Milano, Milan, Italy
| | - O Chiara
- Acute Care Surgery and Trauma, ASST GOM Niguarda, Milan, Italy
- Department of Pathophysiology and Transplantation, Università Degli Studi Di Milano, Milan, Italy
| | - D Sozzi
- Chirurgia Maxillo Facciale, Fondazione IRCCS San Gerardo Dei Tintori, Via Pergolesi 33, Monza, Italy
- Dipartimento di Medicina e Chirurgia, School of Medicine, Università Degli Studi di Milano-Bicocca, Milan, Italy
| | - G Novelli
- Chirurgia Maxillo Facciale, Fondazione IRCCS San Gerardo Dei Tintori, Via Pergolesi 33, Monza, Italy
- Dipartimento di Medicina e Chirurgia, School of Medicine, Università Degli Studi di Milano-Bicocca, Milan, Italy
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Granieri S, Sileo A, Altomare M, Frassini S, Gjoni E, Germini A, Bonomi A, Akimoto E, Wong CL, Cotsoglou C. Short-Term Outcomes after D2 Gastrectomy with Complete Mesogastric Excision in Patients with Locally Advanced Gastric Cancer: A Systematic Review and Meta-Analysis of High-Quality Studies. Cancers (Basel) 2023; 16:199. [PMID: 38201626 PMCID: PMC10778561 DOI: 10.3390/cancers16010199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/17/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024] Open
Abstract
Complete mesogastric excision (CME) has been advocated to allow for a more extensive retrieval of lymph nodes, as well as lowering loco-regional recurrence rates. This study aims to analyze the short-term outcomes of D2 radical gastrectomy with CME compared to standard D2 gastrectomy. A systematic review of the literature was conducted according to the Cochrane recommendations until 2 July 2023 (PROSPERO ID: CRD42023443361). The primary outcome, expressed as mean difference (MD) and 95% confidence intervals (CI), was the number of harvested lymph nodes (LNs). Meta-analyses of means and binary outcomes were developed using random effects models to assess heterogeneity. The risk of bias in included studies was assessed with the RoB 2 and ROBINS-I tools. There were 13 studies involving 2009 patients that were included, revealing a significantly higher mean number of harvested LNs in the CME group (MD: 2.55; 95% CI: 0.25-4.86; 95%; p = 0.033). The CME group also experienced significantly lower intraoperative blood loss, a lower length of stay, and a shorter operative time. Three studies showed a serious risk of bias, and between-study heterogeneity was mostly moderate or high. Radical gastrectomy with CME may offer a safe and more radical lymphadenectomy, but long-term outcomes and the applicability of this technique in the West are still to be proven.
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Affiliation(s)
- Stefano Granieri
- General Surgery Unit, ASST Brianza—Vimercate Hospital, 20871 Vimercate, Italy; (E.G.); (A.G.)
| | - Annaclara Sileo
- General Surgery Residency Program, University of Milan, 20122 Milan, Italy; (A.S.); (A.B.)
| | - Michele Altomare
- Trauma Center and Emergency Surgery, ASST Great Metropolitan Hospital Niguarda, 20162 Milan, Italy;
| | - Simone Frassini
- General Surgery Residency Program, University of Pavia, 27100 Pavia, Italy;
| | - Elson Gjoni
- General Surgery Unit, ASST Brianza—Vimercate Hospital, 20871 Vimercate, Italy; (E.G.); (A.G.)
| | - Alessandro Germini
- General Surgery Unit, ASST Brianza—Vimercate Hospital, 20871 Vimercate, Italy; (E.G.); (A.G.)
| | - Alessandro Bonomi
- General Surgery Residency Program, University of Milan, 20122 Milan, Italy; (A.S.); (A.B.)
| | - Eigo Akimoto
- Department of General Surgery, Juntendo University Nerima Hospital, Tokyo 177-8521, Japan;
| | - Chun Lam Wong
- Ruttonjee & Tang Siu Kin Hospital, Hong Kong, China;
| | - Christian Cotsoglou
- General Surgery Unit, ASST Brianza—Vimercate Hospital, 20871 Vimercate, Italy; (E.G.); (A.G.)
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Cioffi SPB, Altomare M, Podda M, Spota A, Granieri S, Reitano E, Zamburlini B, Virdis F, Bini R, Gupta S, Torzilli G, Mingoli A, Chiara O, Cimbanassi S. The burden of the knowledge-to-action gap in acute appendicitis. Surg Endosc 2023; 37:9617-9632. [PMID: 37884735 PMCID: PMC10709474 DOI: 10.1007/s00464-023-10449-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/05/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND The burden of emergency general surgery (EGS) is higher compared to elective surgery. Acute appendicitis (AA) is one of the most frequent diseases and its management is dictated by published international clinical practice guidelines (CPG). Adherence to CPG has been reported as heterogeneous. Barriers to clinical implementation were not studied. This study explored barriers to adherence to CPG and the clinico-economic impact of poor compliance. METHODS Data were extracted from the three-year data lock of the REsiDENT-1 registry, a prospective resident-led multicenter trial. We identified 7 items from CPG published from the European Association of Endoscopic Surgery (EAES) and the World Society of Emergency Surgery (WSES). We applied our classification proposal and used a five-point Likert scale (Ls) to assess laparoscopic appendectomy (LA) difficulty. Descriptive analyses were performed to explore compliance and group comparisons to assess the impact on outcomes and related costs. We ran logistic regressions to identify barriers and facilitators to implementation of CPG. RESULTS From 2019 to 2022, 653 LA were included from 24 centers. 69 residents performed and coordinated data collection. We identified low compliance with recommendations on peritoneal irrigation (PI) (25.73%), abdominal drains (AD) (34.68%), and antibiotic stewardship (34.17%). Poor compliance on PI and AD was associated to higher infectious complications in uncomplicated AA. Hospitalizations were significantly longer in non-compliance except for PI in uncomplicated AA, and costs significantly higher, exception made for antibiotic stewardship in complicated AA. The strongest barriers to CPG implementation were complicated AA and technically challenging LA for PI and AD. Longer operative times and the use of PI negatively affected antibiotic stewardship in uncomplicated AA. Compliance was higher in teaching hospitals and in emergency surgery units. CONCLUSIONS We confirmed low compliance with standardized items influenced by environmental factors and non-evidence-based practices in complex LA. Antibiotic stewardship is sub-optimal. Not following CPG may not influence clinical complications but has an impact in terms of logistics, costs and on the non-measurable magnitude of antibiotic resistance. Structured educational interventions and institutional bundles are required.
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Affiliation(s)
- Stefano Piero Bernardo Cioffi
- Advanced Technologies in Surgery, Department of Surgical Sciences, University of Rome Sapienza, Rome, Italy.
- General Surgery Trauma Team, ASST GOM Niguarda, Viale Ettore Majorana, 20162, Milan, Italy.
| | - Michele Altomare
- Advanced Technologies in Surgery, Department of Surgical Sciences, University of Rome Sapienza, Rome, Italy
- General Surgery Trauma Team, ASST GOM Niguarda, Viale Ettore Majorana, 20162, Milan, Italy
| | - Mauro Podda
- Department of Surgical Sciences, Cagliari State University, Cagliari, Italy
| | - Andrea Spota
- General Surgery Trauma Team, ASST GOM Niguarda, Viale Ettore Majorana, 20162, Milan, Italy
| | - Stefano Granieri
- General Surgery Unit, ASST-Brianza, Vimercate Hospital, Vimercate, Italy
| | - Elisa Reitano
- Division of General Surgery, Department of Translational Medicine, Maggiore Della Carità Hospital, University of Eastern Piedmont, Novara, Italy
- Research Institute Against Digestive Cancer, IRCAD, Strasbourg, France
| | - Beatrice Zamburlini
- General Surgery Trauma Team, ASST GOM Niguarda, Viale Ettore Majorana, 20162, Milan, Italy
- General Surgery Residency Program, University of Milan, Milan, Italy
| | - Francesco Virdis
- General Surgery Trauma Team, ASST GOM Niguarda, Viale Ettore Majorana, 20162, Milan, Italy
| | - Roberto Bini
- General Surgery Trauma Team, ASST GOM Niguarda, Viale Ettore Majorana, 20162, Milan, Italy
| | | | | | - Andrea Mingoli
- Advanced Technologies in Surgery, Department of Surgical Sciences, University of Rome Sapienza, Rome, Italy
| | - Osvaldo Chiara
- General Surgery Trauma Team, ASST GOM Niguarda, Viale Ettore Majorana, 20162, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Stefania Cimbanassi
- General Surgery Trauma Team, ASST GOM Niguarda, Viale Ettore Majorana, 20162, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Santolamazza G, Virdis F, Abu-Zidan F, Cioffi SPB, Reitano E, Altomare M, Bini R, Spota A, Podda M, Kumar J, Chiara O, Cimbanassi S. Contrast-enhanced ultrasound (CEUS) in the follow-up of abdominal solid organ trauma: an international survey prior to the PseAn study. Eur J Trauma Emerg Surg 2023:10.1007/s00068-023-02364-z. [PMID: 37828351 DOI: 10.1007/s00068-023-02364-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/08/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND The blunt and penetrating abdominal trauma follow-up relies on contrast CT scan to detect solid organ injuries. CEUS is not widely used worldwide, despite its accuracy and feasibility in identifying parenchymal and vascular lesions. This survey aims to define the current use of CEUS in Trauma Centers and the expectations of Emergency Surgeons regarding its role. METHODS We sent an online questionnaire composed of 10 questions to trauma physicians worldwide during the period of September 2022 to March 2023. RESULTS 59 participants from 53 different centers answered the questionnaire. 76.2% of the enrolled participants have CEUS available at their Institution, and 49.2% think that it can replace CT scan. Contrast-CT scan remains the preferred option in the follow-up of blunt liver (69.5%), spleen (72.9%) and kidney (76.3%) injuries, followed by CEUS which is used in 18.6% for liver, 20.3% for spleen and 15.3% for kidney injuries. The results are similar for penetrating abdominal trauma, with contrast CT scan being the first-line imaging technique (91.5% for liver, 91.5% for spleen and 88.1% for kidney injuries), followed by CEUS (5.1% for liver, 5.1% for spleen and 6.8% for kidney injuries). CONCLUSIONS Our survey shows that CEUS is still underutilized in the follow-up of abdominal trauma, even though many emergency surgeons consider it as a valid alternative to contrast CT scan.
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Affiliation(s)
- Giuliano Santolamazza
- Department of Emergency and Trauma Surgery, Trauma and Acute Care Surgery Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza Dell'Ospedale Maggiore, 3, 20162, Milan, MI, Italy
| | - Francesco Virdis
- Department of Emergency and Trauma Surgery, Trauma and Acute Care Surgery Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza Dell'Ospedale Maggiore, 3, 20162, Milan, MI, Italy.
| | - Fikri Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Stefano Piero Bernardo Cioffi
- Department of Emergency and Trauma Surgery, Trauma and Acute Care Surgery Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza Dell'Ospedale Maggiore, 3, 20162, Milan, MI, Italy
| | - Elisa Reitano
- IRCAD Research Institute Against Digestive Cancer, Strasbourg, France
| | - Michele Altomare
- Department of Emergency and Trauma Surgery, Trauma and Acute Care Surgery Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza Dell'Ospedale Maggiore, 3, 20162, Milan, MI, Italy
| | - Roberto Bini
- Department of Emergency and Trauma Surgery, Trauma and Acute Care Surgery Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza Dell'Ospedale Maggiore, 3, 20162, Milan, MI, Italy
| | - Andrea Spota
- Department of Emergency and Trauma Surgery, Trauma and Acute Care Surgery Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza Dell'Ospedale Maggiore, 3, 20162, Milan, MI, Italy
- Tissue Bank and Therapy, ASST GOM Niguarda, Milan, Italy
| | - Mauro Podda
- Department of General and Emergency Surgery, Cagliari University Hospital, Cagliari, Italy
| | - Jayant Kumar
- Department of Medicine, Faculty of Surgery and Cancer, Imperial College London, London, England
| | - Osvaldo Chiara
- Department of Emergency and Trauma Surgery, Trauma and Acute Care Surgery Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza Dell'Ospedale Maggiore, 3, 20162, Milan, MI, Italy
| | - Stefania Cimbanassi
- Department of Emergency and Trauma Surgery, Trauma and Acute Care Surgery Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza Dell'Ospedale Maggiore, 3, 20162, Milan, MI, Italy
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8
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Sposito C, Maspero M, Conalbi V, Magarotto A, Altomare M, Battiston C, Cantù P, Mazzaferro V. Impact of Indocyanine Green Fluorescence Imaging on Lymphadenectomy Quality During Laparoscopic Distal Gastrectomy for Gastric Cancer (Greeneye): An Adaptative, Phase 2, Clinical Trial. Ann Surg Oncol 2023; 30:6803-6811. [PMID: 37442913 PMCID: PMC10506942 DOI: 10.1245/s10434-023-13848-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Indocyanine green (ICG)-guided lymphadenectomy using near-infrared visualization (NIR) may increase nodal yield during gastrectomy. The purpose of this study was to evaluate the clinical benefit of NIR visualization on the quality of D2 lymphadenectomy during laparoscopic distal gastrectomy. METHODS This single-arm, open-label, Simon's two-stage, adaptive, phase 2 trial included patients who underwent laparoscopic distal gastrectomy for gastric adenocarcinoma. Endoscopic peritumoral injection of ICG was performed 24 ± 6 h before surgery. Intraoperatively, after standard D2 lymphadenectomy and specimen extraction, NIR was used for eventual completion lymphadenectomy. The primary endpoint was clinical benefit of NIR (i.e., at least one additional harvested station containing lymph nodes, with negative points for every harvested station with no lymph nodes at final pathology). RESULTS We enrolled 18 patients (61% female, median age 69 years). With NIR, an extra 23 stations were harvested: 9 contained no lymph nodes, 12 contained nonmetastatic lymph nodes, and 2 contained metastatic lymph nodes. The most commonly visualized station with NIR were station 6 (8 patients) and 1 (4 patients). The total number of harvested nodes per patient was 32 (interquartile range [IQR] 26-41), with a median of 1 (IQR 0-1) additional lymph node after NIR. Overall, seven (39%) patients had a clinical benefit from NIR, of which two (11%) had one metastatic lymph node harvested with NIR. CONCLUSIONS NIR visualization improves the quality of D2 lymphadenectomy in distal gastrectomy for gastric cancer. Considering the limited improve in the number of harvested lymph nodes, its real oncological benefit is still questionable.
