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4 results on '"Andrea Franchella"'

1. Perioperative management of circumcision in children: Is there a difference between African and European hospitals?

Author

Filippo Ghidini, Calogero Virgone, Bernadette Metangmo Madounkeng, Andrea Franchella, Milo Vason, Dionisio Cumba, Costanza Tognon, and Piergiorgio Gamba

Subjects
children, circumcision, developing countries, loco-regional anaesthesia, Pediatrics, RJ1-570, Surgery, RD1-811
Abstract

Context: The circumcision is the most frequent procedure in paediatric surgery worldwide, performed for medical and ritual purposes. In developing countries, because of the difficult accessibility to healthcare, even a common procedure could be unsafe. Aims: The aim of the article is to compare the perioperative and anaesthesiological management of circumcision in children between two Italian and two sub-Saharan African hospitals. Materials and Methods: Medical records of paediatric circumcision from January 2014 to December 2016 have been reviewed. The involved hospitals were: Padua (Italy), Ferrara (Italy), Sao José em Bor (Guinea Bissau) and Yaoundé (Cameroun). Results: In Padua, 77 circumcisions were performed, 19 of these (24.6%) were ritual. In 75 children (97.4%), locoregional anaesthesia (LRA) together with sedation was used; only one complication (1.3%) occurred. In Ferrara, 200 interventions were done, 140 (70%) ritual; general anaesthesia was administered to 183 (93.5%) patients. There were five complications (2.5%). In Bissau, 53 procedures were performed, 21 (39.6%) ritual; in 34 children (64.1%), LRA with sedation was preferred. Two complications (3.8%) were reported. In Yaoundé, 60 children were circumcised, 15 (25%) for ritual purposes; in 51 (85%), only LRA was performed; there was only one (1.7%) complication. In the African hospital, no post-operative analgesia was administered. Conclusion: Despite the different anaesthesiological techniques, the study shows no difference in rate of complications for the in-hospital setting. Training of the local medical team in pain management and post-operative care should be emphasised.

Published
2020
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2. Multicenter retrospective study on management and outcome of newborns affected by surgical necrotizing enterocolitis

Author

Bruno Noccioli, Luca Pio, Giorgia Totonelli, Carmine Del Rossi, Simona Straziuso, Rossella Angotti, Gabriele Lisi, Veronica Zocca, Elisa Severi, Antonino Appignani, Pietro Bagolan, Girolamo Mattioli, Giovanni Casadio, Andrea Franchella, Giulia Brisighelli, Mario Messina, Valeria Gabriele, Carolina De Chiara, Pierluigi Lelli Chiesa, Fabio Rossi, Ernesto Leva, Lorenzo De Biagi, Mirko Bertozzi, Antonino Tramontano, and Silvana Federici

Subjects
medicine.medical_specialty, medicine.medical_treatment, Birth weight, necrotizing, Gestational Age, Suction, Severity of Illness Index, 03 medical and health sciences, 0302 clinical medicine, Enterocolitis, Necrotizing, Risk Factors, 030225 pediatrics, Laparotomy, pathologic, medicine, Birth Weight, Humans, Surgical emergency, Mortality, Survival rate, Retrospective Studies, Enterocolitis, Constriction, Drainage, Necrotizing, Pathologic, Incidence, Infant, Newborn, Italy, Survival Rate, business.industry, Medicine (all), Gestational age, Infant, Retrospective cohort study, medicine.disease, Newborn, Settore MED/20 - Chirurgia Pediatrica e Infantile, Surgery, 030220 oncology & carcinogenesis, Necrotizing enterocolitis, Settore MED/20, medicine.symptom, business
Abstract

Background Necrotizing enterocolitis (NEC) is the most common surgical emergency in newborns and it is still a leading cause of death despite the improvements reached in the management of the critically ill neonate. The purpose of this study was to evaluate risk factors, surgical treatments and outcome of surgical NEC. Methods We retrospectively evaluated a multicentric group of 184 patients with surgical NEC over a period of 5 years (2008-2012). Indications to operation were modified NEC Bell stages IIIA or IIIB. The main outcome was measured in terms of survival and postsurgical complications. Results Data on 184 patients who had a surgical NEC were collected. The majority of patients (153) had a primary laparotomy (83%); 10 patients had peritoneal drainage insertion alone (5%) and 21 patients had peritoneal drainage followed by laparotomy (12%). Overall mortality was 28%. Patients with lower gestational age (P=0.001), lower birth weight (P=0.001), more extensive intestinal involvement (P=0.002) and cardiac diseases (P=0.012) had a significantly higher incidence of mortality. There was no statistically significant association between free abdominal air on the X-ray and mortality (P=0.407). Mortality in the drainage group was 60%, in the laparotomy group and drainage followed by laparotomy group was of 23-24% (P=0.043). There was a high incidence of stenosis (28%) in the drainage group (P=0.002). On multivariable regression, lower birth weight, feeding, bradycardia-desaturation and extent of bowel involvement were independent predictors of mortality. Conclusions Laparotomy was the most frequent method of treatment (83%). Primary laparotomy and drainage with laparotomy groups had similar mortalities (23-24%), while the drainage alone treatment cohort was associated with the highest mortality (60%) with statistical value (P=0.043). Consequently laparotomy is highly protective in terms of survival rate. Stenosis seemed to be statistically associated with drainage. These findings could discourage the use of peritoneal drainage versus a primary laparotomy whenever the clinical conditions of patients allow this procedure.

Published
2017

3. Neonatal Gonadoblastoma

Author

Cosimo Bleve, Maria Elena Michelini, Luigi Cavazzini, and Andrea Franchella

Subjects
Obstetrics and Gynecology, Surgery
Published
2012

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