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Affiliation(s)
- Carlo Sposito
- Upper GI Surgery and HPB Surgery and Liver Transplantation Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.
| | - Marianna Maspero
- Upper GI Surgery and HPB Surgery and Liver Transplantation Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Valeria Conalbi
- Upper GI Surgery and HPB Surgery and Liver Transplantation Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Andrea Magarotto
- Gastroenterology and Digestive Endoscopy, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Michele Altomare
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Carlo Battiston
- Upper GI Surgery and HPB Surgery and Liver Transplantation Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Paolo Cantù
- Gastroenterology and Digestive Endoscopy, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Vincenzo Mazzaferro
- Upper GI Surgery and HPB Surgery and Liver Transplantation Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Sposito C, Maspero M, Conalbi V, Magarotto A, Altomare M, Battiston C, Cantù P, Mazzaferro V. ASO Visual Abstract: Impact of Indocyanine Green Fluorescence Imaging on Lymphadenectomy Quality During Laparoscopic Distal Gastrectomy for Gastric Cancer (Greeneye): An Adaptative Phase 2 Clinical Trial. Ann Surg Oncol 2023; 30:6814. [PMID: 37488391 DOI: 10.1245/s10434-023-14014-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Affiliation(s)
- Carlo Sposito
- Upper GI Surgery and Liver Transplantation Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
- Department of Oncology and Hemato-Oncology, HPB Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano, University of Milan, Milan, Italy.
| | - Marianna Maspero
- Upper GI Surgery and Liver Transplantation Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Valeria Conalbi
- Upper GI Surgery and Liver Transplantation Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Andrea Magarotto
- Gastroenterology and Digestive Endoscopy, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Michele Altomare
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Carlo Battiston
- Upper GI Surgery and Liver Transplantation Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Paolo Cantù
- Gastroenterology and Digestive Endoscopy, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Vincenzo Mazzaferro
- Upper GI Surgery and Liver Transplantation Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
- Department of Oncology and Hemato-Oncology, HPB Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano, University of Milan, Milan, Italy
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Bini R, Virdis F, Cioffi SPB, Altomare M, Sammartano F, Borotto E, Chiara O, Cimbanassi S. "Stabilize the Unstable": Treatment Pathophysiology in Bleeding Trauma Patients, from the Field to the ICU. State of the Art. J Pers Med 2023; 13:jpm13040667. [PMID: 37109053 PMCID: PMC10145706 DOI: 10.3390/jpm13040667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
The results of the Global Burden of Disease (GBD) study showed that, in 2019, 8% of deaths worldwide were trauma related [...].
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Affiliation(s)
| | | | | | | | - Fabrizio Sammartano
- Trauma Center, San Carlo Borromeo ASST Santi Paolo e Carlo, 20162 Milan, Italy
| | - Erika Borotto
- Intensive Care Unit, Macchi Hospital, 21100 Varese, Italy
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Spota A, Giorgi PD, Cioffi SPB, Altomare M, Schirò GR, Legrenzi S, Villa FG, Chiara O, Cimbanassi S. Spinal injury in major trauma: Epidemiology of 1104 cases from an Italian first level trauma center. Injury 2023; 54:1144-1150. [PMID: 36849304 DOI: 10.1016/j.injury.2023.02.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 01/22/2023] [Accepted: 02/19/2023] [Indexed: 03/01/2023]
Abstract
INTRODUCTION Traumatic spinal injuries are frequent and their management is debated, especially in major trauma patients. This study aims to describe a large population of major trauma patients with vertebral fractures to improve prevention measures and fracture management. PATIENTS AND METHODS Retrospective analysis of 6274 trauma patients prospectively collected between October 2010 and October 2020. Collected data include demographics, mechanism of trauma, type of imaging, fracture morphology, associated injuries, injury severity score (ISS), survival, and death timing. The statistical analysis focused on mechanism of trauma and the search of predictive factors for critical fractures. RESULTS Patients showed a mean age of 47 years and 72.5% were males. Trauma included 59.9% of road accidents and 35.1% of falls. 30.7% patients had at least a severe fracture, while 17.2% had fractures in multiple spinal regions. 13.7% fractures were complicated by spinal cord injury (SCI). The mean ISS of the total population was 26.4 (SD 16.3), with 70.7% patients having an ISS≥16. There is a higher rate of severe fractures in fall cases (40.1%) compared to RA (21.9% to 26.3%). The probability of a severe fracture increased by 164% in the case of fall and by 77% in presence of AIS≥3 associated injury of head/neck while reduced by 34% in presence of extremities associated injuries. Multiple level injuries increased with ISS rise and in the case of extremities associated injuries. The probability of a severe upper cervical fracture increased by 5.95 times in the presence of facial associated injuries. The mean length of stay was 24.7 days and 9.6% of patients died. CONCLUSIONS In Italy, road accidents are still the most frequent trauma mechanism and cause more cervico-thoracic fractures, while falls cause more lumbar fractures. Spinal cord injuries represent an indicator of more severe trauma. In motorcyclists or fallers/jumpers, there is a higher risk of severe fractures. When a spinal injury is diagnosed, the probability of a second vertebral fracture is consistent. These data could help the decisional workflow in the management of major trauma patients with vertebral injury.
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Affiliation(s)
- Andrea Spota
- Acute care surgery and trauma, ASST GOM Niguarda, Milan, Italy; Tissue Bank and Therapy, ASST GOM Niguarda, Milan, Italy.
| | | | | | - Michele Altomare
- Acute care surgery and trauma, ASST GOM Niguarda, Milan, Italy; Tissue Bank and Therapy, ASST GOM Niguarda, Milan, Italy
| | | | | | | | - Osvaldo Chiara
- Acute care surgery and trauma, ASST GOM Niguarda, Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Stefania Cimbanassi
- Acute care surgery and trauma, ASST GOM Niguarda, Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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Cobianchi L, Dal Mas F, Agnoletti V, Ansaloni L, Biffl W, Butturini G, Campostrini S, Catena F, Denicolai S, Fugazzola P, Martellucci J, Massaro M, Previtali P, Ruta F, Venturi A, Woltz S, Kaafarani HM, Loftus TJ, Aapoäÿlu R, Abbott KL, Abdelmalik A, Abebe NS, Abu-Zidan F, Adam YAY, Adamou H, Adamovich DM, Agresta F, Agrusa A, Akin E, Alessiani M, Alexandrino H, Bidoli C, Ali SM, Mihai VA, Almeida PM, Al-Shehari MM, Altomare M, Amico F, Ammendola M, Andreuccetti J, Anestiadou E, Annicchiarico A, Antonelli A, Aparicio-Sanchez D, Ardito A, Argenio G, Arvieux CC, Arvieux C, Askevold IH, Atanasov BT, Augustin G, Awad SS, Bacchiocchi G, Bagnoli C, Bahouth H, Baili E, Bains L, Baiocchi GL, Bala M, Balaguà© C, Balalis D, Baldini E, Baraket O, Baral S, Barone M, Gonzãlez Barranquero A, Barreras JA, Bass GA, Bayhan Z, Bellanova G, Ben-Ishay O, Bert F, Bianchi V, Biancuzzi H, Radulescu RB, Bignell MB, Biloslavo A, Bini R, Bissacco D, Boati P, Boddaert G, Bogdanic B, Bombardini C, Bonavina L, Bonomo L, Bottari A, Bouliaris K, Brachini G, Brillantino A, Brisinda G, Bulanauca MM, Buonomo LA, Burcharth J, Buscemi S, Calabretto F, Calini G, Calu V, Campanile FC, Campo Dall’Orto R, Campos-Serra A, Carvas JM, Cascella M, Pattacini GC, Celentano V, Centonze DC, Ceresoli M, Chatzipetris D, Chessa A, Chiarello MM, Chirica M, Chooklin S, Chouliaras C, Chowdhury S, Cianci P, Cillara N, Cimbanassi S, Cioffi SPB, Colãis-Ruiz E, Colak E, Conti L, Coppola A, de Sa TC, Costa SD, Cozza V, Curro’ G, Dabekaussen KFASA, D’acapito F, Damaskos D, D’Ambrosio G, Das K, Davies RJ, de Beaux AC, De Lebrusant Fernandez SP, De Luca A, De Simone B, De Stefano F, Degrate L, Demetrashvili Z, Demetriades AK, Detanac DS, Dezi A, Di Buono G, Carlo IDI, Di Lascio P, Di Martino M, Di Saverio S, Diaconescu B, Diaz JJ, Dibra R, Dimitrov EN, Dinuzzi VP, Dios-Barbeito S, Diyani JFA, Dogjani A, Domanin M, D’Oria M, Munoz-Cruzado VD, East B, Ekelund M, Ekwen GT, Elbaih AH, Elhadi M, Enninghorst N, Ernisova M, Escalera-Antezana JP, Esposito S, Esposito G, Estaire-Gãmez M, Farã CN, Farre R, Favi F, Ferrario L, Ferrario di Tor Vajana A, Filisetti C, Fleres F, Fonseca VC, Forero-Torres A, Forfori F, Fortuna L, Fradelos E, Fraga GP, Fransvea P, Frassini S, Frazzetta G, Frigerio I, Frountzas M, Gachabayov M, Galeiras R, Garcãa BM, Garcia Vazquez A, Gargarella S, Garzali IU, Ghannam WM, Ghazi FN, Gillman LM, Gioco R, Giordano A, Giordano L, Giove C, Giraudo G, Giuffrida M, Capponi MG, Gois E, Gomes CA, Gomes FC, Gonsaga RAT, Gonullu E, Goosen J, Goranovic T, Gracia-Roman R, Graziano GMP, Griffiths EA, Guagni T, Hadzhiev DB, Haidar MG, Hamid HKS, Hardcastle TC, Hayati F, Healey AJ, Hecker A, Hecker M, Garcia EFH, hodonou AM, huaman EC, Huerta M, Ibrahim AF, Ibrahim BMS, Ietto G, Inama M, Ioannidis O, Isik A, Ismail N, Ismail AMH, Jailani RUHIF, Jang JY, Kalfountzos C, Kalipershad SNR, Kaouras E, Kaplan LJ, Kara Y, Karamagioli E, Karamarkovia A, Katsaros I, Kavalakat AJ, Kechagias A, Kenig J, Kessel BJ, Khan JS, Khokha V, Kim JI, Kirkpatrick AW, Klappenbach R, Kobe Y, Lymperis EK, Kok KYY, Kong V, Korkolis DP, Koukoulis G, Kovacevic B, Kruger VF, Kryvoruchko IA, Kurihara H, Kuriyama A, Landaluce-Olavarria A, Lapolla P, Licari L, Lisi G, Litvin A, Lizarazu A, Bayo HL, Lohsiriwat V, Moreira CCL, Lostoridis E, Luna AT, Luppi D, V. GMM, Maegele M, Maggiore D, Magnone S, Maier RV, Maier RV, Major P, Manangi M, manetti A, Mantoglu B, Marafante C, Mariani F, Marinis A, Mariot ES, Marseglia GR, Martãnez-Pãrez A, Martines G, Perez AM, Martino C, Mascagni P, Massalou D, Matãas-Garcãa B, Mazzarella G, Mazzarolo G, Melo RB, Mendoza-Moreno F, Meric S, Meyer J, Miceli L, Michalopoulos NV, Milana F, Mingoli A, Mishra TS, Mohamed M, Mohamed MIEA, Mohamedahmed AY, Mohammed MJS, Mohan R, Moore EE, Morales-Garcia D, Muhrbeck M, Mulita F, Mustafa SMS, Muttillo EM, Naimzada MD, Navsaria PH, Negoi I, Nespoli L, Nguyen C, Nidaw MK, Nigri G, Nikolopoulos I, O’Connor DB, Ogundipe HD, Oliveri C, Olmi S, Ong ECW, Orecchia L, Osipov AV, Othman MF, Pace M, Pacilli M, Pagani L, Palomba G, Pantalone D, Panyko A, Paolillo C, Papa MV, Papaconstantinou D, Papadoliopoulou M, Papadopoulos A, Papis D, Pararas N, Parreira JG, Parry NG, Pata F, Patel T, Paterson-Brown S, Pavone G, Pecchini F, Pellino G, Pelloni M, Peloso A, del Pozo EP, Pereira RG, Pereira BM, perez AL, Perra T, Perrone G, Pesce A, Petagna L, Petracca G, Phupong V, Picardi B, Picciariello A, Piccoli M, Piccolo D, Picetti E, Pikoulis Pikoulis E, Pintar T, Pirozzolo G, Piscioneri F, Podda M, Porcu A, Privitera F, Punzo C, Quaresima S, Quiodettis MA, Qvist N, Rahim R, de Almeida FR, Ramely RB, Rasa HK, Reichert M, Reinisch-Liese A, Renne A, Riccetti C, Rodriguez-Luna MR, Roizblatt D, Romanzi A, Romeo L, Roscio FPM, Rosnelifaizur RB, Rossi S, Rubiano AM, Ruiz-Úcar E, Sakakushev BE, Salamea JC, Sall I, Samarakoon LB, Sammartano F, Arteaga AS, Sanchez-Cordero S, Santoanastaso DPM, Sasia D, Sato N, Savchuk A, Sawyer RG, Scaioli G, Schizas D, Sebastiani S, Seeliger B, Lohse HAS, Seretis C, Sermonesi G, Serradilla-Martin M, Shelat VG, Shlyapnikov S, Sidiropoulos T, Simoes RL, Siragusa L, Siribumrungwong B, Slavchev M, Solaini L, soldini G, Sopuev A, Soreide K, Sovatzidis A, Stahel PF, Strickland M, Sultan MAH, Sydorchuk R, Sydorchuk L, Syed SMAM, Syed AM, Tallon-Aguilar L, Tamburini AM, Tamini N, Tan ECTH, Tan JH, Tarasconi A, Tartaglia N, Tartaglia G, Tartaglia D, Taylor JV, Tebala GD, Gonsaga RAT, Teuben M, Theodorou A, Tolonen M, Tomasicchio G, Toro A, Torre B, Triantafyllou T, Trigiante Trigiante G, Tripepi M, Trostchansky J, Tsekouras K, Turrado-Rodriguez V, Tutino R, Uccelli M, Uchikov PA, Ugarte-Sierra B, Ukkonen MT, Vailas M, Vassiliu PG, Vazquez AG, Vazquez RG, Verde JE, Verde JM, Veroux M, Viganò J, Vilallonga R, Visconti D, Vittori A, Waledziak M, Wannatoop T, Widmer LW, Wilson MSJ, Wong TH, Xenaki S, Yu B, Yule S, Zachariah SK, Zacharis G, Zaghi C, Zakaria AD, Zambrano DA, Zampitis N, Zampogna B, Zanghã S, Zapsalis K, Zattoni F, Zese M, Farre SP, Atanasov BT, Pegoraro V, Zantedeschi M, Reitano E, Pizzocaro E. Time for a paradigm shift in shared decision-making in trauma and emergency surgery? Results from an international survey. World J Emerg Surg 2023; 18:14. [PMID: 36803568 PMCID: PMC9936681 DOI: 10.1186/s13017-022-00464-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/02/2022] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Shared decision-making (SDM) between clinicians and patients is one of the pillars of the modern patient-centric philosophy of care. This study aims to explore SDM in the discipline of trauma and emergency surgery, investigating its interpretation as well as the barriers and facilitators for its implementation among surgeons. METHODS Grounding on the literature on the topics of the understanding, barriers, and facilitators of SDM in trauma and emergency surgery, a survey was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was sent to all 917 WSES members, advertised through the society's website, and shared on the society's Twitter profile. RESULTS A total of 650 trauma and emergency surgeons from 71 countries in five continents participated in the initiative. Less than half of the surgeons understood SDM, and 30% still saw the value in exclusively engaging multidisciplinary provider teams without involving the patient. Several barriers to effectively partnering with the patient in the decision-making process were identified, such as the lack of time and the need to concentrate on making medical teams work smoothly. DISCUSSION Our investigation underlines how only a minority of trauma and emergency surgeons understand SDM, and perhaps, the value of SDM is not fully accepted in trauma and emergency situations. The inclusion of SDM practices in clinical guidelines may represent the most feasible and advocated solutions.
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Affiliation(s)
- Lorenzo Cobianchi
- Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Via Alessandro Brambilla, 74, 27100, Pavia, PV, Italy. .,IRCCS Policlinico San Matteo Foundation, General Surgery, Pavia, Italy.
| | - Francesca Dal Mas
- grid.7240.10000 0004 1763 0578Department of Management, Ca’ Foscari University of Venice, Venice, Italy
| | - Vanni Agnoletti
- grid.414682.d0000 0004 1758 8744Bufalini Hospital, AUSL Romagna, Cesena, Italy
| | - Luca Ansaloni
- grid.8982.b0000 0004 1762 5736Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Via Alessandro Brambilla, 74, 27100 Pavia, PV Italy ,grid.419425.f0000 0004 1760 3027IRCCS Policlinico San Matteo Foundation, General Surgery, Pavia, Italy
| | - Walter Biffl
- grid.415402.60000 0004 0449 3295Division of Trauma and Acute Care Surgery, Scripps Memorial Hospital La Jolla, La Jolla, CA USA
| | - Giovanni Butturini
- grid.513352.3Department of HPB Surgery, Pederzoli Hospital, Peschiera del Garda, Italy
| | - Stefano Campostrini
- grid.7240.10000 0004 1763 0578Department of Economics, Ca’ Foscari University of Venice, Venice, Italy
| | - Fausto Catena
- grid.414682.d0000 0004 1758 8744Bufalini Hospital, AUSL Romagna, Cesena, Italy
| | - Stefano Denicolai
- grid.8982.b0000 0004 1762 5736Department of Economics and Management, University of Pavia, Pavia, Italy
| | - Paola Fugazzola
- grid.419425.f0000 0004 1760 3027IRCCS Policlinico San Matteo Foundation, General Surgery, Pavia, Italy
| | - Jacopo Martellucci
- grid.24704.350000 0004 1759 9494Department of Surgery, Careggi University Hospital, Florence, Italy
| | - Maurizio Massaro
- grid.7240.10000 0004 1763 0578Department of Management, Ca’ Foscari University of Venice, Venice, Italy
| | - Pietro Previtali
- grid.8982.b0000 0004 1762 5736Department of Economics and Management, University of Pavia, Pavia, Italy
| | - Federico Ruta
- General Direction, ASL BAT (Health Agency), Andria, Italy
| | - Alessandro Venturi
- grid.8982.b0000 0004 1762 5736Department of Political and Social Sciences, University of Pavia, Pavia, Italy ,grid.419425.f0000 0004 1760 3027Bureau of the Presidency, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Sarah Woltz
- grid.416219.90000 0004 0568 6419Department of Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Haytham M. Kaafarani
- grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA ,grid.32224.350000 0004 0386 9924Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, MA USA
| | - Tyler J. Loftus
- grid.430508.a0000 0004 4911 114XDepartment of Surgery, University of Florida Health, Gainesville, FL USA
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Maina C, Cioffi SPB, Altomare M, Spota A, Virdis F, Bini R, Ragozzino R, Renzi F, Reitano E, Corasaniti L, Macchini F, Chiara O, Cimbanassi S. Increasing Trend in Violence-Related Trauma and Suicide Attempts among Pediatric Trauma Patients: A 6-Year Analysis of Trauma Mechanisms and the Effects of the COVID-19 Pandemic. J Pers Med 2023; 13:jpm13010128. [PMID: 36675789 PMCID: PMC9864714 DOI: 10.3390/jpm13010128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/31/2022] [Accepted: 01/03/2023] [Indexed: 01/11/2023] Open
Abstract
Background: Trauma is the leading cause of morbidity and mortality in the pediatric population. During the COVID-19 pandemic (COVID-19), different trends for pediatric trauma (PT) were described. This study aims to explore the trend over time of PT in our center, also considering the effects of COVID-19, focusing on trauma mechanisms, violence-related trauma (VRT) and intentionality, especially suicide attempts (SAs). Methods: All PT patients accepted at Niguarda Trauma Center (NTC) in Milan from January 2015 to December 2020 were retrospectively analyzed. We considered demographics and clinical variables and performed descriptive and year comparison analyses. Results: There were 684 cases of PT accepted at NTC: 84 in 2015, 98 in 2016, 125 in 2017, 119 in 2018, 114 in 2019 and 144 in 2020 (p < 0.001), 66.2% male, mean age 9.88 (±5.17). We observed a higher number of traffic-related, fall-related injuries and an increasing trend for VRT and SAs, peaking in 2020. We report an increasing trend over time for head trauma (p = 0.002). The Injury Severity Score did not significantly change. During COVID-19 we recorded a higher number of self-presenting patients with low priority codes. Conclusions: NTC is the adult level I referral trauma center for the Milan urban area with pediatric commitment. During COVID-19, every traumatic emergency was centralized to NCT. In 2020, we observed an increasing trend in SAs and VRT among PT patients. The psychological impact of the COVID-19 restriction could explain this evidence. The long-term effects of COVID-19 on the mental health of the pediatric population should not be underestimated. Focused interventions on psychological support and prevention of SAs and VRT should be implemented, especially during socio-demographic storms such as the last pandemic.
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Affiliation(s)
- Cecilia Maina
- Acute Care Surgery and Trauma, ASST-GOM Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
- General Surgery, I.R.C.C.S. San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Stefano Piero Bernardo Cioffi
- Acute Care Surgery and Trauma, ASST-GOM Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
- Department of Surgical Sciences, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
- Correspondence: ; Tel.: +39-3386032519
| | - Michele Altomare
- Acute Care Surgery and Trauma, ASST-GOM Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
- Department of Surgical Sciences, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Andrea Spota
- Acute Care Surgery and Trauma, ASST-GOM Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Francesco Virdis
- Acute Care Surgery and Trauma, ASST-GOM Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Roberto Bini
- Acute Care Surgery and Trauma, ASST-GOM Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Roberta Ragozzino
- Acute Care Surgery and Trauma, ASST-GOM Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Federica Renzi
- Acute Care Surgery and Trauma, ASST-GOM Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Elisa Reitano
- Division of General Surgery, Department of Translational Medicine, Maggiore Della Carità Hospital, University of Eastern Piedmont, Corso Giuseppe Mazzini 18, 28100 Novara, Italy
| | - Lucia Corasaniti
- Department of Pediatric Surgery, ASST-GOM Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Francesco Macchini
- Department of Pediatric Surgery, ASST-GOM Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Osvaldo Chiara
- Acute Care Surgery and Trauma, ASST-GOM Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Stefania Cimbanassi
- Acute Care Surgery and Trauma, ASST-GOM Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
- Department of Pathophysiology and Transplantation-State University of Milan-Acute Care Surgery and Trauma, ASST-GOM Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
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14
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Virdis F, Cioffi SPB, Abu-Zidan F, Reitano E, Podda M, Altomare M, Spota A, Bini R, Kumar J, Chiara O, Cimbanassi S. Detection of post-traumatic abdominal pseudoaneurysms by CEUS and CT: A prospective comparative global study (the PseAn study)-study protocol. Front Surg 2023; 10:1124087. [PMID: 36891548 PMCID: PMC9986536 DOI: 10.3389/fsurg.2023.1124087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 01/25/2023] [Indexed: 02/22/2023] Open
Abstract
The success of non-operative management in trauma increased with the availability of new-generation CT scan machines, endoscopy, and angiography, becoming the standard of care in hemodynamically stable trauma patients with abdominal solid organ injuries, with a success rate of 78% to 98%. Post-traumatic pseudoaneurysms (PAs) can develop at any region of an injured artery and they may cause delayed bleeding in splenic or hepatic trauma, with an incidence in patients treated with NOM of 2%-27% and 1.2%-6.1% respectively. Diagnosis is made by angiography, contrast-enhanced computer tomography (CT), or Doppler Ultrasound (US) while the use of contrast-enhanced ultrasound (CEUS), has increased in recent years although few data are available about CEUS feasibility in the follow-up setting. The PseaAn study has been designed to assess the role of CEUS in the follow-up of abdominal trauma by defining its sensitivity, specificity and predictive values compared with abdominal CT scan. The PseAn study is a multi-centric international diagnostic cross-sectional study initiated by the Level I Trauma Center of the Niguarda Ca' Granda Hospital in Milan, Italy. To study the role of CEUS in detecting post-traumatic splenic, hepatic, and renal PAs compared with the gold standard of CT with intravenous contrast at different follow-up time points, and whether it can replace CT scan in the follow-up of solid organ injuries, patients with OIS III and above will undergo a follow-up with both a CEUS and CT scan to detect post-traumatic parenchymal pseudoaneurysm within two to five days from injury. The use of CEUS in the follow-up of abdominal trauma follow-up (particularly blunt trauma) has increased, to minimise the use of ionizing radiation and contrast media and encouraging results have been published during the last decade showing that CEUS is an accurate technique for evaluating traumatic lesions of solid abdominal organs. Conclusions We think that CEUS, which is underused worldwide, is a useful and safe tool that may replace CT scan in follow-up with the major advantage of reduced radiation. Our current study may give stronger evidence to support this view.
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Affiliation(s)
| | | | - Fikri Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Alain, United Arab Emirates
| | - Elisa Reitano
- Department of Translational Medicine, Division of General Surgery, Maggiore Della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Mauro Podda
- Azienda Ospedaliero-Universitaria Cagliari, Cagliari, Italy
| | | | - Andrea Spota
- Trauma and Acute Care Surgery, ASST-GOM Niguarda, Milan, Italy
| | - Roberto Bini
- Trauma and Acute Care Surgery, ASST-GOM Niguarda, Milan, Italy
| | - Jayant Kumar
- University of Chicago Medical Center, Chicago, IL, United States
| | - Osvaldo Chiara
- Trauma and Acute Care Surgery, ASST-GOM Niguarda, Milan, Italy
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15
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Cioffi SPB, Granieri S, Scaravilli L, Molteni M, Altomare M, Spota A, Virdis F, Bini R, Renzi F, Reitano E, Ragozzino R, Gupta S, Chiara O, Cimbanassi S, Albanesi F, Altomare M, Andreatta E, Baldari L, Benuzzi L, Bevilaqua E, Bonomi AM, Brachetti G, Cannavale G, Chierici AP, Cioffi SPB, Cirelli R, Colletti G, D’abrosca V, Danelli P, Del Prete L, Di Capua F, Di Vittorio F, Ferrari D, Ferrario L, Fiore L, Frattaruol C, Froiio C, Gibelli L, Giusti I, Giustizieri U, Grandi S, Granieri S, Iacob G, Kersik A, Lombardi P, Longhi M, Lorusso L, Manara M, Manzo E, Marin JN, Maspero M, Messina V, Milito P, Molteni M, Monti E, Nicastro V, Novelli G, Paleino S, Pavesi S, Perali C, Pezzoli I, Ragozzino R, Santolamazza G, Scaravilli L, Spota A, Tornatore G, Toti F, Tripodi V, Vaterlini E, Vignati B. Surgeons' attitudes during laparoscopic appendectomy: do subjective intraoperative assessments affect the choice of peritoneal irrigation? A spin-off analysis from the REsiDENT-1 multicentre prospective observational trial. Surg Endosc 2023; 37:729-740. [PMID: 36307601 DOI: 10.1007/s00464-022-09674-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 09/24/2022] [Indexed: 01/18/2023]
Abstract
AIMS Laparoscopic appendectomy (LA) for acute appendicitis (AA) is one of the most performed procedures. The effects of peritoneal lavage (PL) and the reasons to perform it have not been cleared and all meta-analyses didn't show a statistical advantage to prevent infectious complications. This study aims to investigate surgeons' perceptions during LA, comparing intraoperative findings with histological results, and exploring how surgeons' subjectivity influences the decision-making process on PL. METHODS Data were extracted from the two-year data lock from REsiDENT-1 registry, a prospective resident-led multicentre observational trial. This study investigates the relationships between PL and postoperative intraabdominal abscesses (pIAA) introducing a classification for AA to standardize the intraoperative grading. We included pre, intra, and postoperative variables. We applied our classification proposal, used a five-point Likert scale (Ls) to assess subjective LA difficulty and ran a concordance analysis between the assessment of AA and histology. Subsequently, a multivariate logistic regression model was built to find factors influencing PL. RESULTS 561 patients were enrolled from twenty-one hospitals and 51 residents. 542 procedures were included in the logistic regression analysis and 441 in the concordance analysis, due to missing data. PL was used in 222 LA (39, 6%). We discovered a moderate positive monotonic relationship between surgical evaluation and histology, p < 0.001. Despite this, the reliability of the surgeon's assessment of appendicitis is progressively lower for gangrenous and perforated forms. The increasing grade of contamination, the increasing grade of subjective difficulty and the intraoperative finding of a gangrenous or perforated appendicitis were independent predictors of PL. CONCLUSION This study shows how surgeons' evaluation of AA severity overestimated more than half of gangrenous or perforated appendices with the perception of a challenging procedure. These perceptions influenced the choice of PL. We proved that the evaluation during LA could be affected by subjectivity with a non-negligible impact on the decision-making process.
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Affiliation(s)
- Stefano Piero Bernardo Cioffi
- General Surgery and Trauma Team, ASST GOM Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162, Milan, Italy. .,Department of Surgical Sciences, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy.
| | - Stefano Granieri
- General Surgery Unit, ASST Vimercate, Via Santi Cosma e Damiano 16, 20871, Vimercate, Italy
| | - Luca Scaravilli
- General Surgery and Trauma Team, ASST GOM Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.,General Surgery Residency Program, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Mattia Molteni
- General Surgery and Trauma Team, ASST GOM Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.,General Surgery Residency Program, San Raffaele Hospital University, Via Olgettina 60, 20132, Milan, Italy
| | - Michele Altomare
- General Surgery and Trauma Team, ASST GOM Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.,Department of Surgical Sciences, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Andrea Spota
- General Surgery and Trauma Team, ASST GOM Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Francesco Virdis
- General Surgery and Trauma Team, ASST GOM Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Roberto Bini
- General Surgery and Trauma Team, ASST GOM Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Federica Renzi
- General Surgery and Trauma Team, ASST GOM Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Elisa Reitano
- IRCAD Research Institute Against Digestive Cancer, Strasbourg, France
| | - Roberta Ragozzino
- General Surgery and Trauma Team, ASST GOM Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Shailvi Gupta
- University of Maryland, Adams Cowley Shock Trauma Center, Baltimore, MD, USA
| | - Osvaldo Chiara
- General Surgery and Trauma Team, ASST GOM Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.,Department of Pathophysiology and Transplants, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Stefania Cimbanassi
- General Surgery and Trauma Team, ASST GOM Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.,Department of Pathophysiology and Transplants, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
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16
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Vettorello M, Altomare M, Spota A, Cioffi SPB, Rossmann M, Mingoli A, Chiara O, Cimbanassi S. Early Hypocalcemia in Severe Trauma: An Independent Risk Factor for Coagulopathy and Massive Transfusion. J Pers Med 2022; 13:jpm13010063. [PMID: 36675724 PMCID: PMC9863326 DOI: 10.3390/jpm13010063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022] Open
Abstract
The rapid identification of patients at risk for massive blood transfusion is of paramount importance as uncontrolled exsanguination may lead to death within 2 to 6 h. The aim of this study was to analyze a cohort of severe trauma patients to identify risk factors associated with massive transfusion requirements and hypocalcemia. All major trauma (ISS > 16) presented directly from the scene to the Niguarda hospital between 1 January 2015 and 31 December 2021 were analyzed. A total of 798 patients were eligible out of 1586 screened. Demographic data showed no significant difference between hypocalcemic (HC) and normocalcemic (NC) patients except for the presence of crush trauma, alcohol intake (27% vs. 15%, p < 0.01), and injury severity score (odds ratio 1.03, p = 0.03). ISS was higher in the HC group and was an independent, even if weak, predictor of hypocalcemia (odds ratio 1.03, p = 0.03). Prehospital data showed a lower mean systolic arterial pressure (SAP) and a higher heart rate (HR) in the HC group (105 vs. 127, p < 0.01; 100 vs. 92, p < 0.001, respectively), resulting in a higher shock index (SI) (1.1 vs. 0.8, p < 0.001). Only retrospective studies such as ours are available, and while hypocalcemia seems to be an independent predictor of mortality and massive transfusion, there is not enough evidence to support causation. Therefore, randomized prospective studies are suggested.
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Affiliation(s)
- Marco Vettorello
- General Surgery and Trauma Team, ASST Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Michele Altomare
- General Surgery and Trauma Team, ASST Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
- Department of Surgical Sciences, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
- Correspondence: or
| | - Andrea Spota
- General Surgery and Trauma Team, ASST Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Stefano Piero Bernardo Cioffi
- General Surgery and Trauma Team, ASST Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
- Department of Surgical Sciences, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Marta Rossmann
- General Surgery and Trauma Team, ASST Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Andrea Mingoli
- Department of Surgical Sciences, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Osvaldo Chiara
- General Surgery and Trauma Team, ASST Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
- Department of Medical-Surgical Physiopathology and Transplantation, University of Milan, Festa del Perdono 7, 20122 Milan, Italy
| | - Stefania Cimbanassi
- General Surgery and Trauma Team, ASST Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
- Department of Medical-Surgical Physiopathology and Transplantation, University of Milan, Festa del Perdono 7, 20122 Milan, Italy
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17
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Reitano E, Cioffi SPB, Virdis F, Altomare M, Spota A, Chiara O, Cimbanassi S. Predictors of Mortality in Bicycle-Related Trauma: An Eight-Year Experience in a Level One Trauma Center. J Pers Med 2022; 12:jpm12111936. [PMID: 36422112 PMCID: PMC9695191 DOI: 10.3390/jpm12111936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/15/2022] [Accepted: 11/19/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Bicycle-related trauma has increased during the last decades, mainly due to the antipollution environmental policies. This study investigates the outcome of bicycle-related trauma in our level-one trauma center over a period of eight years. Methods: Data from 446 consecutive bicycle-related trauma patients admitted to our trauma center from 2011 to 2019 were selected and retrospectively analyzed. The sample was divided into three age groups: <18 years, 18−54 years, and ≥55 years. Mortality rates were obtained for the overall population and patients with an Injury Severity Score (ISS) ≥ 25. Month and seasonal patients’ distribution was described to provide an epidemiological overview of bike-related trauma over the years. Results: Patients ≥ 55 years showed a lower pre-hospital and in-hospital GCS (p ≤ 0.001), higher levels of lactates (p < 0.019) and higher ISS (p ≤ 0.001), probability of death (p ≤ 0.001), and overall mortality (p ≤ 0.001). The head and chest Abbreviated Injury Scale (AIS) ≥ 3 injuries were predictors of mortality, especially in patients over 55 years (p < 0.010). Bicycle-related trauma was more frequent during the summer (34%), particularly in July and August. Conclusions: Age over 55 years old, head and chest injuries, and an ISS > 25 were independent predictors of mortality.
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Affiliation(s)
- Elisa Reitano
- Division of General Surgery, Department of Translational Medicine, Maggiore della Carità Hospital, University of Eastern Piedmont, Corso Giuseppe Mazzini 18, 28100 Novara, Italy
| | | | - Francesco Virdis
- General Surgery and Trauma Team, ASST Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Michele Altomare
- General Surgery and Trauma Team, ASST Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Andrea Spota
- General Surgery and Trauma Team, ASST Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Osvaldo Chiara
- General Surgery and Trauma Team, ASST Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
- Department of Medical-Surgical Physiopathology and Transplantation, University of Milan, Festa del Perdono 7, 20122 Milan, Italy
| | - Stefania Cimbanassi
- General Surgery and Trauma Team, ASST Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
- Department of Medical-Surgical Physiopathology and Transplantation, University of Milan, Festa del Perdono 7, 20122 Milan, Italy
- Correspondence: ; Tel.: +39-0264442541; Fax: +39-02-64442392
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18
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Sposito C, Maspero M, Belotti P, Simonotti N, Altomare M, Ciana P, Mazzaferro V. Indocyanine Green Fluorescence-Guided Surgery for Gastrointestinal Tumors: A Systematic Review. Ann Surg Open 2022; 3:e190. [PMID: 37601143 PMCID: PMC10431291 DOI: 10.1097/as9.0000000000000190] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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] [Accepted: 06/28/2022] [Indexed: 11/25/2022] Open
Abstract
Objective To conduct a systematic review of the currently available literature on the use of ICG to guide surgical dissection in gastrointestinal (GI) cancer surgery. Background Real-time indocyanine green (ICG) fluorescence-guided surgery has the potential to enhance surgical outcomes by increasing patient-tailored oncological precision. Methods MEDLINE, PubMed, EMBASE, and Google Scholar were searched for publications on the use of ICG as a contrast agent in GI cancer surgery until December 2020. Perfusion studies were excluded. Quality of the studies was assessed with the Methodological Index for nonrandomized Studies or Jadad scale for randomized controlled trials. A narrative synthesis of the results was provided, with descriptive statistics when appropriate. Results Seventy-eight studies were included. ICG was used for primary tumor and metastases localization, for sentinel lymph node detection, and for lymph flow mapping. The detection rate for primary colorectal and gastric tumors was 100% after preoperative ICG endoscopic injection. For liver lesions, the detection rate after intravenous ICG infusion was 80% and up to 100% for lesions less than 8 mm from the liver surface. The detection rate for sentinel lymph nodes was 89.8% for esophageal, 98.6% for gastric, 87.4% for colorectal, and 83.3% for anal tumors, respectively. In comparative studies, ICG significantly increases the quality of D2 lymphadenectomy in oncological gastrectomy. Conclusion The use of ICG as a guiding tool for dissection in GI surgery is promising. Further evidence from high-quality studies on larger sample sizes is needed to assess whether ICG-guided surgery may become standard of care.
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Affiliation(s)
- Carlo Sposito
- From the General Surgery and Liver Transplantation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Marianna Maspero
- From the General Surgery and Liver Transplantation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
- University of Milan, Milan, Italy
| | | | | | | | - Paolo Ciana
- Department of Health Sciences, Institute of Pharmacology, University of Milan, Milan, Italy
| | - Vincenzo Mazzaferro
- From the General Surgery and Liver Transplantation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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19
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Altomare M, Chierici A, Virdis F, Spota A, Cioffi SPB, Bekhor SS, Del Prete L, Reitano E, Sacchi M, Ambrogi F, Chiara O, Cimbanassi S. Centralization of Major Trauma Influences Liver Availability for Transplantation in Northern Italy: Lesson Learned from COVID-19 Pandemic. J Clin Med 2022; 11:jcm11133658. [PMID: 35806948 PMCID: PMC9267522 DOI: 10.3390/jcm11133658] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 06/17/2022] [Accepted: 06/19/2022] [Indexed: 02/01/2023] Open
Abstract
Background: During the COVID-19 pandemic, the centralization of patients allowed trauma and transplants referral centers to continue their routine activity, ensuring the best access to health care. This study aims to analyze how the centralization of trauma is linked with liver allocation in Northern Italy. Methods: Cluster analysis was performed to generate patient phenotype according to trauma-related variables. Comparison between clusters was performed to evaluate differences in damage control strategy procedures (DCS) performed and the 30-day graft dysfunction. Results: During the pandemic period, the centralization of major trauma has deeply impaired the liver procurement and allocation between the transplant centers in the metropolitan area of Milan (Niguarda: 22 liver procurement; other transplant centers: 2 organ procurement). Two clusters were identified the in Niguarda’s series: cluster 1 is represented by 17 (27.4%) trauma donors, of which 13 (76.5%) were treated with DCS procedures, and 4 (23.5%) did not; cluster 2 is represented by 45 trauma donors (72.6%), of which 22 (48.8%) underwent DCS procedures. A significant difference was found in the number of DCS procedures performed between clusters (3.18 ± 2.255 vs. 1.11 ± 1.05, p = 0.0001). Comparative analysis did not significantly differ in the number of transplanted livers (cluster1/cluster2 94.1%/95.6% p = 0.84) and the 30-day graft dysfunction rate (cluster1/cluster2 0.0%/4.8% p = 0.34). Conclusions: The high level of care guaranteed by first-level trauma centers could reduce the loss of organs suitable for donation, maintaining the good outcomes of transplanted ones, even in case of multiple organ injuries. The pandemic period underlined that the centralization of major trauma impairs the liver allocation between transplant centers.
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Affiliation(s)
- Michele Altomare
- Department of Surgical Sciences, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
- General Surgery and Trauma Team, ASST Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162 Milan, Italy; (F.V.); (A.S.); (S.P.B.C.); (S.S.B.); (O.C.); (S.C.)
- Correspondence: or
| | - Andrea Chierici
- Centre Hospitalier d’Antibes Juan-les-Pins–Chirugie Digestive, Department of General and Emergency Surgery, 06600 Antibes, France;
| | - Francesco Virdis
- General Surgery and Trauma Team, ASST Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162 Milan, Italy; (F.V.); (A.S.); (S.P.B.C.); (S.S.B.); (O.C.); (S.C.)
| | - Andrea Spota
- General Surgery and Trauma Team, ASST Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162 Milan, Italy; (F.V.); (A.S.); (S.P.B.C.); (S.S.B.); (O.C.); (S.C.)
| | - Stefano Piero Bernardo Cioffi
- General Surgery and Trauma Team, ASST Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162 Milan, Italy; (F.V.); (A.S.); (S.P.B.C.); (S.S.B.); (O.C.); (S.C.)
| | - Shir Sara Bekhor
- General Surgery and Trauma Team, ASST Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162 Milan, Italy; (F.V.); (A.S.); (S.P.B.C.); (S.S.B.); (O.C.); (S.C.)
| | - Luca Del Prete
- General and Liver Transplant Surgery Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Elisa Reitano
- General and Emergency Surgery, Ospedale Maggiore Della Carità di Novara, 28100 Novara, Italy;
| | - Marco Sacchi
- Department Emergenza Urgenza-E.A.S. SOREU Metropolitana, 20161 Milan, Italy;
| | - Federico Ambrogi
- Department of Clinical Science and Community Health, University of Milan, Festa del Perdono 7, 20122 Milan, Italy;
| | - Osvaldo Chiara
- General Surgery and Trauma Team, ASST Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162 Milan, Italy; (F.V.); (A.S.); (S.P.B.C.); (S.S.B.); (O.C.); (S.C.)
- Department of Medical-Surgical Physiopathology and Transplantation, University of Milan, Festa del Perdono 7, 20122 Milan, Italy
| | - Stefania Cimbanassi
- General Surgery and Trauma Team, ASST Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162 Milan, Italy; (F.V.); (A.S.); (S.P.B.C.); (S.S.B.); (O.C.); (S.C.)
- Department of Medical-Surgical Physiopathology and Transplantation, University of Milan, Festa del Perdono 7, 20122 Milan, Italy
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Cioffi SPB, Chiara O, Del Prete L, Bonomi A, Altomare M, Spota A, Bini R, Cimbanassi S. Failure to Rescue (FTR) and Pitfalls in the Management of Complex Enteric Fistulas (CEF): From Rescue Surgery to Rescue Strategy. J Pers Med 2022; 12:jpm12020292. [PMID: 35207780 PMCID: PMC8875978 DOI: 10.3390/jpm12020292] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose: Complex enteric fistulas (CEF) represent general surgeons’ nightmare. This paper aims to explore the impact on failure-to-rescue (FTR) rate of a standardised and integrated surgical and critical care step-up approach. Methods: This was a retrospective observational cohort study. Patients treated for CEF from 2009 to 2019 at Niguarda Hospital were included. Each patient was approached following a three-step approach: study phase, sepsis control and strategy definition phase, and surgical rescue phase. Results: Sixteen patients were treated for CEF. Seven fistulas were classified as complex entero-cutaneous (ECF) and nine as entero-atmospheric fistula (EAF). Median number of surgical procedures for fistula control before definitive surgical attempt was 11 (IQR 2–33.5). The median time from culprit surgery and the first access at Niguarda Hospital to definitive surgical attempt were 279 days (IQR 231–409) and 120 days (IQR 34–231), respectively. Median ICU LOS was 71 days (IQR 28–101), and effective hospital LOS was 117 days, (IQR 69.5–188.8). Three patients (18.75%) experienced spontaneous fistula closure after conversion to simple ECF, whereas 13 (81.25%) underwent definitive surgery for fistula takedown. Surgical rescue was possible in nine patients. Nine patients underwent multiple postoperative revision for surgical complications. Four patients failed to be rescued. Conclusion: An integrated step-up rescue strategy is crucial to standardise the approach to CEF and go beyond the basic surgical rescue procedure. The definition of FTR is dependent from the examined population. CEF patients are a unique cluster of emergency general surgery patients who may need a tailored definition of FTR considering the burden of postoperative events influencing their outcome.
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Affiliation(s)
- Stefano Piero Bernardo Cioffi
- General Surgery and Trauma Team, ASST GOM Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy; (S.P.B.C.); (O.C.); (M.A.); (A.S.); (R.B.)
| | - Osvaldo Chiara
- General Surgery and Trauma Team, ASST GOM Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy; (S.P.B.C.); (O.C.); (M.A.); (A.S.); (R.B.)
- Department of Pathophysiology and Transplants, State University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Luca Del Prete
- General and Liver Transplant Surgery Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Alessandro Bonomi
- General Surgery Residency Program, State University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy;
| | - Michele Altomare
- General Surgery and Trauma Team, ASST GOM Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy; (S.P.B.C.); (O.C.); (M.A.); (A.S.); (R.B.)
- Department of Surgical Sciences, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Andrea Spota
- General Surgery and Trauma Team, ASST GOM Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy; (S.P.B.C.); (O.C.); (M.A.); (A.S.); (R.B.)
| | - Roberto Bini
- General Surgery and Trauma Team, ASST GOM Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy; (S.P.B.C.); (O.C.); (M.A.); (A.S.); (R.B.)
| | - Stefania Cimbanassi
- General Surgery and Trauma Team, ASST GOM Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy; (S.P.B.C.); (O.C.); (M.A.); (A.S.); (R.B.)
- Department of Pathophysiology and Transplants, State University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
- Correspondence:
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Orsaria P, Grasso A, Caggiati L, Altomare M, Altomare V. Update on oncoplastic techniques in breast conserving surgery: algorithms for predictable results and custom-made reconstructions. Minerva Surg 2021; 76:512-525. [PMID: 34338466 DOI: 10.23736/s2724-5691.21.08976-0] [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: 11/08/2022]
Abstract
Breast cancer surgery is going to be a relevant specialty involved in the multidisciplinary disease management, finalized to guarantee high performances on mortality reduction together with a quality of life improvement. The intellectual architecture of this field is characterized by its inclination to respect, sharing, empathy and scientific knowledge that can make it a high model of medical culture. In this context, oncoplastic breast conserving surgery is identified by special aesthetic sensitivities, as well as creativity and innovation. Knowing how to reshape the gland and fill the gaps, planning the targeted exeresis design, while anticipating the final outcome, respecting symmetries and ensuring first of all oncological safety, are the new skills that are required to the breast surgeon. Several tecniques could provide a refined surgical treatment but always challenging according to anatomical findings and patient expectations, as a systematic process of self-critical reflection, with the purpose to optimize criteria for improving therapeutic results.
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Affiliation(s)
- Paolo Orsaria
- Department of Breast Surgery, Campus Bio-Medico University Hospital, Rome, Italy -
| | - Antonella Grasso
- Department of Breast Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Lorenza Caggiati
- Department of Breast Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Michele Altomare
- Department of General Surgery, University of Milan, Milan, Italy
| | - Vittorio Altomare
- Department of Breast Surgery, Campus Bio-Medico University Hospital, Rome, Italy
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Granieri S, Altomare M, Bruno F, Paleino S, Bonomi A, Germini A, Facciorusso A, Fagnani D, Bovo G, Cotsoglou C. Surgical treatment of gastric cancer liver metastases: Systematic review and meta-analysis of long-term outcomes and prognostic factors. Crit Rev Oncol Hematol 2021; 163:103313. [PMID: 34044098 DOI: 10.1016/j.critrevonc.2021.103313] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 02/10/2021] [Accepted: 03/29/2021] [Indexed: 12/18/2022] Open
Abstract
The prognosis of patients with metastatic gastric cancer remains dismal, with palliative treatment as standard of care. However, encouraging results have been reported for surgical resection of liver only metastatic gastric cancer in carefully selected patients. A systematic review of articles published from 2000 onwards was conducted according to PRISMA guidelines. Twenty-nine studies were included in qualitative and quantitative analysis. Meta-analysis of proportions pointed out 29.1 % 5ySR (I 2 = 39 %). The pooled weighted median of MSTs was 31.1 months. T stage > 2, metastasis greatest dimension ≥ 5 cm, the presence of multiple metastases and bilobar disease resulted among the strongest predictors of mortality. Funnel plots, Egger's tests, and P-curve analyses failed to show significant publication bias. Based on strict selection criteria and robust statistical analyses, our results show that, in very carefully selected patients without extrahepatic disease, surgical resection with curative intent may significantly improve overall survival.
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Affiliation(s)
- Stefano Granieri
- General Surgery Unit, ASST Vimercate, Via Santi Cosma e Damiano 10, 20871, Vimercate, Italy.
| | - Michele Altomare
- University of Milan, Via Festa del Perdono, 7, 20122, Milan, Italy; Gastrointestinal, Hepato-Pancreatic Surgery and Liver Transplantation Unit, Fondazione IRCCS Istituto Nazionale Tumori, Via Venezian 1, 20133, Milan, Italy.
| | - Federica Bruno
- General Surgery Unit, ASST Vimercate, Via Santi Cosma e Damiano 10, 20871, Vimercate, Italy.
| | - Sissi Paleino
- General Surgery Unit, ASST Vimercate, Via Santi Cosma e Damiano 10, 20871, Vimercate, Italy; University of Milan, Via Festa del Perdono, 7, 20122, Milan, Italy.
| | - Alessandro Bonomi
- University of Milan, Via Festa del Perdono, 7, 20122, Milan, Italy; General Surgery Unit, ASST Fatebenefratelli-Sacco, Via Giovanni Battista Grassi, 74, 20157, Milan, Italy.
| | - Alessandro Germini
- General Surgery Unit, ASST Vimercate, Via Santi Cosma e Damiano 10, 20871, Vimercate, Italy.
| | - Antonio Facciorusso
- Department of Medical Sciences, Gastroenterology Unit, Ospedali Riuniti di Foggia, Viale Luigi Pinto, 1, 71122, Foggia, Italy.
| | - Daniele Fagnani
- Medical Oncology Unit, ASST Vimercate, Via Santi Cosma e Damiano 10, 20871, Vimercate, Italy.
| | - Giorgio Bovo
- Pathology Unit, ASST Vimercate, Via Santi Cosma e Damiano 10, 20871, Vimercate, Italy.
| | - Christian Cotsoglou
- General Surgery Unit, ASST Vimercate, Via Santi Cosma e Damiano 10, 20871, Vimercate, Italy.
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Radaelli S, Altomare M, Frezza AM, Stacchiotti S, Pasquali S, Fiore M, Callegaro D, Ferrari A, Casali PG, Gronchi A. Desmoplastic small round cell tumor: A series of patients surgically treated at a single institution. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e23555] [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: 11/20/2022] Open
Abstract
e23555 Background: Desmoplastic small round cell tumor (DSRCT) is an ultra rare sarcoma predominantly involving the abdomino-pelvic peritoneum and mostly occurring in male children and young adults. It is marked by the EWSR1-WT1 fusion gene. Prognosis is poor with reported 5-year overall of < 20%. Methods: Data of patients with primary intra-abdominal DSRCT, who had surgery at our institution between 2000 and 2020, were analyzed. Information regarding disease presentation, cytoreductive surgery (CRS) with or without hypertermic intraperitoneal chemotherapy (HIPEC) and perioperative treatments were reported. Kaplan-Meier survival analysis was performed for both the whole cohort (A) and separately for peritoneal (B) vs peritoneal + lymphnode involvement (C) at disease presentation. Also, patients who underwent CRS alone vs CRS + HIPEC were compared. Results: 43 patients (pts) were identified, only 18 (42%) underwent surgical resection with curative intent in addition to perioperative chemotherapy (CT) ± radiotherapy (RT). 6 pts had also synchronous abdominal nodal metastases and one resectable liver metastases. Median tumor size was 19cm (12-20). 9 pts received pre and postoperative chemotherapy (CT), 7 pts preoperative CT, 2 pts postoperative CT. Postoperative abdominal RT was administered in 3 pts. Partial response (PR) to preoperative CT was observed in more than 50% of pts. Complete cytoreduction was achieved in 14 pts (78%). HIPEC was performed in 5 patients (28%). Overall, 8 pts died (44%), 1 patient after developing liver and lung metastases while 7 had peritoneal and intra-abdominal lymphnode recurrence. Of 10 patients alive, 7 had a recurrence. Of them, 5 are alive with disease (1 presenting extra-abdominal recurrence, 3 lymph node involvement and 1 liver metastases) at 75, 38, 33, 15 and 31 months, respectively, from diagnosis. 2 are alive without disease (after having a further surgery for local recurrence) at 35 and 36 months, respectively, from diagnosis. 3 patients are alive without disease at 12, 64, and 213 months from diagnosis. As a result, 5-year OS was 39.6%, 35.6% and 40% for group A, B and C, respectively. Median survival time was 39.2, 39.2 and 57.7 months for group A, B and C, respectively. 5-year OS was 35.2% and 50% for CRS and CRS + HIPEC group respectively. Conclusions: Despite an intense multimodal approach, DSRCT prognosis remains poor. CRS may improve oncologic outcomes. Our data confirmed significant tumor shrinkage after administration of preoperative CT which may be helpful to achieve macroscopically complete resections. The value of HIPEC and radiation therapy is more controversial and needs to be further investigated in a larger series. Interestingly, the presence of synchronous nodal metastases was not a negative survival prognosticator showing comparable outcome to peritoneal disease.
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Affiliation(s)
- Stefano Radaelli
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Michele Altomare
- Department of Surgery, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - Anna Maria Frezza
- Adult Mesenchymal and Rare Tumor Unit, Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Sandro Pasquali
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marco Fiore
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Dario Callegaro
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Paolo Giovanni Casali
- Adult Mesenchymal and Rare Tumor Unit, Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandro Gronchi
- Sarcoma Service, Department of Surgery, Istituto Nazionale Dei Tumori, Milan, Italy
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24
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Altomare M, Sposito C, Regalia E, Coppa J, Flores M, Manzo E, Droz Dit Busset M, Mazzaferro V. Resection of Retro-Hepatic Vena Cava (RHVC) En-bloc with Caudate Lobe without Vascular Exclusion for a Low Grade Leiomyosarcoma of Inferior Vena Cava. Ann Surg Oncol 2021; 28:6848-6849. [PMID: 33481123 DOI: 10.1245/s10434-020-09428-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/06/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Leiomyosarcomas (LMS) of the inferior vena cava (IVC) originate in the retrohepatic (RHVC) portion in 15% of cases.1 Due to complex anatomy and need to preserve venous outflow from the infra-diaphragmatic viscera, the operation may require total vascular exclusion, veno-venous bypass and hypothermic liver resections.2,3 In this video, virtual planning of the operation allowed a parenchyma-sparing radical resection in a patient with limited liver reserve. METHODS A 12-cm LMS of RHVC invading the entire segment 1 (i.e., Spiegel's lobe, paracaval portion, and caudate process) was diagnosed in a man with metabolic steato-hepatitis (BMI: 34). He had no response to previous chemotherapy. Major hepatectomy was excluded considering the high risk of postoperative liver failure. 3D-reconstruction of regional anatomy allowed planning of a parenchymal-sparing, en bloc resection of tumor, RHVC, and caudate lobe while avoiding hilar and suprahepatic venous clamping. RESULTS The operation strategy relied on the en bloc separation of caudate lobe, RHVC, and tumor from the hepatic veins confluence and the posterior segments after complete mobilization of the liver. Vessel loop-assisted hanging maneuver, encircling tumor, and RHVC with superimposed 3D-reconstructions guided the parenchymal transection, while preserving the middle hepatic vein outflow. RHVC was replaced with prosthetic material. CONCLUSIONS Complex resection of primary tumor of the IVC en bloc with caudate lobe and RHVC can be attempted in chronic liver diseases at-risk of postoperative failure. Preservations of transhepatic flow and liver function depends on tumor size and preservation of noninvaded hepatic-veins confluence. Preoperative virtual 3D reconstruction is crucial in surgical planning.
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Affiliation(s)
- Michele Altomare
- HPB Surgery and Liver Transplant Unit, IRCCS National Cancer Institute, University of Milan, Via Venezian 1, 20133, Milan, Italy.,HPB Surgery and Liver Transplant Unit, IRCCS National Cancer Institute, Via Venezian 1, 20133, Milan, Italy
| | - Carlo Sposito
- HPB Surgery and Liver Transplant Unit, IRCCS National Cancer Institute, University of Milan, Via Venezian 1, 20133, Milan, Italy.,HPB Surgery and Liver Transplant Unit, IRCCS National Cancer Institute, Via Venezian 1, 20133, Milan, Italy
| | - Enrico Regalia
- HPB Surgery and Liver Transplant Unit, IRCCS National Cancer Institute, Via Venezian 1, 20133, Milan, Italy
| | - Jorgelina Coppa
- HPB Surgery and Liver Transplant Unit, IRCCS National Cancer Institute, Via Venezian 1, 20133, Milan, Italy
| | - Maria Flores
- HPB Surgery and Liver Transplant Unit, IRCCS National Cancer Institute, Via Venezian 1, 20133, Milan, Italy
| | - Elena Manzo
- HPB Surgery and Liver Transplant Unit, IRCCS National Cancer Institute, University of Milan, Via Venezian 1, 20133, Milan, Italy.,HPB Surgery and Liver Transplant Unit, IRCCS National Cancer Institute, Via Venezian 1, 20133, Milan, Italy
| | - Michele Droz Dit Busset
- HPB Surgery and Liver Transplant Unit, IRCCS National Cancer Institute, Via Venezian 1, 20133, Milan, Italy
| | - Vincenzo Mazzaferro
- HPB Surgery and Liver Transplant Unit, IRCCS National Cancer Institute, University of Milan, Via Venezian 1, 20133, Milan, Italy. .,HPB Surgery and Liver Transplant Unit, IRCCS National Cancer Institute, Via Venezian 1, 20133, Milan, Italy.
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25
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Altomare M, Mazzaferro V. ASO Author Reflections: Amid Anatomic Restrictions, Three-Dimensional Surgical Planning Eases En Bloc Resection of the Retro-Hepatic Vena Cava and the Caudate Lobe of the Liver. Ann Surg Oncol 2021; 28:6850-6851. [PMID: 33389286 DOI: 10.1245/s10434-020-09439-w] [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] [Received: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Michele Altomare
- GI-HPB and Liver Transplant Unit, IRCCS Istituto Nazionale Tumori, University of Milan, Milan, Italy
| | - Vincenzo Mazzaferro
- GI-HPB and Liver Transplant Unit, IRCCS Istituto Nazionale Tumori, University of Milan, Milan, Italy.
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26
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Zurleni T, Altomare M, Serio G, Catalano F. Multifocal early gastric cancer in a patient with atrophic gastritis and pernicious anemia. Int J Surg Case Rep 2020; 72:433-437. [PMID: 32563836 PMCID: PMC7306513 DOI: 10.1016/j.ijscr.2020.06.010] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/05/2020] [Accepted: 06/06/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Pernicious anemia (PA) caused by vitamin B12 deficiency is associated with Autoimmune Metaplastic Atrophic Gastritis (AMAG). Patients with AMAG have threefold risk of the development of gastric cancer. PRESENTATION OF CASE We describe a case of a 66 year old man with a history of PA and atrophic antral-corpus gastritis. After endoscopic and chromoendoscopic evaluation the patient was treated with subtotal gastrectomy plus D2 lymphadenectomy. The tumor was diagnosed as Stage Ia; pT1a pN0 pM0 G2 with multiple foci of high grade dysplasia and intramucosal adenocarcinoma. DISCUSSION Multifocal Early Gastric Cancer can be a problem for minimally invasive treatment such as endoscopic excision. Surgical management where it is not possible Endoscopic Mucosal Resection or Submucosal Resection (EMR/ESD) should include D1 or more type of lymphadenectomy because of the risk of nodes metastases. The chromoendoscopic evaluation may be helpful in the preoperative work-up and during the follow-up period. CONCLUSION Multidisciplinary approach is very important to reduce the under-treatment risk in multifocal early gastric cancer. Further studies will be needed to evaluate the safety of Subtotal vs Total Gastrectomy in this kind of disease.
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Affiliation(s)
- Tommaso Zurleni
- Department of General Surgery, ASST Valle Olona, Busto Arsizio Hospital, Italy.
| | - Michele Altomare
- Department of General Surgery, ASST Valle Olona, Busto Arsizio Hospital, Italy
| | - Giovanni Serio
- Department of Anatomical Pathology, ASST Valle Olona, Busto Arsizio Hospital, Italy
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27
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Rossi RE, Monteleone M, Altomare M, Cattaneo L, Torchio M, Coppa J, Mazzaferro V. Adjuvant radiotherapy in urothelial neuroendocrine carcinoma. MINERVA CHIR 2020; 75:210-212. [PMID: 32083410 DOI: 10.23736/s0026-4733.20.08259-0] [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: 11/08/2022]
Affiliation(s)
- Roberta E Rossi
- Gastrointestinal and Hepatopancreatic Surgery and Liver Transplantation Unit, IRCCS Istituto Nazionale Tumori Foundation, Milan, Italy - .,University of Milan, Milan, Italy -
| | - Michela Monteleone
- Gastrointestinal and Hepatopancreatic Surgery and Liver Transplantation Unit, IRCCS Istituto Nazionale Tumori Foundation, Milan, Italy
| | - Michele Altomare
- Gastrointestinal and Hepatopancreatic Surgery and Liver Transplantation Unit, IRCCS Istituto Nazionale Tumori Foundation, Milan, Italy
| | - Laura Cattaneo
- Department of Pathology and Laboratory Medicine, IRCCS Istituto Nazionale Tumori Foundation, Milan, Italy
| | - Martina Torchio
- Department of Medical Oncology, IRCCS Istituto Nazionale Tumori Foundation, Milan, Italy
| | - Jorgelina Coppa
- Gastrointestinal and Hepatopancreatic Surgery and Liver Transplantation Unit, IRCCS Istituto Nazionale Tumori Foundation, Milan, Italy
| | - Vincenzo Mazzaferro
- Gastrointestinal and Hepatopancreatic Surgery and Liver Transplantation Unit, IRCCS Istituto Nazionale Tumori Foundation, Milan, Italy.,University of Milan, Milan, Italy
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Cioffi SPB, Altomare M, Spota A, Granieri S, Cimbanassi S, Chiara O. REsiDENT 1 (Re-assessment of Appendicitis Evaluation during laparoscopic appendectomy: Do we End a Non-standardized Treatment approach and habit?): peritoneal irrigation during laparoscopic appendectomy-does the grade of contamination matter? A prospective multicenter resident-based evaluation of a new classification system. World J Emerg Surg 2019; 14:25. [PMID: 31164914 PMCID: PMC6543631 DOI: 10.1186/s13017-019-0243-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 05/09/2019] [Indexed: 12/31/2022] Open
Abstract
Background Laparoscopic appendectomy has progressively gained acceptance as the standard of care for acute appendicitis. Focusing on the incidence of postoperative intra-abdominal abscess after a laparoscopic appendectomy, discordant data have been reported ranging from 1.5 to 20%. Besides, evidence advocating advantages from peritoneal irrigation over suction only are lacking. Most studies are burdened by a high level of heterogeneity regarding the severity of the appendicitis and modalities of peritoneal irrigation. One of the main drawbacks is the lack of an accepted classification for different degrees of appendicitis and peritoneal contamination. The aim of the study is to introduce a classification to clarify the relationship between grade of appendicitis, contamination, and postoperative incidence of IAA considering the surgeon’s attitude toward irrigation or suction alone. Preoperative, intra-operative, and postoperative predictive factors for infectious complication will also be assessed. This study is meant to be the first Italian multicenter resident-based observational study. Methods Patients suffering from acute appendicitis will be enrolled during a 1-year period, according to inclusion and exclusion criteria. Participants will fill an online form reporting all clinical and intra-operative data of each patient undergoing a laparoscopic appendectomy. General surgery residents will be responsible for data collection. Our proposal of classification is based on the histological grade of appendicitis and intra-operative degree of peritoneal contamination. For each grade, a progressively increasing score is assigned. Discussion The observational nature of this study is mandatory to examine surgeons’ attitude toward peritoneal contamination during laparoscopic appendectomy for appendicitis. Identification of different severity grades of acute appendicitis and their relationship with the development of postoperative abscesses is necessary. The resulting classification and score, even considering peritoneal lavage or suction alone, will define risk classes of peri-appendiceal contamination each one related to a specific incidence rate of postoperative IAA. Nowadays, maximum effort should be made to reach the best procedural standardization and surgical decision-making should be supported by solid evidence, especially in an emergency surgery setting.
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Affiliation(s)
| | - Michele Altomare
- University of Milan, General Surgery Residency Program., Via Festa del Perdono 7, 20122 Milan, Italy
| | - Andrea Spota
- University of Milan, General Surgery Residency Program., Via Festa del Perdono 7, 20122 Milan, Italy
| | - Stefano Granieri
- University of Milan, General Surgery Residency Program., Via Festa del Perdono 7, 20122 Milan, Italy.,2Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | | | - Osvaldo Chiara
- University of Milan, General Surgery Residency Program., Via Festa del Perdono 7, 20122 Milan, Italy.,2Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy
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Altomare M, Cimbanassi S, Chiara O, Salvi PF. Acute appendicitis. Update of clinical scores. Ann Ital Chir 2019; 90:231-237. [PMID: 31354149] [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: 06/10/2023]
Abstract
OBJECTIVES Evaluate Alvarado Score's (AS) accuracy related with C-reactive protein (CRP). Evaluate the accuracy rate of ultrasonography (US). MATERIALS AND METHODS We analyzed data on 290 patients admitted to Emergency Department (ED) of Sant'Andrea Hospital (Rome - Italy) presenting abdominal pain in lower quadrants between Jan2009-Apr2015. AS, laboratory tests, images and report from CT-scan and US were collected. Histological examination is considered as Gold Standard. We calculated Specificity(Sp), Sensitivity(Se), Accuracy(Ac), positive predictive value(PPV), and negative predictive value(NPV). We use Exact Fisher Test (EFT) for samples less than 50 units, and Chi square test (χ2). CRP were assessed as possible laboratory marker to be added to AS. RESULTS Two hundred and forty patients (82%) were enrolled following the inclusion criteria. The variations obtained from the AS with C-reactive protein show no difference. CT-scan vs US results show a higher Sp for US despite CT (p= 0.0509 χ2=3.803. Se and NPV are higher in CT compared to the US (Se: p=0.000315 χ2= 12.88 NVP: p=0.015. We evaluated Ac of US and CT within the individual groups (low(L), Intermediate(I), High(H): L; 37 patients show no statistically significant difference (EFT=1; p>0.05). I: show superiority of CT-scan in Se and NPV (FE:0.0162 p<0.05; FE:0.0432 p<0.05). Regarding H only Se show an acceptable p-value (p<0.0021). CONCLUSION Alvarado score (AS) can be used as the first diagnostic approach in the diagnosis of acute appendicitis (AA). Ultrasound must be considered the first level instrumental examination; necessary and sufficient in low risk patients (0-3 pt) to exclude, with a high reliability rate, the diagnosis of acute appendicitis. KEY WORDS Acute Appendicitis, Alvarado Score, CT scan, Ultrasound, Peritonitis.
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Zurleni T, Gjoni E, Altomare M, Rausei S. Conversion surgery for gastric cancer patients: A review. World J Gastrointest Oncol 2018; 10:398-409. [PMID: 30487951 PMCID: PMC6247102 DOI: 10.4251/wjgo.v10.i11.398] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/25/2018] [Accepted: 10/07/2018] [Indexed: 02/05/2023] Open
Abstract
Gastric cancer (GC) is the third most common cancer-related cause of death worldwide. In locally advanced tumors, neoadjuvant chemotherapy has recently been introduced in most international Western guidelines. For metastatic and unresectable disease, there is still debate regarding correct management and the role of surgery. The standard approach for stage IV GC is palliative chemotherapy. Over the last decade, an increasing number of M1 patients who responded to palliative regimens of induction chemotherapy have been subsequently undergone surgery with curative intent. The objective of the present review is to analyze the literature regarding this approach, known as “conversion surgery”, which has become one of the most commonly adopted therapeutic options. It is defined as a treatment aiming at an R0 resection after chemotherapy in initially unresectable tumors. The 13 retrospective studies analyzed, with a total of 411 patients treated with conversion therapy, clearly show that even if standardization of unresectable and metastatic criteria, post-chemotherapy resectability evaluation and timing of surgery has not yet been established, an R0 surgery after induction chemotherapy with partial or complete response seems to offer superior survival results than chemotherapy alone. Additional larger sample-size randomized control trials are needed to identify subgroups of well-stratified patients who could benefit from this multimodal approach.
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Affiliation(s)
- Tommaso Zurleni
- Department of Surgery, ASST Valle Olona, Busto Arsizio 21052, Italy
| | - Elson Gjoni
- Department of Surgery, ASST Valle Olona, Busto Arsizio 21052, Italy
| | - Michele Altomare
- Department of Surgery, ASST Valle Olona, Busto Arsizio 21052, Italy
| | - Stefano Rausei
- Department of Surgery, ASST Valle Olona, Gallarate. 21013, Italy
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Lepore G, Bonfanti R, Bozzetto L, Di Blasi V, Girelli A, Grassi G, Iafusco D, Laviola L, Rabbone I, Schiaffini R, Bruttomesso D, Mammì F, Bruzzese M, Schettino M, Nuzzo M, Di Blasi V, Fresa R, Lambiase C, Iafusco D, Zanfardino A, Confetto S, Bozzetto L, Annuzzi G, Alderisio A, Riccardi G, Gentile S, Marino G, Guarino G, Zucchini S, Maltoni G, Suprani T, Graziani V, Nizzoli M, Acquati S, Cavani R, Romano S, Michelini M, Manicardi E, Bonadonna R, Dei Cas A, Dall'aglio E, Papi M, Riboni S, Manicardi V, Manicardi E, Manicardi E, Pugni V, Lasagni A, Street M, Pagliani U, Rossi C, Assaloni R, Brunato B, Tortul C, Zanette G, Li Volsi P, Zanatta M, Tonutti L, Agus S, Pellegrini M, Ceccano P, Pozzilli G, Anguissola B, Buzzetti R, Moretti C C, Leto G, Pozzilli P, Manfrini S, Maurizi A, Leotta S, Altomare M, Abbruzzese S, Carletti S, Suraci C, Filetti S, Manca Bitti M, Arcano S, Cavallo M, De Bernardinis M, Pitocco D, Caputo S, Rizzi A, Manto A, Schiaffini R, Cappa M, Benevento D, Frontoni S, Malandrucco I, Morano S, Filardi T, Lauro D, Marini M, Castaldo E, Sabato D, Tuccinardi F, Forte E, Viterbori P, Arnaldi C, Minuto N, d'Annunzio G, Corsi A, Rota R, Scaranna C, Trevisan R, Valentini U, Girelli A, Bonfadini S, Zarra E, Plebani A, Prandi E, Felappi B, Rocca A, Meneghini E, Galli P, Ruggeri P, Carrai E, Fugazza L, Baggi V, Conti D, Bosi E, Laurenzi A, Caretto A, Molinari C, Orsi E, Grancini V, Resi V, Bonfanti R, Favalli V, Bonura C, Rigamonti A, Bonomo M, Bertuzzi F, Pintaudi B, Disoteo O, Perseghin G, Perra S, Chiovato L, De Cata P, Zerbini F, Lovati E, Laneri M, Guerraggio L, Bossi A, De Mori V, Galetta M, Meloncelli I, Aiello A A, Di Vincenzo S, Nuzzi A, Fraticelli E, Ansaldi E, Battezzati M, Lombardi M, Balbo M, Lera R, Secco A, De Donno V, Cadario F, Savastio S, Ponzani C, Aimaretti G, Rabbone I, Ignaccolo G, Tinti D, Cerutti F, Bari F, Giorgino F, Piccinno E, Zecchino O, Cignarelli M, Lamacchia O, Picca G, De Cosmo S, Rauseo A, Tomaselli L, Tumminia A, Egiziano C, Scarpitta A, Maggio F, Cardella F, Roppolo R, Provenzano V, Fleres M, Scorsone A, Scatena A, Gregori G, Lucchesi S, Gadducci F, Di Cianni S, Pancani S, Del Prato S, Aragona M, Crisci I, Calianno A, Fattor B, Crazzolara D, Reinstadler P, Longhi S, Incelli G, Rauch S, Romanelli T, Orrasch M, Cauvin V, Franceschi R, Lalli C, Pianta A, Marangoni A, Aricò C, Marin N, Nogara N, Simioni N, Filippi A, Gidoni Guarneri G, Contin M.L M, Decata A, Bondesan L, Confortin L, Coracina A, Lombardi S, Costa Padova S, Cipponeri E, Scotton R, Galasso S, Boscari F, Zanon M, Vinci C, Lisato G, Gottardo L, Bonora E, Trombetta M, Negri C, Brangani C, Maffeis C, Sabbion A, Marigliano M. Metabolic control and complications in Italian people with diabetes treated with continuous subcutaneous insulin infusion. Nutr Metab Cardiovasc Dis 2018; 28:335-342. [PMID: 29428572 DOI: 10.1016/j.numecd.2017.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 10/31/2017] [Accepted: 12/02/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND AIM The objective of this cross-sectional study was to evaluate the degree of glycaemic control and the frequency of diabetic complications in Italian people with diabetes who were treated with continuous subcutaneous insulin infusion (CSII). METHODS AND RESULTS Questionnaires investigating the organisation of diabetes care centres, individuals' clinical and metabolic features and pump technology and its management were sent to adult and paediatric diabetes centres that use CSII for treatment in Italy. Information on standard clinical variables, demographic data and acute and chronic diabetic complications was derived from local clinical management systems. The sample consisted of 6623 people with diabetes, which was obtained from 93 centres. Of them, 98.8% had type 1 diabetes mellitus, 57.2% were female, 64% used a conventional insulin pump and 36% used a sensor-augmented insulin pump. The median glycated haemoglobin (HbA1c) level was 60 mmol/mol (7.6%). The HbA1c target (i.e. <58 mmol/mol for age <18 years and <53 mmol/mol for age >18 years) was achieved in 43.4% of paediatric and 23% of adult participants. Factors such as advanced pump functions, higher rate of sensor use, pregnancy in the year before the study and longer duration of diabetes were associated with lower HbA1c levels. The most common chronic complications occurring in diabetes were retinopathy, microalbuminuria and hypertension. In the year before the study, 5% of participants reported ≥1 episode of severe hypoglycaemic (SH) episodes (SH) and 2.6% reported ≥1 episode of ketoacidosis. CONCLUSIONS Advanced personal skills and use of sensor-based pump are associated with better metabolic control outcomes in Italian people with diabetes who were treated with CSII. The reduction in SH episodes confirms the positive effect of CSII on hypoglycaemia. CLINICAL TRIAL REGISTRATION NUMBER NCT 02620917 (ClinicalTrials.gov).
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Arigliani M, Canciani MC, Mottini G, Altomare M, Magnolato A, Loa Clemente SV, Tshilolo L, Cogo P, Quanjer PH. Evaluation of the Global Lung Initiative 2012 Reference Values for Spirometry in African Children. Am J Respir Crit Care Med 2017; 195:229-236. [PMID: 27564235 DOI: 10.1164/rccm.201604-0693oc] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Despite the high burden of respiratory disease, no spirometry reference values for African children are available. OBJECTIVES Investigate whether the Global Lung Initiative (GLI-2012) reference values for spirometry are appropriate for children in sub-Saharan Africa and assess the impact of malnutrition on lung function. METHODS Anthropometry and spirometry were obtained in children aged 6 to 12 years from urban and semiurban schools in three African countries. Spirometry z-scores were derived using the GLI-2012 prediction equations for African Americans. Thinness (body mass index z-score < -2) was a surrogate for malnutrition. Spirometry outcomes were compared with those of African American children from the third National Health and Nutrition Survey. MEASUREMENTS AND MAIN RESULTS Spirometry data were analyzed from 1,082 schoolchildren (51% boys) aged 6.0 to 12.8 years in Angola (n = 306), Democratic Republic of the Congo (n = 377), and Madagascar (n = 399). GLI-2012 provided a good fit with mean (SD) z-scores of -0.11 (0.83) for FEV1, -0.08 (0.86) for FVC, and -0.07 (0.83) for FEV1/FVC. Because of low scatter, the fifth centile corresponded to -1.3 z-scores in boys and -1.5 z-scores in girls. Malnourished African children had a normal FEV1/FVC ratio but significant reductions of ∼0.5 z-scores (∼5%) in FEV1 and FVC compared with African American peers from the third National Health and Nutrition Survey. Children in Angola had the lowest, and those in Madagascar had the highest, zFEV1 and zFVC. CONCLUSIONS The results of this study support the use of GLI-2012 reference values for schoolchildren in sub-Saharan Africa. Malnutrition affects body growth, leading to a proportionately smaller FEV1 and FVC without respiratory impairment, as shown by the normal FEV1/FVC ratio.
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Affiliation(s)
- Michele Arigliani
- 1 Department of Clinical and Experimental Medical Sciences, Unit of Pediatrics, University Hospital of Udine, Udine, Italy
| | - Mario C Canciani
- 1 Department of Clinical and Experimental Medical Sciences, Unit of Pediatrics, University Hospital of Udine, Udine, Italy
| | - Giovanni Mottini
- 2 International Health Cooperation Project, University Campus Bio-Medico, Rome, Italy
| | | | | | | | - Leon Tshilolo
- 6 Service de Pédiatrie, Centre Hospitalier Monkole and Centre de Formation et d'Appui Sanitaire, Kinshasa, Democratic Republic of the Congo; and
| | - Paola Cogo
- 1 Department of Clinical and Experimental Medical Sciences, Unit of Pediatrics, University Hospital of Udine, Udine, Italy
| | - Philip H Quanjer
- 7 Department of Pulmonary Diseases and.,8 Department of Paediatrics-Pulmonary Diseases, Erasmus Medical Centre, Erasmus University, Rotterdam, the Netherlands
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Mohammadpour F, Moradi M, Lee K, Cha G, So S, Kahnt A, Guldi DM, Altomare M, Schmuki P. Enhanced performance of dye-sensitized solar cells based on TiO2 nanotube membranes using an optimized annealing profile. Chem Commun (Camb) 2015; 51:1631-4. [DOI: 10.1039/c4cc08266d] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Free standing TiO2 nanotube membranes are transferred onto FTO slides in front-side illuminated dye-sensitized solar cells (DSSCs). The electronic properties of the tubes and, as a result, the efficiency of the DSSCs can be considerably improved by ramped annealing.
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Affiliation(s)
- F. Mohammadpour
- Physics Department
- College of Science
- Shiraz University
- 71454 Shiraz
- Iran
| | - M. Moradi
- Physics Department
- College of Science
- Shiraz University
- 71454 Shiraz
- Iran
| | - K. Lee
- Department of Material Science and Engineering
- WW4-LKO
- University of Erlangen-Nuremberg
- D-91058 Erlangen
- Germany
| | - G. Cha
- Department of Material Science and Engineering
- WW4-LKO
- University of Erlangen-Nuremberg
- D-91058 Erlangen
- Germany
| | - S. So
- Department of Material Science and Engineering
- WW4-LKO
- University of Erlangen-Nuremberg
- D-91058 Erlangen
- Germany
| | - A. Kahnt
- University of Erlangen-Nuremberg
- D-91058 Erlangen
- Germany
| | - D. M. Guldi
- University of Erlangen-Nuremberg
- D-91058 Erlangen
- Germany
| | - M. Altomare
- Department of Material Science and Engineering
- WW4-LKO
- University of Erlangen-Nuremberg
- D-91058 Erlangen
- Germany
| | - P. Schmuki
- Department of Material Science and Engineering
- WW4-LKO
- University of Erlangen-Nuremberg
- D-91058 Erlangen
- Germany
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Altomare M, La Vignera S, Asero P, Recupero D, Condorelli RA, Scollo P, Gulisano A, Magro E, Tumino D, Tumino S, Vicari E, Leanza V, D'Agata R, Calogero AE. High prevalence of thyroid dysfunction in pregnant women. J Endocrinol Invest 2013; 36:407-11. [PMID: 23095459 DOI: 10.3275/8658] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND/AIM Maternal thyroid dysfunction during pregnancy has been associated with adverse obstetric and neonatal outcomes. This prospective study evaluates the prevalence of these disorders in pregnant women. SUBJECTS AND METHODS Serum levels of TSH, free T4 (fT4), and thyroperoxidase antibodies (TPO-Ab) were measured in 951 women at different gestational ages of pregnancy. Trimester-specific reference ranges for TSH were used to classify pregnant women into five groups: 1) Overt hypothyroidism (OH); 2) Subclinical hypothyroidism (SCH); 3) Isolated hypothyroxinemia (IH); 4) Low TSH (isolated or associated with high fT4); and 5) Normal. A classification was made also according to the lower and upper ranges provided by the manufacturer for thyroid hormones. Pregnant women who were at a high risk of developing thyroid disease were identified. RESULTS Altogether, 117 women (12.3%) had hypothyroidism and 25 (2.6%) had low TSH. The prevalence of both OH and SCH was higher in the high-risk group than in the low-risk group, but 17.9% of women with hypothyroidism were classified at low-risk. A family history of thyroid disorders and TPO-Ab positivity increased the risk of SCH. Using non-pregnant reference range for TSH, 10.6% of women were misclassificated. CONCLUSIONS The high prevalence of hypothyroidism observed in this study suggests that accurate thyroid screening with trimester specific reference ranges should be warranted, particularly in areas with mild to moderate iodine deficiencies.
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Affiliation(s)
- M Altomare
- Section of Endocrinology, Andrology and Internal Medicine, Department of Medical and Paediatric Sciences, University of Catania, Via S. Sofia 78, Catania, Italy.
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Lastretti M, Visalli N, Grossi G, Altomare M, Carletti S, Gentili P, Fratino M, Marianetti M, Abbruzzese S. M177 ‘ONCE UPON A TIME’ OUTPATIENT MEDICAL AND PSYCHOLOGICAL INTERVENTION FOR WOMEN WITH PREVIOUS GDM. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)61371-x] [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: 10/27/2022]
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Grossi G, Giovannini M, Passarello A, Visalli N, Altomare M, Abbruzzese S, Carletti S, Lastretti M, Suraci C, Leotta S. O286 DIABETES AND PREGNANCY: OUR EXPERIENCE IN A MULTIDISCIPLINARY AMBULATORY. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)60716-4] [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: 10/27/2022]
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Fanizza E, Altomare M, Di Mauro AE, Del Sole T, Corricelli M, Depalo N, Comparelli R, Agostiano A, Striccoli M, Curri ML. Polyelectrolyte multilayers as a platform for luminescent nanocrystal patterned assemblies. Langmuir 2012; 28:5964-5974. [PMID: 22409721 DOI: 10.1021/la300213n] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The fabrication of uniform and patterned nanocrystal (NC) assemblies has been investigated by exploiting the possibility of carefully tailoring colloidal NC surface chemistry and the ability of polyelectrolyte (PE) to functionalize substrates through an electrostatic layer-by-layer (LbL) strategy. Appropriate deposition conditions, substrate functionalization, and post-preparative treatments were selected to tailor the substrate surface chemistry to effectively direct the homogeneous electrostatic-induced assembly of NCs. Water-dispersible luminescent NCs, namely, (CdSe)ZnS and CdS, were differently functionalized by (1) ligand-exchange reaction, (2) growth of a hydrophilic silica shell, and (3) formation of a hydrophilic inclusion complex, thus providing functional NCs stable in a defined pH range. The electrostatically charged functional NCs represent a comprehensive selection of examples of surface-functionalized NCs, which enables the systematic investigation of experimental parameters in NC assembly processes carried out by combining LbL procedures with microcontact printing and also exploiting NC emission, relevant for potential applications, as a prompt and effective probe for evaluating assembly quality. Thus, an ample showcase of combinations has been investigated, and the spectroscopic and morphological features of the resulting NC-based structures have been discussed.
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Verriello V, Altomare M, Masiello G, Curatolo C, Balacco G, Altomare DF. Treatment of post-prostatectomy rectourethral fistula with fibrin sealant (Quixil™) injection: a novel application. Tech Coloproctol 2010; 14:341-3. [PMID: 20549535 DOI: 10.1007/s10151-010-0590-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Accepted: 05/24/2010] [Indexed: 11/28/2022]
Abstract
Rectourethral fistulas in adults is a rare but potentially devastating postoperative condition requiring complex and demanding surgery. Fibrin glue treatment has been used with some success in anal and rectovaginal fistulas, and in the case we present here this indication has been extended to a postoperative rectourethral fistula following radical prostatectomy. For the first time, to our knowledge, a fibrin sealant (Quixil) was injected into the fistula tract, and a rectal mucosal flap was used to close the internal opening. The fistula healed in few weeks, and the patient is symptom free after 1 year of follow-up.
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Affiliation(s)
- V Verriello
- Urological Department, Don Tonino Bello Hospital, ASL BA, Molfetta, Italy
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Abstract
AIM To evaluate plasma protein Z (PZ) levels in healthy and high-risk newborn infants. METHODS A longitudinal observational study was conducted. Inclusion criteria were: healthy term and preterm newborns normal for gestational age and newborns belonging to one of the following groups: newborns small for gestational age (SGA), newborns affected by respiratory distress syndrome (RDS), newborns from mothers with pre-eclampsia. Newborns with sepsis, congenital malformation or haemorrhagic disorders were excluded. Plasma PZ levels, protein C (PC) concentration, PC activity and protein-induced vitamin K absence levels were measured. RESULTS 53 newborns were enrolled into the study. PZ and PC antigen levels varied significantly among analysed subgroups on day 1 (p < 0.01): lower levels of these inhibitors were found in RDS newborns (group C), newborns from mothers affected by pre-eclampsia (group D) and SGA newborns (group E) than in healthy term and preterm newborns (groups A and B). CONCLUSION PZ deficiency occurs in newborns affected by severe RDS, in newborns from pre-eclamptic mothers and in SGA newborns, probably owing to activated coagulation in the first two conditions and to reduced PZ synthesis in the last condition.
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Affiliation(s)
- F Schettini
- Dipartimento di Biomedicina dell'Età Evolutiva, Sezione di Neonatologia e Terapia Intensiva Neonatale, University of Bari, Italy.
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Abstract
OBJECTIVE The term 'giant prolactinoma' can be used for tumours larger than 4 cm in diameter and/or with massive extrasellar extension. Cabergoline (CAB), a long-lasting dopamine agonist (DA), safe and well tolerated, is effective in normalizing PRL levels and inducing tumour shrinkage in micro- and macroprolactinomas. The purpose of this prospective study was to evaluate the efficacy and safety of CAB also for giant prolactinomas. PATIENTS AND METHODS Ten men with giant prolactinomas with a median age of 44.8 years were treated with CAB. Before CAB, four patients had previously undergone transsphenoidal surgery without modifying the parasellar extension of the tumour or their visual defects. Pretreatment serum prolactin (PRL) levels ranged between 1230 and 22 916 micro g/l (mean +/- SEM: 5794 +/- 1996) and tumour volume was between 21.8 and 105.5 cm3 (mean +/- SEM: 50.7 +/- 8.8). CAB was administered at an initial low dose of 0.5 mg three times a week and, in five patients who did not achieve serum PRL normalization, the dose was progressively increased up to 10.5 mg/week. The duration of treatment was 13-68 months (mean 38.9). PRL levels and pituitary target organ hormones were assayed before, after 30 days and then every 3 months after the beginning of CAB treatment. Magnetic resonance imaging (MRI) was carried out before, after 1-3 months, after 6 months and then every 10-12 months to evaluate tumour shrinkage. RESULTS In every patient, a significant PRL decrease (P = 0.0086) of at least 96% of the pretreatment values occurred (from 5794 +/- 1996 to 77 +/- 38, mean +/- SEM); a persistent normalization of PRL levels was achieved in five out of 10 patients (50%) beginning from the first 3-6 months of CAB treatment (only one patient needed 12 months of therapy). A significant tumour shrinkage (P = 0.0003) was achieved after 12 months of therapy in nine out of 10 patients (90%), with a volume reduction greater than 95% in three, of 50% in four and 25% in two patients. Tumour volume decreased from 50.7 +/- 8.8 to 28.6 +/- 9.4 and then to 22.3 +/- 8.8 cm3 (mean +/- SEM) after 6 and 12 months of CAB treatment, respectively. An improvement of visual field defects (VFD) was obtained in six of the seven patients presenting visual impairment before CAB treatment. Among the eight patients presenting libido and potency (L-P) failure, five normalized their PRL levels. In two of these a complete restoration of libido and potency was observed. Three patients with secondary hypoadrenalism and a patient with secondary hypothyroidism were treated with substitutive therapy during all the study time. The drug was well tolerated by all patients and no one discontinued the therapy. CONCLUSIONS These data suggest that, in giant, aggressive prolactinomas, CAB represents a first-line therapy effective in reducing PRL levels and determining tumour shrinkage.
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Affiliation(s)
- S M Corsello
- Institute of Endocrinology, Catholic University School of Medicine, Rome, Italy.
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Laforgia N, Difonzo I, Altomare M, Mautone A. Cord blood endothelin-1 and perinatal asphyxia. Acta Paediatr 2001; 90:351-2. [PMID: 11332180] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
UNLABELLED Discordant data have been reported on endothelin-1 (ET-1), a potent endothelium-derived vasoconstriction peptide, during the neonatal period, and elevated levels have been found in various neonatal diseases. This study evaluated ET-1 in the cord blood of 74 neonates of different gestational age, birthweight, mode of delivery and 5'-Apgar score. CONCLUSION Higher ET-1 levels were found in neonates born by emergency caesarean section, and in newborns with low 5'-Apgar score, suggesting that ET-1 could be a marker of perinatal asphyxia.
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Affiliation(s)
- N Laforgia
- Dipartimento di Biomedicina dell'Età Evolutiva, Università degli Studi di Bari, Italy.
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Giordano P, Del Vecchio GC, Santoro N, Arcamone G, Coppola B, Altomare M, Schettini F, Iolascon A, De Mattia D. Thrombin generation in children with acute lymphoblastic leukemia: effect of leukemia immunophenotypic subgroups. Pediatr Hematol Oncol 2000; 17:667-72. [PMID: 11127398 DOI: 10.1080/08880010050211376] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Elevated plasma concentrations of endogenous thrombin generation markers and thrombotic events have been reported in children with leukemia. The aim of this study was to evaluate the effects of cancer and its treatment on thrombin generation (TAT levels) in children with acute lymphoblastic leukemia (ALL). The authors evaluated 32 children (23 M, 9 F) aged between 1 and 15 years (mean 6) affected by ALL (immunophenotypic subgroups: 16 common, 7 T, and 9 pre-B type). In all patients TAT levels at onset and after 5-6 doses of L-asparaginase were evaluated. TAT levels were higher in patients both at onset (13.04 +/- 10.90 ng/L) and after the 5-6 doses of L-asp (19.41 +/- 11.05 ng/L) with respect to controls (4 +/- 1 ng/L) (p < .001 and p < .001). TAT levels after 5-6 doses of L-asp were higher than those at onset (p < .001). Factorial ANOVA showed that at onset there was a significant effect of leukemia immunophenotypic subgroups upon TAT levels (p < .05) and no effect of inherited thrombotic risk factors. These results indicate that in children with ALL an important role is played by acquired thrombotic risk factors, among which the indirect cancer procoagulant activity has its importance.
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Affiliation(s)
- P Giordano
- Dipartimento di Biomedicina Età Evolutiva, University of Bari, Bari, Italy
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Abstract
Inherited thrombocytopenias are a heterogenous group of disorders. Different criteria have been suggested to classify the forms, such as the inheritance mechanism and the platelet volume as well as the number and morphology of megakaryocytes. However, the classification is often descriptive, and the precise mechanism of thrombocytopenia still remains unknown. We describe the clinical, biologic, and molecular findings of an autosomal dominant thrombocytopenia in a large family. The 17 patients had normocellular bone marrow and normal platelet volume. Platelets also showed a normal aggregation test and normal response to ADP and thrombopoietin (TPO). In the affected subjects, the mean +/- SD levels of platelet count and plasma TPO were 62+/-25 and 258+/-151, respectively. Comparative analysis showed that the patients with platelet count <70000 had higher plasma TPO concentration. The data are consistent with a mild clinical form of the disease associated with only a few episodes of bleeding. To exclude the possible role of TPO and its receptor c-mpl in the etiology of this condition, linkage analysis was performed using microsatellite markers close to the TPO and c-mpl genes on chromosomes 3q26.3-q27 and 1p34, respectively. The absence of cosegregation within the affected family indicated that these genes, as well as two other candidate loci on chromosomes 11 and 21, are not responsible for this hereditary dominant form of thrombocytopenia. A genome-wide search and subsequent identification of the gene will provide new insight into the pathogenesis of this disorder.
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Affiliation(s)
- A Iolascon
- Department of Biomedicine, University of Bari, Italy
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Giordano P, Galli M, Del Vecchio GC, Altomare M, Norbis F, Ruggeri L, Petronelli M, de Mattia D. Lupus anticoagulant, anticardiolipin antibodies and hepatitis C virus infection in thalassaemia. Br J Haematol 1998; 102:903-6. [PMID: 9734637 DOI: 10.1046/j.1365-2141.1998.00853.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Anticardiolipin antibodies (ACA) and lupus anticoagulant (LA) have been detected in patients with hepatitis C virus (HCV) infection and have been associated in autoimmune diseases (i.e. systemic lupus erythematosus) with an increased risk of thromboembolic events. Because of the high prevalence of HCV infection and the thrombotic risk described in thalassaemia we decided to investigate the prevalence of ACA and LA in a cohort of 68 thalassaemia patients. We found a high prevalence (34%) of beta2-glycoprotein I independent ACA in our thalassaemia patients which was related to HCV infection. None of patients developed any complications related to antiphospholipid antibodies (APL); therefore the clinical significance of positivity for APL in patients with HCV infection is at present unclear. In conclusion, the results of our study indicate that ACA in the serum of HCV-infected thalassaemic patients exhibit the characteristics of natural autoantibodies rather than those of the pathogenic autoantibodies that are found in patients with systemic lupus erythematosus.
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Affiliation(s)
- P Giordano
- Dipartimento di Biomedicina Età Evolutiva, University of Bari, Italy
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Giordano P, Del Vecchio GC, Altomare M, Coppola B, Schettini F, Iolascon A, De Mattia D. Resistance to activated protein C in thalassaemic patients: an underlying cause of thrombosis. Eur J Haematol 1998; 61:123-7. [PMID: 9714525 DOI: 10.1111/j.1600-0609.1998.tb01072.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We evaluated 81 thalassaemia major and 4 thalassaemia intermedia patients (48 M, 37 F), median age 17 years; 62/85 patients were HCV-positive, 3/85 HIV-positive, 19/85 were splenectomized. Forty normal healthy children were recruited as the control group. The number of thrombotic events was studied retrospectively. Platelet poor plasma was filtered and quick-frozen at -70 degrees C until time of assay. APC resistance was measured in an activated thromboplastin time and results were expressed as normalized ratio. All tests were done with diluted 1 in 5 (v/v) factor V deficient plasma and with undiluted plasma. Molecular genetic investigation of factor V gene was performed with polymerase chain reaction, followed by digestion of amplified products with restriction enzyme Mnl I. Data obtained with molecular investigation revealed the presence of 4 heterozygous subjects for factor V Leiden (4.7%). Functional tests were able to detect all heterozygotes for factor V Leiden both with undiluted and with diluted plasma, and there were no false negative subjects. However, undiluted plasma revealed a greater number of false positive subjects (n=15) than did diluted plasma. Therefore, tests done with undiluted and diluted plasma revealed a 100% sensitivity, while specificity was 81% for undiluted plasma and 97% for diluted plasma. Only one thrombotic event was observed in one of the 85 studied patients, as a case of stroke in a thalassaemia intermedia patient with APC resistance. In the same patient an additional thrombogenic risk factor was represented by a pronounced haematocrit increase at the beginning of her transfusion regimen.
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Affiliation(s)
- P Giordano
- Department of Biomedicine of Developmental Age, University of Bari, Italy
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Abstract
AIM The activation pattern of the clotting and fibrinolytic systems in 63 preterm infants (GA 31, 6 +/- 2.3 weeks) was studied. METHODS The infants were divided into four groups: (i) IRDS, (ii) asphyxia at birth, (iii) sepsis, and (iv) mild infection. A control group was composed of preterm infants without any apparent disease (GA 32 +/- 1.8 weeks). RESULTS During IRDS we found a systemic activation of both coagulation and fibrinolysis at birth which was represented by lower levels of ATIII (27.7 +/- 8.8%) and significantly greater levels of TAT (37.9 +/- 31.9 ng/ml), D-dimers (1242.7 +/- 206.9 ng/ml), tPA Ag (10.9 +/- 5.3 ng/ml) and PAI Ag (59.9 +/- 16.7 ng/ml) than in the control group. In the asphyxiated newborns there were no significant differences from the controls. During their seventh day of life, a significant reduction of all the analysed parameters (TAT, D-dimers, tPA, PAI) and a significant increase in ATIII were seen in the newborns with IRDS, while no significant modification was observed in the newborns with asphyxia at birth. When the newborns with sepsis were compared with those with mild infection, their TAT and PAI values proved to be significantly higher for the first tests (21.7 +/- 18.8 vs 9.2 +/- 6.9 microg/l and 53.6 +/- 14.4 vs 37.7 +/- 10.2 ng/ml respectively). During the second tests, 7 days later, only TAT (16.7 +/- 14.7 vs 6.3 +/- 4 microg/l) levels remained high while D-dimers (1094.2 +/- 400.6 vs 646 +/- 200ng/ml) and tPA (11.3 +/- 8 vs 4.9 +/- 2 ng/ml) were significantly higher in the septic group of newborns than those with mild infection. CONCLUSIONS These data indicate that there is an activation of the clotting and fibrinolytic systems both in the initial phase of IRDS as well as during sepsis.
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Affiliation(s)
- A Mautone
- Dipartimento di Biomedicina dell'età evolutiva, Università di Bari, Italy
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De Mattia D, Penza R, Giordano P, Del Vecchio GC, Aceto G, Altomare M, Schettini F. von Willebrand factor and factor XIII in children with Henoch-Schonlein purpura. Pediatr Nephrol 1995; 9:603-5. [PMID: 8580019 DOI: 10.1007/bf00860949] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
levels of von Willebrand factor antigen (vWf:Ag) and factor XIII activity (F XIII) were studied in relation to the severity of clinical symptoms (scored from 0 to 3) and to immunological parameters [IgA, C3, C4, and circulating immune complexes (CIC)] in 16 children (7 males, 9 females, aged 3-11 years) with Henoch-Schonlein purpura (HSP) at presentation. vWf:Ag was increased in 7 patients, F XIII activity was decreased in 6. In all children we found high levels of IgA, while C3 and C4 levels were normal; CIC were elevated in 11. vWf:Ag correlated with clinical score and with IgA and CIC, probably as a result of immune-mediated endothelial cell damage. The haemostatic alterations observed in HSP are important for understanding the pathophysiology of the disease.
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Affiliation(s)
- D De Mattia
- Dipartimento di Biomedicina dell'Età Evolutiva, University of Bari, Italy
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De Mattia D, Regina G, Giordano P, Del Vecchio GC, Altomare M, Schettini F. Association of congenital afibrinogenemia and K-dependent protein C deficiency--a case report. Angiology 1993; 44:745-9. [PMID: 8357104 DOI: 10.1177/000331979304400913] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The authors describe a rare case of congenital afibrinogenemia with concomitant K-dependent protein C deficit that was brought to our observation for ischemic lesions of the foot in association with fibrinogen concentrate infusions. These lesions can be attributed to the association of various factors: fibrinogen infusion without heparin coverage, microtrauma, and protein C (PC) deficit. In fact, thromboembolic complications during afibrinogenemia were previously reported usually in association with substitutive therapy, and it is also known that PC deficit predisposes to thrombotic complications. The the authors' knowledge, the case described by them is the first in which PC deficit is associated with afibrinogenemia. This association cannot be explained by a common genetic mechanism because the genes for fibrinogen and for protein C are located on different chromosomes (chromosomes 4 and 2 respectively).
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Affiliation(s)
- D De Mattia
- Dipartimento di Biomedicina dell'Età Evolutiva-I Clinica Pediatrica, Università di Bari, Italy
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De Mattia D, Penza R, Giordano P, Di Bitonto G, Altomare M, Del Vecchio GC, Schettini F. Thromboembolic risk in children with nephrotic syndrome. Haemostasis 1991; 21:300-4. [PMID: 1806458 DOI: 10.1159/000216240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The in vivo activation of the hemostatic system was evaluated in 14 children (4-13 years old) with nephrotic syndrome at different stages of the disease. The blood platelet count, beta-thromboglobulin (beta-TG), platelet factor 4 (PF4), fibrinogen, the coagulation inhibitors antithrombin III and protein C (ATIII:Ag and PC:Ag), and D-dimers were determined. Platelet number was significantly higher at the onset of the disease than in the next stages (p less than 0.05). beta-TG, PF4 and fibrinogen were significantly increased as compared with controls at the onset (p less than 0.001) and decreased progressively during the course of the disease without reaching the control values. Blood coagulation inhibitors behaved differently; PC was higher in patients than in controls at all stages (p less than 0.05) whereas ATIII values were significantly decreased at the onset (p less than 0.05), but increased during the course the disease (p less than 0.01). No changes were observed in the D-dimer plasma levels. These data suggest that the thrombotic risk in nephrotic syndrome is particularly evident at the onset of the disease, and appears to be due mainly to changes in platelet number and function, and to increased fibrinogen levels rather than to alterations of plasma anticoagulant factors.
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Affiliation(s)
- D De Mattia
- Institute of Clinical and Preventive Pediatrics, University of Bari, Italy
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De Mattia D, Mautone A, Montagna O, Giordano P, Altomare M, Del Vecchio GC, Schettini F. Coagulation inhibitors (protein C and antithrombin III) in the preterm infant during the first month of life. Acta Paediatr Scand 1990; 79:1235-6. [PMID: 2085112 DOI: 10.1111/j.1651-2227.1990.tb11415.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- D De Mattia
- Institute of Clinical and Preventive Paediatrics, University of Bari Policlinico, Italy
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